Louise Sutton

The practice of rapid weight loss in mixed martial arts (MMA) is an increasing concern but data remains scarce. The aim of this study was to investigate the prevalence, magnitude, methods and influencers of rapid weight loss in professional and amateur MMA athletes. MMA athletes (n=314; 287 men, 27 women) across nine weight categories (strawweight to heavyweight), completed a validated questionnaire adapted for this sport. Sex-specific data were analysed, and sub-group comparisons were made between athletes competing at professional and amateur levels. Most athletes purposefully reduced body weight for competition (men: 97.2%; women: 100%). The magnitude of rapid weight loss in one week prior to weigh-in was significantly greater for professional athletes compared to those competing at amateur level (men: 5.9% v 4.2%; women: 5.0% v 2.1% of body weight; p<0.05). In the 24 h preceding weigh-in, the magnitude of rapid weight loss was greater at professional than amateur level in men (3.7% v 2.5% of body weight; p<0.05. Most athletes 'always' or 'sometimes' used water loading (72.9%), restricting fluid intake (71.3%) and sweat suits (55.4%) for rapid weight loss. Coaches were cited as the primary source of influence on rapid weight loss practices (men: 29.3%, women: 48.1%). There is a high reported prevalence of rapid weight loss in MMA, at professional and amateur levels. Our findings, constituting the largest enquiry to date, call for urgent action from MMA organisations to safeguard the health and wellbeing of athletes competing in this sport.

Modern-day nutritional approaches for rugby players require careful application of research findings to practice, underpinned by a sound understanding of the physical and physiological demands of the professional game. Leanness for players is considered important for their power-to-weight ratios. However, data has shown that strength, as a reflection of muscle mass, is still more important for success, not body fat levels. Significant injuries or reduced training loads will force change on a professional player’s nutritional profile. The goals for most players during an injury are to mobilise as soon as possible, prevent unnecessary weight gain and maintain muscle mass, which shifts the energy and macronutrient requirements. Recently, the women’s game has gained popularity with the first group of professional contracts being offered to English players in 2018. Using websites, webinars, infographics and other communication strategies, both the promotion of nutrition education and access to what the professionals are eating has become more available.

The aim was to determine if the implementation of a nutrition education program can improve the nutritional knowledge and dietary practice of male academy rugby union players. On obtaining institutional ethics approval, 16 players were recruited and split by age category. Both an under 16 (U16) group N=9 (17 ± 1 y) and under 19 (U19) group N=7 (19 ± 0 y) participated in an eight session program. The sessions informed participants on the principles of sports nutrition and met individual nutrition needs. Both groups completed a nutrition knowledge questionnaire and a 7 day diet diary pre and post program delivery. Dietary analysis was conducted and adequacy of intake was assessed by comparison with calculated recommended values. Delta values were used to assess the difference between required and actual intake values for different dietary components. Results show increases in nutrition knowledge scores for all participants, 31.5–37.2 (p=0.000). There was a strong positive correlation between age and nutrition knowledge scores both pre (r=0.518, n=18, p<0.027) and post (r=0.472, n=18, p<0.48). There was improvement in energy and carbohydrate intake within the U19 group, t (6) = −3.837, p<0.009, t (6) = −4.653, p<0.003 respectively. Although not significant, improvements in fluid intake were seen as average intakes increased by 1.72 l (U19) and 0.68 l (U18). The main finding was improvements in nutrition knowledge following a nutrition education program. A link between age and knowledge was highlighted. There were improvements in dietary intake whereby participants more closely met recommended intakes. For the U19, improvements were statistically significant, but for the U18 who are not solely responsible for their dietary intake improvements were less evident. Further research into the barriers facing younger athletes in achieving adequate dietary intake is warranted.

Background. In this Position Statement, the International Society of Sports Nutrition (ISSN) provides an objective and critical review of the literature pertinent to nutritional considerations for training and racing in single-stage ultra-marathon. Recommendations for Training. i) Ultra-marathon runners should aim to meet the caloric demands of training by following an individualized and periodized strategy, comprising a varied, food-first approach; ii) Athletes should plan and implement their nutrition strategy with sufficient time to permit adaptations that enhance fat oxidative capacity; iii) The evidence overwhelmingly supports the inclusion of a moderate-to-high carbohydrate diet (i.e., ~60% of energy intake, 5 – 8 g⸱kg−1·d−1) to mitigate the negative effects of chronic, training-induced glycogen depletion; iv) Limiting carbohydrate intake before selected low-intensity sessions, and/or moderating daily carbohydrate intake, may enhance mitochondrial function and fat oxidative capacity. Nevertheless, this approach may compromise performance during high-intensity efforts; v) Protein intakes of ~1.6 g·kg−1·d−1 are necessary to maintain lean mass and support recovery from training, but amounts up to 2.5 g⸱kg−1·d−1 may be warranted during demanding training when calorie requirements are greater; Recommendations for Racing. vi) To attenuate caloric deficits, runners should aim to consume 150 - 400 kcal⸱h−1 (carbohydrate, 30 – 50 g⸱h−1; protein, 5 – 10 g⸱h−1) from a variety of calorie-dense foods. Consideration must be given to food palatability, individual tolerance, and the increased preference for savory foods in longer races; vii) Fluid volumes of 450 – 750 mL⸱h−1 (~150 – 250 mL every 20 min) are recommended during racing. To minimize the likelihood of hyponatraemia, electrolytes (mainly sodium) may be needed in concentrations greater than that provided by most commercial products (i.e., >575 mg·L−1 sodium). Fluid and electrolyte requirements will be elevated when running in hot and/or humid conditions; viii) Evidence supports progressive gut-training and/or low-FODMAP diets (fermentable oligosaccharide, disaccharide, monosaccharide and polyol) to alleviate symptoms of gastrointestinal distress during racing; ix) The evidence in support of ketogenic diets and/or ketone esters to improve ultra-marathon performance is lacking, with further research warranted; x) Evidence supports the strategic use of caffeine to sustain performance in the latter stages of racing, particularly when sleep deprivation may compromise athlete safety.

Nutrition guidelines specific to short stature athletes are lacking. Achondroplasia, the most common cause for disproportionate short stature (dwarfism), potentially increases resting energy requirements. Therefore, for the first time, this case study aimed to establish the resting metabolic rate (RMR), physical activity energy expenditure (PAEE), and total energy expenditure (TEE) of a dwarf para-powerlifter across rest and training days. A second aim was to determine the suitability of RMR prediction equations recommended for use in athletic populations. RMR was measured using indirect calorimetry on four occasions (two days post-competition, one day post-training, one- and three-days post-training camps). PAEE was monitored using a wrist-worn accelerometer for two 7-day periods. The thermic effect of feeding was estimated; therefore, TEE was inferred. RMR was greater 1- and 3-days post-training camps (1896 and 1992 kcal∙day−1, respectively) than post-training (1613 kcal∙day−1) and post-competition (1409 kcal∙day−1). PAEE and TEE was similar between rest and training days (PAEE, 957 and 948; TEE, 2715 and 2705 kcal∙day−1, respectively). Accuracy of RMR prediction equations utilised ranged from − 580 to + 189 kcal∙day−1 when compared to measured RMR post competition and training. Underestimation was greater (−412 ± 107 kcal∙day−1) post training camps. Results highlight the importance of establishing the energy requirements of dwarf para-athletes, particularly because prediction equations were not accurate in this case study. Further investigation of energy demands during training camps, particularly the relationship of workload on energy expenditure, are now warranted in a larger population.

The Marathon des Sables consists of 5.5 marathons in 6 days, while competitors are required to carry all food and living provisions in temperatures exceeding 50°C. Competitors may undertake sports science support prior to the event, likely to focus on hydration strategies due to the extreme heat of the event and the association with dehydration and potential hypernatraemia or hyponatraemia. Despite this, no data exists to aid practitioners when supporting clients running the Marathon des Sables. The purpose of the support was to educate a 40-year-old recreationally trained male client on the effect of running speed and rucksack weight on fluid loss, Na+ loss and blood[Na+] change during exercise in the heat. The client completed five trials, manipulating running speed and rucksack weight: 6.0 km h-1 (0 and 10 kg), 10.0 km h-1 (0 and 10 kg) and 8.0 km h-1 (7.5 kg) in a heat chamber (40°C and 20% relative humidity) for 30 min on a motorised treadmill. Ad libitum water intake was permitted (measured via mass change of drinks bottles) and body mass (BM) was determined pre- and post-exercise. Sweat patches were worn during exercise and analysed for [Na+]. Blood[Na+] was also measured preand post-exercise. Fluid loss was calculated (BMpre (kg) – BMpost (kg) + fluid intake (kg)) and estimations of fluid loss at various ecologically valid running speed and rucksack weights were calculated. Na+ loss was calculated based on [Na+] and fluid loss. Institutional ethical approval to use case study data for research purposes was obtained retrospectively. Fluid loss was 0.54 L h-1 at 6.0 km h-1 (0.0 kg), 0.94 L h-1 at 6.0 km h-1 (10.0 kg), 1.22 L h-1 at 10.0 km h-1 (0.0 kg) and 2.12 L h-1 10.0 km h-1 (10.0 kg). There was a strong significant positive relationship between fluid loss and sweat[Na+] (r = 0.966, P = 0.034) and a strong negative relationship between fluid loss and ?blood[Na+] (r = -0.776, P = 0.269). Estimations of potential fluid and Na+ deficits at the end of the day, dependent on the duration of stage, running speed and rucksack weight, were presented to the client. The physiological responses during this support were normal: increase in FL versus increase in running speed and rucksack weight and an increase in sweat [Na+] versus an increase in fluid loss, due to a reduction in Na+ reabsorption in the sweat gland duct (Cage and Dobson, 1965, Journal of Clinical Investigation, 44, 1270–1276). Despite the known findings, the client reported that the support was sufficient to provide confidence in his hydration strategy and an increased awareness of pacing, thus completing the Marathon des Sables safely without developing debilitating dehydration, hypernatraemia or hyponatraemia. D1.

Athlete adherence to nutritional guidance is critical for optimal health and performance, yet little is known about the barriers and enablers to athletes’ dietary behaviours within high-performance sport. To advance understanding, we applied a theoretical lens derived from the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore the qualitative accounts of sports nutritionists. Five focus groups comprising sports nutritionists working in Olympic and Paralympic sport (n = 14), professional sport (n = 6), or both (n = 6) were undertaken. Thematic analysis was conducted and the interpretations of the findings were guided by COM-B and the TDF. To achieve nutritional adherence, the behavioural analysis identified the need to intervene across all three COM-B components and at least five associated TDF domains (e.g., decision-making processes, reinforcement, social influences, behavioural regulation and environmental context and resource). For the first time, the findings illustrate the complex interplay of the training setting with the capabilities, opportunities, and motivation of the practitioners, athletes and coaches. By applying established behavioural science theories to sports nutrition, the foundations for the development of targeted and multifaceted behavioural interventions addressing athlete dietary adherence in high-performance sport have been laid.

The purpose of this article is to provide a descriptive and reflective account of the multidisciplinary support (i.e., nutrition, physiology and psychology) provided to a 40-year-old male client entering the Marathon des Sables (MdS) for the first time. Reflections will be provided from client and practitioner perspectives. An initial assessment phase, consisting of intake interview (e.g., initial introductions and contracting), sport analysis and client needs analysis (e.g., nutritional requirements for training/racing; performance profiling and physiological testing), was conducted 16 weeks prior to the race to identify key priorities and inform support provision. Professional codes of ethics and conduct (e.g., British Association of Sport and Exercise Sciences [BASES], British Psychological Society [BPS] and Sport and Exercise Nutrition Register [SENR]) were consistently adhered to. Institutional ethical approval to use case study data for research purposes was obtained retrospectively. “Priority areas” (e.g., fitness and mental endurance) and “unknown aspects” (e.g., heat/hydration, nutrition and tent-mates) of race preparation and completion were initially identified. Based on this information, a programme of client-tailored support consisting of psychological skills training (e.g., goal-setting), dietary analysis (e.g., completion/evaluation of diet diaries) and physiological testing (e.g., heat chamber trials to monitor fluid balance and sodium loss during treadmill running) was provided. “Unknown aspects” became particularly salient for client and practitioners following a serious ankle injury sustained by the client within the first month of the support programme. Despite intentions to provide an interdisciplinary support programme, a predominantly multidisciplinary approach was adopted. Furthermore, in the face of limited time and availability, the support team employed a largely clientled consultancy approach (i.e., client empowered to take responsibility for decision-making and problemsolving). Client feedback (e.g., “cautious confidence” about hydration/nutrition, adapting overall race goal to “complete” rather than “compete” and being able to draw on previous experiences of dealing with unfamiliar scenarios) indicated that the consultancy approach was successful in facilitating client involvement in developing appropriate race strategies. Although the support team did not accompany the client to the race venue, remote support (i.e., online messages) was provided throughout the race. During a debrief interview conducted 3 days postrace, the client reflected on the sense of “reassurance” which the support programme had provided en route to achieving his adapted goal of race completion. This case study provides an account of the multidisciplinary support offered to an ultra-marathon debutant over a short yet turbulent timeframe. Reflections on the challenges, successes and learning experiences encountered during the support programme demonstrates that developing the ability to adapt to novel and unexpected circumstances represents an important challenge for both clients and practitioners alike.

The Marathon Des Sables (MdS) is a multistage ultra-endurance footrace across the Sahara Desert. Event organisation supplies rationed water (9 L · day–1) but entrants must provide and carry a minimum of 2000 kcals · day–1 selecting provisions best suited to personal needs, health, environmental conditions, weight and backpack preference. This case study account details pre-race nutritional planning and preparation of a 40-year-old, recreationally trained but occupationally sedentary male client. The purpose of collaboration was to develop nutritional strategies to support training, alongside an event food plan that adhered to race regulations and maximised energy delivery within a client-determined backpack food weight allowance of 5 kg. The client (body mass 83.7 kg) self-referred 16 weeks prior to the event. Following initial assessment and dietary analysis, a nutrition intervention was designed to sustain training. Total energy requirement (TER) was predicted using basal metabolic rate and a physical activity level of 1.7 (2934 kcal). Nutritional targets were set based on American College of Sports Medicine (ACSM) guidelines; carbohydrate (CHO) 6–7 g · kgBM–1 · day–1, protein 1.2–1.7 g · kgBM–1 · day–1, fat 20–25% TER. A tailored event food plan was formulated and trialled pre-race. Post-race debrief occurred 3 days following completion. Initial assessment identified the need to shift the balance of CHO (mean intake 305 g, target 502–586 g) and protein (mean intake 192 g, target 100– 117 g) contributions to TER to support training. With emphasis placed on recovery nutrition strategies, an augmented CHO intake was advised as training duration increased. The client was taught to self-manage through the use of simple CHO content of common food resources. In respect of the event plan, using the limits of his own knowledge and generic information provided on the race website, the client had set a minimum target daily energy intake equivalent to 3000 kcal · day–1 using a range of freeze-dried meals and snack foods and sought the practitioner’s expertise to optimise energy availability of race provisions resulting in a mean energy and macronutrient profile of 3082 kcal, 389 g CHO, 110 g protein, 132 g fat. Post-race debrief indicated the intervention provided reassurance through the process of negotiation and practitioner expertise in accommodating the client’s taste preferences to formulate an event plan that was “fine-tuned” to safeguard product durability in extreme heat offering sufficient variety ensuring palatability and consumption. With the growing popularity of ultra-endurance events and the associated time and financial commitments of participants, this case study highlights the success of individualised nutrition strategies to facilitate performance and build client confidence in race completion.

Sub-optimal calcium, vitamin D and iron intakes are typical in athletes. However, quantification by dietary intake may be erroneous, with biomarkers providing a more accurate assessment. This study aimed to determine the calcium, vitamin D and iron status of 8 junior (i.e., under-18 [U18]; age 15.5 ± 0.5 years; height 180.4 ± 6.7 cm; body mass 81.6 ± 14.3 kg) and 12 senior (i.e., over-18 [O18]; age 19.7 ± 1.8 years; height 184.9 ± 6.9 cm; body mass 97.4 ± 14.4 kg) male rugby union players, and assess their adequacy against reference values. Fasted serum calcium, 25(OH)D and ferritin concentrations were analysed using Enzyme-Linked Immunosorbent Assay during the in-season period (March-April). U18 had very likely greater calcium concentrations than O18 (2.40 ± 0.08 vs. 2.25 ± 0.19 mmol.l-1). Differences between U18 and O18 were unclear for 25(OH)D (20.21 ± 11.57 vs. 29.02 ± 33.69 nmol.l-1) and ferritin (59.33 ± 34.61 vs. 85.25 ± 73.53 µg.l-1). Compared to reference values, all U18 had adequate serum calcium concentrations, whereas 33% and 67% of O18 were deficient and adequate, respectively. All U18 and 83% of O18 had severely deficient, deficient or inadequate vitamin D concentrations. Adequate (8%) and optimal (8%) concentrations of vitamin D were observed in O18. All U18 and 75% of O18 had adequate ferritin concentrations. Potential toxicity (17%) and deficient (8%) ferritin concentrations were observed in O18. Vitamin D intake should be increased and multiple measures obtained throughout the season. More research is required on the variation of micronutrient status

Designing and implementing successful dietary intervention is integral to the role of sport nutrition professionals as they attempt to positively change the dietary behaviours of athletes. High-performance sport is a time-pressured environment where immediate results can often supersede pursuit of the most effective evidence-based practice. However, efficacious dietary intervention necessitates comprehensive, systematic and theoretical behavioural design and implementation if the habitual dietary behaviours of athletes are to be positively changed. Therefore, this case study demonstrates how the Behaviour Change Wheel was used to design and implement an effective nutritional intervention within professional rugby league. The eight-step intervention targeted athlete consumption of a high quality dietary intake of 25.1 MJ each day, to achieve an overall body mass increase of 5 kg across a twelve-week intervention period. The Capability, Opportunity, Motivation-Behaviour model and APEASE criteria were used to identify population-specific intervention functions, policy categories, behaviour change techniques and modes of intervention delivery. The resulting intervention was successful, increasing the average daily energy intake of the athlete to 24.5 MJ, which corresponded in a 6.2 kg body mass gain. Despite consuming 0.6 MJ less per day than targeted, secondary outcome measures of diet quality, strength, body composition and immune function all substantially improved, supporting a sufficient energy intake and the overall efficacy of a behavioural approach. Ultimately, the Behaviour Change Wheel provides sport nutrition professionals with an effective and practical step-wise method via which to design and implement effective nutritional interventions for use within high-performance sport.

The ultimate aim of bodybuilding is to achieve an aesthetically pleasing physique through gains in lean body mass (LBM) and reductions in fat mass (FM). Favourable blood lipid profile (BLP) adaptations have been reported but research is equivocal. Total energy intake (EI) has been suggested to be one of the biggest dietary predictors for optimum body composition with daily distribution of meals less important. However, high quality protein per meal as a means to maintain muscle protein synthesis suggests that higher daily meal frequency (MF) may be a more appropriate dietary strategy. Our aim was to investigate the interplay between habitual MF, body composition and BLP in non-competitive bodybuilders. Following ethics approval, 44 males and 10 females met participation criteria. Upper and lower 25th percentiles of response to number of eating occasions were calculated. Arranged into a low (LFG, 2.6±0.8: n=12, 28±5 years, 80.9±17.8 kg) or high (HFG, 6.6±0.8: n=12, 27±7 years, 85.2±16.8 kg) daily MF group, participants completed a 3-day diet diary, had a dual energy X-ray absorptiometry scan, and blood lipids measured. The HFG (13.9±3.8%) had lower (P=0.024) %body fat than the LFG (19.2±6.7%) but LBM in the HFG (70.2±14.4 kg) was not different from that of the LFG (62.1±14.5 kg). Blood lipids were within healthy range, while the HFG completed more (P=0.000) weekly training sessions (4.3±0.8) than the LFG (5.5±0.7). There was no difference in energy intake between the groups: HFG 2564±681 kcal; LFG 2215±533. Protein intake in the HFG was higher (P=0.054) than the LFG (2.6±1.0 vs 1.9±0.5 g/kg-1/BW/d-1). Differences were not observed in fat (1.2±0.6 and 1.4±0.6 g/kg-1/BW/d-1) or carbohydrate (2.5±1.4 and 1.9±1.1 g/kg-1/BW/d-1 in LFG and HFG respectively) intakes. In relative terms, the carbohydrate intake in the HFG (25±9%) was lower (P=0.027) than that of the LFG (35±12%). In conclusion, BLP was within the healthy range in both groups. Furthermore, higher MF was associated with better sport-specific body composition outcomes. This is potentially due to higher consumption of dietary proteins (35% of daily EI) resulting in optimisation of muscle synthetic response and training capacity.

The ultimate aim of bodybuilding is to achieve an aesthetically pleasing physique through gains in lean tissue mass (LTM) and reductions in fat mass (FM). Favourable blood lipid profile (BLP) adaptations have been reported but research is equivocal. Total energy intake (EI) has been suggested to be one of the biggest dietary predictors for optimum body composition with daily distribution of meals less important. However, high quality protein per meal as a means to maintain muscle protein synthesis suggests that higher daily meal frequency (MF) may be a more appropriate dietary strategy. Our aim was to investigate the interplay between habitual MF, body composition and BLP in non-competitive bodybuilders. Following ethical approval, 44 males and 10 females met participation criteria. Upper and lower 25th percentiles of response to number of eating occasions were calculated. Arranged into a low (LFG, 2.6±0.8) (n=12, 27.9±5.1 years, 80.9±17.8 kg) or high (HFG, 6.6±0.8) (n=12, 27.3±7.2 years, 85.2±16.8 kg) daily MF group, participants (n=24, 27.9±6.1 years, 83.0±17.1 kg), completed a 3-day diet diary, had a dual energy X-ray absorptiometry scan, blood lipids measured. The HFG (13.9±3.8%) had significantly lower (P=0.024) %body fat than the LFG (19.2±6.7%). There was a trend for higher LTM in the HFG (70.2±14.4 kg) compared to the LFG (62.1±14.5 kg). Blood lipids were within normal range, while the HFG completed significantly (P=0.000) more weekly training sessions (4.3±0.8) than the LFG (5.5±0.7). Despite the HFG consuming more energy (2564±681 kcal) than the LFG (2215±533), the difference was not significant. Protein intake in the HFG was significantly higher (P=0.54) than the LFG (2.6±1.0 vs 1.9±0.5 g/kg-1/BW/d-1). Differences were not observed in fat (1.2±0.6 and 1.4±0.6 g/kg-1/BW/d-1) or carbohydrate (2.5±1.4 and 1.9±1.1 g/kg-1/BW/d-1 in LFG and HFG respectively) intakes. In relative terms, the carbohydrate intake in the HFG (25±9.0%) was significantly lower (P=0.027) than that of the LFG (35±12%). In conclusion, BLP was within healthy range in both groups. Furthermore, higher MF was associated with optimum sport-specific body composition outcomes. This is potentially due to higher consumption of dietary proteins (35% of daily EI) resulting in optimisation of muscle synthetic response and training capacity.

Good nutrition is essential for the physical development of adolescent athletes, however data on dietary intakes of adolescent rugby players are lacking. This study quantified and evaluated dietary intake in 87 elite male English academy rugby league (RL) and rugby union (RU) players by age (under-16 (U16) and under-19 (U19) years old) and code (RL and RU). Relationships of intakes with body mass and composition (sum of 8 skinfolds) were also investigated. Using 4-day diet and physical activity diaries, dietary intake was compared to adolescent sports nutrition recommendations and the UK national food guide. Dietary intake did not differ by code, whereas U19s consumed greater energy (3366 ± 658 vs. 2995 ± 774 kcal.day-1), protein (207 ± 49 vs. 150 ± 53 g.day-1) and fluid (4221 ± 1323 vs. 3137 ± 1015 ml.day-1) than U16s. U19s consumed a better quality diet than U16s (greater intakes of fruit and vegetables; 4.4 ± 1.9 vs. 2.8 ± 1.5 servings.day-1; non-dairy proteins; 3.9 ± 1.1 vs. 2.9 ± 1.1 servings.day-1) and less fats and sugars (2.0 ± 1. vs. 93.6 ± 2.1 servings.day-1). Protein intake vs. body mass was moderate (r = 0.46, p < 0.001), and other relationships were weak. The findings of this study suggest adolescent rugby players consume adequate dietary intakes in relation to current guidelines for energy, macronutrient and fluid intake. Players should improve the quality of their diet by replacing intakes from the fats and sugars food group with healthier choices, while maintaining current energy, and macronutrient intakes.

The consumption frequency and portion size of discretionary snacks are thought to contribute to a greater food intake and risk of overweight or obesity in the developed world but evidence from epidemiological studies is inconclusive. To investigate this, we systematically evaluated evidence on the effects of discretionary snack consumption on weight status, energy intake, and diet quality. Articles involving discretionary snacks reported against the outcome measures of any primary, peer-reviewed study using human participants from free-living conditions for all age groups were included. A total of 14,780 titles were identified and 40 eligible publications were identified. Three key outcomes were reported: weight status (n = 35), energy intake (n = 11), and diet quality (n = 3). Increased discretionary snack consumption may contribute modestly to energy intake, however, there is a lack of consistent associations with increased weight/BMI. Although cross-sectional analyses offered conflicting findings, longitudinal studies in adults showed a consistent positive relationship between discretionary snack intake and increasing weight or body mass index. Given that experimental findings suggest reducing the size of discretionary snacks could lead to decreased consumption and subsequent energy intake, food policy makers and manufacturers may find it valuable to consider altering the portion and/or packaging size of discretionary snacks.

The Vendée Globe is a solo round-the-world sailing race without stopovers or assistance, a physically demanding challenge for which appropriate nutrition should maintain energy balance and ensure optimum performance. This is an account of prerace nutritional preparation with a professional and experienced female racer and assessment of daily nutritional intake (NI) during the race using a multimethod approach. A daily energy intake (EI) of 15.1 MJ/day was recommended for the race and negotiated down by the racer to 12.7 MJ/day, with carbohydrate and fluid intake goals of 480 g/day and 3,020 ml/day, respectively. Throughout the 99-day voyage, daily NI was recorded using electronic food diaries and inventories piloted during training races. NI was assessed and a postrace interview and questionnaire were used to evaluate the intervention. Fat mass (FM) and fat-free mass (FFM) were assessed pre- (37 days) and postrace (11 days) using dual-energy X-ray absorptiometry, and body mass was measured before the racer stepped on the yacht and immediately postrace. Mean EI was 9.2 MJ/day (2.4-14.3 MJ/day), representing a negative energy balance of 3.5 MJ/day under the negotiated EI goal, evidenced by a 7.9-kg loss of body mass (FM -7.5 kg, FFM -0.4 kg) during the voyage, with consequent underconsumption of carbohydrate by ~130 g/day. According to the postrace yacht food inventory, self-reported EI was underreported by 7%. This intervention demonstrates the practicality of the NI approach and assessment, but the racer's nutrition strategy can be further improved to facilitate meeting more optimal NI goals for performance and health. It also shows that evaluation of NI is possible in this environment over prolonged periods, which can provide important information for optimizing nutritional strategies for ocean racing.

Criterion data for total energy expenditure (TEE) in elite rugby are lacking, which prediction equations may not reflect accurately. This study quantified TEE of 27 elite male rugby league (RL) and rugby union (RU) players (U16, U20, U24 age groups) during a 14-day in-season period using doubly labelled water (DLW). Measured TEE was also compared to estimated, using prediction equations. Resting metabolic rate (RMR) was measured using indirect calorimetry, and physical activity level (PAL) estimated (TEE:RMR). Differences in measured TEE were unclear by code and age (RL, 4369 ± 979; RU, 4365 ± 1122; U16, 4010 ± 744; U20, 4414 ± 688; U24, 4761 ± 1523 Kcal.day-1). Differences in PAL (overall mean 2.0 ± 0.4) were unclear. Very likely differences were observed in RMR by code (RL, 2366 ± 296; RU, 2123 ± 269 Kcal.day-1). Differences in relative RMR between U20 and U24 were very likely (U16, 27 ± 4; U20, 23 ± 3; U24, 26 ± 5 Kcal.kg-1.day-1). Differences were observed between measured and estimated TEE, using Schofield, Cunningham and Harris-Benedict equations for U16 (187 ± 614, unclear; -489 ± 564, likely and -90 ± 579, unclear Kcal.day-1), U20 (-449 ± 698, likely; -785 ± 650, very likely and -452 ± 684, likely Kcal.day-1) and U24 players (-428 ± 1292; -605 ± 1493 and -461 ± 1314 Kcal.day-1, all unclear). Rugby players have high TEE, which should be acknowledged. Large inter-player variability in TEE was observed demonstrating heterogeneity within groups, thus published equations may not appropriately estimate TEE.

This narrative review examines the mechanisms underlying the development of cardiovascular (CVD) and metabolic diseases (MDs), along with their association with sarcopenia. Furthermore, non-pharmacological interventions to address sarcopenia in patients with these conditions are being suggested. The significance of combined training in managing metabolic disease and secondary sarcopenia in type II diabetes mellitus is emphasized. Additionally, the potential benefits of resistance and aerobic training are being explored. This review emphasises the role of nutrition in addressing sarcopenia in patients with CVD or MDs, focusing on strategies such as optimising protein intake, promoting plant-based protein sources, incorporating antioxidant-rich foods and omega-3 fatty acids, and ensuring sufficient vitamin D levels. Moreover, the potential benefits of targeting gut microbiota through probiotics and prebiotic fibres in sarcopenic individuals are being considered. Multidisciplinary approaches that integrate behavioural science are explored to enhance the uptake and sustainability of behaviour-based sarcopenia interventions. Future research should prioritise high-quality randomized controlled trials to refine exercise and nutritional interventions and investigate the incorporation of behavioural science into routine practices. Ultimately, a comprehensive and multifaceted approach is essential to improve health outcomes, well-being, and quality of life in older adults with sarcopenia and coexisting cardio-vascular and metabolic diseases.