1 5. Sundgot-Borgen J,Torstve¡t MK.Prevalence of eating disorders in eliteathletes is higher than in the generalpopulation. C/in J Sport Med.2004;14:25-32.16. Quatromoni PA. Clinical observa-tions from nutrition services in col-lege athletics.J Amer Diet Assoc.2008;108:689-694.17. Croll JK Neumark-Sztainer D, StoryM, et al. Adolescents involved inweight-related and power teamsports have better eating patternsand nutrient intakes than non-sport-involved adolescents. J Amer DietAssoc. 2006;1 06:7 09-7 1 7 .

18. Nattiv A, Loucks AB, Manore MM,et al. American College of SportsMedicine position stand:The femaleathlete triad.Med sciSport Exer.2007;39:1867-1882.

19. Barrack MT, Rauh MJ, Nichols JF.

Prevalence of and traits associatedwith low BMD among female adoles-cent runners.Med Sci Sport Exer.2008;40:2015-2021.20. Smolak L, Murnen 5K, Ruble A. Fe-male athletes and eating problems: a

meta-a na lysi s. I nt J Eat Disorder. 2000;27:371-380.21.Taub DE, Blinde EM. Eating disor-ders among adolescent female ath-letes: lnfluence of athleticparticipation and sport team mem-be rs h i p. Adol escence. 1992;27 :833-848.22. Nichols JF, Rauh MJ, Lawson MJ, etal. Prevalence of the female athletetriad syndrome among high schoolathletes. Arch Pediatr Adolesc Med.2006;160:1 37-142.23. Loud KJ, Gordon CM, Micheli LJ, et

al. Correlates of stress fracturesamong preadolescent and adoles-cent girls. Ped¡atrics. 2005,11 5:e399-e406.24. Oppliger RA, Nelson Steen SA,Scott JR.Weight loss practices of col-lege wrestlers.lnt J Sport Nutr ExercMetab.2003;13:29-46.25. McKay Parks PS, Read MH. Adoles-cent male athletes: Body image, diet,and exercise . Adolescen ce.1997;32:593-602.26. Laurson KR, Eisenmann JC. Preva-lence of overweight among highschool football linemen. J Am er MedA s so c. 2007 ;297 :363-364.27. PernickY Nichols JF, Rauh MJ, et al.Disordered eating among a multi-racial/ethnic sample of female high-school ath letes. J Adolescent H ealth.2006;38:689-695.

"Only recently have food guidesystems ¡ncluded fluids."

Food Pyramids in Sports Nutritionby Samuel Mettler, PhD ond Nanna L. Meye1 PhD, RD, CSSD

Food pyramids are pictorial represen-tations of dietary goals that translatescientific reference data into easilyunderstandable nutrition recommen-dations. ln general, there are two ap-pioaches to designing foodpyramids. ln the nutritive approach,food recommendations are calcu-lated to fulfill dietary reference valuesfor energy, macronutrients, and mi-cronutrients.l Consequently, servingsizes for different food groups andcorresponding numbers of servingsare calculated to meet the energYand nutrient requirements of the tar-get population, Most pictorial foodguide systems follow this strategy.lnthe second approach,the metabolicapproach, eating guidelines arelinked to the metabolic effect a par-ticular food may exert on physiologicparameters. For example, the lowglycemic index pyramid2 focuses onthe effect of food on blood glucose.

Many pyramids today also highlightthe quality of food in their pictorialrepresentations (e.g.,The Healthy Eat-ing Pyramid3 and the German three-

1 2 I scnvs put-sE winter 2010,vo|.29, No. 1

dimensional Food Guide Pyramid,2005a). Several pyramids from aroundthe world emphasize cultural influ-ences and traditional cuisine,s andsome of these (e.9, MediterraneanFood Guide Pyramid) have been usedin both research and clinical settingsfor the purpose of health promotionand disease prevention.6-e

Comparatively, food guide pyramidsdo not differ substantially from each

other with respect to their food andnutrient recommendations. ln fact,Painter and colleagues5 demon-strated that although food guide sys-tems varied in shapes (e.9., pyramid,wheel, pagoda, rainbow), their basicfood group classifícations were simi-lar. Only recently have food guide sys-tems included fluids, and only a fewhave incorporated more novel ap-

proaches (e.g., vegetables and fruit asthe base before grains; moreprotein).10,1 1 Most pictorial represen-tations include daily physicalactivity.12,13

The majority of food pyramids andother píctorialfood guide systemsprovide a range of serving sizesand/or number of servings per foodgroups to allow individualization fordifferences in body masses, physical

activity levels, and different energyneeds.The U.S. Food Guidance Sys-tem (MyPyramid) provides a range ofsuggested number of servings foreach food group,which is dependenton an individual's energy require-ments ranging from 1,600 to 3,000kcal/day. Consequently, men andwomen of dífferent ages with threedifferent physical activity levels are

able to identify the suggested num-ber of servings per food group.la

General Food Pyramids andthe Athlete's Needs

Few pyramids address an athlete'sneeds. Although the new U.S. FoodGuide Pyramid can be used to fit ath-letes' dietary needs, the recommen-dations and available worksheets arelimited to a total daily energy intakeof 3,000 kcal/day, and these guide-lines were not developed specificallyto address the athlete's energy andnutrient needs.l5 Similarly,Houtkooperr6 modified the standard1992 U,S. Food Guide Pyramid and in-cluded fluids as a new food categoryat the base of the pyramid, emphasiz-ing the importance of hydration forathletes.The Mediterranean FoodGuide Pyramid may be used to ac-commodate higher energy needs ofendurance athletes through in-creased intake of fat, particularly oilsfrom olives, nuts, and fish.15 Finally,the Vegetarian Food Guide PyramidlTmay be adjusted to fit the vegetarianathlete.ls

When incorporating general foodguide pyramids into sports nutritioncounseling w¡th athletes and adjust-ing the number of serving sizes andfood group contributions, sports di-etitians must have an understandingof how individuals may interpret themessages in these pyramidsl3,1e-21 sothat use of the pyramid assists inmeeting energy, nutrient, and fluidneeds. Nonetheless, although suchpyramids are useful, they will alwaysbe limited because they are not in-tended to address the athlete's en-ergy, nutrient, and fluid needs andtiming of ingestion.

One complication that exists insports nutrition deals with the factthat training programs are periodizedwith high and low intensity/volumetraining cycled throughout the an-nual training and competition plan. Aquick guide for adding calories tocover variable training demandsusing a pyramid format for athletescould assist in successful sports nutri-tion applications. ln light of the com-

plexities and variability of energy, nu-trient, and fluid needs of athletes,22 asimplified pyramid could be ex-tremely helpful, although it wouldnot be without limitations.The FoodPyramid of Swiss Athletes was devel-oped with this concept in mind.

The Food Pyramid forSwiss Athletes

The Food Pyramid for Swiss Athletes(FPSA) represents a quick referenceguide for athletes training more than5 hours per week, providing detailson serving sizes for different body

ent, and fluid needs for the athleteswere extrapolated.

The primary aim of the FPSA was toprovide a quantitative and qualitativerepresentation of food and fluidneeds ofathletes ofvarying bodymass and training volume at a fixedmoderate intensity (set at 0,1kcal/kg/min, representing running at8 km/h, cycling at 2 Wkg, or intermit-tent exercise ofteam sports),The sec-ondary aim of the FPSA was to meetthe reference values for micronutri-ents established by the Dietary Refer-ence lntakes (DRls).2ate Thus, the

su¡t the needs of all athletes."

"..,food and cultures varyglobally and no pyram¡d w¡ll

masses, number of servings adjustedto number of hours of training perday, and appropriate macronutrientchoices to meet the demands oftraining (Figure 1, page 14).This re-cently published pyramid10,23 was de-veloped by the Swiss Forum of SportsNutrition (www.sfsn.ch),the primarysports nutrition organization inSwitzerland. lt is important to empha-size that foods and cultures varyglobally and no pyramid will suit theneeds of all athletes under all circum-stances. However, this pyramid can beused to teach several key conceptsthat are common yet difficult for ath-letes to integrate successfully intotheir daily nutrition practices: adjust-ing energy, nutrient, and fluid needsto changes in training loads (i.e,, vol-ume and intensity).

Nutritional recommendations for ath-letes, as for other population groups,should primarily promote a well-bal-anced diet to ensure long-termhealth.The FPSA is an extension of anexisting food guide pyramid fornonathletes:the Food Pyramid forHealthy Swiss Adults of the Swiss So-ciety for Nutrition.ll The "basic pyra-mid" layout of FPSA provided thefoundation from which energy, nutri-

Swiss group used the nutritive ap-proach in its pyramid development.

Development and Validationof the Pyramid

As a first step, an additional energyrequirement per kilogram of bodymass and per hour of exercise wasdefined.To calculate the additionalenergy expended from exercise, theenergy need ofan average sitting ac-tivity was always subtracted, as exer-cise replaces a sedentary lifestylerather than being added to it.t0Theadditional energy requirement wasthen distributed as extra servingsacross the different food groups ofthe basic pyramid, considering thespecific macronutrient recommenda-tions for sports3o,3r and whether theextra servings were feasibly inte-grated into an athlete's real life. Fur-thermore, sports foods and fluids(e.9., sports drinks, bars, recoveryproducts) were included as a choicefor extra servings next to the fooditems shown on the basic pyramid.The issue of different energy needsrelative to body mass was solved byusing variable serving'sizes. Conse-quently, it is the daily exercise dura-tion that determines the number of

SCAN'S PULSEWinter 2010,Vo|.29,No. I | 1 3

Figure 1

Food Pyram¡d for AthletesFor athletes exercising > 5 hours per week

Based on the Food Pyramid for healthy adultsof the Swiss SocietY for Nutrition

Oils, fats, and nuts

O 2OO5 Sw¡ss Soc¡ety for Nutrition sSN \y

The Food Pyramid for Athletes is basedon the Food Pyramid designed and de-veloped by the Swiss Soc¡ety for Nutr¡-t¡on (Schweizer¡sche Gesellschaft fürErnährung) for healthy adults, whichwill be referred to as the Basic Foodgrramid. This Bas¡c Food Pyramid hasbeen expanded to cover the energy andnutrient needs for daily exercise tyPi-cally performed by athletes and activeindividuals.

The Food Pyramid for Athletes is aimedat healthy adults exercising on most days ofthe week for at least one hour or more perday at moderate intensity, total¡ng at least 5

hours of exercise per week

Moderate intensity represents cont¡nuousactivities such as sw¡mm¡ng (2 5 km/h). run-ning (8 km/h) or cycling (2 watts per kg bodymass) orthe "stop and go" of mostintermit-tent and team sports such as an ice hockey

match, a soccer game or tennis match TheBasic Food Pyramid reflects balance in foodchoice, and the same applies to the recom-mendations for athletes Both pyram¡ds en-sure sufficient energy and nutrient supplyfor their target population All foods areallowed, but it is ¡mportant that a varietyof foods are chosen from each section, thatproduce is chosen seasonally, and all foodsare prepared and processed with care Theregular intake of vitamin and/or m¡neral

,

1 4 I scn¡l's PULSE Winter 2010,Vo|.29, No. 1

Consume sweels, salty snacks and sweetened drinks (e.9, softdr¡nkt ¡ce tea, energy dr¡nks) in moderation When consumingalcoholic beveraget do so ¡n moderation and as part of a meal.Use sah wilh added ¡odine and fluor¡de, and in l¡m¡ted quantitiesonly.

Use one serv¡ng (1 0-1 5 g = 2-3 teaspoons) a day of plant-basedo¡ls for cold dishes (e.g,, canola or ol¡ve o¡l), one portion lorcooking (e g . ol¡ve oil), and if needed one port¡on (1 0 g = 2 tea-spoons) butter or spread A da¡ly seru¡ng of nuts (20-309) ¡s alsorecommended

Each day altemate among 1 *rv¡ng of meat fish, eqgt chffie orplant source of protein such as tofr¡ (1 æry¡ng = 100-120 g meaufish fraw we¡ghtl or 2-3 eggs or 200 g cottage chæse or 609 hardchæ or loo-120g tofu). ln addition, consume 3 seryings of m¡lkor dairy products a day preferably low fat Er¡eti6 (1 ponion =200 ml of m¡lk or 150-180 9 of yogurt or 20Og of cottage chseor 3G-609 of chees).

Eat 3 seryings a day and make 2 of them whole grain if possible1 seru¡ng = 7F125 g bread or 60-1009 [dry we¡ght] legumessuch as lentils or garbanzo beans or180-3009 potatæs or45-75g [dry we¡qhtl of cereals/pasta/rice/com or other grainproducts

Eat 3 serv¡ngs of vegetabl6 a day, at least one ofwhich should beraw (1 *ry¡ng = 1 209 of vegetabls as an s¡de, slad, or soup).Eat 2 serv¡ngs offru¡t a day (1 sery¡ng = 120 g or 1 "handful')'one dô¡ly serying of ftuit or vegetables @n be repla(ed by 2oomlof unseeten€d fiu¡t or vegetable iuice.

Drink 1-2 l¡ters of l¡quid a day, preferably unsweetened (e.g tap/mineral water or fru¡t/herb teas). Caffeinated beverages (coffee,blacldgreen tea) should be consumed ¡n moderation only

SportThe same appl¡es to the athleteHowever, ¡t should be considered that alcoholicbeverages or low sodium dr¡nks may delay recoveryafter exercise

\ t\l\ \ \ For each additional hour of exercise,add % seruingThe add¡t¡onal y2 serying can be chosen from any of thefoods listed.

The eme applles to the athlete

for the athlete t@, s no additional sery¡ngs arenæs9ry.

I I I I For each add¡t¡onal hour of exercise, add I seryingwhen exercis¡ng more than 2 houE a day, sponfoodldrinks can also be used ¡nstead offood from thebasis pyramid 1 seNíng of sport food = 6(F909 of a bar,50-70g carbohydrale gel or 300 to 400m| of aregeneration drink.

The same applies to the athleteIt ¡s als accepted to eat more than 3 æruings ofvegetablg and 2 sery¡ngs of hu'rts ¡f loleratedw¡thout gaslrcintestinal issus.

4 4For each add¡t¡onal hour of exercisqadd 400 to 80oml of sport dr¡nkÌhe spon drink may be used shortly before and duringexercise For exercise last¡ng up to t hour a day andact¡v¡t¡es larget¡ng fat melabol¡sm, water should bepreferred over a sport dr¡nk. Sport dr¡nks can also beconsumed after exercise. As requ¡red, add¡t¡onal watercan be consumed before, during, and after exercise.

t hour t hour t hour t hourServinos oer hour of exercise o

Basic

Servings fromthe basic pyramid

IIII¡,IIIII,

t!III,

IIIII¡

I¡III

IIII

+ Servings per per day

Vers¡on 1.2 O 2OO9 Sw¡ss Fo¡um for Sport Nutr¡t¡on. M.sfsn.ch, in collaborat¡on w¡th ETH Zurich and Federal Off¡<e of SPort FOSPO

fortified foods and beverages or the use ofdietary supplements may exceed the uppertolerable intake level for mlcronutr¡ents

Adherence to the Food Pyramid for- Ath-letes offers a solid foundation for longterm,successful performance capability lncon-trast to the Basic Food Pyramid, where therecommendations do not have to be fol-lowed str¡ctly on a daily basis, ¡t is suggestedthat athletes meet the guidelines consistently

to ensure optimal regenerat¡on and perform-ance capability The additional requirementto cover exercise training includes a volumeof 1 to 4 hours of moderate intensity exer-cise per day For high ¡ntensity exercise and/or greater volumes, the energy and nutrientrequirements w¡ll be higher An experiencedsports dietitian may help with adjustingfood selection and seruing size to ind¡v¡dualneeds

Seruing s¡ze select¡on: From the seru-ing size range given in the pyramid, smallathletes of about 50 kg body mass shouldchoose the smallest seruing size, whereasthe largest seruing size applies to athletesweighing about 85 kg lntermed¡ate serv¡ngsizes apply to athletes of corresponding in-termediate body mass (e g medium seruingsize Íor 67 5 kg)

SCAN'S PULSEWinter2010,Vol.29,No. 1 | 1 5

extra serv¡ngs, whereas the athlete'sbody mass determines the servingsize.ro

The finalversion of the FPSA (Figure1)was validated quantitatively by de-signing 168 meal plans according tothe pyramid's recommendations forathletes with body masses of 50 kg to85 kg and a daily training volumefrom 0 (simulating resting days) to 4hours.The evaluation of the mealplans revealed that energy intake ofthe meal plans met the calculated en-ergy requirement by 97o/o.1oThemacronutrient intakes, expressed rel-ative to body mass per day (g/kg/d),by training volume are shown in thetop part of Figure 2 (below).The pyra-mid fulfilled international standardsfor macronutrient intakes using vari-able training volumes.30'3r The mi-cronutrient supply was well beyondthe DRls for nearly all micronutri-s¡15.2n-2r Potential critical elements(e.g. iron for women with a low en-ergy budget or vitamin D) and fur-ther details about the development

and validation of the pyramid are ex-plained in the literature.lo'23

Application to Practice

ln practice, the pyramid may be usedin several ways.The pyramid may rep-resent a food guide, and meal Plansmay be designed according to thepyramid.This application is probablymost suitable for sports nutrition ed-ucation, particularly to illustrate thedifferenqes between the energy andnutrient needs for sedentary individ-uals (or rest days for athletes) andathletes.ln addition, the pyramid eas-ily translates carbohydrate guidelinesinto practice. Athletes often fail toconsu me'sufficient carbohyd rates toensure recovery from repetitive, in-tense training.32 The pyramid, at leastbased on hours trained, can provide a

simple tool to put carbohydrate goalsinto practice.The pyramid also maybe used to compare actual eatinghabits with pyramid guidelines. Forexample, empty pyramid handoutsmay be used in a team presentation

where athletes are asked to inserttheir foods and fluids consumed. Asmore awareness is built around theimportance of how to link changes intraining volume with changes in foodand fluid intakes,the pyramid canserve as a simple yet optimal refer-ence guide. ln fact, team presenta-tions can be built on food PYramidsand by integrating short workshops,both teaching and learning becomemore effective.

Professionals and athletes may won-der why the FPSA does not recom-mend additional servings ofprotein-rich foods relative to traininghours.This is due to the fact that thebasic pyramid in Switzerland followsrecent trends of slightly increasedprotein intakes recommended forsedentary individuals for the purposeof weight control.33This is also an ad-vantage for athletes, as the proteinsupply is already conveniently highfor athletes with a lower training vol-ume (e.g., power athletes), while notgetting too high for athletes with

Figure 2. Average daily macronutrient intake of the 168 meal plans by traìning volume(níean + SD) ¡n élkgl¿-(upper figures) or as percent (o/o) of energy ir take (bottom figures).

10

EèBl¿o)Ø^o-(ú

3.4-c.o6Zo

2.0

=o)t¿g)

1.0fttlr

0.5

_ 2.0o,l¿Þ r.o.ço)attfL

0.8

¡1,c)Ë60!Èsoo_oo40C)\o

30o)

P. 20IJJ

60

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LJJ 5

01234Hours of exercise

01234Hours of exercise

012-34Hours of exercise

I 6 I scn¡¡'s PULsE w¡nter 2010,VoI.29, No. 1

high training volumes (e.9., en-durance athletes).The high proteinsupply at low training volumes mayalso assist with weight control innonendurance sports such as gym-nastics.3aWith increasing training vol-umes, more protein is delivered byadditional servings from grains aswell as sports and recovery foods.

This food pyramid for athletes givesonly a general message about sportsnutrition, and as with any other guid-ance system, fine-tuning of individualand sport-specific requirements by asports dietitian is necessary, Users ofthe FPSA should consider that the ad-

ply of macronutrients increases withincreasing training volume; however,contributions in o/o El only increase forcarbohydrate but do not exceed 600/oof El, while o/oElfor protein and fatdecrease.This clearly shows thatmacronutrient recommendationsbased on o/oEl are inappropriate insports nutrition, as they do not pro-vide any information on the energyand macronutrient supply nor on thecorresponding fuel needs of exercis-ing muscles.30 Macronutrient require-ments insports nutrition shouldexclusively be calculated ing/kg/ day.3o Whether practitionerscommunícate these numerical rec-

validatedath letes

around the world."

ditional servings are calculated for anaverage, moderate exercise intensíty,as defined in the pyramid (see Figure1). Overfueling and underfueling mayoccur in low volume (e.9., gymnas-tics) and high volume sports (e.9.,ru nnin g, cycli ng), respectively. How-ever, in practice, an athlete exercisingat lower intensitíes simply needs toround the number of servíngs (e.9.,eating for 2 h of exercise according tothe pyramid, while exercising for 3 h).Finally, the pyramid is not limited to 4hours of exercise per day. Furtherservings may be added for the fífthand sixth hour of training,as indi-cated by the dotted lines at the rightend of the food group layers.

One aspect not directly related to thepyramid but revealed by the valida-tion data, which represent interna-tíonal standards for sportsnutritíon,30'31 is the divergent behav-ior of the macronutrient data ex-pressed either in percent of energyintake (o/o El) or relative to body mass(g/kg/d).Figure 2 shows how the sup-

"There is no other compiarable andas thoroughlyfood gu¡de for

pictorialavailable

ommendations to athletes dependson individual factors. However, inmost cases pyramids, plates, singleservíng size equivalents (e.9., cups), orother practicaltools should be usedto translate these quantitative datainto easily understandable guide-lines.

Although this food pyramid for ath-letes reflects to some degree the cul-tural foods of Switzerland, the varietyof foods modelled within each foodgroup is large and it would be possi-ble to replicate these choices in manycountries around the world, particu-larly Western countries, including theUnited States and Western Europe,where eating practices are compara-ble to Switzerland. Furthermore, theamounts of nutrients resulting fromthe pyramid's recommendation arecons¡stent with internationally ac-cepted DRls and guidelines.2+3r

ln summary,the FPSA illustrates dif-ferent energy, macronutrient, andfluid needs of athletes trainíng at

variable training volumes in compari-son to normally active or sedentaryindividuals.To date,there is no othercomparable and as thoroughly vali-dated pictorial food guide for ath-letes available around the world.

Samuel Mettler, PhD, is o sports nutri-tionist at the Swiss Federol lnstitute ofSport, Magglingen and at the Depart-ment of Agriculturol and Food Sci-ences, ETH Zu rich, Switzerla nd. He isolso a leading portner of the SwissForum for Sports Nutrition,www.sfsn.ch,which is an open occessand independent sports nutrition infor-mation platform for Switzerland andoth er Ger m a n - speaki n g co u ntri es.Nanna Meyer, PhD, RD, CSSD, is an as-sistant professor at the University ofColorado at Colorado Springs and di-rector of the sport nutrition graduoteprogram.She is olso a consultont insports dietetics at the United StatesOlym pi c Trai ning Center i n ColorodoSprings,CO.

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o