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国际运动营养学会立场声明:女性运动员的营养问题。

International society of sports nutrition position stand: nutritional concerns of the female athlete.

机构信息

SPRINZ Auckland University of Technology, Auckland, New Zealand.

Exercise & Sport Nutrition Lab, Department of Kinesiology and Sport Management, Saint Charles, TX, USA.

出版信息

J Int Soc Sports Nutr. 2023 Dec;20(1):2204066. doi: 10.1080/15502783.2023.2204066.


DOI:10.1080/15502783.2023.2204066
PMID:37221858
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10210857/
Abstract

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and needs and peri and post-menopausal athletes should track against training and recovery metrics to determine the individuals' unique patterns. 2. The primary nutritional consideration for all athletes, and in particular, female athletes, should be achieving adequate energy intake to meet their energy requirements and to achieve an optimal energy availability (EA); with a focus on the timing of meals in relation to exercise to improve training adaptations, performance, and athlete health. 3. Significant sex differences and sex hormone influences on carbohydrate and lipid metabolism are apparent, therefore we recommend first ensuring athletes meet their carbohydrate needs across all phases of the menstrual cycle. Secondly, tailoring carbohydrate intake to hormonal status with an emphasis on greater carbohydrate intake and availability during the active pill weeks of oral contraceptive users and during the luteal phase of the menstrual cycle where there is a greater effect of sex hormone suppression on gluconogenesis output during exercise. 4. Based upon the limited research available, we recommend that pre-menopausal, eumenorrheic, and oral contraceptives using female athletes should aim to consume a source of high-quality protein as close to beginning and/or after completion of exercise as possible to reduce exercise-induced amino acid oxidative losses and initiate muscle protein remodeling and repair at a dose of 0.32-0.38 g·kg. For eumenorrheic women, ingestion during the luteal phase should aim for the upper end of the range due to the catabolic actions of progesterone and greater need for amino acids. 5. Close to the beginning and/or after completion of exercise, peri- and post-menopausal athletes should aim for a bolus of high EAA-containing (~10 g) intact protein sources or supplements to overcome anabolic resistance. 6. Daily protein intake should fall within the mid- to upper ranges of current sport nutrition guidelines (1.4-2.2 g·kg·day) for women at all stages of menstrual function (pre-, peri-, post-menopausal, and contraceptive users) with protein doses evenly distributed, every 3-4 h, across the day. Eumenorrheic athletes in the luteal phase and peri/post-menopausal athletes, regardless of sport, should aim for the upper end of the range. 7. Female sex hormones affect fluid dynamics and electrolyte handling. A greater predisposition to hyponatremia occurs in times of elevated progesterone, and in menopausal women, who are slower to excrete water. Additionally, females have less absolute and relative fluid available to lose via sweating than males, making the physiological consequences of fluid loss more severe, particularly in the luteal phase. 8. Evidence for sex-specific supplementation is lacking due to the paucity of female-specific research and any differential effects in females. Caffeine, iron, and creatine have the most evidence for use in females. Both iron and creatine are highly efficacious for female athletes. Creatine supplementation of 3 to 5 g per day is recommended for the mechanistic support of creatine supplementation with regard to muscle protein kinetics, growth factors, satellite cells, myogenic transcription factors, glycogen and calcium regulation, oxidative stress, and inflammation. Post-menopausal females benefit from bone health, mental health, and skeletal muscle size and function when consuming higher doses of creatine (0.3 g·kg·d). 9. To foster and promote high-quality research investigations involving female athletes, researchers are first encouraged to stop excluding females unless the primary endpoints are directly influenced by sex-specific mechanisms. In all investigative scenarios, researchers across the globe are encouraged to inquire and report upon more detailed information surrounding the athlete's hormonal status, including menstrual status (days since menses, length of period, duration of cycle, etc.) and/or hormonal contraceptive details and/or menopausal status.

摘要

基于专家和国际运动营养学会(ISSN)选定成员对女性运动员营养关注问题的综合回顾和批判性分析,以下结论代表学会的官方立场:

  1. 女性运动员具有独特且不可预测的激素谱,这会影响她们在整个生命周期中的生理和营养需求。为了了解激素波动如何影响个体,我们建议生育年龄的女性运动员应跟踪其激素状态(自然状态、激素驱动)与训练和恢复的关系,以确定其个人模式和需求,而绝经前后的运动员应跟踪与训练和恢复指标的关系,以确定个体的独特模式。
  2. 所有运动员,特别是女性运动员的首要营养考虑因素应该是摄入足够的能量以满足能量需求并实现最佳能量可用性(EA);重点关注与运动相关的进餐时间,以改善训练适应、表现和运动员健康。
  3. 碳水化合物和脂质代谢存在明显的性别差异和性激素影响,因此我们建议首先确保运动员在月经周期的所有阶段都满足碳水化合物需求。其次,根据激素状态调整碳水化合物的摄入,重点是在口服避孕药使用者的活跃药丸周和月经周期黄体期增加碳水化合物的摄入和可用性,因为性激素抑制对运动时糖异生的输出有更大影响。
  4. 根据有限的可用研究,我们建议绝经前、月经规律和使用口服避孕药的女性运动员应尽可能在开始和/或运动后立即摄入高质量蛋白质源,以减少运动引起的氨基酸氧化损失,并以 0.32-0.38 g·kg 的剂量启动肌肉蛋白重塑和修复。对于月经规律的女性,由于孕激素的分解代谢作用和对氨基酸的更大需求,应在黄体期摄入较高的蛋白质。
  5. 接近运动开始和/或运动后,绝经前后的运动员应摄入富含必需氨基酸(~10 g)的完整蛋白质源或补充剂,以克服合成代谢抵抗。
  6. 所有处于月经功能各阶段(绝经前、绝经后和避孕药使用者)的女性运动员,无论运动类型如何,每日蛋白质摄入量应处于当前运动营养指南的中等到较高范围(1.4-2.2 g·kg·day),并将蛋白质剂量均匀分布在每天 3-4 小时之间。在黄体期和绝经前后的运动员中,月经规律的运动员应摄入较高的蛋白质,无论运动类型如何。
  7. 女性性激素会影响液体动力学和电解质处理。在孕激素升高时,女性更容易发生低钠血症,而在绝经后女性中,她们的水排泄速度较慢。此外,女性相对于男性来说,绝对和相对的液体流失量较少,因此液体流失的生理后果更为严重,尤其是在黄体期。
  8. 由于缺乏针对女性的具体研究和任何女性的差异影响,因此缺乏针对特定性别的补充证据。咖啡因、铁和肌酸在女性中最有使用证据。铁和肌酸对女性运动员都非常有效。建议每天摄入 3 至 5 克肌酸,以支持肌酸补充的肌肉蛋白动力学、生长因子、卫星细胞、肌生成转录因子、糖原和钙调节、氧化应激和炎症的机制支持。绝经后女性从骨健康、心理健康以及骨骼肌大小和功能中受益,当摄入较高剂量的肌酸(0.3 g·kg·d)时。
  9. 为了促进和推动涉及女性运动员的高质量研究调查,研究人员首先应停止排除女性,除非主要终点受到性别特异性机制的直接影响。在所有研究情况下,鼓励全球各地的研究人员询问并报告更详细的运动员激素状态信息,包括月经状态(上次月经日期、经期长度、周期持续时间等)和/或激素避孕药细节和/或绝经状态。
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10c6/10210857/fca25ae3ae08/RSSN_A_2204066_F0001_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10c6/10210857/fca25ae3ae08/RSSN_A_2204066_F0001_OC.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/10c6/10210857/fca25ae3ae08/RSSN_A_2204066_F0001_OC.jpg

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