REVIEW ARTICLE

Nutritional Considerations for the Older Athlete

Wayne W. Campbell, PhD, and Rachel A. Geik, MS, RD From the Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana, USA
In this review article, nutritional considerations of the aging athlete are discussed. The focuses of the review include energy, carbohydrate, protein, selected vitamins and minerals, and uids. Age-associated changes in body composition, resting energy expenditure, and volume and intensity of training, may decrease the need for dietary energy and the intakes of macro- and micronutrients and uids. The older athlete should monitor nutrient intakes to insure adequacy, especially regarding carbohydrate to promote glucose storage and use as an energy source during exercise, and protein to promote strength-traininginduced muscle hypertrophy. Emphasis should also be placed on the dietary intakes of certain micronutrients, as well as the potential need for supplementation of certain vitamins and minerals, including the vitamins B2, B6, B12, D, E, and folate, and the minerals calcium and iron. Age-associated changes in thermoregulation and an increased susceptibility to dehydration underscore the critical importance to the older athlete of adequate uid intake to sustain health and performance. Nutrition is a tool that the older athlete should use to enhance exercise performance and health. Nutrition 2004;20:603 608. Elsevier Inc. 2004 KEY WORDS: exercise, elderly, macronutrient intake, vitamins, minerals, sport, aging

INTRODUCTION
The American College of Sports Medicine (ACSM) recommends that all adults develop and maintain cardiorespiratory tness, body composition, muscular strength and endurance, and exibility by regularly exercising for 20 to 60 min/d, 3 to 5 d/wk, by using a variety of activities and exercising at moderate intensity.1 The ACSM also cautions that older persons should prudently and cautiously initiate an exercise program and apply a more gradual approach to exercise training than might be appropriate for a younger adult, although it is clearly stated that exercise training should not be limited by age. As of 2002, there were about 35.6 million persons older than 65 y living in the United States (12.3% of the population), and the number of older persons is expected to double to about 70 million (20% of the population) by 2030.2 Whereas the percentage of adults who regularly participate in common vigorous activities (e.g., jogging, aerobics, weight lifting, and high-intensity team sports) declines with advancing age, the percentage of adults who report participating in some form of regular, vigorous physical activity (dened as exercise at least 50% of age- and sex-specic maximum cardiorespiratory capacity for at least 20 min/occasion on at least three times per week) is actually higher in adults older than 65 y than in younger adults.3 This nding relates, in part, to increased awareness of the health benets of regular physical activity and more leisure time among older persons and to the fact that some activities (e.g., walking and gardening) considered moderate intensity for younger adults are considered vigorous for older adults due to an age-related decline in cardiorespiratory capacity.3 The 2000 National Health Interview Survey data indicated that among persons older than 65 y in the United States, 18.2% of men and 13.1% of women are routinely very active while doing usual daily activities and participate in regular leisure-time physical activity.4 An increasing number of older adults desire and choose to achieve physical tness for health and well-being by using recreational or competitive athletics and

to include performance as a goal.5 Nutrition is well documented to inuence athletic performance, and the appropriate selection and timing of food, uid, and supplement intakes are considered a cornerstone for optimal health and exercise performance.6 Nutrition is also well documented to be inuenced by age.7,8 The aging athlete who uses food as a tool to enhance exercise performance must consider exercise- and age-associated changes in nutrient use and dietary needs. The dietary reference intakes, reported by the Food and Nutrition Board of the Institute of Medicine of the National Academies,9 are a foundation for nutrient intakes for healthy persons to maintain health and to reduce the risk of chronic disease. These recommendations are presented for various life-stage groups across the lifespan. The life-stage grouping for older adults includes ages 51 to 70 y and older than 70 y. The Joint Position Statement on Nutrition and Athletic Performance from the ACSM, the American Dietetic Association, (ADA) and the Dietitians of Canada (DC) 6 articulates current recommendations regarding dietary energy, nutrient, and uid intakes for adults who are recreationally or competitively active. These recommendations do not consider chronological age other than to emphasize that health professionals should adapt these guidelines as necessary to meet the sports-related nutritional goals of the individual athlete. This review describes special nutritional considerations of the aging athlete to achieve health and performance.

ENERGY NEEDS OF THE AGING ATHLETE

A general denition of energy need is the amount of energy that a person who maintains a desirable body weight must consume to balance energy expenditure, including the energy expended by regular physical activity. This denition is applicable to the general population and athletes alike, with the understanding that an upward adjustment in the amount of dietary energy consumed is likely required for persons who routinely engage in physically demanding activities, including competitive athletics. All athletes, independent of age, need to consume adequate dietary energy to offset energy expenditure, maintain body weight and health, and maximize the training effects.6 Failure to do this might result in the
0899-9007/04/$30.00 doi:10.1016/j.nut.2004.04.004

Correspondence to: Wayne W. Campbell, PhD, Department of Foods and Nutrition, Purdue University, 700 West State Street, West Lafayette, IN 47907-2059, USA. E-mail: campbellw@purdue.edu Nutrition 20:603 608, 2004 Elsevier Inc., 2004. Printed in the United States. All rights reserved.

604

Campbell and Geik

Nutrition Volume 20, Numbers 7/8, 2004 consumed on average 8703 kJ/d (2077 kcal/d) of energy, with a macronutrient distribution of 56% carbohydrate, 16% protein, and 31% fat. This carbohydrate intake of about 290 g/d corresponded to 5.2 g kg 1 d 1. Although these older female athletes consumed 2.2-fold higher carbohydrate than the RDA, the carbohydrate intake below 6 g kg 1 d 1 might not have provided sufcient carbohydrate to achieve optimal carbohydrate stores.6 These women would have needed to consume 65% of energy as carbohydrate (338 g/d) to achieve the minimum suggested intake.

loss of muscle and bone masses, increase the risks of fatigue, injury and illness, and cause menstrual dysfunction in young women. Whereas the energy requirement of an individual athlete is determined by a host of factors (including body composition, exercise mode, intensity, duration, and volume), the energy requirement of older athletes may be lower than for younger athletes10 and higher than for age-matched sedentary persons.11 The reduced energy requirement of older athletes is reported to be associated with age-associated declines in resting energy expenditure and volume of exercise training.12 An age-associated loss of fat-free mass and a decline in non-training physical activity also may contribute to a reduced energy requirement. Older athletes who maintained exercise training volumes comparable to those of young athletes did not experience the decline in resting energy expenditure or dietary energy requirement.12 Previously sedentary older persons who initiated an exercise program did not experience signicantly higher dietary energy requirements during the rst few months of endurance training11,13 or resistance training,14 possibly due to offsetting changes in non-exercise energy expenditure (i.e., becoming more sedentary during the rest of the day). Older athletes should monitor energy intakes and ensure that sufcient energy is consumed to balance expenditure and to maintain appropriate body weight and composition.

PROTEIN
The RDA for protein is 0.8 g kg 1 d 1 for all healthy adults, with no increase for persons who exercise regularly.9 The Food and Nutrition Board stated that, In view of the lack of compelling evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise. 9 In contrast, the ACSM, ADA, and DC committee concluded that the need for protein in highly physically active persons is higher than that for sedentary persons.6 Specically, endurance athletes may require 1.2 to 1.4 g kg 1 d 1 and strength-trained athletes may require as much as 1.6 to 1.7 g kg 1 d 1. The higher protein requirement of athletes was deemed necessary to provide adequate amino acids for the repair of exercise-induced muscle damage, the accretion of lean tissue mass, and the modestly increased use of protein as an energy source during exercise. When evaluating these disparate recommendations, it is important to consider that the ACSM, ADA, and DC recommendations are very likely the maximum requirements of highly trained athletes who routinely exercise at high intensity and long duration, training routines that most people do not attempt or maintain. One should also consider the possibility that the protein requirement of athletes is below that needed to enhance or optimize athletic performance,19 although more research is required to resolve this issue. Most athletes customary diets provide enough protein to adequately meet need, especially when the diets contain sufcient energy and include complete sources of protein (e.g., dairy, meats, eggs, and sh).19 The protein needs of the older athlete are currently difcult to establish. Reaburn10 suggested that older athletes might not require as much dietary protein as younger athletes, due in part to ageassociated declines in fat-free and muscle masses and decreased volume and intensity of training. Independent of exercise or training status, the protein requirement for older people is not known with condence. Although the RDA for protein is not different in elderly and younger adult humans,9,20 research supports increased21 and unchanged22,23 dietary protein needs of sedentary older people. Research by Campbell et al.24 showed a signicant decrease in midthigh muscle size, consistent with a marginal protein intake, of sedentary older men and women who habitually consumed the RDA for protein for 14 wk. Campbell et al. 25 also found that concurrent strength training during the 14-wk period of consuming the RDA for protein offset muscle atrophy in the exercised muscle groups but did not prevent the apparent loss of whole-body fat-free mass. The apparent loss of fat-free mass, despite resistive exercise training, was also observed in older men who for 12 wk consumed the RDA for protein as part of a lacto-ovo-vegetarian diet.26 In contrast, older men who performed the same 12-wk resistive exercise training program and consumed an omnivorous (meat-containing) diet that provided 125% of the RDA for protein achieved the expected hypertrophy of the exercised muscles and an increase in whole-body fat-free mass.26 In a separate research study, the muscle hypertrophy response to a 12-wk period of strength training in older men who consumed 129% to 144% of the RDA for protein did not differ from that in men who consumed beef (omnivorous) or soy (lacto-ovovegetarian) foods.27 Collectively, these data suggest that the quantity of protein, not the source, was likely responsible for the

MACRONUTRIENT INTAKES
The energy needs of an athlete are met by the ingestion of carbohydrates, fats, and proteins, along with alcohol. An acceptable macronutrient distribution range for healthy diets has been set by the Food and Nutrition Board of the Institute of Medicine to be 45% to 65% carbohydrate, 10% to 35% protein, and 20% to 35% fat.9 The ACSM, ADA, and DC Joint Position Statement indicates that athletes may obtain adequate macronutrients by consuming a body weight maintenance diet that provides energy as 55% to 58% carbohydrate, 12% to 15% protein, and 25% to 30% fat,15 ranges of macronutrient intakes that are within the broader dietary reference intake ranges. The ranges are appropriate for the older athlete. However, older athletes who consume less than 8380 kJ/d (2000 kcal/d) of energy may be at risk of not consuming adequate carbohydrate and protein to meet minimum requirements (see below) and are encouraged to monitor the intake of these macronutrients.

CARBOHYDRATE
Carbohydrates (sugars and starches) are important to provide energy to cells throughout the body, particularly the brain, the bodys only carbohydrate-dependent organ.9 Carbohydrates are also very important to help maintain blood glucose during exercise and to restore muscle glycogen during rest and recovery from exercise.6 The recommended dietary allowance (RDA) for carbohydrate is 130 g/d for adults, independent of age and level of physical activity.9 The RDA for carbohydrate is meant primarily to provide adequate substrate for glucose use by the brain and should be viewed as a minimum necessary intake. Athletes are recommended to consume 6 to 10 g kg 1 d 1, with the athletes type and amount of exercise performed, total energy expenditure, sex, and environmental conditions inuencing the total amount consumed.6 Older athletes retain the capacity to store ingested carbohydrate as glycogen in liver and muscle tissues, to use glycogen as a source of energy-producing substrate during submaximal endurance exercise, and to restore muscle glycogen levels postexercise (in association with carbohydrate ingestion).10,16 18 Some older athletes may be at risk of not consuming adequate carbohydrate to meet the minimum recommendation of 6 g kg 1 d 1. Butterworth et al.11 reported that 67- to 85-y-old women engaged in endurance training (mean body weight 56 kg)

Nutrition Volume 20, Numbers 7/8, 2004 differential body composition and muscle hypertrophy responses to strength training in older men and that the RDA for protein might not be sufcient to fully support muscle hypertrophy induced by strength training in older persons. The older athlete should consider following the protein intakes suggested for younger endurance athletes, i.e., about 1.2 to 1.4 g kg 1 d 1. Currently there are no data to support added benets from intakes above this range. It is also important to emphasize that this recommendation is for healthy persons, not those with acute or chronic diseases that necessitate therapeutic diets (e.g., lower protein intake for persons with impaired renal function).

Older Athlete Nutrition

605

FAT
Fat provides energy, fat-soluble vitamins, and essential fatty acids to an athletes diet. Although there is no RDA for total fat or saturated fat, the acceptable macronutrient distribution range of 20% to 35% of energy from fat should help achieve adequate intakes of essential nutrients and reduce the risk of chronic disease.9 The ACSM, ADA, and DC6 do not recommend that athletes restrict fat intake below 20% of energy or consume high-fat diets because these practices will not enhance physical performance. Attention to the dietary intake of specic types of dietary fat (i.e., decreased saturated fat and increased monounsaturated and polyunsaturated fats) may enhance health and slow the progression of disease, but not necessarily improve athletic performance. The suggested adequate intakes for -6 polyunsaturated fatty acids (linoleic acid) are 14 g/d for older men and 11 g/d for older women.9 The suggested adequate intakes for -3 polyunsaturated fatty acids ( -linolenic acid) are 1.6 g/d for older men and 1.1 for older women.9 Older persons are encouraged to continue these recommended fat intakes throughout life.28 These recommendations are sound and applicable to older athletes.

trient intake and requirements.10 The ACSM, ADA, and DC recommendation that [n]o single nutrient supplement should be used without a specic medical or nutritional reason6 is particularly appropriate for the older athlete. However, the recommendation that [i]n general, no vitamin and mineral supplements should be required if an athlete is consuming adequate energy from a variety of foods to maintain body weight6 may not universally apply to older athletes who have a lower energy requirement, and thus consume fewer nutrients. Consultation with a registered dietitian will help older competitive athletes evaluate the adequacy of their nutrient intakes. Table I lists vitamins and minerals for which there are data suggesting modications for older competitors. Thus far, there is not sufcient evidence to provide different micronutrient recommendations for older competitors for the vitamins and minerals not listed.

FLUIDS
For an athlete of any age, negative effects on athletic performance have been demonstrated even with modest ( 2%) dehydration.35 Sweat rate is lower at a given core temperature when an athlete is hypohydrated as opposed to euhydrated.36 As a consequence, thermoregulation is impaired and core body temperature increases. Almost any amount of dehydration elevates core temperature and impairs cardiovascular function.37 As body water losses continue, core temperature increases linearly.38 In exercising individuals, each 1000 mL of water loss (corresponding to 1.4% loss of body weight) resulted in a 0.3C higher rectal temperature.37 In older competitors, susceptibility to dehydration and the subsequent negative effects on thermoregulation and athletic performance may be increased as a result of numerous age-related changes. Perturbations in the thirst mechanism, kidney function, and sweat responses inhibit an older exercisers ability to consume adequate uids and cope with the physiologic stresses of exercise.10 One age-related change is decreased renal functioning, which in an older individual causes water output by the kidneys to be higher than in a younger person.39 Another effect of aging occurs within the blood vessels: structural changes attenuate vasodilation and decrease skin blood ow as a means of dissipating metabolic heat. Older athletes may have 25% to 40% lower skin blood ow than younger competitors at the same thermic load.40 An additional change may be in the sweating responses of older individuals. It appears that older people have lower sweating rates41 and begin sweating later during an exercise bout10 compared with their younger counterparts. It is unclear whether these decits translate into a limited ability to exercise or whether they are simply differences in the way older and younger competitors handle metabolic heat. Environment, exercise intensity, and genetics introduce variability.42 Further, the thirst mechanism becomes less sensitive with advancing age.43,44 During 10 d of strenuous hill walking, older (mean age 56 y) male hikers perceived less thirst than did younger (mean age 24 y) male hikers and consequently did not consume enough uids to balance body water losses. As a result, the older hikers became progressively dehydrated, whereas the younger hikers remained hydrated.45 The goal of hydration is to prevent, or at least minimize, hypohydration during exercise. To that end, the amount of body water lost (sweat) should be replaced by uid intake. During exercise, 6 to 12 oz of uid should be consumed every 15 or 20 min, if possible. Fluid intake should begin early in the training session to prevent, rather than reverse, hypohydration. Pre-exercise uid intake encompasses generous intake in the 24 h before an exercise session,6 which translates to daily for a regularly training athlete. Specically, 400 to 600 mL (14 to 22 oz) should be consumed 2 to 3 h before exercise. After exercise, uid losses

MICRONUTRIENTS
Regular, intense training may increase an athletes requirement for vitamins and minerals above recommended levels as a result of decreased gastrointestinal absorption; increased losses via sweat, urine, and/or feces; increased degradation rates; increased need for tissue maintenance and repair; adaptation in the beginning stages of heavy training; and/or acute training that may increase energy metabolism.29 Sedentary individuals may not notice the effects of marginal micronutrient deciencies. However, inadequate micronutrient intakes by athletes may adversely affect performance due to small impairments in exercise capacity.30 Micronutrient deciencies are most likely to occur in those athletes who restrict energy intake, practice severe methods of weight loss, leave out one or multiple food groups from their dietary intake, or consume empty-calorie foods and beverages in place of more nutrient-dense foods and beverages.6 The ACSM, ADA, and DC advise against the aforementioned practice and encourage athletes to strive to consume diets that provide at least the RDAs/dietary reference intakes for all micronutrients from food.6 The increased energy demands of training and competition require a higher overall energy intake. Assuming adequate dietary intake and variety and quality of food choices to meet these elevated needs, an athlete will likely meet increased vitamin and mineral requirements.6,30 32 However, even with adequate energy intakes, insufcient micronutrient intakes in athletes, including older competitors, have been documented.1,10,33,34 Micronutrient considerations for the older competitor are further complicated by changes associated with the aging process. Often reported in an elderly population, low energy intakes, impaired nutrient absorption and/or use, chronic medical conditions, medications, and specic age-related risk factors affect micronu-

606

Campbell and Geik TABLE I.

Nutrition Volume 20, Numbers 7/8, 2004

MICRONUTRIENTS OF SPECIAL CONCERN FOR THE OLDER COMPETITOR Differences for older competitors Riboavin requirements were increased in endurancetrained older women, 50 67 y47 Recommendations for older competitors Russell and Suter48 suggested increases to 1.3 and 1.7 mg/d for women and men, respectively; a high-carbohydrate intake may enhance bacterial synthesis of riboavin, and thus decrease dietary riboavin needs48 Sacheck and Roubenoff51 suggested an increase to 2.0 mg/d for women and men

Micronutrient Riboavin

Function Coenzyme in energy metabolism

DRI Women 5070 y: 1.1 mg 70 y: 1.1 mg Men 5070 y: 1.3 mg 70 y: 1.3 mg

UL ND

Vitamin B6

Coenzyme in the metabolism of amino acids and glycogen

Women 5070 y: 1.5 mg 70 y: 1.5 mg Men 5070 y: 1.7 mg 70 y: 1.7 mg Women 5070 y: 2.4 70 y: 2.4 Men 5070 y: 2.4 70 y: 2.4

100 mg

Vitamin B12

Coenzyme in the metabolism of nucleic acids; prevents megaloblastic anemia; required for red blood cell formation

ND g g g g

Folate

Coenzyme in the metabolism of amino acids, nucleic acids, and red blood cell formation; prevents megaloblastic anemia Promotes growth and mineralization of bones by maintaining calcium and phosphorus homeostasis; enhances absorption of calcium; modulates phagocyte and lymphocyte immune cells Antioxidant-protects body tissues from oxidative damage

Vitamin D

Women 5070 y: 400 g 70 y: 400 g Men 5070 y: 400 g 70 y: 400 g Women 5070 y: 10 g 70 y: 15 g Men 5070 y: 10 g 70 y: 15 g

1000 g

50 g

Vitamine E

Women 5070 y: 15 mg 70 y: 15 mg Men 5070 y: 15 mg 70 y: 15 mg

1000 g

It is not totally clear why age affects vitamin B6 requirements, but some studies have found increased needs and comprised immunity with inadequate B649,50 Atrophic gastritis, not uncommon in aging individuals;10 decreases stomach acid and intrinsic factor secretion, which creates malabsorption of vitamin B12 and risk of anemia A decrease in stomach acid production due to atrophic gastritis can decrease absorption of folate and thus increase the risk of anemia The skin of an older person is less able to synthesize vitamin D52; less exposure to sunlight due to clothing, northern latitude, and/or indoor training may further compromise vitamin D status Supplementation may offer protection against health problems typically encountered as one ages, such as cataracts and cardiovascular disease10; there is no clear consensus as to whether extra vitamin E is necessary or benecial for hard-training athletes6

Sacheck and Roubenoff51 suggested an increase to 2.8 g/d for women and men, particularly for vegetarians because dietary vitamin B12 is found only in animalderived foods. The latest (1998) DRI for folate was increased from the 1989 RDA of 180 g for women and 200 g for men Vitamin D requirements for adults 70 y old were increased from 10 g in 1987 to 15 g in 1997

Calcium

Required for blood clotting, muscle contraction, nerve transmission, and bone health

Women 5070 y: 1200 mg 70 y: 1200 mg Men 5070 y: 1200 mg 70 y: 1200 mg

2500 mg

Older athletes whose bone density and/or dietary calcium intakes are low are at particular risk of stress fractures, especially with high-impact, repetitive sport activities53; atrophic gastritis negatively affects calcium bioavailability10;

The latest DRI for vitamin E (2000) was increased from the 1989 RDA of 8 mg for women and 10 mg for men; there continues to be great interest in supplementation of vitamin E; Sacheck and Roubenoff51 suggested that older competitors who are training for endurance events consider a daily supplement of 100200 mg If an older athlete is unable to consume adequate dietary calcium, then a supplement is warranted

Nutrition Volume 20, Numbers 7/8, 2004 TABLE I.

CONTINUED

Older Athlete Nutrition

607

Micronutrient

Function

DRI

UL

Differences for older competitors Low vitamin D intake hinders calcium absorption; calcium is lost via sweat Because iron stores tend to increase with age, older individuals have less need fordietary iron54

Recommendations for older competitors

Iron

Required as a component of hemoglobin and myoglobin, for oxygen transportation within blood and muscle tissue; prevents microcytic hypochromic anemia

Women 5070 y: 8 mg 70 y: 8 mg Men 5070 y: 8 mg 70 y: 8 mg

45 mg

Sackek and Roubenoff51 suggested that older female or vegetarian competitors who are endurance athletes training in temperature extremes consume up to 15 mg/d

DRI, dietary reference intake; ND, not determined; RDA, recommended dietary allowance; UL, upper limit

must be replaced. Athletes should ingest 450 to 675 mL (16 to 24 oz) for every pound of body weight lost.6 It is recommended that athletes strive to adhere to the drinking schedules described above (as opposed to ad libitum intake) because of the inadequacy of the thirst mechanism. Fluids should be cool (40F to 50F) to enhance palatability and promote gastric emptying.6 Older competitors should be encouraged to experiment with different hydration strategies during training and to identify likes and dislikes among the variety of sports drinks available.46

DIET AND HEALTH CONSIDERATIONS

Older exercisers and athletes are encouraged to learn about and adopt eating habits that promote health and physical performance. Such practices will not only support their active lifestyles by making appropriate food choices to achieve recommended nutrient intakes but also serve as a foundation for good health if or when the older person no longer chooses or is unable to perform highintensity exercise. Sensible food choices may also reduce the risk of developing chronic degenerative diseases. The Dietary Guidelines for Americans (DGA)15 serve as a guide to good health for healthy children (2 y and older) and adults of any age. The DGA are divided into three basic messages. The rst message, to aim for tness, reinforces the message that everyone should strive to achieve a healthy body weight, dened as a body mass index of 18.5 to 25 kg/m2, and to be physically active each day, dened for adults of all ages as a minimum of 30 min of moderate-intensity activity most days of the week, preferably daily. The appropriate caution is made that men older than 40 y and women older than 50 y who plan to start a vigorous activity program should consult with a physician or other qualied health care provider. The second message, to build a healthy base, focuses on making sensible food choices, based on the Food Guide Pyramid, that include daily consumption of a variety of whole grains, fruits, and vegetables. An older athlete may use the pyramid to choose nutrient-dense foods and beverages, critical to achieve adequate intakes of carbohydrate, protein, the vitamins B2, B6, B12, D, E, and folate, and the minerals calcium and iron. The Tufts University Food Guide Pyramid for Older Adults28 is another valuable guide for older persons, especially those 70 y and older. It is a modication of the DGA Food Guide Pyramid that emphasizes special nutritional considerations of older people. These considerations include eating a variety of lower-energy, nutrient-dense or fortied, ber-containing foods, the importance of drinking adequate

water and uids to promote hydration and prevent constipation, and the possible benet of selected supplements to help achieve adequate calcium, vitamin D, and vitamin B12 intakes. The second DGA message also focuses on the critical importance of handling, storing, and preparing food safely to decrease the risk of foodborne illness and emphasizes that older persons are at high risk of foodborne illness. The third message of the DGA, to choose sensibly, encourages the selection of foods that are low in saturated fat and cholesterol and moderate in total fat; discourages the selection of foods and beverages that contain a lot of added sugars and syrups; encourages choosing and preparing foods with less salt; and states that a person who drinks alcoholic beverages should do so in moderation.

CONCLUSIONS
There is a paucity of studies that have evaluated the interactive effects of diet and exercise in older persons, especially the habitually trained older person. Therefore, there is a conspicuous need for more research to assess the inuence of exercise on dietary intake and nutritional status of the older athlete and to use indices of performance as primary outcomes. Most of the research to date has evaluated the effect of relatively short periods of diet and exercise ( 6 mo) using previously sedentary persons as subjects; these subjects would not be considered master athletes. More diet-based research is required in older persons who are habitually training. The very limited data available in older people generally support the ACSM, ADA, and DC recommendations for desired nutritional practices by athletes. The older athlete should be made aware of these recommendations that emphasize the importance to health and performance of adequate energy, carbohydrate, protein, micronutrients, and uid intakes, and the DGA to make effective food and beverage choices. High-quality nutritional practices will provide a strong foundation for the aging athlete to continue to excel at sport and to maintain health and well-being.

REFERENCES
1. Chatard JC, Boutet C, Tourny C, et al. Nutritional status and physical tness of elderly sportsmen. Eur J Appl Physiol Occup Physiol 1998;77:157 2. US Department of Health and Human Services, Administration on Aging. A prole of older Americans, 2003. Available at: http://www.aoa.gov/prof/ statistics/prole/2003/2003prole.pdf. Accessed January 30, 2004

608

Campbell and Geik

Nutrition Volume 20, Numbers 7/8, 2004

27. Haub MD, Wells AM, Tarnopolsky MA, Campbell WW. Effect of protein source on resistive-training-induced changes in body composition and muscle size in older men. Am J Clin Nutr 2002;76:511 28. Russell RM, Rasmussen H, Lichtenstein AH. Modied Food Guide Pyramid for people over seventy years of age. J Nutr 1999;129:751 29. Chen J. Vitamins: effects of exercise on requirements. In: Maughan RJ, ed. Nutrition in sport. The encyclopedia of sports medicine, Vol VII. London: Blackwell Science, 2000:281 30. Maughan RJ. Role of micronutrients in sport and physical activity. Br Med Bull 1999;55:683 31. Clarkson PM, Haymes EM. Exercise and mineral status of athletes: calcium, magnesium, phosphorus, and iron. Med Sci Sports Exerc 1995;27:831 32. Lukaski HC. Micronutrients (magnesium, zinc, and copper): are mineral supplements needed for athletes? Int J Sport Nutr 1995;5(suppl):S74 33. Economos CD, Bortz SS, Nelson ME. Nutritional practices of elite athletes. Practical recommendations. Sports Med 1993;16:381 34. Hawley JA, Dennis SC, Lindsay FH, Noakes TD. Nutritional practices of athletes: are they sub-optimal? J Sports Sci 1995;13(special issue):S75 35. Barr SI. Effects of dehydration on exercise performance. Can J Appl Physiol 1999;24:164 36. Sawka MN, Young AJ, Latzka WA, et al. Human tolerance to heat strain during exercise: inuence of hydration. J Appl Physiol 1992;73:368 37. Coyle EF, Montain SJ. Benets of uid replacement with carbohydrate during exercise. Med Sci Sports Exerc 1992;24:S324 38. Montain SJ, Coyle EF. Inuence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J Appl Physiol 1992;73:1340 39. Rolls BJ, Phillips PA. Aging and disturbances of thirst and uid balance. Nutr Rev 1990;48:137 40. Kenney WL, Tankersley CG, Newswanger DL, et al. Age and hypohydration independently inuence the peripheral vascular response to heat stress. J Appl Physiol 1990;68:1902 41. Kenney WL, Fowler SR. Methylcholine-activated eccrine sweat gland density and output as a function of age. J Appl Physiol 1988;65:1082 42. Kenney WL, Hodgson JL. Heat tolerance, thermoregulation and ageing. Sports Med 1987;4:446 43. Kenney WL, Chiu P. Inuence of age on thirst and uid intake. Med Sci Sports Exerc 2001;33:1524 44. Phillips PA, Rolls BJ, Ledingham JG, et al. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med 1984;311:753 45. Ainslie PN, Campbell IT, Frayn KN, et al. Energy balance, metabolism, hydration, and performance during strenuous hill walking: the effect of age. J Appl Physiol 2002;93:714 46. Maughan R. Fluid and carbohydrate intake during exercise. In: Burke L, Deakin V, eds. Clinical sports nutrition. Melbourne: McGraw-Hill, 2000:369 47. Winters LR, Yoon JS, Kalkwarf HJ, et al. Riboavin requirements and exercise adaptation in older women. Am J Clin Nutr 1992;56:526 48. Russell RM, Suter PM. Vitamin requirements of elderly people: an update. Am J Clin Nutr 1993;58:4 49. Meydani SN, Ribaya-Mercado JD, Russell RM, et al. Vitamin B-6 deciency impairs interleukin 2 production and lymphocyte proliferation in elderly adults. Am J Clin Nutr 1991;53:1275 50. Ribaya-Mercado JD, Russell RM, Sahyoun N, Morrow FD, Gershoff SN. Vitamin B-6 requirements of elderly men and women. J Nutr 1991;121:1062 51. Sacheck JM, Roubenoff R. Nutrition in the exercising elderly. Clin Sports Med 1999;18:565 52. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985;76:1536 53. Myburgh KH, Hutchins J, Fataar AB, Hough SF, Noakes TD. Low bone density is an etiologic factor for stress fractures in athletes. Ann Intern Med 1990;113: 754 54. Casale G, Bonora C, Migliavacca A, Zurita IE, de Nicola P. Serum ferritin and ageing. Age Ageing 1981;10:119

3. US Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996 4. Barnes P, Schoenborn C. Physical activity among adults: United States, 2000. Advance data from vital and health statistics, No 333. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003 5. Trappe S. Master athletes. Int J Sport Nutr Exerc Metab 2001;11(suppl):S196 6. American College of Sports Medicine, American Dietetic Association, Dietitians of Canada. Joint position statement. Nutrition and athletic performance. Med Sci Sports Exerc 2000;32:2130 7. Bates CJ, Benton D, Biesalski HK, et al. Nutrition and aging: a consensus statement. J Nutr Health Aging 2002;6:103 8. Chernoff R. Nutrition and health promotion in older adults. J Gerontol A Biol Sci Med Sci 2001;56(2):47 9. Institute of Medicine of the National Academies. Dietary reference intakes for energy, carbohydrate, ber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington, DC: National Academies Press, 2002 10. Reaburn P. Nutrition and the ageing athlete. In: Burke L, Deakin V, eds. Clinical sports nutrition. Melbourne: McGraw-Hill, 2000:602 11. Butterworth DE, Nieman DC, Perkins R, Warren BJ, Dotson RG. Exercise training and nutrient intake in elderly women. J Am Diet Assoc 1993;93:653 12. van Pelt RE, Dinneno FA, Seals DR, Jones PP. Age-related decline in RMR in physically active men: relation to exercise volume and energy intake. Am J Physiol Endocrinol Metab 2001;281:E633 13. Keytel LR, Lambert MI, Johnson J, Noakes TD, Lambert EV. Free living energy expenditure in post menopausal women before and after exercise training. Int J Sport Nutr Exerc Metab 2001;11:226 14. Campbell WW, Kruskall LJ, Evans WJ. Lower body versus whole body resistive exercise training and energy requirements of older men and women. Metabolism 2002;51:989 15. US Department of Agriculture, US Department of Health and Human Services. Nutrition and your health: dietary guidelines for Americans, 5th ed. Home and Garden Bulletin 232. 2000 16. Cartee G. Aging skeletal muscle. Response to exercise. In: Holoszy, ed. Exercise and sport sciences reviews. Baltimore: Williams & Wilkins, 1994:91 17. Meredith CN, Frontera WR, Fisher EC, et al. Peripheral effects of endurance training in young and old subjects. J Appl Physiol 1989;66:2844 18. Tarnopolsky MA, Bosman M, Macdonald JR, et al. Postexercise proteincarbohydrate and carbohydrate supplements increase muscle glycogen in men and women. J Appl Physiol 1997;83:1877 19. Lemon PW. Beyond the zone: protein needs of active individuals. J Am Coll Nutr 2000;19:513S 20. Rand WM, Pellett PL, Young VR. Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults. Am J Clin Nutr 2003;77:109 21. Campbell WW, Crim MC, Dallal GE, Young VR, Evans WJ. Increased protein requirements in elderly people: new data and retrospective reassessments. Am J Clin Nutr 1994;60:501 22. Millward DJ, Fereday A, Gibson N, Pacy PJ. Aging, protein requirements, and protein turnover. Am J Clin Nutr 1997;66:774 23. Fereday A, Gibson NR, Cox M, Pacy PJ, Millward DJ. Protein requirements and ageing: metabolic demand and efciency of utilization. Br J Nutr 1997;77:685 24. Campbell WW, Trappe TA, Wolfe RR, Evans WJ. The recommended dietary allowance for protein may not be adequate for older people to maintain skeletal muscle. J Gerontol A Biol Sci Med Sci 2001;56:M373 25. Campbell WW, Trappe TA, Jozsi AC, et al. Dietary protein adequacy and lower body versus whole body resistive training in older humans. J Physiol 2002;542: 631 26. Campbell WW, Barton ML, Jr, Cyr-Campbell D, et al. Effects of an omnivorous diet compared with a lactoovovegetarian diet on resistance-training-induced changes in body composition and skeletal muscle in older men. Am J Clin Nutr 1999;70:1032