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Issn 1129-8723 VOLUME 15 NUMERO 1/2013

P R O G R E S S I N

NUTRITION
Giornale Italiano del Metabolismo e della Nutrizione
Mat tioli i8 85
1/2013

POSTE ITALIANE S.P.A. - SPED. IN A. P. - D.L. 353/2003 (CONV. IN L. 27/02/2004 N. 46) ART. 1, COMMA 1, DCB PARMA - FINITO DI STAMPARE MARZO 2013
Recensita su
Excerpta Medica
Sci Search®
Journal Citation Reports
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SPORTS NUTRITION SCIENCES: AN ESSENTIAL


OVERVIEW

NUTRIZIONE E STRATEGIE DI INTEGRAZIONE


SELETTIVA NEL MANAGEMENT CLINICO DEL
RECUPERO MUSCOLARE POST INFORTUNIO

CONSUMERS ABILITY TO DISCERN FOOD QUALITY


UNDER BLIND CONDITIONS

MONOACILGLICEROLI E LORO INFLUENZA


SULL’EVOLUZIONE DEI FENOMENI OSSIDATIVI IN OLI
VEGETALI PURIFICATI

OBESITÀ IN POST-TRAPIANTO DI RENE: EFFICACIA


E SICUREZZA DI UNA DIETA CHETOGENICA
Board PROGRESS IN NUTRITION 1/2013

Fondatore / Founding Editor Organo Ufficiale della Società Italiana di Scienza dell’Alimentazione (S.I.S.A.)
Massimo Cocchi Con il patrocinio dell’Associazione Ricercatori di Nutrizione e Alimenti (A.R.N.A.)
Scottish Agricultural College, Edinburgh
Direttore Scientifico / Editor
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Azienda Ospedaliera Universitaria di Parma
Presidente / President
Andrea Strata
Sommario
Università di Parma
Comitato Scientifico / Executive Editors
F. Arfini
Università di Parma
D. Atkinson
Scottish Agricultural College, Edinburgh
G. Ballarini
Università di Parma
S. Bernasconi
Università di Parma HIGHLIGHTS
G. Bertoni 3 M. Negro, S. Rucci, D. Buonocore, A. Focarelli, F. Marzatico
Università di Piacenza
S.E. Carlson
Sports Nutrition Sciences: an essential overview (PART I)
Kansas City University
F. Di Lisa
Università di Padova REVIEWS
G. Fatati
Università di Terni 31 F. Cioni
N.G. Frega Nutrizione e strategie di integrazione selettiva nel
Università di Ancona management clinico del recupero muscolare post infortunio
C. Galli
Università di Milano
C. Giacomini
Università di Parma ORIGINAL ARTICLE
G.M. Halpern 43 C. Pasta, G. Cortese, G. Marino, G. Licitra
Hong Kong Polytechnic University
T. Leighton Consumers ability to discern food quality under blind
Berkeley University conditions
M.C. Mancini
Università di Parma
R. Marchelli
53 F. Caponio, G. Bruno, V.M. Paradiso, C. Summo, T. Gomes
Università di Parma Monoacilgliceroli e loro influenza sull’evoluzione dei
P. Migliaccio fenomeni ossidativi in oli vegetali purificati
Università Sapienza di Roma
A.L. Mordenti
Università di Bologna
K. Mullis CASE REPORT
Premio Nobel per la Chimica 1993 58 L. Vigna, C. Barberi, D. Sommaruga, L. Ghio, M. Belingheri,
F. Nicastro
Università di Bari
A. Sala, L. Riboldi
R.C. Noble Obesità in post-trapianto di rene: efficacia e sicurezza di una
Scottish Agricultural College of Edinburgh dieta chetogenica
G. Riccardi
Università di Napoli
C.M. Rotella
Università di Firenze

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HIGHLIGHTS

M.NEGRO, S. RUCCI, Sports Nutrition Science: an essential


D. BUONOCORE, overview
A. FOCARELLI, F. MARZATICO

PROGRESS IN NUTRITION
VOL. 15, N. 1, 3-30, 2013 Summary
The topic of sports nutrition has received considerable attention over the
past few decades, and it is likely to get even more attention, given that nutri-
TITLE tion plays such an important and sometimes crucial role in an athlete’s per-
Scienza della Nutrizione dello formance. Indeed, nutrition influences nearly every process in the body in-
Sport: una panoramica volved in energy production and recovery from exercise. To understand and
essenziale apply the principles of sport nutrition, some basic understanding of nutri-
tion, exercise physiology and sport science are necessary. The nutritional ap-
KEY WORDS
proach for training and competition is one of the most important concerns
Physical activity, body composition,
of sport nutrition science. Exercise produces several molecular, biochemical
sweat loss, dehydration, elderly and
and physiological responses and the aim of a well designed diet is to guaran-
young athletes, energy balance in
tee a correct intake of energy, carbohydrates, proteins, fats, vitamins, mine-
physical exercise, female triad, sport
rals and water in order to support basic nutrition requirements as well as
and immune function, sports
nutrition, sport supplements. pre-, during and post-exercise specific nutrition phases. A very interesting
subject of sport nutrition is the use of supplements and their effects on hu-
PAROLE CHIAVE man performance and health. The number of supplements introduced to the
Attività fisica, composizione market is huge, however, only few products are apparently effective and
corporea, sudorazione, deidratazione, scientifically proven by a solid core of reference. For many other supple-
atleti anziani, bilancio energetico ments normally used by athletes, the data are anecdotic or based on only a
nell’esercizio fisico, triade dell’atleta, few studies and thus their use cannot be universally recommended. A key
sport e funzione immunitaria, item in sport nutrition is the manipulation of body mass and body composi-
nutrizione dello sport, atleti tion. Reducing fat mass is desirable in many sports with weight categories
adolescenti, supplementi ed and increasing muscle mass can be an advantage in sports that require
integratori alimentari strength and power. Finally, nutritional requirements can be different for
women, young and elderly athletes. These categories have different age and
Laboratorio di Farmacologia, sex-related physiological needs and specific nutrition strategies must be
Biochimica, Nutrizione e planned to guarantee adequate exercise adaptation and maintain overall
Nutraceutica del Benessere health.
Università di Pavia, Pavia, Italia
Riassunto
Address for correspondence: La nutrizione applicata allo sport ha ricevuto una considerevole attenzione
Massimo Negro negli ultimi 10 anni; un’attenzione destinata ad aumentare in quanto
Address:Via Ferrata, 9-27100 Pavia (PV) l'alimentazione gioca un ruolo chiave, talvolta determinante nelle prestazioni
Phone numbre: (0039)0382986468
Fax number: (0039)0382986390 di un atleta. In effetti, l'alimentazione incide su quasi tutti i processi fisiolo-
e-mail: massimo.negro@unipv.it gici coinvolti nella produzione di energia e nel recupero muscolare. Per com-

3
VOLUME 15

prendere e applicare i principi della nutrizione sportiva, sono necessarie co-


noscenze di base della nutrizione, fisiologia dell’esercizio e scienza dello
sport. L'approccio nutrizionale per l’allenamento e la competizione è uno dei
target più importanti di cui si occupa la scienza della nutrizione dello sport.
L’esercizio fisico produce diverse risposte molecolari, biochimiche e fisiologi-
che e l'obiettivo di una dieta ben programmata è quello di garantire un cor-
retto apporto di energia, carboidrati, proteine, grassi, vitamine, minerali e ac-
qua, al fine di soddisfare le specifiche richieste nutrizionali delle fasi pre-,
durante e post-attività fisica. Un argomento molto interessante trattato dalla
nutrizione dello sport è l'uso di supplementi e la comprensione dei loro ef-
fetti sulle prestazioni fisiche e sulla salute umana. Il numero di supplementi
introdotti sul mercato è enorme, tuttavia, solo pochi prodotti sono stati
scientificamente testati mostrando una certa efficacia. Per molti altri prodot-
ti, normalmente utilizzati dagli atleti, i dati sono aneddotici o ricavati da po-
chi studi, e quindi il loro uso non può essere raccomandato. La nutrizione
sportiva si occupa, inoltre, di studiare le variazioni di massa e composizione
corporea negli atleti. La riduzione della massa grassa è auspicabile in molti
sport che contemplano categorie di peso, mentre un aumento di massa mu-
scolare può essere un vantaggio negli sport che richiedono forza e potenza.
Infine, le richieste nutrizionali possono essere diverse per donne, atleti giova-
ni ed anziani. Queste categorie hanno diverse esigenze fisiologiche legate a
sesso ed età per cui specifiche strategie nutrizionali devono essere pianificate
per garantire sia i meccanismi di adattamento all’esercizio fisico, sia il man-
tenimento dello stato di salute.

Energy and nutrients for physi- and different sports have different ATPase) provides the energy for
cal activity energy requirements. Therefore, muscle contraction. Three mecha-
athletes must adjust their food in- nisms are involved in the resyn-
Although the human body has take accordingly (1). thesis of ATP for muscle force
some energy reserves, most of its Energy is stored in the body as fat, generation: 1) PCr hydrolysis, 2)
energy must be obtained through glycogen, phosphocreatine (PCr), glycolysis, which involves metabo-
nutrition. During exercise, energy and adenosine triphosphate lism of glucose-6-phosphate, de-
requirements increase and energy (ATP). ATP is the essential ener- rived from muscle glycogen or
provision can become critical. In gy source used by the muscle for blood-borne glucose, and produces
athletes, energy provision can be performing work or producing ATP by substrate-level phospho-
crucial and energy depletion (par- force. The breakdown of ATP to r ylation reactions, and 3) the
ticularly carbohydrate depletion) is adenosine diphosphate (ADP) products of carbohydrate, fat and
one of the most common causes of and inorganic phosphate (Pi) by a protein metabolism enter the tri-
fatigue. Different types of exercise specific muscle enzyme (myosin carboxylic acid (TCA) cycle in the

4
PROGRESS IN NUTRITION 1/2013

mitochondria and are oxidized to energy balance is “negative” and that short burst of intense exercise
carbon dioxide and water; this weight loss will result. Over the can be very high. However, be-
process is known as oxidative long term, energy balance is main- cause this high intensity is typical-
phosphorylation and yields energy tained in weight-stable individuals ly followed by a longer period of
for the synthesis of ATP (1). even though on a day-to-day basis relatively low intensity, walking or
this balance may be either positive even standing, the average energy
and or negative (1). expenditure for this activity is rel-
Energy balance atively low. Tennis played at a
Energy balance in different activities high level will have shorter peri-
The energy balance is usually cal- Some physical activities have ods of rest and the average inten-
culated over longer periods of higher energy outputs than others, sity is much higher.
time, days or weeks, and repre- as shown in table 1. Tennis, for ex- In continuous sports such as cy-
sents the difference between ener- ample, has relatively low energy cling and running, in which there
gy intake and energy expenditure. expenditure if played recreational- is usually little or no recovery dur-
When energy intake exceeds ener- ly and could be classified as a ing the activity, energy expendi-
gy expenditure, the energy balance light-to-moderate activity. Al- tures can be relatively high.
is “positive” and will result in though during a game, the exer- The energy requirements of an in-
weight gain. When energy intake cise can sometimes be very intense dividual are influenced by factors
is below energy expenditure, the and energy expenditure during such as body size, body composi-

Tabella 1 - Estimated energy cost in some physical activities (mean values in Kcal/min).
Body weight
Activity 50 Kg (110 lb) 60 Kg (132 lb) 70 Kg (154 lb) 80 Kg (176 lb) 90 Kg (198 lb)
Basketball 7.2 8.8 10 11.5 13
Circuit training 5.5 6.5 7.5 8.5 10
Cycling
9 Km/h 3.3 4 4.5 5.3 6
15 Km/h 5.3 7 8 8.3 9.5
racing 8.8 10.5 12.3 14 15.8
Football 7 8.3 9.8 11 12.5
Gymnastics 3.5 4 4.8 5.5 6.3
Hockey 4.5 5 6 7.3 8.3
Judo 10.3 12.3 14.3 16.3 18.3
Tennis
recreational 3.8 4.3 5 5.8 6.5
competitive 9.3 11 12.5 14.5 16.3
Volleyball 2.5 3 3.6 4.3 4.8

5
VOLUME 15

tion, movement efficiency, goals muscles and 75-100 g is stored in pasta, sugar drinks, cakes, etc.)
and the energy cost of training (1, the liver. This is enough carbohy- may need to be reduced to reflect
2). drate to run at a moderate intensi- a decreased training load. Others
ty for about 20 miles (3). Howev- dietary goals required for weight
er, carbohydrate requirements are management or aesthetic sports
Food and nutrients largely influenced by training should consider a reduction of
loads (frequency, duration and in- daily carbohydrate intake (table 2)
Nutrients are usually divided into tensity of training sessions) and (2, 3).
five different categories: carbohy- the demands of competition. Giv-
drates, proteins, fats, vitamins, and en this, daily carbohydrate intake Protein
minerals (1). should reflect daily exercise levels. Protein is needed to support the
Low body stores of carbohydrate repair of damaged body tissues
Carbohydrate can result in fatigue, impairment and the building of new proteins
Carbohydrate remains a key nutri- of performance during training or in response to the training stimu-
ent for athletes. It provides the competition, and negatively im- lus (1-3). Endurance athletes un-
major fuel for exercise, especially pact immune function. dertaking heavy training may re-
during prolonged continuous exer- On high activity days, carbohy- quire extra protein to cover a pro-
cise or high-intensity work. The drate intake needs to be increased portion of the energy costs of their
body has a limited capacity to to facilitate optimal exercise per- training, and for repair and recov-
store carbohydrate (as glycogen in formance and promote recovery ery after a workout. Strength-
the muscles and liver) and stores between exercise sessions. Con- trained athletes look for additional
must be replenished regularly to versely, on low activity days, car- protein to increase muscle size and
support training (2). About 300- bohydrate intake (particularly strength in response to resistance
500 g of glycogen is stored in the from high-density sources such as training. Negative energy balance

Tabella 2 - Carbohydrate intake levels in sports nutrition (mean values for Kg of body weight).
Activity Daily carbohydrate
intake
Minimal physical activity 2-3g
Recovery after muscle injury or bed rest conditions
3-5 hr/week of training for dexterity sports (e.g. archery, bowling, golf, horse-back riding) 3-5g
Fat loss management
Bodybuilding pre-contest diet
10 hr/week of training for power and team sports (e.g. bodybuilding off-season diet, canoeing, 6-7g
football, martial arts, sprinting, tennis, weight lifting)
20 hr/week of training of endurance sports (e.g. cross-country skiing, cycling, Nordic skiing, 7 - 10 g
running, trekking)
Carbohydrates loading for endurance and ultra-endurance events (e.g. triathlon ironman, 10 - 12 g
ultra-trail)

6
PROGRESS IN NUTRITION 1/2013

and inadequate carbohydrate in- tein intake are those with restrict- centage contribution of fat may
take during heavy training can al- ed energy intakes and unusual di- actually decrease.
so increase protein needs. Several etary practices (poorly chosen veg- Diet also has marked effects on fat
experts have suggested guidelines etarian diets, extremely high car- oxidation (1). Generally a high-
for protein intakes for athletes bohydrate or low-fat diets) (2). carbohydrate, low-fat diet reduces
that reflect these possible increases fat oxidation, whereas a high-fat,
in protein requirements (table 3) Fat low-carbohydrate diet increases fat
(2). There is evidence to suggest In contrast to carbohydrate stores, oxidation. Although the hypothe-
that the greatest increases in pro- fat stores are large in humans and sis that chronic high-fat diets may
tein requirements occur above all are regarded as practically unlimit- increase the capacity to oxidize fat
in the early stages of a new exer- ed. The stores of fat are mainly lo- and improve exercise performance
cise program or a new level of ex- cated in adipose tissue but signifi- during competition is attractive,
ercise stress (for example, a change cant amounts also exists as intra- little evidence indicates that it is
in the type, volume or intensity of muscular triacylglycerols, which true (1). The rate of carbohydrate
training). However, once the body can provide an important fuel dur- utilization during prolonged
adapts to this stress, protein re- ing exercise (1). Carbohydrate and strenuous exercise is closely related
quirements may be reduced to a fat are always oxidized as a mix- to the energy needs of the work-
more modest level. ture, and the relative contribution ing muscle. In contrast, fat utiliza-
Protein comes from a variety of of these two substrates depends on tion during exercise is not tightly
sources, such as beef, chicken, the exercise intensity and dura- regulated. No known mechanism
pork, eggs, milk, cheese, etc. Some tion, the level of aerobic fitness, exists that closely matches the me-
high carbohydrate foods are also diet and the carbohydrate intake tabolism of fat to energy expendi-
good sources of protein. Protein before and during exercise. ture. Fat oxidation is, therefore,
needs are easily taken care of In absolute terms, fat oxidation mainly influenced by fat availabili-
when a varied diet that focuses on increases as the exercise intensity ty and the rate of carbohydrate
nutrient-rich foods is consumed. increases from low to moderate utilization (1).
Athletes at risk of inadequate pro- intensities, even though the per-

Tabella 3 - Protein intake levels in sports nutrition (mean values for Kg of body weight).
Activity Daily protein intake
Recreational exercise (adult) 1,0 - 1,4 g
Resistance/strength training 1,2 - 1,4 g
Resistance/strength training (gain muscle mass) 1,4 -1,8 g
Endurance training 1,2 - 1,4 g
Intermittent, high-intensity training (e.g. cross-training) 1,2 - 1,8 g
Ultra-endurance training 1,4 - 2,0 g
Weight-restricted sports (e.g. bodybuilding, weight lifting, power lifting)
Adolescent athletes 2g

7
VOLUME 15

Vitamins and minerals above RDA values. At present, the losses of several minerals in sweat
Vitamins and minerals are needed data are sufficient to recommend and urine, which means that the
in the body for several important antioxidant supplements for ath- daily requirement for most minerals
processes, including the growth letes, in particular when daily is increased in athletes engaged in
and repair of body tissues, as co- physical workload is very high or heavy training. However, with the
factors in enzyme catalyzed meta- when several competitions are exception of iron and zinc, isolated
bolic reactions, for oxygen trans- matched in short period of time mineral deficiencies are rare (3).
port and oxidative metabolism, for (1).
immune function and as antioxi- In nutrition, the term mineral
dants. Any sustained deficiency of usually refers to those dietary con- Sports Supplements
an essential vitamin or mineral stituents essential to life processes.
will cause ill health, and an un- Minerals are classified as Dietary supplements can play a
healthy athlete is extremely un- macrominerals or microminerals meaningful role in helping ath-
likely to perform to the best of his (trace elements), based upon the letes consume the proper amount
or her potential (1). extent of their occurrence in the of calories, carbohydrate, and pro-
Vitamins are organic compounds body and the amounts that are tein in their diet (3). However,
that are needed in ver y small needed in the diet (3). Appropri- they should be viewed as supple-
quantities in the diet. Although ate dietary intake of minerals is ments to the diet, not replace-
physical activity may increase the necessary for optimal health and ments for a good diet. While it is
requirement for some vitamins physical performance. Some min- true that most dietary supple-
(e.g. vitamin C, riboflavin and erals (e.g., calcium and phospho- ments available for athletes have
possibly pyridoxine, vitamin A rus) are the building blocks for little scientific data supporting
and vitamin E), this increased re- body tissues, including bones and their potential role to enhance
quirement is typically met by con- teeth. A number of minerals (e.g., training and/or performance, it is
suming a balanced high-carbohy- magnesium, copper, and zinc) are also true that a number of nutri-
drate, moderate-protein, low-fat essential for the normal function ents and/or dietary supplements
diet. Some vitamins work as an- of enzymes that are involved in have been shown to help improve
tioxidants. Evidence suggests that the regulation of metabolism, and performance and/or recovery. Sup-
antioxidants provide an important some minerals (e.g., iron and zinc) plementation with these nutrients
defence mechanism in the body have an essential role in the func- can help augment the normal diet
against the damaging effects of tioning of immune cells. Several to help optimize performance.
free radicals (1). Many athletes other minerals (e.g., sodium, Sports nutrition specialists must
consume large doses of antioxi- potassium, and chloride) exist as be aware of the current data re-
dant vitamins (vitamins A, C and ions or electrolytes dissolved in garding nutrition, exercise, and
E), however excessive antioxidant the intracellular and extracellular performance and be honest about
ingestion may not be uniformly fluids. Like the vitamins, minerals educating their clients about re-
helpful. The controversy continues cannot be used as a source of ener- sults of various studies (whether
as to whether physically active in- gy (3). pro or con). Care should also be
dividuals should consume antioxi- Regular exercise, particularly in a taken to make sure they do not
dant compounds in amounts hot environment, incurs increased contain any banned or prohibited

8
PROGRESS IN NUTRITION 1/2013

nutrients and/or substances with bohydrate, protein, and other nu- meals to assist with rehydration
any adverse effects. Some of the trients prior to and/or following (3, 4).
most important supplements are exercise in an attempt to optimize
discussed in the following section nutrient intake when an athlete Sports bars
(3, 4) doesn’t have time to sit down for a A range of sports bars is available.
good meal or wants to minimize Differentiating characteristics in-
food volume. However, as men- clude the amount and type of pro-
Sports foods tioned previously they should be tein and carbohydrate. W hile
used to improve dietary availabili- some “high-protein” bars may
Sports foods such as sports drinks, ty of macronutrients – not as a re- contain 20-30 g of protein of high
bars, gels, ready to drink supple- placement for a good diet (3, 4). quality, other bars provide only 5-
ments (RTD’s), and meal replace- 10 g of protein from var ying
ment powders (MRP’s) offer prac- Sports drinks sources and more carbohydrates.
tical and convenient options to Sports drinks are designed to de- Some sports bars are fortified with
help athletes meet their special liver a balanced amount of carbo- micronutrients, while others may
nutritional needs. When used ap- hydrate and fluid to allow an ath- be enriched with performance or
propriately, these products are a lete to simultaneously rehydrate recovery enhancing ingredients,
useful addition to the nutrition and refuel during exercise. Ac- such as creatine monohydrate
program of many athletes. They cording to various expert position (CM), branched-chain amino
are typically fortified with vita- stands, to provide rapid delivery of acids (BCAA), and leucine.
mins and minerals and differ on fluid and fuel and to maximise Sports bars provide a low-fibre,
the amount of carbohydrate, pro- gastric tolerance and palatability, easily consumed form of carbohy-
tein, and/or fat they contain. They sports drinks should be within a drate and protein for use in differ-
may also vary based on whether compositional range of 4-8% (4-8 ent situations: pre-event
they are fortified with various nu- g/100 ml) carbohydrate and 23-69 meal/snacks, where the athlete is
trients purported to promote mg/100mL (10-30 mmol/L) sodi- at high risk of gastrointestinal
weight gain, enhance weight loss, um. problems during exercise; follow-
and/or improve performance. Sports drinks provide a convenient ing a training session or competi-
Most people view these supple- option for simultaneously address- tion to contribute to carbohydrate
ments as a nutrient dense snack ing fuel, fluid and electrolyte needs for refuelling (and if the
and use them to help control needs before, during and after ex- protein content is adequate, to
caloric intake when trying to gain ercise. Before exercise sport drinks contribute to protein synthesis
and/or lose weight. Sports foods may be part of the pre-exercise goals); and as a snack to provide
can provide a convenient way for meal or consumed immediately energy/macronutrient intake with-
people to meet specific dietary before exercise to top up fluid and out need to prepare or eating ad-
needs and/or serve as good alter- fuel status. During exercise the ditional food or meals (3, 4).
natives to fast food other foods of major role for sport drinks is to
lower nutritional value. Use of promote hydration and refuelling. Sports gels
these types of products can be par- After exercise they may be part of For situations which require a
ticularly helpful in providing car- post-exercise recovery snacks and high rate of carbohydrate delivery

9
VOLUME 15

to working muscle, gels containing meal shake. When used to achieve essary. There is no evidence that
“multiple transportable carbohy- sports nutrition goals, both RTD’s supplementation with vitamins
drates” (a blend of carbohydrates and MRP’s may enhance training and minerals enhance perform-
such as glucose and fructose which adaptations or competition out- ance except in cases where a pre-
use different intestinal trans- comes. Following a training ses- existing deficiency exists. Howev-
porters) may overcome the usual sions (resistance training or pro- er, supplementation with different
limitation of gut uptake. Studies longed/high intensity training) or combinations of vitamins and
show that such mixtures are effec- strenuous competition events they minerals may be justified when
tive in increasing muscle oxidation provide a practical form of energy there is an unavoidable reduction
of carbohydrate consumed during and blend of macronutrients, to in energy intake or the nutrient
exercise compared with glucose- provide targeted amounts of pro- density of dietary intake (e.g. a
based products. Different charac- tein and carbohydrate to simulta- prolonged period of travel, partic-
teristics of gels include the volume neously promote repair/adaptation ularly to countries with an inade-
and amount/concentration of car- and refuelling. RTD’s and MRP’s quate or otherwise limited food
bohydrate, type/mixture of carbo- can also be used in situations re- supply; a prolonged period of en-
hydrates, the consistency or tex- quiring energy/macronutrient in- ergy restriction or weight loss, or
ture of gel, and the presence of take without need to prepare or weight maintenance; restricted di-
other “active ingredients” (e.g. eating additional food or meals etary intake in fussy eaters or ath-
electrolytes and caffeine). Sports (program to increase lean body letes with significant food intoler-
gels provide a compact and mass, heavy training loads, growth ances who are unable/unwilling to
portable source of carbohydrate spurts, appetite suppression). increase food range; heavy compe-
(each gel provides ~ 20-25 g of RTD’s and MRP’s can often be tition schedule, involving disrup-
carbohydrates), which can easily overused, leading to inappropriate tion to normal eating patterns and
be consumed immediately before replacement of whole foods and reliance on a narrow range of
or during exercise to assist with over-reliance on an expensive al- foods and sports foods) (3, 4).
meeting carbohydrate intake tar- ternative. Food sources should al-
gets. (3, 4). ways be considered as the first op-
tion for meals and snacks (3, 4). Protein supplements
RTD’s and MRP’s
Differentiating characteristics in- As previously described, research
clude the amount/type of key Multivitamins and minerals has indicated that people under-
macronutrients protein and carbo- going intense training may need
hydrate, fat and fibre content, fla- Regular, prolonged strenuous ex- additional protein in their diet to
vors, fortification with vitamins ercise may result in an increased meet protein needs (i.e., 1.4 – 2.0
and minerals and the presence of dietary requirement for certain vi- grams/kg bodyweight/day) (3).
other “active ingredients”. RTD’s tamins and minerals. If the daily People who do not ingest enough
can be used very quickly before or energy intake is high and a nutri- protein in their diet may exhibit
soon after the exercise session ent-dense diet is consumed, gen- slower recovery and training adap-
while MRP’s can be mixed with erally a supplementation with vi- tations. Protein supplements offer
milk or water in order to obtain a tamins and/or minerals is not nec- a convenient way to ensure that

10
PROGRESS IN NUTRITION 1/2013

athletes consume quality protein ter resistance training can increase on protein concluded that EAA
in the diet and meet their protein protein synthesis and gains in lean and BCAA have been shown to
needs. However, ingesting addi- mass beyond normal adaptation acutely stimulate protein synthe-
tional protein beyond that neces- (3, 4). sis, aid in glycogen resynthesis,
sary to meet protein needs does delaying the onset of fatigue, and
not appear to promote additional help maintain mental function in
gains in strength and muscle mass Essential Amino Acids (EAA) aerobic-based exercise (4). Aside
(3, 4). The research focus over re- and Branched Chain Amino from protein supplements, con-
cent years has been to determine Acids (BCAA). suming EAA (in addition to car-
whether different types of protein bohydrates) before and/or follow-
(e.g., whey, casein, soy, milk pro- Recent studies have indicated that ing exercise is another choice for
teins, colostrum, etc) have varying ingesting 3 to 6 g of EAA prior to athletes to stimulate protein syn-
effects on the physiological, hor- and/or following exercise stimu- thesis and muscle recovery (3).
monal, and/or immunological re- lates net protein synthesis (3).
sponses to training. In addition, a Theoretically, this may enhance
significant amount of research has gains in muscle mass during train- Creatine monohydrate (CM).
examined whether timing of pro- ing. To support this theory, studies
tein intake and/or provision of found that ingesting EAA with Without question, the most effec-
specific amino acids may play a carbohydrate immediately follow- tive nutritional supplement avail-
role in promoting net protein ac- ing resistance exercise promoted able to athletes to increase high
cretion (i.e. lean mass) and/or significantly greater training adap- intensity exercise capacity and
training adaptations, although tations in elderly, untrained men, muscle mass during training is
most of this has been conducted as compared to waiting until 2- CM (3, 4). Numerous studies have
in untrained populations (4). Al- hours after exercise to consume indicated that CM supplementa-
though more research is necessary the supplement. Although more tion increases body mass and/or
in this area, evidence clearly indi- data is needed, there appears to be muscle mass during training.
cates that protein needs of indi- strong theoretical rationale and Gains are typically 2 – 5 pounds
viduals engaged in intense training some supportive evidence that greater than controls during 4 – 12
are elevated, different types of EAA supplementation may en- weeks of training (4). The gains in
protein have varying effects on an- hance protein synthesis and train- muscle mass appear to be a result
abolism and catabolism, that dif- ing adaptations (5). Because EAA of an improved ability to perform
ferent types of protein subtypes include BCAA, it is probable that high intensity exercise enabling an
and peptides have unique physio- positive effects on protein synthe- athlete to train harder and thereby
logical effects, and timing of pro- sis from EAA ingestion are likely promote greater training adapta-
tein intake may play an important due to the BCAA content. tions and muscle hypertrophy. The
role in optimizing training adapta- BCAA, and leucine in particular, only clinically significant side ef-
tions following exercise (4). Ac- are the key amino acids that stim- fect occasionally reported from
cording to the current literature ulate protein synthesis (6). The CM supplementation has been the
we know that the addition of pro- International Society of Sports potential for weight gain (3, 4).
tein (about 20 g) before and/or af- Nutrition (ISSN) Position Stand Although concerns have been

11
VOLUME 15

raised about the safety and possi- positive effect on energy expendi- Weight management.
ble side effects of creatine supple- ture, weight and body fat loss.
mentation, recent long-term safe- Caffeine has also been shown to Body weight management is an
ty studies have reported no appar- be an effective ergogenic aid. Re- important determinant of per-
ent side effects and/or that CM searches investigating the effects formance for many athletes and is
may lessen the incidence of injury of caffeine in trained cyclist found one of the key issues in sports nu-
during training. Additionally a re- that caffeine improved speed, and trition (1, 3). Some athletes try to
cent review was published which power capacity (3, 4). Studies in- achieve weight loss, and others try
addresses some of the concerns dicate that ingestion of caffeine to achieve weight gain. In some
and myths surrounding CM sup- (e.g., 3-9 mg/kg taken 30 – 90 weight-bearing activities, such as
plementation (4). Consequently, minutes before exercise) can spare running and jumping, extra
supplementing the diet with CM carbohydrate use during exercise weight may be a disadvantage and
and/or CM containing formula- and thereby improve endurance reducing body fat is important,
tions seems to be a safe and effec- exercise capacity. In addition to though in some contact sports,
tive method to promote high-in- the apparent positive effects on such as American football and
tensity exercise performance and endurance performance, caffeine rugby, extra weight may be an ad-
increase muscle mass. The quick- has also been shown to improve vantage and increasing muscular
est method of increasing muscle repeated sprint performance bene- mass is a common goal. For other
creatine stores appears to be to fiting the anaerobic athlete (4). sports, such as dancing and gym-
consume ~0.3 grams/kg/day of Due to attenuation of its effects, nastics, leanness is important
CM for at least 3 days followed by people who drink caffeinated mainly for aesthetic reasons. The
3–5 g/d thereafter to maintain ele- drinks regularly (habitual users) desire to lose or gain weight is not
vated stores. Ingesting smaller appear to experience less er- limited to competitive athletes but
amounts of CM (e.g., 2– 3 g/d) gogenic benefits from caffeine is also common among recreation-
will increase muscle creatine stores than who consume caffeine spo- al athletes and sedentary individu-
over a 3–4 week period, however, radically. als who wish to change their phys-
the performance effects of this Some concern has been expressed ical appearance (1, 3).
method of supplementation are that ingestion of caffeine prior to
less supported (3, 4). exercise may contribute to dehydra-
tion although recent studies have Body composition
not supported this concern (4).
Caffeine. The typical caffeine dosage in By measuring body composition
sport is from 3 to 6 mg/Kg/body one can quantify the most impor-
Caffeine is a naturally derived weight. O ver 9 mg/Kg/body tant structural components of the
stimulant found in many nutri- weight several adverse effects can body: muscle, bone, and fat. A va-
tional supplements typically as occur (e.g. palpitations, headache, riety of techniques have been de-
gaurana, bissey nut, or kola. Caf- insomnia) and this dosage is not veloped to measure body composi-
feine can also be found in coffee, recommended (3, 4). tion (table 4) (1). The traditional
tea, soft drinks, energy drinks, and weight-height tables to measure
chocolate. Caffeine can have a body mass index (BMI) have

12
PROGRESS IN NUTRITION 1/2013

strong limitations when applied to which can potentially be harmful thermoregulatory systems and de-
an athletic population. For in- to their performance and/or their pression. Athletes should be coun-
stance, a bodybuilder (180 cm, health (1,7,8). These unhealthy seled on the harmful effects of un-
100 Kg [6 ft, 220 lb]) may have weight control practices include healthy weight-loss practices and
very low body fat but could be food restriction, vomiting, over ex- informed that body weight is not
classified as overweight according ercising, diet-pill use, inappropri- an accurate indicator of body fat
to BMI tables. Clearly the “extra” ate use of prescribed stimulants, or lean muscle mass (8). For these
weight is muscle and not body fat, nicotine use and voluntary dehy- athletes systematic body composi-
which would lead to erroneous dration. They end up with subop- tion measurements can be very
classification and possibly mistak- timal performances because of im- helpful and are recommended.
en advice (1, 3). paired strength and muscle mass, Weight loss may be beneficial when
reaction time, endurance, elec- it is achieved by healthy means and
trolyte imbalance and acidosis. involves losing excess fat without
Weight loss Mental skills can also be negative- reducing lean muscle mass or caus-
ly affected such as concentration, ing dehydration. In general, body
In most cases, a sustained moder- alertness, mood, cognitive state, fat percentage should not be lower
ate energy deficit is required to and learning ability (7). In severe than 5% for male athletes and 12-
avoid any performance impair- cases, extreme weight loss can re- 14% for women, but there are some
ment caused by an inadequate sult in medical complications in- exceptions. For example, in swim-
food intake. Unfortunately, ath- cluding delayed physical matura- mers a reasonable amount of fat
letes of many sports (bodybuild- tion in young athletes, oligomen- mass helps buoyancy and is the
ing, cheerleading, dancing, dis- orrhea and amenorrhea in female main reason why women and men
tance running, cross-country ski- athletes, development of eating in this sport have similar perform-
ing, diving, figure skating, gym- disorders, potential permanent ance at high levels (at least in dis-
nastics, martial arts, rowing, growth impairment, increased in- tance-based events) (8). Weight
swimming, weight-class football, cidence of infectious diseases, loss, when necessary, should be
and wrestling) often resort to un- changes in cardiovascular, en- gradual and should not exceed 1.5%
healthy weight-control practices, docrine, gastrointestinal, renal and of the total body weight, each week.

Tabella 4 - Some of the most utilized techniques to measure body composition.


Skinfold thickness Measurement of subcutaneous fat with a calliper that gives an estimation
of fat mass
Hydrostatic weighing Underwater weighing based on Archimedes’ principle to estimate
lean-body mass and fat mass
Air plethysmography (BOB POD) Measurement of air displacement to estimate lean-body mass
Bioelectrical impedance analysis (BIA) Measurement of resistance to an electrical current to estimate total-body
water, lean-body mass, and fat mass
Duel energy x-ray absorptiometry (DEXA) X-ray scan at two intensities to measure total-body water, lean-body
mass, fat mass, and bone-mineral density

13
VOLUME 15

In contrast, when weight is lost too social and enjoyment aspects of eat- grams per kilogram body mass to
rapidly or by a drastic reduction in ing should not be overlooked. Meal minimise the impact on training
energy intake, lean muscle mass will frequency also may have an impor- quality. Nevertheless, all athletes
also be lost, and this can negatively tant role in body composition regu- should monitor training perform-
affect performance (8). Athletes in- lation. Although recent studies have ances and recovery and adjust car-
volved in sports that require questioned this approach, most nu- bohydrate intake when their success
mandatory weight categories trition experts recommend eating at daily refuelling appears to be
should be encouraged to compete at frequent meals habitually (e.g., ~4-6 compromised (2).
a weight that is appropriate for meals per day) because of the bene-
their age, height, physique, and ficial effects on plasma insulin as Maintain adequate protein intake
stage of growth and development. well as the regulation of appetite A reduced-energy diet still needs to
Reasonable and individualized during the day. The input of a sports provide an adequate amount of pro-
weight and body composition goals dietitian can help the athlete to un- tein, spread across meals and snacks
should be identified by appropriate- derstand their individual require- over the day. Ensuring that protein
ly trained health care personnel ments and set realistic goals (2). requirements are met is important
(i.e., athletic trainers, sports dieti- to help minimise muscle wasting
tians, physicians) (8). Maintain adequate carbohydrate in- and loss of strength during periods
take during fat loss of weight loss (2, 3). Protein added
Which diet works best? Muscle stores of carbohydrate, re- to a meal or snack can increase the
Given the known individual differ- filled from dietary carbohydrate in- satiety value of the food choice,
ences in biochemistry and metabo- take, provide an important source of helping with appetite control. Final-
lism, a ‘one diet fits all’ approach fuel for training, particularly quality ly, many lean protein-rich foods also
typically does not work (2). In gen- workouts. Even when total energy provide other key nutrients to the
eral though, the basic approach for intake is reduced, daily carbohydrate menu, such as iron, calcium and B-
weight loss is to decrease total ener- intake needs to be aligned to the vitamins. The daily protein intake
gy intake by 2000–4000 kilojoules training load. At present there is no for fat loss is not easy to establish
per day (approximately 500–1000 simple method of monitoring glyco- and it is very variable; a range from
calories), while maintaining ade- gen stores, other than expensive or 1,5 g to 2 g of protein daily per kilo-
quate intakes of protein, carbohy- invasive laboratory procedures such gram of body weight could be ade-
drate, essential fats and other nutri- as muscle biopsies. Adjusting carbo- quate for many athletes, but not for
ents. Consideration needs to be giv- hydrate intake based on daily train- others. Strength athletes and body-
en to the demands of the sport, the ing requirements must therefore be builders often need more protein
intensity, frequency and duration of done by ‘trial and error’. General during targeted fat loss programs,
training and an individual’s physical guidelines can be provided as a because their carbohydrate restric-
size. It can often be challenging to starting point, particularly for ath- tion can be very large and more pro-
find the balance between reducing letes who must undertake prolonged tein is required to preserve muscle
energy intake and providing the nu- sessions of moderate and high-in- mass and power output. Regarding
tritional needs of training (2). Menu tensity activity. Such athletes are en- the claim that “high protein” diets
patterns must also attempt to ad- couraged to maintain a carbohy- may have deleterious effects on the
dress the athlete’s appetite, and the drate intake of approximately 4-6 body, this has no basis in fact. Pro-

14
PROGRESS IN NUTRITION 1/2013

tein intakes up to 2,8 g daily per gain in excess of 1.5% of body Protein needs for increasing muscle
kilogram of body weight do not im- weight per week may result in un- mass
pair renal or other physiological wanted fat gain (2, 3). Often, ath- Most athletes easily meet their
functions in well-trained athletes letes use supplements (which may protein requirements. Simply in-
(2-4). be of unproven value and potentially creasing total energy intake from a
harmful) or anabolic compounds well-chosen eating plan will allow
Target high fat foods (which are harmful to athletes’ most athletes to achieve or exceed
Energy reductions can be achieved health) to gain weight instead of protein intake goals. However, re-
most easily by removing surplus evaluating their nutritional and search suggests that an appropri-
amounts of fat from the diet. Strate- training programs. Before trying to ate timing of protein intake may
gies to meet this goal include choos- change body composition, athletes be more effective in optimising
ing lower-fat versions of everyday must understand potential genetic gains in lean muscle tissue rather
foods and using low-fat cooking limitations. Athletes with a solid than simply eating large amounts
methods where possible (2). Learn- body build (mesomorphy) can ex- of protein. There is strong scien-
ing to read food labels is another as- pect to gain more weight than ath- tific evidence that consuming pro-
set that can help the athlete to ad- letes with a slender body build (ec- tein supplements and/or amino
dress the quantity and quality of tomorphy). Inadequate energy in- acids (in particular the EAA) soon
their food choices. The commonly take is often the limiting factor for after the resistance training can
held consensus is that 20% to 25% athletes trying to increase muscle profoundly affect skeletal muscle
of total caloric intake should come mass. To increase body mass and protein synthesis and enhance
from fats. To maximize perform- gain lean tissue, an athlete needs to muscle mass (3, 4). The daily diet
ance, athletes should take in no less follow a well-structured resistance for a strength/hypertrophy athlete
than 15% of total caloric intake training program and to consume a should contain ~1.8-2.0 g of pro-
from dietary fats. Based on current diet that provides an energy intake tein per kilogram of body mass
recommendations (4), fat intake that is greater than daily energy ex- (3). Of this total amount, approxi-
should minimize partially hydro- penditure (that is, achieve positive mately 20 g of protein should be
genated, unsaturated (trans) fats and energy balance). Total energy intake taken as soon as possible after the
saturated fats and promote the in- should be increased by 2000–4000 exercise session. In young and
gestion ofo mono- and polyunsatu- kilojoules per day (approximately middle aged athletes, more protein
rated fats (particularly omega-3 fats 500–1000 calories), with approxi- is not required but in older sub-
from marine sources). mately 55%-60% of calories in the jects up to 40 g may be necessary
form of carbohydrates, 30% from fat to maximise protein kinetics (9).
Increasing muscle mass and an extra portion of protein-rich The quality of the protein source is
food sources (2, 3). A pattern of fre- an important factor for increasing
Sports such as football, rugby, bas- quent meals and snacks is helpful in muscle mass and this is determined
ketball, power lifting, and body- achieving additional energy require- by its essential amino acid content.
building often motivate athletes to ments and in promoting the out- Some foods contain all of the es-
gain weight. As with weight loss, comes of training by providing key sential amino acids and in amount
weight gain has to be reached prop- nutrients at important times. sufficient to stimulate protein syn-
erly: it has to be gradual, because a thesis (e.g., dairy products, eggs,

15
VOLUME 15

meat and fish), whereas others are sein) is a valid solution when a solid es of fatigue during exercise that is
lacking in one or more amino acids meal cannot be consumed within 1- sustained for long periods of time.
(grains, vegetables, fruits) and for 2 hours. The fatigue is directly related to
this reason are less effective in pro- muscle glycogen depletion because
moting muscle growth. Clearly, muscle glucose uptake is too slow to
daily diet should contain a proper Nutritional strategies for train- support the carbohydrate needs of
combination of food sources in or- ing and competition the exercising muscles even when
der to have the best protein plan blood glucose levels are normal (3).
strategy. A key priority for athletes is to es- Although depletion of muscle
tablish a well-chosen training diet glycogen is normally associated
Protein supplements that can be easily manipulated when with fatigue during continuous aer-
Protein supplements offer a quick special situations emerge (e.g., obic exercises such as marathon
and convenient way to take protein changes to training load, changing running, it is important to recog-
with appropriate timing (3, 4). The body composition goals, or special nize its impact for team and skill
best sources of high quality protein competition needs). A good base di- sports that require bursts of speed
found in supplements are reported et will provide adequate nutrients or powerful movements. Without
to be whey, casein, milk, and egg and energy to enhance adaptations adequate muscle glycogen it be-
proteins. Whey protein, especially from training, support optimal re- comes impossible for the basketball
whey protein isolate and hydrolyzed covery and avoid excessive exercise- player to continually sprint up and
whey peptides, is widely promoted related stress. Heavy training and down the court or the tennis player
to strength athletes as being perhaps competition increase the need for to move quickly to and from the
the best protein, based on its high nutrients, particularly carbohydrate, net. Adequate muscle glycogen
digestibility and bioavailability and protein, water and electrolytes in stores are critical for top athletic
its content of several critical amino sport-specific manner. The next sec- performance (3).
acids (i.e., glutamine, leucine, tion focuses on the nutritional
isoleucine, and valine) (4). Casein is strategies adopted by athletes be- Diet strategy before exercise: Carbo-
the major component of protein fore, during, and after exercise, in hydrate loading
found in diary products and, like relation to the type of activity. Carbohydrate loading strategies
whey, it is a complete protein. Re- have evolved significantly over the
search has shown that dietary amino Nutrition before, during, and af- last 30 years (2). In endurance-
acids absorption is faster with whey ter exercise for the endurance and based events, starting the compe-
protein than with casein and this team sport tition with elevated muscle glyco-
can differently modulate muscle gen stores can help postpone such
amino acid deposition, protein syn- The causes of fatigue during pro- fatigue. Carbohydrate loading in-
thesis and breakdown after the exer- longed, aerobic exercise will vary ac- creases muscle glycogen signifi-
cise session (3, 4). Normally, after a cording to the type of exercise and cantly (50-100 per cent) above
weight training session the athletes the environmental conditions in normal resting values. This poten-
prefer to consume a whey protein which the exercise is performed (3). tially results in a 20 per cent en-
supplement; the addition of casein Depletion of carbohydrate is now hancement of endurance, or in
in a protein blend (i.e. whey + ca- considered one of the primary caus- fixed distance events, an improved

16
PROGRESS IN NUTRITION 1/2013

race time of 2-3 per cent. It may events often mean a shorter time Suggestions for pre-event food and
also improve movement patterns frame is more practical. A small fluid intake
and maintain skill at the end of proportion of athletes respond 2–4 hours prior to exercise:
prolonged team games (2). negatively when carbohydrate is • Pasta/rice with low fat pasta
The most recent evidence suggests consumed close (within one hour) sauce
that optimal muscle glycogen lev- to exercise. An exaggerated carbo- • Fruit salad with low fat yoghurt
els can be achieved in well-trained hydrate oxidation and subsequent Baked potato served with baked
athletes by combining an exercise decrease in blood glucose concen- beans
taper with a high carbohydrate in- tration at the start of exercise can • Toast with jam and sports drink
take (7-12 g per kilogram body cause symptoms of hypogly- • Crumpets or English muffins
mass). In most cases, 24-72 hours caemia, including fatigue (2). with jam/honey + fruit smoothie
will be required to fully carbohy- The exact cause is unknown but • Breakfast cereal with low fat
drate-load, but there is also a 1- useful strategies for these athletes milk plus tinned fruit
day CHO loading study (10). may be to allow longer time frame • Lean meat, veggies and rice
Foods and fluids consumed in the between eating and exercise, con- • RTD’s alone or + fruit
four hours prior to competition sume a substantial amount of carbo- 60 minutes prior to exercise:
complete an athlete’s nutritional hydrate in the pre-event snack • Sports drink or gels
preparation. The pre-event meal (more than 1g per kilogram body • Cereal/muesli bars + banana +
adds to muscle glycogen stores if mass or ~ 70g for the typical ath- water
they have not been fully restored lete) and include low glycaemic in- • juice and fruit + yogurt
since the last exercise session. It dex (GI) foods in the pre-event
also restores liver glycogen for ear- meal (2). Athletes who experience Quality of carbohydrates: type of food
ly morning events, ensures the gastrointestinal problems during ex- The carbohydrate foods most suit-
athlete is hydrated and prevents ercise may also benefit from allow- ed to pre-exercise meals are choic-
hunger. Food choice also impacts ing a longer period of time between es that are low-fat, low-fibre and
on gastrointestinal comfort and eating and exercise. Research sug- low-moderate in protein; these are
the athlete’s psychological outlook. gests that endurance performance is less likely to cause gastrointestinal
improved when athletes consume a upset.
Timing and amount of carbohydrate substantial amount of carbohydrate Consuming low GI foods has
intake (200–300g) in the 2–4 hours before been proposed as a clever pre-
Individual tolerance and competi- exercise. This is achievable when event strateg y for endurance
tion schedule dictate the ideal events are held later in the day but is events (2). GI is a measure of the
timing for the pre-event meal. not always practical before early blood glucose response following
General guidelines suggest a meal morning events. In many situations ingestion of carbohydrate-con-
or series of snacks should be con- athletes must settle for a smaller taining foods. Foods with a high
sumed 1–4 hours before exercise meal or snack before the event, then GI are digested and absorbed
(2). The longer time frame allows make up for lower than recom- more rapidly by the body, deliver-
carbohydrate intake to contribute mended carbohydrate intakes by ing glucose quickly into the
to liver and muscle glycogen consuming carbohydrate during the bloodstream. Foods with a low-GI
stores. However, early morning event (2). are digested and absorbed more

17
VOLUME 15

slowly, resulting in a gradual re- • Fruit smoothie made with milk known. However, in events lasting
lease of glucose. It is thought that and/or yoghurt longer than 60 minutes, athletes
low-GI foods might reduce the • W holegrain sandwich made are encouraged to consume carbo-
sudden increase in blood glucose with Soy and Linseed bread hydrate at a rate of 30–60g per
levels prior to an event, and pre- • Breakfast cereal plus low fat hour (2, 3). Experimentation in
vent the subsequent drop in blood milk training or less important events
glucose once exercise is com- may allow the athlete to fine tune
menced. In addition, a low-GI Nutrition during Exercise this plan for their specific needs
pre-event meal might provide a Many studies have shown that con- and opportunities. It makes sense
continued supply of carbohydrate sumption of carbohydrates during for refuelling during the event to
during the exercise session (2). In prolonged exercise (>60-90 min- start well before fatigue is experi-
general, studies have failed to utes) enhances endurance and per- enced and before a fluid deficit
show a universal benefit to per- formance (2). More recently, carbo- can build to a level where gastric
formance from consuming low-GI hydrate intake has also been shown emptying is reduced. The effects
foods prior to exercise. When car- to benefit performance during of consuming fluid and carbohy-
bohydrate is consumed during ex- shorter (60 minutes) events and drate during exercise are additive.
ercise according to sports nutrition ‘stop and go’ intermittent sports A variety of options exist for car-
guidelines, any effect of consum- such as tennis and soccer (2). The bohydrate intake, however sports
ing low-GI foods in the pre-event performance benefit may occur due drinks offer a convenient strategy
meal is negated. When fuel can- to sparing of muscle glycogen for meeting fluid and carbohy-
not be consumed during a pro- stores, the prevention of low blood- drate needs simultaneously. If oth-
longed exercise session, some ath- glucose levels (hypoglycaemia) or er carbohydrate choices are used,
letes may derive benefits by con- effects on the central nervous sys- care should be taken to consume
suming a low-GI pre-event meal. tem that are not well explained as of adequate amounts of fluid.
However, for most occasions, the yet. The benefits can translate into
athlete can choose the foods con- faster race times, a delay in the onset Nutrition for recovery
sumed in their pre-event meal of fatigue towards the end of the Post-exercise recovery is an im-
based on personal preference, event, ability to cover more ground portant challenge for many ath-
availability and gastrointestinal at faster speeds in the last half or letes (1-3). Optimal recovery can
comfort (2). quarter of game, and better mainte- enhance adaptations to training
nance of skills and concentration and help prepare for the next
Examples of low-GI foods (GI right to the final siren. Also, carbo- workout. In competitions involv-
value <55): hydrate supplementation during ex- ing a series of games or races, re-
• Pasta served with a mixed bean ercise has a protective effect on the covery is important for good per-
pasta sauce immune system post exercise, while formances in the subsequent and
• Vegetable curry made with veg- also maintaining an adequate supply final bouts. Recovery nutrition in-
etables and lentils of energy substrate for the immune corporates a range of nutrition-re-
• Fresh fruit, such as apples and system during exercise (11). lated processes, including:
oranges The optimal rate of carbohydrate • refuelling/restoring muscle and
• Full-cream or low-fat yoghurt ingestion during exercise is un- liver glycogen stores

18
PROGRESS IN NUTRITION 1/2013

• repair, regeneration and adapta- a single day). This is especially im- Addition of protein to a carbohydrate
tion of muscle tissue following the portant following glycogen-de- supplement
damage caused by exercise pleting exercise such as a pro- Several studies have also docu-
• rehydration and replacement of longed session of endurance train- mented that the addition of pro-
fluid and electrolytes lost in sweat. ing or intermittent work such as in tein to a carbohydrate supplement
A number of factors can interfere team sports. Aggressive refuelling will enhance the rate of muscle
with recovery strategies in both should be undertaken so that car- glycogen synthesis (3). These re-
the training and competition bohydrate stores are adequate for sults have important implications
phases. These include fatigue, loss the subsequent exercise session. for athletes who wish to limit their
of appetite, poor access to foods, Current research suggests that op- carbohydrate intake in an effort to
post-exercise commitments such timal refuelling occurs when control body weight and for those
as team debriefings and injury 1–1.5g of carbohydrate per kilo- athletes who participate in sports
treatments, and traditional post- gram body mass is consumed that have very short recovery peri-
exercise celebratory activities. A every hour in the early stages of ods during competition such as
planned approach ensures recovery recovery, contributing to a total basketball, ice hockey, and soccer
needs are taken care of, despite carbohydrate intake of 6–10g per (3). The ingestion of protein with
this array of distractions. kilogram body mass over 24 carbohydrate also has the added
hours. This can be challenging for benefit of stimulating muscle pro-
Refueling post-exercise smaller athletes and/or those with tein synthesis and tissue repair (3).
It may take up to 24 hours for a poor appetite (2). In fact, during prolonged strenu-
restoration of muscle glycogen These guidelines are based on ous exercise there is generally
levels when stores are fully deplet- achieving maximal glycogen stor- damage to the active muscles and
ed (2, 3). Several strategies have age during a passive recovery peri- this damage can continue long af-
been investigated to speed up the od. Athletes with extremely high ter exercise because of an accelera-
replenishment of glycogen stores. workloads may require additional tion in protein degradation. For
These include altering the fre- carbohydrate. Athletes who do not complete recovery, it is important
quency of carbohydrate ingestion, fully deplete glycogen stores in to initiate protein synthesis and
manipulating the type of carbohy- their daily training will require limit protein degradation as
drate consumed and combining less. Athletes with smaller energy quickly as possible. Similar to
carbohydrate with other nutrients. budgets will need to incorporate glycogen storage, muscle protein
While these factors can fine tune recovery eating into their normal synthesis and degradation are af-
the rate of glycogen storage, the meal pattern in order to avoid fected by the type, amount and
most important factor in the over-consumption of kilojoules. timing of nutrient supplementa-
process is the amount of carbohy- W hen the recover y period is tion. Appropriate protein supple-
drate consumed. Special tactics are longer than eight hours, aggressive mentation post-exercise has been
needed if there is less than eight refuelling is not necessary and found to limit muscle damage, in-
hours between exercise sessions athletes can consume their carbo- crease protein synthesis and in-
(for example, when the athlete hydrate intake targets within their crease training adaptation. This
trains more than once each day or usual meal schedule (2). can be obtained from 10-20 g of
where a tournament is played over high quality protein (whey, milk,

19
VOLUME 15

or egg) or from 6-8 g of essential ysis. Most strength/power athletes respond to training, a well-
amino acids (3). do not realize how much muscle planned diet that meets energy-
glycogen is used during a typical intake needs and incorporates
training session. One set of 10 bi- proper timing of essential nutri-
Nutrition before, during, and after ceps curls can result in a 12% loss ents is vital (3). Athletes that do
exercise for the strength/power of muscle glycogen, 3 sets can re- not consume enough calories
athletes sult in 35% depletion, and 6 sets and/or do not consume enough of
can result in 40% depletion (3). the right type of macronutrients
Several studies have documented Resistance training is not without may hinder training adaptations
that strength/power athletes can its damaging effects. Intense re- and subsequent performance (3).
improve their training sessions sistance training, especially the ec- Furthermore, maintaining a diet
and performance with a combina- centric phase, essentially causes that is deficient of the essential
tion of both proper everyday nu- microscopic tears in muscle fibres macronutrients over time may lead
trition and supplementation (3). leading to muscle damage (3). De- to a loss of body mass, muscle
Proper nutrition can prepare the layed onset muscle soreness can mass, an increased susceptibility to
athlete for intense exercise, pro- set in at least 24 hours after a illness, and an increase in the
vide the energy for muscular con- workout because of the subse- symptoms associated with over-
tractions, help reduce post-exer- quent inflammatory response to training. Otherwise, athletes who
cise muscle damage, and enhance the intense training bout. The consume a well-planned diet strat-
recovery in anticipation of the body responds to the training by egy can help the body adapt to
next workout. The effectiveness of making bigger and stronger mus- training and will likely notice im-
these processes is largely based on cle fibers in order to sustain future proved performance (3).
the types of macronutrients select- demands. In addition to the mi-
ed and the timing of their inges- croscopic tears, the catabolic hor- Pre-exercise nutrition
tion. It has been well established mone cortisol is released from the Pre-exercise nutrition should con-
that there are preferred types of adrenal cortex during high-inten- sist largely of moderate to low GI
macronutrients that aid this sity exercise such as resistance foods/supplements that provide a
process based on their quality and training (3). Cortisol is the most slow, sustained release of carbohy-
speed of digestion (3). Creatine potent glucocorticoid produced by drates and protein necessary to fu-
phosphate (CP) and muscle glyco- the adrenal cortex and is major el a workout. It generally takes
gen are the primary sources used stress hormone that acts to supply about 4 hours for dietary carbohy-
for rapid repletion of ATP during the exercising muscles with fuel drate to be digested and begin to
an intense resistance-training through gluconeogenesis, lipolysis, be stored as muscle and liver
workout. CP levels within the and even proteolysis (3). The glycogen. Thus, pre-exercise meals
muscle are also limited and can be breakdown of body protein can al- should be consumed about 4-6
depleted after 10-15 seconds of so contribute to muscle damage hours before exercise. Putting this
maximal intensity effort. The rap- and eventual muscle soreness. To into an average everyday scenario
id restoration of ATP and CP in- combat the damaging and deplet- means that if an athlete trains in
volves the anaerobic breakdown of ing effects of intense resistance the afternoon, breakfast is the
muscle glycogen known as glycol- training and further help the body most important meal to top off

20
PROGRESS IN NUTRITION 1/2013

muscle and liver glycogen levels. If hypertrophy over a prolonged pe- ferent formulations to find the one
the athlete trains first thing in the riod (3). that works best for them before
morning, the meal the evening be- competition. Recent research has
fore is vital. The choice of Nutrition during exercise also shown that the addition of
foods/supplements selected is Nutrition during an intense resist- protein can have added benefits to
largely up to the individual athlete ance-training session can aid in a supplement ingested during ex-
and their personal preferences. It the quality of the workout, espe- ercise by reducing muscle protein
is recommended that the cially if the workout exceeds 60- degradation and speeding post ex-
strength/power athlete consume 90 minutes. Nutrition during ex- ercise recovery (3). Carbohydrate
something familiar on the day of ercise for the strength/power ath- and protein intake significantly al-
competition as opposed to experi- lete usually centers on supple- ters circulating metabolites and
menting with a new ments more so than pre and post the hormonal milieu (i.e. insulin,
food/supplement. Recent re- exercise nutrition if for no other testosterone, growth hormone and
searches have indicated that in- reason than the convenience sup- cortisol) as well as the response of
gesting a light carbohydrate and plements provide. Convenience muscle protein and glycogen bal-
protein snack 30-60 minutes be- supplements include meal replace- ance (3). For the strength/power
fore exercise (e.g. 50 g of carbohy- ment powders, ready to drink sup- athlete, the addition of protein to
drate and 5-10 g of protein) serves plements, energy bars, energy gels a carbohydrate supplement will al-
to further increase carbohydrate and fitness waters. They are typi- so enhance performance gains.
availability toward the end of an cally fortified with differing Whey is the preferred protein to
intense exercise bout because of amounts of vitamins and minerals ingest during exercise because of
the slight increase in glucose and and differ on the amount of car- its rapid absorption rates and the
insulin levels (3). This can serve to bohydrate, protein and fat they fact that it contains all of the es-
increase the availability of amino contain. The beneficial effects of sential amino acids as well as a
acids and decrease exercise-in- solid and liquid carbohy- high percentage of leucine and
duced protein catabolism. Insulin drate/protein supplements are glutamine, which are two amino
inhibits protein degradation and similar when thermal stress is not acids that the body uses during
apparently offsets the catabolic ef- a factor. Liquid supplements do sustained exercise. High GI car-
fects of other hormones (i.e., cor- provide the added benefits of aid- bohydrates (glucose, sucrose and
tisol and catecholamines). Ana- ing rehydration and tend to digest maltodextrin) should be combined
bolic actions of insulin seem to be easier for most athletes while exer- with the protein in a 4:1 ratio to
related to its nitrogen- sparing ef- cising. Rapid nutrient availability provide optimal benefits (3).
fects and promotion of nitrogen is especially important during a
retention (3). In addition, resist- workout in order to maintain en- Nutrition for recovery
ance training in combination with ergy levels and training intensity. Post-exercise nutrition for the
immediate post-exercise amino Thus high GI sources should strength/power athlete is vital to re-
acid administration has been make up the majority of supple- store muscle glycogen stores, en-
shown to augment net protein ments ingested during a hance skeletal muscle fiber repair
synthesis acutely. One would thus strength/power workout. The ath- and growth and maintain overall
expect more pronounced muscle lete should experiment with dif- heath and wellness. This is especial-

21
VOLUME 15

ly important for those athletes en- amino acid availability maximize proximately equal to respiratory
gaging in prolonged training or the stimulation of muscle protein water losses and gastrointestinal
competition sessions on the same or synthesis and results in even greater tract losses (1). Kidneys regulate
successive days. An example could muscle anabolism than when di- water balance by adjusting urine
be a bodybuilder working one mus- etary amino acids are not present. A output (20 to 1000 mL/h). Dur-
cle group in the morning and an carbohydrate/protein combination ing exercise and heat stress, both
opposing muscle group that was 38% more effective in stimulat- glomerular filtration and renal
evening. In addition, athletes in- ing protein synthesis than a protein blood flow are markedly reduced,
volved with team sports (e.g. foot- supplement and more than twice as resulting in decreased urine out-
ball, basketball and soccer) that effective as a carbohydrate supple- put. Therefore, sweating provides
hold a strength/power training ses- ment. Thus athletes should con- the primary avenue of water loss
sion throughout the day and week sume carbohydrate and protein during exercise-heat stress allow-
are especially susceptible to nutrient foods/supplements (e.g. ~1g/kg of ing heat dissipation and the re-
deficiencies and performance decre- carbohydrate and 0,5g/kg of pro- duction of body temperature
ments if proper post exercise nutri- tein) within 30 minutes after exer- (thermoregulation) increased by
tion is not followed (12). Whereas cise (3). the physiologic adaptations to
the majority of the everyday diet for muscle contraction. Thermoregu-
the strength/power athlete should latory mechanisms prevent exces-
be a low to moderate GI diet, the Water and electrolyte balance sive rises in body temperature. In-
post exercise diet should be cen- creased muscular activity during
tered on moderate to high GI Being well hydrated is an impor- exercise causes an increase in heat
sources. This nutritional approach tant consideration for optimal ex- production in the body because of
has been found to accelerate glyco- ercise performance. Dehydration the inefficiency of the metabolic
gen resynthesis as well as promote a (loss of »2% body weight) increas- reactions that provide energy for
more anabolic hormonal state that es the risk of potentially life- muscle force development (13,
may speed recovery. The increased threatening heat injury such as 14).
protein and glycogen synthesis is heat stroke, and beyond compro- Sweat losses are influenced by the
believed to be the result of insulin mise aerobic exercise and cognitive duration and intensity of exercise,
secretion from the pancreas com- performance (1, 13). the environmental conditions, the
bined with an increase in muscle Daily water balance depends on type of clothing/equipment worn
insulin sensitivity. A strength/power the net difference between water and by many individual character-
exercise session can have a pro- gain and water loss. Water gain istics such as body weight, genetic
found effect on muscle growth only occurs from water intake (liquids predisposition, heat acclimatiza-
if muscle protein synthesis exceeds and food) and body production tion state, and metabolic efficien-
muscle protein breakdown. In addi- (metabolic water), while water cy. As a result, there is a large
tion to carbohydrate the amino acid losses occur from respiratory, gas- range in sweat rates and total
availability is an important regula- trointestinal, renal, and sweat loss- sweat losses among individuals
tor of muscle protein metabolism. es. In normal conditions, the vol- and within activities, and in some
The interaction of post exercise ume of metabolic water produced cases even in the same event on a
metabolic processes and increased during cellular metabolism is ap- given day (15).

22
PROGRESS IN NUTRITION 1/2013

Body water content and sweat can range from as little as 0.3 to as tions for any given sweating rate
losses much as 2.4 L/h, demonstrating (15).
the difficulties in providing a “one
Total body water (TBW) averages size fits all” recommendation. Fol-
~60% of body mass, with a range lowing the end of exercise, over a Hydration and exercise
from approximately 45 to 75% (1). protracted period (e.g., 8–24 h), if
These differences are primarily due adequate fluid and electrolytes are Considering the importance of
to body composition: fat-free mass consumed, the water losses will being well hydrated to avoid
is ~70 to 80% water, while adipose usually be fully replaced to health risks and optimize athletic
tissue is ~10% water (1). Trained reestablish the ‘‘normal’’ TBW performance and the numerous
athletes have relatively high TBW (15). variables which affect sweating
values by virtue of having a high rate and composition, for correct
muscle mass. When assessing an recommendations we referred to
individual’s hydration status, there Electrolytes content in sweat the American College of Sports
is no one TBW that represents eu- Medicine (ACSM) position stand,
hydration (normally hydration), Besides containing water, sweat though considering as best prac-
and determinations need to be contains “lost” electrolytes (1). tice for the athletes to learn to as-
made of body water fluctuations Sweat electrolyte losses depend on sess their hydration needs and de-
beyond a range that have function- the total sweat losses and sweat velop a personalized hydration
al consequences. The use of first electrolyte concentrations. Sweat strategy (13).
morning body weight measure- sodium concentration averages
ment after voiding, in combination ~35 mEq/L and varies depending Hydration before exercise
with a measure of urine concentra- upon genetic predisposition, diet, Because even mild dehydration
tion should allow sufficient sensi- sweating rate, and heat acclimati- has debilitating effects on exercise
tivity (low false negative) to detect zation state. Sweat concentrations performance, some athletes at-
deviations in fluid balance. Urine of potassium averages 5 mEq/L, tempt hyperhydration (greater
specific gravity (USG) of <1.020 is calcium 1 mEq/L, magnesium 0.8 than normal body water content)
indicative of being euhydrated. For mEq/L and chloride 30 mEq/L. by drinking large amounts of fluid
well-hydrated persons the first Dehydration can increase sweat (approximately 5–7 mL/kg body
morning (after urinating) nude concentrations of sodium and weight of water or a sport bever-
body weight will be stable and fluc- chloride. Sweat glands reabsorb age) immediately before exercise
tuate by ~1% (15) sodium and chloride, but the abili- in the hopes of improving ther-
Acute changes in body weight ty to reabsorb these electrolytes moregulation by expanding blood
during exercise can be used to cal- does not increase proportionally volume and thereby improving
culate sweating rates and pertur- with the sweating rate. As a result, heat dissipation and exercise per-
bations in hydration status. This the concentration of sweat sodium formance. However, several find-
approach assumes that 1 mL of and chloride increases as a func- ings on this strategy provide no
sweat loss represents a 1g loss in tion of sweating rate. Heat accli- clear physiologic or performance
body weight (i.e., specific gravity matized individuals usually have advantage over euhydration and
of sweat is 1.0 g/mL). Sweat rates lower sweat sodium concentra- we therefore discourage this prac-

23
VOLUME 15

tice. Instead, drink the same vol- tying rates that in turn limit fluid temperature, heat cannot be dissi-
ume of fluid about 4 h before ex- absorption, and most often, rates pated by radiation. Moreover, the
ercise. This will allow enough of fluid ingestion by athletes dur- potential to dissipate heat by evapo-
time to optimize hydration status ing exercise fall short of amounts ration of sweat is substantially re-
and for excretion of any excess flu- that can be emptied from the duced when the relative humidity is
id as urine (13). stomach and absorbed by the gut high. There is a very high risk of
(14). Commercially available heat illness when temperature and
Hydration during exercise sports drink with 4-8% of carbo- humidity are both high. If competi-
Athletes dissipate heat produced hydrates and 10-25 mEq/L pro- tive events (especially for endurance
during physical activity by radia- mote effective rehydration during athletes) occur under these condi-
tion, conduction, convection, and exercise (especially for events last- tions, it is necessary to take every
vaporization of water (1). In hot, ing longer than 1 h) and simulta- precaution to ensure that athletes
dry environments, evaporation ac- neously deliver an additional are well hydrated, have ample access
counts for more than 80% of source of fuel for muscle and brain to fluids, and are monitored for
metabolic heat loss. The intent of (2, 13). The optimal rate of fluid heat-related illness.
drinking during exercise is to avert ingestion during exercise is un- It is possible for dehydration to
a water deficit in excess of 2% of known; authors suggest 400-1000 occur in cool or cold weather. Fac-
body weight. The amount and rate ml per hour, however this should tors contributing to dehydration
of fluid replacement is dependent be individualized through moni- in cold environments include res-
on the individual athlete’s sweat toring and practice (2, 13). piratory fluid losses and sweat
rate, exercise duration, and oppor- losses that occur when insulated
tunities to drink should not de- Effect of fluid and electrolytes loss clothing is worn during intense
pend on thirst to prompt them to Exercise-induced dehydration de- exercise. Dehydration can also oc-
drink because people do not typi- velops because of fluid losses that cur because of low rates of fluid
cally get thirsty until they have exceed fluid intake. Although some ingestion. If an athlete is chilled
lost a significant amount of fluid individuals begin exercise euhydrat- and available fluids are cold, the
through sweat. Consumption of ed and dehydrate over an extended incentive to drink may be reduced.
beverages containing electrolytes duration, athletes in some sports Finally, removal of multiple layers
and carbohydrates can help sustain might start training or competing of clothing to urinate may be in-
fluid and electrolyte balance and in a semi-dehydrated state because convenient and difficult for some
improve endurance exercise per- the interval between exercise ses- athletes, especially women, and
formance (14). Fluids containing sions is inadequate for full rehydra- they may voluntarily limit fluid in-
sodium and potassium help re- tion. Another factor that may pre- take. Respiratory water losses may
place sweat electrolyte losses, dispose an athlete to dehydration is be as high as 1900 mL/d in men
whereas sodium stimulates thirst ‘‘making weight’’ as a prerequisite and 850 mL/d in women (1, 3).
and fluid retention and carbohy- for a specific sport or event (8, 13). Total fluid intake at high altitude
drates provide energy. Fluid bal- The risk for dehydration and heat approaches 3–4 L/d to promote
ance during exercise is not always injury increases dramatically in hot, optimal kidney function and
possible because maximal sweat humid environments. When the maintain urine output of 1.4 L in
rates exceed maximal gastric emp- ambient temperature exceeds body adults (1, 3).

24
PROGRESS IN NUTRITION 1/2013

Exercise-induced dehydration with adequate time, intake of normal fluid intake should be increased.
an electrolyte deficit is associated meals and beverages will restore 3. ‘‘Salty sweaters’’ may need
with skeletal muscle cramps and hydration status by replacing flu- drinks with more salt and may
muscle fatigue and are more com- ids and electrolytes lost during ex- need more salt in food when sweat
mon in profuse sweaters who expe- ercise. Rapid and complete recov- losses are high. Self-assessment of
rience large sweat sodium losses. ery from excessive dehydration can salt losses can be done by wearing
Hypohydration, a practice of some be accomplished by drinking at a black T-shirt and looking for salt
athletes competing in weight-class least 450–675 mL of fluid for stains on the chest and under the
sports (i.e., wrestling, boxing, light- ever y pound (0.5 kg) of body armpits where the sweat has evap-
weight crew, martial arts, etc.), can weight lost during exercise. Con- orated. High salt losses are a con-
occur when athletes dehydrate suming rehydration beverages and tributing factor in some cases of
themselves before beginning a salty foods at meals/snacks will muscle cramps.
competitive event. Hypohydration help replace fluid and electrolyte
can develop by fluid restriction, cer- losses (1, 13).
tain exercise practices, diuretic use, Women, young and elderly ath-
or sauna exposure before an event. Practical messages letes
In addition, fluid deficits may span Some of the methods outlined
workouts for athletes who partici- above require equipment or ex- Although general sports nutrition
pate in multiple or prolonged daily pertise that are not available to all guidelines regarding macronutri-
sessions of exercise in the heat (13). athletes. However, there are sever- ent composition, meal timing, and
Hyponatremia (serum sodium con- al simple steps that they can take recovery nutrition are applicable
centration less than 130 mmol/L) themselves to identify whether to all athletes, there are special
can result from prolonged, heavy their current hydration practice is needs for subgroups of athletes in-
sweating with failure to replace appropriate to their needs. cluding youth, women, and the
sodium, or excessive water intake. 1. Athletes should get into the elderly.
Hyponatremia is not common but habit of weighing themselves be-
can occur in novice marathoners fore and after training sessions of
who run slowly, sweat less, or con- different durations and intensities Women
sume excessive sodium-free water and in different weather condi-
before, during, or after an event. tions to estimate their sweat loss- Some female athletes have unique
Hyponatremia is associated with es. Weight loss should generally nutritional needs because of food
symptoms such as confusion, not exceed about 1–2% of body influences on their hormonal func-
headaches, fatigue and coma (13). mass. If more than this has been tions (3). In fact inadequate energy
lost, then they should drink more intake, low body fat content and
Hydration after exercise next time. If body mass loss was strict training program can cause
Because many athletes do not less than this, fluid intake was menstrual irregularities which
consume enough fluids during ex- probably greater than was neces- could result in inadequate bone
ercise to balance fluid losses, they sary for hydration purposes. growth and fracture proneness.
complete their exercise session de- 2. If urine volume is small and There is enormous pressure on
hydrated to some extent. Given urine color is darker than usual, many women to achieve an unre-

25
VOLUME 15

alistic body weight and body fat training load and to ensure an opti- Female athletes should be
level. This can compromise both mal performance (3). screened periodically to assess and
short term athletic performance To reduce the risk of developing a monitor their iron status. They
and long term health. Any athlete bone disorder, it is advisable for should be tested not only for he-
with menstrual irregularities female athletes to pay close atten- moglobin levels but also serum
should treat these as a possible tion to their calcium intake. The ferritin, a more sensitive measure
warning sign, and seek profession- principal calcium-rich foods are of iron status. If the values are low,
al advice. If there is a need to re- dairy products but they are often improving the diet is the first step
duce body fat, this should be done eliminated from female diets due in learning to resolve iron defi-
sensibly. to their high fat content. Thus, it ciency. In particular, they could
may be necessary to take calcium consume moderate servings of red
Female triad supplements to reach a total daily meats (well-absorbed iron) in 3-5
The existing interrelationship be- intake of 1500 mg of elemental meals per week, choose iron-forti-
tween nutritional, menstrual and calcium. The consumption of 400- fied cereal products such as break-
bone disorders is known as the fe- 800 IU per day of vitamin D may fast cereals, combine plant and
male athlete triad. Menstrual dys- aid calcium absorption and help non-meat sources of iron (e.g.
functions include subclinical ovu- maintain bone health (17). legumes, cereals, eggs, green leafy
latory disorders such as luteal vegetables) with food factors that
phase deficiency and anovulation, Female and iron needs enhance iron absorption (vitamin
in addition to clinical disorders Female athletes are also at risk of C and a factor found in
such as oligomenorrhea and iron deficiency because of increased meat/fish/chicken). It is important
amenorrhea. Bone disorders range iron requirements due to menstrual to remind athletes to add iron
from the inability to reach the blood losses matched against a slowly to minimize gastro intes-
peak bone mass, a reduction in smaller intake of food. Iron is re- tinal distress. If an iron supple-
bone mineral density (osteopenia), quired for the formation of oxygen mentation is necessary, the goal
and the pathological manifesta- carrying proteins, hemoglobin and could be adding at least 20 addi-
tion known as osteoporosis (3). myoglobin, and for enzymes in- tional milligrams of iron per day.
It should be considered that physi- volved in energy production (3). Normally, the dietary reference in-
cally active and amenorrheic ado- Oxygen carrying capacity is essen- take for iron is 15 to 18 mg/d, but
lescents may not be worried about tial for endurance exercise as well as the recommendation for athletes is
the long-term risk for osteoporosis, normal function of the nervous, be- at least 18 mg/d for both men and
but may be persuaded to change havioral, and immune systems. So women (17).
their food intake and load of exer- iron deficiency can result in a vari-
cise training when warned against ety of deleterious symptoms, in-
the risks of stress fracture and prob- cluding fatigue exacerbated by exer- Young athletes
lems with hypothermia during ex- tion, dyspnea, increased lethar-
ercise in cold climates. The first aim gy/sleepiness/apathy, poor concen- Athletes should be encouraged to
of a female athlete diet is to provide tration, moodiness/irritability, in- develop good nutritional habits at
the adequate energy intake to allow creased susceptibility to injury, and an early age. Adolescence is a time
normal body functions, to sustain complaints of feeling cold (3). marked by an increased independ-

26
PROGRESS IN NUTRITION 1/2013

ence in food choice and food er surface area to weight ratio, a in adulthood. If a reduction in
preparation. The promise of sport- slower acclimatization, and low- body mass is required, it should be
ing success may provide strong er sweating rate. gradual and not more than 1.5%
motivation to develop good di- Active young people may find dif- of body mass each week (19).
etary practices. Information and ficulties to meet their needs for Changes in body composition
the example of good role models energy and nutrients when the should be monitored by qualified
may help a young person to devel- costs of training and growth are personnel in order to assess its ef-
op healthy eating practices in added. For example children’s en- fects on health and performance.
everyday (training) diets as well as ergy requirements per kilogram of
the specific preparation for com- body mass during walking and Macronutrients
petition. running can be as much as 30% The macronutrient needs for ac-
Young athletes have to eat a wide higher than in adults (3). tive child and teenagers are higher
range of foods and normally they Furthermore it has to be consid- than their sedentary counterparts
do not need dietary supplements. ered that a negative energy bal- mainly because of the increased
Good eating practices, involving ance may inhibit the production of energy demands of their sports.
good choices of foods and drinks, growth factors typical of normal However, significant differences in
are part of the formula for sport- growth and development such as calorie needs only exist for very
ing success, and a healthy life. growth hormone and IGF-1 (3, active youth compared to their
18, 19). These hormonal changes sedentary peers. In terms of pro-
Special needs of young athletes could impair normal growth and tein requirements, limited data are
Although many of the sports nu- development of body size. So available for young athletes. In
trition principles identified for young athletes should be correctly adults, the upper level of protein
adults are similar to those for advised by nutrition professionals requirement for athletes is about
young athletes, there are some im- about how to reach a proper ener- 2.0 g/kg/day, and it is expected
portant physiological, metabolic, gy and protein intake, avoid an ex- that this amount is also adequate
and biomechanical differences (3, cessive intake of fat and sugar-rich for children and adolescents in-
18, 19): foods, and ensure adequate vita- volved in a regular program of
• the growth spurts during child- min and mineral intake to avoid physical activity (3).
hood and adolescents require growth impairments.
additional nutritional support in Subjects at a particular risk of de- Micronutrients
terms of adequate intake of en- layed growth and maturation are The intake of at least two minerals
ergy, protein, essential fats and athletes aiming to reduce body should be evaluated in the youth
minerals; mass or fat content (20). It often population: calcium and iron.
• young athletes have a higher occurs among female athletes in- Among the multitude of factors
metabolic cost of locomotion volved in sports which esthetics, responsible for bone mineral ac-
and preferential fat oxidation strength and weight are determin- cretion, adequate calcium intake,
during exercise; ing factors. It could result also in especially during childhood, is
• young athletes, particularity amenorrhoea and reduced bone critical (3). Athletes who restrict
children, are at a thermoregula- density, with increased risk to de- their energy intake may be at par-
tory disadvantage due to a high- velop osteopenia or osteoporosis ticular risk for suboptimal calcium

27
VOLUME 15

intake. Although calcium is im- and monitor fluid intake by chil- Physical activity maintains a simi-
portant for bone mass develop- dren and adolescents during phys- lar post-exercise muscle protein
ment in all children, for athletes ical exercise. For long-lasting synthetic response in the elderly,
inadequate calcium intake and low sports activities, especially those although it is delayed compared to
bone mineral content have also over 90 minutes, a sport drink younger subjects. Resistance type
been associated with stress frac- with adequate carbohydrate con- exercise training represents an ef-
tures. To ensure a correct daily cal- centration (6 - 8%) and osmolarity fective therapeutic strategy to in-
cium intake level, the diet has to may be used, having as advantage crease skeletal muscle mass and
meet energy requirement with at a more pleasant flavor than nor- improve functional performance in
least three servings per day of mal water. Young athletes should the elderly.
dairy products and/or other calci- be encouraged to drink 150-300
um enriched food (3). mL every 15-20 minutes during Calorie and macronutrient needs
Studies show a high percentage of physical activity (3). Bottled Calorie needs are generally consid-
iron deficiency in adolescent ath- drinks should be readily available ered to be age-dependent with a
letes, typically in teenage girls. to facilitate ingestion and be based decrease later on in life (3). Be-
Iron deficiency impairs athletic on individual preference. cause many elderly individuals
performance, reducing the capaci- have decreases in muscle mass with
ty of haemoglobin and myoglobin aging, it is vital that they consume
to carry oxygen in the blood and Elderly athletes adequate calories, carbohydrate
muscles. In order to assess iron and protein to maintain and even-
deficiency it is important to meas- Aging is accompanied by a pro- tually rebuild muscle mass. There
ure haemoglobin, hematocrit and gressive loss of skeletal muscle are no studies that estimate the
also total iron binding capacity, mass and strength, leading to the caloric needs of the athletic elder-
serum ferritin, and transferring loss of functional capacity and an ly; for this, a weekly food record-
(3). In case of iron deficiency, increased risk of developing ing with a monitoring of body
young athletes should encourage chronic metabolic disease. The composition could be useful to
to increase servings of red meat or age-related loss of skeletal muscle planning a correct diet strategy (3).
fortified iron food weekly. mass is attributed to a disruption Calculating the energy demands of
in the regulation of skeletal muscle exercise during aging is another
Fluid intake during exercise protein turnover, resulting in an factor that should be considered.
Finally, young athletes should imbalance between muscle protein Some types of activities (i.e. en-
monitor their fluid intake. They synthesis and degradation. Recent durance training) increase the
should be advised to monitor body studies suggest that the muscle caloric needs more than others (i.e.
mass before and after the exercise protein synthetic response to food resistance training), and this has to
to avoid dehydration. During de- intake is blunted in the elderly. In be taken into account in order to
hydration, young athletes have a addition, glucose intolerance may optimize a nutrition strategy for
faster increase in their internal also play an important role in a re- elderly athletes (3).
temperature when compared to duced post-prandial increase in There has been some controversy
adults (3). These findings empha- muscle protein synthesis in elderly regarding the adequacy of the
size the necessity to encourage people. RDA for protein in elderly indi-

28
PROGRESS IN NUTRITION 1/2013

viduals. Recent studies suggest the development of these clinical 2. Burke L. In: Practical Sports Nutrition
that the muscle protein synthesis events (3). 2007. Ed. Human Kinetics.
3. Jose A, Kalman D, Stout JR, et al. Es-
response to the ingestion of small- Vitamin D has also other healthy sential of sports nutrition and supple-
er, meal-like amounts of amino effects and its deficiency is wide- ments 2008. Humana Press.
acids is attenuated and delayed in spread among elderly people. It 4. Kreider RB, Wilborn CD, Taylor L, et
the elderly compared with young seems to protect from infections, al. International Society of Sports Nu-
trition (ISSN), exercise & sport nutri-
controls (3). Because of this, some and vitamin D insufficiency is tion review: research & recommenda-
data suggest that elderly men and suggested to be a risk factor for tions. J ISSN 2010; 7:7.
women should consume dietary chronic inflammatory and various 5. Paddon-Jones D, Sheffield-Moore M,
protein above current recommen- types of autoimmune diseases (3). Zhang XJ, et al. Amino acid ingestion
improves muscle protein synthesis in
dations (0.8 g/kg/day) to optimize Vitamin E, instead, with its an- the young and elderly. Am J Physiol
muscle mass (3). Other studies tioxidant properties, could reduce Endocrinol Metab 2004; 286(3):
demonstrate that the attenuated free radicals levels, which nega- E321–E328.
muscle protein synthesis response tively contribute to all the inflam- 6. Negro M, Giardina S, Marzani B,
Marzatico F. Branched-chain amino
to food intake in the elderly can, matory and age related disease (3). acid supplementation does not en-
at least partly, be compensated for Finally, considering that aging is hance athletic performance but affects
by increasing certain amino acids associated with an increased risk muscle recovery and the immune sys-
content of a meal (i.e. essential of anaemia and iron deficiency, tem. J Sports Med Phys Fitness 2008;
48(3): 347-51.
amino acids, BCAA, or leucine) elderly athletes should try to in- 7. Choma CW, Sforzo GA, Keller BA.
with foods or supplements (21, gest adequate amounts of iron rich Impact of rapid weight loss on cogni-
22). However it’s the interactive foods (3). tive function in collegiate wrestlers.
effects of exercise and nutrient in- Medicine and Science in Sports and
Exercise 1998; 30(5): 746–49.
gestion that produce an anabolic 8. Brito CJ, Roas AF, Brito IS, Marins
response in muscle. Acknowledgments JC, Cordova C, Franchini E: Methods
of body mass reduction by combat
The authors would like to thank Dr. Tim sport athletes. Int J Sport Nutr Exerc
Micronutrient requirements N. Ziegenfuss, past-president of Interna- Metab 2012; 22:89–97.
Besides protein usefulness to re- tional Society of Sports Nutrition 9. Koopman R, van Loon LJ. Aging, ex-
duce the risk of muscle loss, which (ISSN), internationally recognized au- ercise, and muscle protein metabolism.
could worsen in sarcopenia, there thor, speaker and researcher, and Jennifer J Appl Physiol 2009; 106(6):2040-8.
are other nutrient requirements Hofheins, registered dietitian and certi- 10. Bussau VA, Fairchild TJ, Rao A, et al.
fied sports nutritionist, for reviewing this Carbohydrate loading in human mus-
that may change with age. Rec- book chapter and for giving us their in- cle: an improved 1 day protocol. Euro-
ommendations for increased calci- valuable suggestions and scientific sup- pean Journal of Applied Physiology
um, vitamin D, and vitamin E in- port. 2002; 87(3):290-5.
takes for elderly people have been 11. Gunzer W, Konrad M, Pail E: Exer-
cise-Induced Immunodepression in
made (3). With aging a reduction
Endurance Athletes and Nutritional
in bone mineral density occurs, References Intervention with Carbohydrate, Pro-
which could result in an increased tein and Fat—What Is Possible, What
risk of fractures and osteoporosis. 1. Jeukendrup A, Gleeson M. In: Sport Is Not? Nutrients 2012; 4: 1187-1212.
Nutrition: An introduction to energy 12. Holway FE, Spriet LL. Sport-specific
Calcium and vitamin D supple- production and performance 2004. Ed. nutrition: practical strategies for team
ments may be useful to counteract Human Kinetics. sports. Journal of Sports Science 2011;

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29 (Suppl 1):S115-25. Environments. Human Kinetics 2000. Committee on Sports Medicine and
13. Maughan RJ, Shirreffs SM. Dehydra- 17. Nattiv A, Loucks AB, Manore MM, Fitness. Promotion of healthy weight-
tion and rehydration in competitive Sanborn CF, Sundgot-Borgen J, War- control practices in young athletes. Pe-
sport. J Med Sci Sports 2010; 20 ren MP; American College of Sports diatrics 2005; 116(6):1557-64.
(Suppl. 3): 40–47. Medicine. American College of Sports 21. Volpi E, Kobayashi H, Sheffield-
14. American College of Sports Medicine, Medicine position stand. The female Moore M, et al. Essential amino acids
American Dietetic Association, Dieti- athlete triad. Med Sci Sports Exerc are primarily responsible for the amino
tians of Canada. Nutrition and athletic 2007; 39(10):1867-82. acid stimulation of muscle protein an-
performance. Journal of American 18. Meyer F, O’Connor H, Shirreffs SM. abolism in healthy elderly adults. Am J
Medical Association 2009; Nutrition for the young athlete. J Clin Nutr 2003; 78: 250–258.
109(3):509–27. Sports Sci 2007; 25(S1): S73 – S82. 22. Katsanos CS, Kobayashi H, Sheffield-
15. Institute of Medicine. Water. In: Di- 19. American Academy of Pediatrics, Moore M, et al. A high proportion of
etary Reference Intakes for Water, Committee on Nutrition - Sports nu- leucine is required for optimal stimu-
Sodium, Cholride, Potassium and Sul- trition. In: Kleinman RE.. Pediatric lation of the rate of muscle protein
fate 2005; National Academy Press, Nutrition Handbook 2004; 5th ed. Elk synthesis by essential amino acids in
pp. 73–185. Grove Village, IL; 155–66. the ederly. Am J Physiol Endocrinol
16. Armstrong L. Performing in Extreme 20. American Academy of Pediatrics Metab 2006; 291:E381-E387.

30
REVIEW

F. CIONI Nutrizione e strategie di integrazione


selettiva nel management clinico del
recupero muscolare post infortunio

PROGRESS IN NUTRITION
Summary
VOL. 15, N. 1, 31-42, 2013
Muscle injury is statistically a very frequent event in people playing sports
both at an amateur and professional level and is far from rare in the general
TITOLO population: whatever the cause, it results in varying periods of forced im-
Nutrition and selective mobility or reduced mobility, causing even a serious loss of muscle mass
supplementation strategies in and strength, with serious consequences on a sportsman’s performance and
the clinical management of on the general health status of a person who does not do sport. The causes
muscle injury recovery of muscle injury are multiple and can be roughly divided into two big
groups: direct traumas (tackles, unnatural movements etc.) and indirect
KEY WORDS traumas (in which harmful forces develop within the muscle structure). In
Muscle injury, bed rest, both cases dietary intervention has proved to be an efficient tool in sup-
supplementations, muscle porting orthopaedic physical therapy and physiotherapy and rehabilitation
catabolism in the clinical management of functional recovery, optimising the muscle’s
anabolic capacity, improving the outcome and reducing the healing time.
PAROLE CHIAVE The key points of such intervention are the regulation of calorie count and
Infortunio muscolare, riposo of protein intake, as well as of the possible dietary supplementation, de-
forzato, integratori, catabolismo pending on the duration of the various injury healing phases: the period
muscolare immediately following the injury itself, the following period of bed rest
and, finally, the functional recovery phase. In all these phases dietary sup-
plementation with branched amino acids, other amino acids such as ala-
nine, glutamine and arginine, creatinine, hydroxymethyl butyrate, mineral
salts (zinc, magnesium and calcium) and vitamins (vitamin C and B-com-
plex vitamins) is an approach that can be used not only in the sportsman
but also in the general population, with the objective of limiting any dam-
age the injury may cause, both directly and indirectly, to the muscle mass.

Riassunto
L’infortunio muscolare è un evento statisticamente molto frequente in chi
pratica sport a livello sia professionale che amatoriale e tutt’altro che raro
Direttore Scientifico Progress in anche nella popolazione generale: quale che ne sia la causa esso determina
Nutrition un periodo più o meno prolungato di immobilità forzata o di ridotta mobi-
lità, ingenerando perdite anche gravi di massa e forza muscolare con serie
Corrispondence:
Dr. Federico Cioni conseguenze sulla capacità di prestazione dello sportivo e sullo stato di salu-
federicocioni@mattioli1885.com te in generale del non sportivo. Le cause di infortunio muscolare sono mol-

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VOLUME 15

teplici e possono essere grossolanamente suddivise in due grandi gruppi: i


traumi diretti (contrasto di gioco, movimenti innaturali, ecc) ed i traumi in-
diretti (in cui le forze lesive si sviluppano nell’unità funzionale motoria). In
entrambi i casi l’intervento nutrizionale si è comunque dimostrato un effi-
cace strumento di supporto a quello ortopedico-fisiatrico e a quello fisiote-
rapico-riabilitativo nella gestione clinica del recupero funzionale, ottimiz-
zando le capacità anaboliche del muscolo, migliorando l’outcome e riducen-
do i tempi di recupero. Cardini di tale intervento sono la modulazione del-
l’apporto calorico, di quello proteico e delle eventuali integrazioni dieteti-
che, in funzione della durata delle diverse fasi in cui è possibile suddividere
il recupero post-infortunio: il periodo immediatamente successivo all’infor-
tunio stesso, il successivo periodo di riposo forzato e infine la fase di recu-
pero funzionale. In tutte queste fasi l’integrazione della dieta con aminoaci-
di ramificati, altri aminoacidi come alanina, glutammina e arginina, creati-
na, idrossi-metil-butirrato, sali minerali (zinco, magnesio e calcio) e vitami-
ne (vitamina C e vitamine del gruppo B), trova un suo razionale non solo
nello sportivo, ma nella popolazione generale, nell’ottica di limitare il danno
che l’infortunio può determinare, sia direttamente che indirettamente, a ca-
rico della massa muscolare.

L’infortunio muscolare fallosa (1). I dati del CONI del zione diffusa del tono muscolare
2003 relativi ai calciatori sono gros- senza lesioni anatomicamente di-
Il danno da infortunio muscolare, so modo sovrapponibili. Uno sporti- mostrabili. Di stiramento o elonga-
inteso in senso stretto come lesione vo su tre, o su due nel calcio, è quin- zione quando l’allungamento delle
di fibre muscolari senza interessa- di a rischio di infortunio moderato- fibre muscolari supera il limite fi-
mento della matrice extracellulare, severo nel corso della sua carriera: se siologico, senza che ciò provochi un
dell’irrorazione ematica e dell’inner- però si prendono in considerazione reale danno sotto forma di strappo
vazione, è un evento frequente negli gli infortuni più leggeri questa pro- o distrazione (corrisponderebbe al
sportivi e nella popolazione genera- porzione è destinata ad aumentare. livello I della AMA). Di strappo
le, ma definirne l’esatta epidemiolo- La American Medical Association quando l’unità anatomo-funzionale
gia non è semplice. Alcuni studi (3) classifica le lesioni muscolari in muscolo-tendinea è interrotta a tut-
condotti su calciatori professionisti diversi livelli a seconda della gravità ti gli effetti (livelli I e III della
collocano attorno al 40% la percen- della causa intrinseca ed estrinseca e AMA). Particolare attenzione me-
tuale di soggetti che va incontro a dell’entità del danno anatomo-fun- ritano anche i classici crampi mu-
infortunio con lesione da moderata zionale. Altre classificazioni molto scolari ed il dolore a comparsa rapi-
a severa (per 3/4 lesioni moderate) utilizzate sono quelle di Reid e da o ritardata post-esercizio, che
(1,2). Per più di due terzi del totale Kouvalchouk (Tab. 1). pur non rientrando nel novero degli
gli infortuni sono riconducibili a Nel linguaggio comune si parla di infortuni, possono risultare molto
contatto con l’avversario o ad azione contrattura intendendo una altera- fastidiosi e limitare le capacità di

32
PROGRESS IN NUTRITION 1/2013

Tabella 1 - Classificazioni di Reid e Kovalchouk degli infortuni muscolari (4,5).


Lesioni da trauma diretto: (Reid, 1992)
• GRADO LIEVE (è consentita oltre la metà dello spettro di movimento);
• GRADO MODERATO (è concessa meno della metà, ma più di 1/3 dello spettro di movimento);
• GRADO SEVERO (è permesso uno spettro di movimento inferiore ad 1/3).
Lesioni da trauma indiretto: (Kouvalchouk, 1992)
• CONTRATTURA O LESIONE DI GRADO “O” (assenza di lesioni anatomiche. L’evento traumatico responsabi-
le è poco definito. Tale condizione è attribuita ad uno stato di fatica muscolare che, per modificazioni metaboliche,
determina un’alterazione del tono muscolare);
• LESIONE DI 1°GRADO -o elongazione o stiramento- (in questo caso, pur non sussistendo interruzioni delle fibre
muscolari microscopicamente rilevabili sono evidenziabili alcune anomalie biochimiche ben definite identificate come
modificazioni metaboliche intra-citoplasmatiche, disorganizzazioni miofibrillari, lesioni mitocondriali);
• LESIONE DI 2°GRADO -o distrazione- (è caratterizzata da un’effettiva lesione anatomica con interruzione di un
numero variabile di fibre muscolari. Questo tipo di lesione presenterebbe poi quattro stadi:
- 1°stadio: rottura completa di qualche fibra muscolare senza interessamento del connettivo di sostegno;
- 2°stadio: rottura di un numero maggiore di fibre muscolari, con iniziale interessamento della struttura connettivale,
senza un significativo versamento ematico;
- 3°stadio: o rottura parziale, caratterizzata dall’interessamento di un elevato numero di fibre, associata a lesione del
connettivo e delle strutture vascolari e nervose, con formazione di abbondante ematoma intramuscolare;
- 4°stadio: o rottura muscolare completa, in cui si interrompe la continuità del ventre muscolare.

movimento del soggetto (6). Tutti Tabella 2 - Possibili fattori predisponenti all’infortunio muscolare
questi eventi riconoscono fra le altre
• Insufficiente recupero (inferiore alle 48 ore)
(Tab. 2), cause di tipo metabolico
riconducibili in estrema sintesi a • Avvio troppo veloce dell’esercizio (mancato riscaldamento)
deficit energetici, squilibri idrosalini • Errata tecnica di Corsa
e aumento dei radicali liberi. Il trat-
• Vecchie Lesioni
tamento delle lesioni muscolari si
basa su una corretta diagnosi delle • Sovraccarico (sia in fase di allenamento che di gara)
stesse cui seguirà in caso di sempli- • Alterazioni morfofunzionali dell’unità motoria (squilibrio fra muscoli agoni-
ce contrattura un programma di sti ed antagonisti e fra componente muscolare e tendinea)
massaggi, esercizi blandi e stret- • Condizioni ambientali (temperatura, umidità)
ching che in breve tempo potrà ri- • Squilibri biochimici secondari a patologie o a errori alimentari
mettere il soggetto in condizione di
muoversi. In caso di lesioni più gra-
vi con danno anatomico delle fibre L’eventuale somministrazione di meno grave limitazione della mobi-
muscolari, il protocollo di tratta- farmaci miorilassanti e analgesici è lità del soggetto per un periodo va-
mento previsto nelle prime 24 ore è sotto controllo medico, quella di riabile a seconda della entità della
il classico PRICE (Protection, Rest, FANS è da valutare attentamente lesione. E’ proprio da questa immo-
Ice, Compression, Elevation) che perché i meccanismi infiammatori bilità che discendono rilevanti con-
prevede protezione, riposo, applica- possono essere di qualche utilità seguenze cataboliche a carico del
zione di ghiaccio 3-4 volte al di per nell’accelerare i tempi di guarigione tessuto muscolare, riduzione dei vo-
non più di 20 minuti, bendaggio dei tessuti lesi. In tutti i casi la con- lumi e della forza muscolare ed ul-
compressivo e scarico dell’arto. seguenza dell’infortunio è una più o teriore allungamento dei tempi di

33
VOLUME 15

Figura 1 - Confronto tra l’aumento di citochine indotto da sepsi e da esercizio fisico. In corso di sepsi vi è un aumento
circolatorio rapido e marcato del fattore di necrosi tumulare (TNF)-α, che è seguito da un amento di interleuchina
(IL)-6. Al contrario durante l’esercizio fisico, il forte aumento di IL-6 non è preceduto da innalzamento del TFN-α.

Sepsi Esercizio fisico

IL-6 IL-6

TNF-α
IL-1ra IL-1ra
TNF-R IL-10 TNF-R IL-10

recupero negli sportivi. Le conse- due componenti: quella determinata le miochine pro- e quelle antiin-
guenze cliniche più gravi si avran- dall’infortunio stesso e quella deter- fiammatorie e di interazione meta-
no, però, nei soggetti che praticano minata dall’immobilità secondaria bolica con ormoni anabolici quali
sport non professionali, nello spor- all’infortunio. Il danno primario sa- l’insulina e catabolici come il corti-
tivo occasionale o addirittura nei se- rà di tipo meccanico e l’estensione solo. In particolare l’aumento della
dentari che sono andati incontro a anatomica della lesione influenzerà IL6 è maggiore dopo esercizi con-
infortunio muscolare casualmente e direttamente il tipo di trattamento e centrici vs esercizi eccentrici e, in
che, non disponendo di un trofismo i tempi di recupero. La prima con- condizioni fisiologiche, non si asso-
muscolare importante già in avvio, seguenza sarà l’innescarsi di un pro- cia a picchi del TNF-α, tipiche del-
subiranno danni proporzionalmente cesso infiammatorio, scatenato dal lo stress muscolare che si osserva
molto più gravi, in funzione dell’età rilascio da parte delle cellule musco- dopo sepsi e dopo infortunio (Fig.
e della eventuale comorbilità. Ecco lari lese di citochine (miochine), 1)(7). Questo dato è di particolare
allora che le esperienze condotte che contribuirà alla più rapida ripa- importanza perché i picchi di
sugli sportivi professionisti con razione della lesione, ma che, se TNF-α determinano una resistenza
l’obiettivo di migliorare le perfor- troppo esteso nel tempo, potrà ri- anabolica che è responsabile della
mance o di accelerare i tempi di re- sultare dannoso. L’attività fisica di perdita di massa magra che si osser-
cupero post-infortunio, possono di- per se determina l’insorgere di in- va in questa fase e può vanificare
ventare preziose nella gestione cli- fiammazione muscolare, ma con l’efficacia sull’anabolismo muscolare
nica del recupero anche nei non meccanismi biomolecolari diversi: di una semplice implementazione
sportivi. in particolare durante la “normale” proteica nel primo periodo post-in-
infiammazione post-esercizio si os- fortunio. Nella fase successiva inve-
serva un aumento molto significati- ce, ridottisi i livelli di TNF-α e di
Le conseguenze muscolari dell’in- vo della Interleuchina (IL) 6 e in citochine infiammatorie, entrano in
fortunio e dell’immobilità forzata misura minore di IL 10, dell’anta- gioco complessi meccanismi trascri-
gonista recettoriale della IL 1 e di zionali, translazionali e post-trans-
In caso di infortunio il danno a ca- altre IL, quali la IL 8 e la IL 15, in lazionali, attivati essenzialmente
rico del muscolo vedrà sommarsi un fine gioco di compensazione fra dallo stress ossidativo e dall’aumen-

34
PROGRESS IN NUTRITION 1/2013

Figura 2 - Flow chart dei percorsi noti e regolazione molecole/geni che media-
no la segnalazione intracellulare nel muscolo in fase di non uso

DISUSO/INATTIVITÀ/SCARICO
(volo spaziale, riposo a letto,
immobilizzazione degli arti)
atleta che dovrà lavorare a lungo per
recuperare da un infortunio, ma lo è
ancora di più per il non atleta, che
Ormoni, meccanosensori, non dispone degli strumenti di ri-
stress ossidativo, danni al DNA
abilitazione funzionale che sono of-
ferti a un professionista e che ri-
schia di sommare i danni da infor-
Principali vie di segnale intracellulare (mediatori) tunio alle conseguenze di una scor-
Akt/m TOR; ubiquitina-proteasoma; caspasi; MAPK retta gestione motoria e nutriziona-
le della convalescenza.

Downregulation molecole/geni Upregulation molecole/geni L’intervento nutrizionale e le stra-


IRS-1, Akt, mTOR, S6K, 4E-BP1, m-calpaina, catepsina B/L/D, tegie di integrazione selettiva nel-
elF4E, eEF2, GSK-3β ubiquitina, 14-kDa E2, C2, C9, MAFbx,
MuRF1, Nedd4, caspasi-3, p38, JNK, le diverse fasi del recupero post-
ERK, p53, endonucl. G, NF-κB, Bcl-2 infortunio

L’intervento nutrizionale dovrà es-


sere articolato su più livelli, in tempi
↓ Sintesi proteica, ↑ degradazione proteica, diversi. Nella fase dell’immediato
↓ crescita, ↑ sintesi di glicogeno, apoptosi post-infortunio (giorni) l’obbiettivo
sarà quello di modulare i fisiologici
processi di infiammazione e ripara-
zione tissutale. Nella seconda fase
Ritiro delle miofibre (atrofie), ↑ affaticabilità,
↓ produzione di forza, malattie metaboliche (settimane/mesi) di immobilità o di
riposo forzato, l’accento si porrà sul-
la prevenzione della eccessiva perdi-
to dei livelli di ormoni catabolici guenza è una perdita di massa e ta di massa magra e/o dell’accumulo
quali il cortisolo (ormone dello funzione che si manifesta soprattut- di massa grassa. Infine nella fase di
stress per eccellenza, che si è dimo- to a carico dei muscoli delle gambe riabilitazione, la cui durata dipende
strato in grado di stimolare la pro- e della schiena e che, dopo 28 gior- da quella delle prime due fasi e in
duzione di miostatina, enzima che ni di bed-rest, può arrivare a circa ultima analisi dall’entità dell’infortu-
limita la crescita muscolare), ma an- 500 g, con una riduzione della forza nio, l’obbiettivo sarà il recupero del
che di adrenalina, noradrenalina e alla leg extension nell’ordine del trofismo e di una funzionalità mu-
glucagone, che in ultima analisi 25% (10). Le evidenze disponibili scolare la più completa possibile.
conducono ad uno squilibrio fra i in letteratura sono concordi nell’in- Nella prima fase post-infortunio la
meccanismi di sintesi e degradazio- dicare la movimentazione precoce dieta dovrà essere isocalorica rispet-
ne delle proteine muscolari, secon- del paziente e l’intervento nutrizio- to alle esigenze del soggetto, calcola-
do un meccanismo a cascata rias- nale come cardini del recupero (9). te in quel frangente tenendo conto
sunto nella Fig. 2 (8,9). La conse- Questo è vero certamente per un di un aumento del metabolismo ba-

35
VOLUME 15

sale nell’ordine del 20% in funzione muscolare. L’arginina è inoltre coin- zio (17). Molto importante in que-
dell’attivazione dei processi di recu- volta nel metabolismo dell’ ossido sta fase è anche l’apporto vitaminico
pero (11). L’apporto quotidiano di nitrico (NO), che regola (soprattutto vitamine del gruppo B)
nutrienti dovrà essere suddiviso in l’espressione muscolare del Trans- e di sali minerali (calcio, ferro, ma-

β), a sua volta coinvolto nella forma-


5/6 pasti. Particolare attenzione an- forming Growth Factor-β (TGF- gnesio), che potrà essere garantito
drà data alla scelta di alimenti a bas- dal consumo di frutta e verdura e
so indice glicemico, all’apporto di zione del tessuto cicatriziale fibroti- dall’eventuale dall’utilizzo di inte-
vegetali e di fibra ed alla riduzione co nella fase di riparazione del dan- gratori. Interessanti sono i dati dis-
dell’apporto di grassi saturi e zuc- no a carico delle fibre muscolari ponibili sull’utilizzo della glutammi-
cheri semplici. Tutto ciò con lo sco- (14). L’integrazione con idrossi-me- na come agente anti-catabolico che
po di esercitare per quanto possibile til-butirrato si è infine dimostrata ne sostengono l’impiego in questa
una azione antiinfiammatoria, ridu- efficace nel ridurre l’attività del delicata fase (18).
cendo fra l’altro i picchi insulinemici complesso ubiquitina-proteasoma Infine nella fase di recupero e riabi-
post-prandiali. Sul piano delle scelte (azione anticatabolica) e nell’au- litazione tutte le indicazioni di cui
lipidiche, oltre a ridurre l’apporto di mentare i livelli di IGF-1 (azione sopra dovranno essere implementa-
grassi saturi, verranno privilegiati i anabolica) (15). te in un percorso integrato nutrizio-

della serie ω3 (acido docosaesaenoi-


grassi mono-insaturi e poli-insaturi Nella successiva fase di riposo forza- nale e motorio che dovrà a questo
to, particolare attenzione andrà po- punto tenere conto della comparti-

di quelli della serie ω 6, alcuni dei


co e eicosapentaenoico) a discapito sta nel ricalcolo delle esigenze ener- mentazione della massa magra, del-
getiche del soggetto, per evitare la la massa grassa e dell’acqua corpo-
quali (acido arachidonico) sono pre- deprivazione calorica, concausa di rea (intra- ed extracellulare) correg-
cusori di prostaglandine a spiccata catabolismo muscolare. Se il sogget- gendo di conseguenza gli apporti

to dietetico ω3/ω6 considerato idea-


azione proinfiammatoria. Il rappor- to è sovrappeso al momento dell’in- calorici, proteici e di oligoelementi
fortunio non è questo il momento di al fine di ottimizzare la risintesi
le è collocato fra 1/4 e 1/6, ed è rag- farlo calare: l’espressione della mio- muscolare e la perdita della even-
giungibile aumentando il consumo statina che è già maggiore nel mu- tuale massa grassa in eccesso.
di pesce e noci e riducendo quello di scolo traumatizzato rispetto agli altri L’integrazione in questa fase con
cereali e di olii vegetali polinsaturi. muscoli, cala ulteriormente in corso creatina può supportare dal punto

di ω3 può essere presa in considera-


Anche l’integrazione dietetica a base di diete ipocaloriche (16). Ferme re- di vista energetico il lavoro di po-
stando le indicazioni già date per la tenziamento muscolare previsto nel
zione (12). Fra le bevande, oltre na- prima fase, di cruciale importanza è programma di recupero funzionale.
turalmente all’acqua, si potrà dare a questo è punto la qualità e la
spazio a infusi di the verde, che ha quantità dell’apporto proteico, che
dimostrato efficacia antiossidante dovrà attestarsi fra 1,5 e 2,5 g pro kg Strategie di integrazione selettiva
(13). L’integrazione precoce con ar- (11). L’utilizzo in questa fase di in-
ginina e glutammina sembra favore tegratori a base di AA essenziali L’utilizzo intensivo e mirato di inte-
la sintesi muscolare rispettivamente (AAE) in genere e ramificati gratori nello sportivo, specie nella
tramite la vasodilatazione e la sintesi (BCAA) in particolare, contrasta la delicata fase del recupero post-in-
di collagene e l’ingresso di acqua, resistenza anabolica e in generale la fortunio, offre un interessante fonte
glucosio ed elettroliti nella cellula perdita di massa magra post-eserci- di esperienze cliniche eventualmen-

36
PROGRESS IN NUTRITION 1/2013

te utilizzabile nella pratica clinica di allenamento sostenuto per incre- gono captati e metabolizzati diret-
quotidiana, anche sulla popolazione mentare la massa o mantenere la tamente dai muscoli e sono indicati
generale (Tab. 3). Allo stesso modo forza e la potenza muscolare nell’integrazione dietetica dei pa-
le esperienze effettuate su pazienti (19,20). In particolare nel recupero zienti infortunati sia nella fase del
costretti a riposo forzato dopo inter- da un infortunio muscolare un ap- riposo forzato post-infortunio che
venti chirurgici o per qualunque al- porto proteico assoluto nell’ordine in quella del recupero funzionale
tra causa, offrono a nutrizionisti e fi- di 1,5-2,5 g di proteine Kg appare (17). Per ottimizzare il metabolismo
siologi dell’esercizio importanti in- ottimale: in termini percentuali ciò dei ramificati è opportuno assumer-
formazioni. dovrebbe corrispondere ad un 20% li, insieme a piridossina (vit. B6), al
La necessità di una integrazione dell’apporto energetico complessivo dosaggio complessivo di circa 10/12
proteica durante la fase di allena- (21,22). Sul piano qualitativo si da- g/die (rapporto leucina, isoelucina,
mento muscolare è ampiamente ac- rà la preferenza a proteine di alto valina 2/1/1) (23-29).
cettata: ciò in conseguenza non solo valore biologico, ricche in AAE: fra Concentrata per il 95 % nelle cellu-
dell’utilizzo “strutturale” primario questi i BCAA meritano alcune le muscolari (125 mmol per kg di
dei substrati proteici ma anche di considerazioni a parte. Leucina, iso- muscolo secco, con oscillazioni tra
quello energetico. Questo riguarda leucina e valina, rappresentano circa 90 e 160 mmol), la creatina può es-
soprattutto i BCAA che vengono il 35% degli AAE nelle proteine sere accumulata sia nella forma li-
ossidati preferibilmente nel musco- muscolari. In clinica vengono utiliz- bera (per circa un terzo del totale)
lo scheletrico piuttosto che nel fe- zati per aiutare il recupero delle vit- che in forma fosforilata (fosfocreati-
gato. Se la captazione di energia da time di ustioni e nel trattamento di na, PCr). Le fibre muscolari di tipo
altre fonti (in primis glucidiche) alcuni casi di encefalopatia epatica, II (veloci) presentano una quantità
non soddisfa la spesa energetica du- oltre che nell’integrazione alimen- di PCr da 4 a 6 volte maggiore ri-
rante un allenamento pesante, an- tare della dieta dello sportivo. Co- spetto a quella dell’ATP. La creatina
che il doppio del fabbisogno protei- me tutti gli AAE, anche i BCAA svolge un ruolo chiave nelle attività
co medio può non essere sufficiente hanno funzione plastica: inoltre, che richiedono grandi quantità di
a mantenere in equilibrio il bilancio grazie alla loro porzione alifatica, energia per periodi relativamente
azotato. Dunque, carenze di appor- possono essere catabolizzati per brevi di tempo: è infatti la principa-
to energetico possono influenzare produrre energia (gluconeogenesi). le sostanza implicata nelle reazioni
negativamente gli esiti di un regime Assorbiti nell’intestino tenue, ven- di liberazione di energia per via
anaerobica alattacida. La fonte pri-
Tabella 3 - I principali prodotti utilizzabili nelle diverse fasi di una strategia di in- maria di creatina è l’alimentazione
tegrazione selettiva nel recupero post-infortunio (il fabbisogno medio giornaliero di
Acidi grassi ω3 e ω6
un adulto è coperto da 250 g di car-
Glutammina
ni rosse), ma una quota è prodotta
Fitocomposti e infusi (the verde) Creatina anche dal fegato, dai reni e dal pan-
Vitamine A ed E Zinco, ferro, magnesio, calcio creas partendo dagli aminoacidi gli-
Idrossi-metil-butirrato Vitamine B6 e B 12 cina, arginina e metionina. A segui-
BCAA, EAA Vitamina C to della sua sintesi, la creatina viene
trasportata nell’ambiente cellulare
Arginina, glicina, alanina
dove subisce la conversione in PCr.

37
VOLUME 15

Circa 2 g al giorno di creatina sono serviranno per la produzione endo- po per molti scopi: può fornire ener-
irreversibilmente convertiti in crea- gena di creatina. L’Arginina stimola gia in condizioni di elevato cataboli-
tinina, successivamente trasportata anche la produzione di GH (ormo- smo, viene usata come coadiuvante
dalle cellule muscolari al rene e ne della crescita) ed è coinvolta nel nelle terapie dell’affaticamento, sia
quindi espulsa con le urine. Negli metabolismo dell’ossido nitrico. In fisico che mentale, ed è importante
atleti l’integrazione di creatina particolare l’ossido nitrico (NO o nel metabolismo dell’azoto. Secon-
comporta un aumento delle risorse più correttamente monossido di do numerosi studi, la glutammina
energetiche muscolari (di tipo anae- azoto) è un mediatore endogeno di previene il catabolismo muscolare
robico alattacido) sino al 20%. La processi particolarmente importan- (34). In soggetti con particolari dif-
ridotta capacità di produzione di ti, come la vasodilatazione e la tra- ficoltà a recuperare un adeguato tro-
creatina da parte dell’organismo, smissione degli impulsi nervosi. fismo muscolare (come nei soggetti
che è in grado di immagazzinarne Inoltre l’NO concorre alla differen- anziani o in chi viene da un lungo
al massimo 0,3 g per ogni kg di pe- ziazione e attivazione delle cellule periodo di stop a causa di malattia)
so corporeo, fa sì che l’assunzione satelliti muscolari, processo inne- si osserva un maggior rilascio di
giornaliera di creatina con la dieta scato dall’allungamento e dalla le- Growing Hormone, se si segue un
assuma una notevole importanza. sione delle fibre muscolari, e inibi- programma di integrazione con glu-
Il suggerimento del Ministero della sce l’espressione del TGF-β, di cui tammina (35).
Salute è di non superare il dosaggio abbiamo già detto. Queste caratte- Lo zinco ed il magnesio sono oli-
di 3 g/die in persone comuni, men- ristiche consentono all’Arginina di goelementi essenziale per la vita.
tre negli atleti sono ammessi fino a avere un ruolo importante fin dalle Una carenza di zinco condiziona
6 g/die per un periodo non superio- primissime fasi di un programma di pesantemente la crescita corporea e
re ai 30 giorni, tenuto conto anche supplementazione dedicato al recu- l’aumento di peso. Il magnesio svol-
delle condizioni fisiche del soggetto pero muscolare (11,14). ge un ruolo essenziale in un gran
trattato. Per soggetti normali, dopo L’AA non essenziale Alanina, desti- numero di importanti reazioni cel-
un periodo di attacco al dosaggio di nato principalmente alla produzione lulari. La sua concentrazione nei li-
3 g/die (dosaggio massimo consen- di energia attraverso il ciclo alanina- quidi extracellulari è di importanza
tito dal Min. Sal.) è suggerita una glucosio, ottimizza l’utilizzo struttu- critica, insieme a quella del calcio e
fase di mantenimento con quantità rale dei BCAA tamponando la ri- di altri cationi, per il mantenimento
pari a 1,5-2 g/die, per cicli di tratta- chiesta energetica di derivazione del potenziale di membrana dei ner-
mento di 2-3 mesi. Elevate concen- aminoacidica dell’organismo. Ciò vi e dei muscoli. Inoltre stimola
trazioni di PCr intramuscolare permette un maggiore utilizzo dei l’assorbimento di altri minerali (cal-
consentono agli atleti di aumentare BCAA nella sintesi proteica. cio, fosforo, sodio, potassio) e il me-
l’intensità dell’allenamento e risul- La glutammina è un AA condizio- tabolismo delle vitamine del com-
tano utili anche in attività dedicate natamente essenziale che può essere plesso B e delle vitamine C ed E. Ai
al recupero muscolare svolte in pa- sintetizzato nel tessuto muscolare fini del recupero post-infortunio, il
lestra (30-33). dal nostro organismo a partire da al- magnesio ha dimostrato di ridurre il
Arginina e glicina sono due AA tri AA. Particolarmente abbondante livelli di cortisolo, ormone dello
condizionatamente essenziali, la cui nel muscolo, dove rappresenta il stress con documentato effetto cata-
disponibilità permette all’organismo 65% degli AA presenti, la glutam- bolico in laboratorio e in vivo
di accedere alle molecole che gli mina viene utilizzata dal nostro cor- (36,37). L’associazione zinco-ma-

38
PROGRESS IN NUTRITION 1/2013

gnesio si è dimostrata in grado di to gastroenterico. In caso di apporto of the European Communities,


influenzare positivamente gli ormo- elevato, l’eccesso viene rapidamente 1993), considerando un apporto
ni anabolici (testosterone) e di con- escreto nelle urine (39,41). proteico pari a circa il 15% dell’e-
seguenza la forza muscolare in spor- Con il termine di vitamina B6 ven- nergia della dieta, nell’adulto e nel
tivi professionisti (38). gono compresi tre composti meta- bambino. Tale raccomandazione
Il calcio svolge diverse funzioni nel bolicamente convertibili tra loro: la viene pertanto adottata anche nella
nostro organismo: permette la con- piridossina, il piridossale e la piri- nuova edizione dei LARN (39,41).
trazione della muscolatura liscia e la dossamina. Questi ultimi composti Le numerose funzioni attribuite alla
liberazione di glicogeno, permette il sono metabolicamente attivi e si tro- vitamina C (acido L-ascorbico) so-
rilascio di insulina e degli ormoni vano legati a numerosi enzimi che no riconducibili alla sua capacità di
steroidei, favorisce l’aggregazione intervengono in massima parte nel ossidarsi (in acido deidroascorbico,
piastrinica, regola l’attività enzimati- metabolismo degli aminoacidi e di dotato anch’esso di attività vitamini-
ca, costituisce, insieme ai fosfati, il altre sostanze azotate (reazioni di ca) e di ridursi reversibilmente. La
tessuto osseo, favorisce la comunica- transaminazione, decarbossilazione vitamina C introdotta con la dieta
zione tra le cellule, modula il rilascio e racemizzazione). Questo spiega viene assorbita dalla mucosa dell’ap-
di segnali nervosi, permettendo la come dall’apporto di questa vitami- parato digerente (stomaco e intesti-
fisiologica contrazione muscolare na con la dieta dipenda la buona no tenue) mediante un processo di
(39,40). utilizzazione delle proteine alimen- diffusione passiva. L’assorbimento è
La vitamina B1 (tiamina) ha un tari. La vitamina B6 è anche impli- quasi completo a basse dosi; a dosi
ruolo importante nella decarbossila- cata in alcune reazioni del metaboli- più elevate diminuisce fino a rag-
zione ossidativa del piruvato e smo glucidico (glicogenolisi) e lipi- giungere valori del 16%. La quantità
dell’α-chetoglutarato nel ciclo di dico (sintesi degli acidi grassi insatu- totale di vitamina C nel corpo di un
Krebs e nella reazione transchetola- ri). La vitamina B6 è largamente adulto normale è intorno ai 1500
sica nel ciclo dei pentosi fosfato diffusa negli alimenti di origine sia mg. La carenza grave di vitamina C
(importante per la produzione di animale che vegetale. Per la stretta porta ad un quadro clinico cono-
NADPH e di ribosio 5-fosfato). dipendenza con il metabolismo sciuto sin dai tempi antichi con il
Essendo idrosolubile, una grande aminoacidico, il fabbisogno di que- nome di scorbuto, e caratterizzato
quantità di vitamina B1 viene persa sta vitamina viene calcolato in fun- da fragilità ed emorragia capillare
durante la cottura: nei legumi circa il zione del contenuto proteico della diffusa dovute in particolare alla
40%, nelle carni circa il 30%, nelle dieta. Sulla base di studi di deple- mancata formazione di matrice ex-
uova il 25% e nei cereali il 10%. I li- zione e replezione proteica, con mi- tacellulare e collagene. La vitamina
velli di assunzione raccomandati dal sure dello stato di nutrizione per la C è largamente diffusa negli ali-
LARN sono di 0,4 mg/1000kcal vitamina B6, si è visto che un livello menti di origine vegetale; particolar-
con un minimo di 0,8 mg/giorno di 13 mg/g di proteine alimentari mente ricchi sono gli agrumi, i kiwi,
nel caso di diete al di sotto delle era in grado di mantenere un buono i peperoni, i pomodori e gli ortaggi a
2000 kcal/giorno. Deficienze croni- stato di nutrizione vitaminica. Per- foglia verde. La verdura e la frutta
che di vitamina B1 portano altera- tanto il Comitato Scientifico Euro- che vengono conservate per lungo
zioni a carico del metabolismo ener- peo ha fissato una raccomandazione tempo prima di essere consumate,
getico, del sistema nervoso, del si- per l’adulto pari a 1,5 mg per 100 g subiscono però ingenti perdite vita-
stema cardiovascolare e dell’appara- di proteine alimentari (Commission miniche (39).

39
VOLUME 15

Figura 3 - Effetto di una strategia di integrazione selettiva con Rebilfast® (a base di Aminoacidi Ramificati (BCAA) e Creatina)
sulla capacità di esprimere forza dopo infortunio (42).

SCOPO DELLO STUDIO Metodo:


Valutare l’effetto di un integratore (Rebilfast®) a base di creatina ed ami- I due gruppi hanno assunto in doppio cieco rispettivamente un integrato-
noacidi ramificati nel recupero muscolare post-traumatico o post-chirurgi- re ed un placebo.
co a dosaggi non farmacologici L’elaborazione finale dei dati è stata eseguita da personale esterno
esperto in statistica.
MATERIALI E METODI Gli esercizi erano standardizzati secondo schemi riabilitativi specifici e la
Reclutamento quantità di integratore standard era stata valutata secondo un questiona-
- 14 pazienti (12 uomini, 2 donne), età 22-38 anni, suddivisi in due gruppi da rio alimentare dato ai pazienti.
7 in maniera random Parametri valutati in dinamometria isocinetica:
- Ipotrofia post-trauma e /o post-intervento di un quadricipite rispetto al- 1) massimo momento di forza (MMF, Nm); 2) Massimo lavoro per ripeti-
l’altro (23% circa) zione (MLR, J); 3) Massima potenza istamtanea (MPI W/kg)

Sviluppo dello studio

Guppo 1: Guppo 2:
Valutazione iniziale parametri
Trattamento con Trattamento con
isocinetici sui 14 pazienti
INTEGRATORI PLACEBO

POSOLOGIA: Valutazione parametri


Rebilfast® 2 buste isocinetici dopo 3 settimane
al giorno, tutti i giorni

Incremento relativo dei dati al test isocinetico


dopo le prime 3 settimane
+32,9% +29,3% +31,3%

20,00

15,00
%

10,00

5,00

0,00
Max Mdf Max lavoro per rip Max potenza ist
(ext) (ext) (ext)

Integratore Placebo
Guppo 1: Guppo 2:
Trattamento con Trattamento con
PLACEBO INTEGRATORI
CROSS OVER

Valutazione parametri POSOLOGIA:


isocinetici dopo 3 settimane
Rebilfast® 2 buste
al giorno, tutti i giorni

Incremento relativo dei dati al test isocinetico


dopo le ultime 3 settimane
+39,8% +51,3% +53,4%
10,00
8,00

6,00
%

4,00

2,00
0,00
Max Mdf Max lavoro per rip Max potenza ist
(ext) (ext) (ext)

Integratore Placebo

CONCLUSIONI
Nello studio condotto, si è ossevato un aumento significativo dei paramentri isocinetici nel campione trattato rispetto al placebo. Pertanto, il processo riabilitativo
dei calciatori infortunati può risultare significativamente influenzato dalle scelte alimentari, con particolare riferimento all’integrazione con BCAA e creatina.

40
PROGRESS IN NUTRITION 1/2013

Conclusioni tiva, che preveda l’utilizzo di inte- sportivo. Aspetti clinici, riabilitativi e
gratori come BCAA, creatina, argi- medico-legali, 2000
7. Pedersen B, Febbraio M. Muscle as an
La corretta gestione clinica del re- nina, L-glutamina, sali minerali e endocrine organ: focus on muscle-der-
cupero post-infortunio rappresenta vitamine, si è dimostrata ben tolle- icved inteerleukin-6. Phsiol Rev 2006;
un obiettivo prioritario da perse- rata ed efficace nel migliorare i 88: 1379-1406,
guire sia negli atleti professionisti parametri di valutazione dei sog- 8. Kortebein P, Brock Symons, Ferrando A
et al. Functional impact of 10 days of
che nella popolazione in genere e getti studiati, accelerando i tempi bed rest in healthy older adults. J of
può giovarsi in misura significativa di recupero, migliorando l’outcome Gerontology 2008; 63 (10): 1076-1081
dell’intervento dietoterapico. Nu- e riducendo il rischio di danni se- 9. Bajotto G, Shimomura Y. Determinants
merose esperienze confermano co- condari all’immobilità forzata post- of disuse induced skeletal muscle atro-
phy: exercise and nutrition countermea-
me il supporto nutrizionale possa infortunio (42). La disponibilità di sures to prevent protein loss. J Nutr Sci
ridurre la perdita di massa magra in prodotti che offrono dosaggi otti- Vitaminol 2006; 52: 233-247
corso di periodi prolungati di ripo- mizzati dei diversi integratori uti- 10. Paddon Jones D, Scheffield-Moore M,
so forzato (17) o migliorare la ca- lizzabili in un’unica somministra- Cree MG et al. Atrophy and impaired
muscle protein synthesis during pro-
pacità di esprimere forza dopo in- zione, può offrire al clinico un effi- longed inactivity and stress. The J of Cl
fortunio (Fig. 3). Ferma restando cace strumento di integrazione se- End and Met 2006; 918 (12), 4836-
l’importanza fondamentale di una lettiva, semplice da assumere ed in 4841
corretta dieta, l’impostazione di grado di ottimizzare la compliance 11. Montagna G, Rucci S, Tamburo S,
Sponsiello N. Nutrizione nella gestione
una strategia di integrazione selet- del paziente anche per periodi pro- dell’infortunio muscolo scheletrico. Riv-
lungati (Tab. 4). ista della Società Italiana di Medicina
Tabella 4 - Composizione di un inte- Generale 2011; 6: 1-4
12. Wall R, Paul Ross R, Fitzgerald GF,
gratore selettivo complesso (Rebil-
Stanton C. Fatty acids from fish: the an-
fast®) References ti-inflammatory potential of long-chain
Creatina 3.000 mg omega-3 fatty acids. Nutrition Reviews,
1. Junge A, Langevoort G, Pipe A et al. 2010; 68 (5): 280-289
Leucina 2.500 mg Injuries in team sports tournament dur- 13. Serafini m, Ghiselli A, Ferro-LuzziA.
ing the 2004 Olympic Gam. Am J of In vivo antioxidant effect of green and
Isoleucina 1.250 mg
Sports Med 2006; 34(4): 565-576 black tea in man. Europea J of Clinical
Valina 1.250 mg 2. Dvorak J, Junge A. Football injuries and Nutrition 1996; 50(1): 28-32
physical symptoms: a review of the liter- 14. Demling RH. Nutrition, anabolism and
Alanina 500 mg
ature, American Journal of Sports Med- the wound healing process: an overview.
Glutammina 500 mg icine 2000; 28(S5), S3-S9 Eplasty 2009; 9: 65-94
3. Craig TT. Comments in Sports Medi- 15. Kornasio R, Riedere I, Butler-Browne
L-Arginina 400 mg
cine, American Medical Association G et al. Beta-hydroxybetamethilbtyrate
Calcio 240 mg Pubb, Chicago, 1973 (HMB) stimulates myogenic cell prolif-
4. Reid DC. Sports injury assessment and eration, differentiation and survival via
Vitamina C 120 mg
rehabilitation. Churchill Livingstone, the MAPK/ERK and PI3K/Akt path-
Glicina 100 mg New York, 1992, pp 282–289, ways. Biochin Biophys Acta 2009; 1793:
5. Kouvalchouk JF, Durey A. Pathologie 755-776
Magnesio 120 mg
traumatique du muscle striè chez le 16. Allen DL, Cleary AS, Lindsay SF et al.
Zinco 7 mg sportif, Editions Techniques Encycl. Myostatin eexpression is increased by
Med. Chir. Paris, 1992 food deprivation in a muscle-specific
Vit B6 1 mg
6. Nanni G, Roi GS, Vasapollo D. Le le- manner and contributes to muscle atro-
Vit B1 0,7 mg sioni muscolari dell’arto inferiore nello phy during prolonged food deprivation

41
VOLUME 15

in mice. J Appl Physiology 2010; 109: N, Kobayashi H, Mawatari K. Nu- men using creatine supplementation. J
692-701 traceutical effects of branched-chain Int Soc Sports Nutr 2011; 8(1): 17-27
17. Paddon-Jones D, Sheffield-Moore M, amino acids on skeletal muscle, J Nutr 33. Burke DG, Philip D. Chilibeck, K.
Randall J et al. Essential Amino-acid 2006; 136 (2), 529S-532S Davison S, Candow DG, Farthing J,
and carbohydrate supplementation 26. Blomstrand E, Eliasson J, Karlsson HK, Smith-Palmer T. The effect of whey
ameliorates muscle protein loss in hu- Köhnke R. Branched-chain amino acids protein supplementation with an d
man during 28 days bed-rest. The J of activate key enzymes in protein synthe- without creatine monohydrate com-
Cl Endocrinolog y & Metabolism sis after physical exercise. J Nutr 2006; bined with resistance training on lean
2004; 89(9): 4351-4358 136 (S1), 269S-273S tissue mass and muscle strength. Inter-
18. Antonio J, Street C. Glutamine: a po- 27. Karlsson HK, Nilsson PA, Nilsson J, national Journal of Sport Nutrition
tential useful supplement fot atlete. Chibalin AV, Zierath JR, Blomstrand and Exercise Metabolism, 2001
Canadian J of Appl Physiology 1999; E. Branched-chain amino acids in- 34. De Bandt. Cynober: Amino acids with
24: 1-14 crease p70S6k phosphorylation in hu- anabolic properties . Curr Opin Clin
19. Mac Dougall JD et al. The time course man skeletal muscle after resistance Nutri Metab Care 1998; 1(3): 263-272
for elevated muscle protein synthesis exercise. Am J Physiol Endocrinol 35. Arwert LI, Deijen JB, Drent ML. Ef-
following heavy resistance exercise. Metab 2004; 287(1): E1-7 fects of an oral mixture containing
Canadian J of Appl Phhysiology 1995; 28. Borgenvik M, Apró W, Blomstrand E. glycine, glutamine and niacin on memo-
20: 480-486, Intake of branched-chain amino acids ry, GH and IGF-I secretion in middle-
20. Tipton KD et al. Timing of aminoacid influences the levels of MAFbx mR- aged and elderly subjects. Nutr Neu-
and carbohydrate ingestion alters ana- NA and MuRF-1 total protein in rest- rosci 2003; 6(5): 269-75
bolic response of muscle to resistance ing and exercising human muscle, Am 36. Golf SW et al. Plasma aldosterone, cor-
exercise. Am J of Physiology 2001; J Physiol Endocrinol Metab 2012; 1, tisol and electrolyte concentrations in
281, E197-206 302(5): E510-21, physical exercise after magnesium sup-
21. McArdle WD, Katch FI, Katch VL. 29. Bajotto G, Sato Y, Kitaura Y, Shimo- plementation J of Cl Chemistry and Cl
Alimentazione nello Sport, Casa Ed- mura Y. Effect of branched-chain Biochemistry 1984; 22: 717-721
itrice Ambrosiana, Milano, 2001 amino acid supplementation during 37. Crowley MA, Matt KS, Hormonal reg-
22. Topi G. L’alimentazione dell’atleta. Lin- unloading on regulatory components ulation of skeletal muscle hypertrophy
eamenti di fisiologia della nutrizione e of protein synthesis in atrophied soleus in rats: testosterone-cortisol ratio. Euro-
dietetica generale applicata allo sport, muscles. Eur J Appl Physiol 111(8), pean J of Applied Physiology 1996; 73
Lombardo Editore, Roma, 2003 1815-1828, 2005 (1-2): 66-72,
23. Howatson G, Hoad M, Goodall S, 30. Rawson ES, Volek JS. Effects of crea- 38. Brilla LR, Conte V. Effect of a novel
Tallent J, Bell PG, French DN. Exer- tine supplementation and resistance zinc-magnesium formulation on hor-
cise-induced muscle damage is re- training on muscle strength and mones and strength. J of Excercise
duced in resistance-trained males by weightlifting performance. J Strength Physiology 2000; 3(4): 26-36
branched chain amino acids: a ran- Cond Res. 2003; 17(4): 822-831, 39. Arsenio L, Strata A. Alimentazione ed
domized, double-blind, placebo con- 31. Kilduff LP, Vidakovic P, Cooney G, esercizio fisico, Guatteri SPA (RE),
trolled study. J Int Soc Sports Nutr Twycross-Lewis R, Amuna P, Parker 1995
2012; 9(1): 20-28 M, Paul L, Pitsiladis YP. Effects of 40. Cerretelli P, Strata A. Linee guida per
24. Luz CR, Nicastro H, Zanchi NE, creatine on isometric bench-press per- una corretta alimentazione del calcia-
Chaves DF, Lancha AH Jr. Potential formance in resistance-trained hu- tore. Guatteri SPA (RE), 1993
therapeutic effects of branched-chain mans. Med Sci Sports Exerc 2002; 41. SINU, LARN: Livelli di assunzione
amino acids supplementation on re- 34(7): 1176-1183. raccomandati degli alimenti, 2006
sistance exercise-based muscle damage 32. Souza-Junior TP, Willardson JM, 42. Pongolini M, Bonazzi I, Cioni F. Effica-
in humans. J Int Soc Sports Nutr Bloomer R, Leite RD, F leck SJ, cia e sicurezza dell’impiego clinico di un
2011; 14, 8-23 Oliveira PR, Simão R. Strength and integratore funzionale (Rebilfast®) nel
25. Shimomura Y, Yamamoto Y, Bajotto hypertrophy responses to constant and percorso di recupero muscolare post-in-
G, Sato J, Murakami T, Shimomura decreasing rest intervals in trained fortunio. Gimar 2012; 3: 3-10

42
ORIGINAL A RT I C L E

C. PASTA1, G. CORTESE1, Consumers ability to discern food


G. MARINO3, G. LICITRA1,2,3 quality under blind conditions

PROGRESS IN NUTRITION
VOL. 15, N. 1, 43-52, 2013 Summary
Purpose: This study aims to investigate consumers ability to discern food
product quality in absence of information compared to mass products.
TITOLO Design/methodology/approach: Milk types were selected in order to satisfy
Abilità dei consumatori nel two dimensions: fat content and quality difference. Two experiments
saper distinguere la qualità di were run: in the first standardized or mass milks (Ultra-High-Tempera-
un prodotto alimentare in ture /UHT) were compared considering the fat dimension (3.5% vs
assenza di informazioni 1.8%), whereas in the second experiment quality milks were compared
according to quality attributes (Whole Fresh High Premium Quality
KEY WORDS Milk vs Raw Milk). In both experiments, consumers performed a trian-
Milk, consumer behaviour, gle test and filled a computerized form indicating the odd milk, their
intrinsic quality, preferences, preference, habits of consumption as well as demographic information.
information Findings: Consumers both inability and ability to spot the odd milk was
not affected by preference or consumption habits. Results showed that in
PAROLE CHIAVE absence of information consumers easily detected high quality products
Latte, Comportamento dei rather than standardized or mass products. In fact, between standardized
consumatori, qualità intrinseche, (UHT milk types) 64% of participants did not spot correctly the odd
preferenza, informazione milk (p<0.01) whereas, when quality milks were compared, 63 % of par-
ticipants detected correctly the odd one (p<0.01). Conclusion: What af-
fects consumers milk preference and attitude is quality, in absence of in-
formation as well as products awareness. Therefore, the sector needs to
highlight quality characteristics in marketing strategies.
1
Marketing Sperimentale,
CoRFiLaC, Ragusa, Italia Riassunto
2
DISPA (Dipartimento Scienze Obiettivo: Il presente studio si pone come obiettivo primario di capire se
Produzioni Agro-Alimentari),
i consumatori sono in grado di distinguere un prodotto di qualità da un
Università di Catania, Catania, Italia
prodotto di massa in assenza di informazioni. Metodo: Le tipologie di
3
Laboratorio Sensory, CoRFiLaC,
Ragusa, Italia latte da mettere a confronto, sono state selezionate secondo due criteri
principali: il contenuto in grassi e la qualità del prodotto. Due esperi-
Address for correspondence: menti sono stati condotti. Nel primo esperimento sono state confrontate
Ms. Catia Pasta
CoRFiLaC, Department of Experimental due tipologie di latte standardizzato, tipico del consumo di massa (Ultra-
Marketing Sp 25 Ragusa Mare km 5 High-Temperature/UHT) tenendo conto come carattere distintivo il
Zip code 97100, Ragusa, Italy contenuto in grassi (3.5% vs 1.8%). Nel secondo esperimento invece due
Tel. +39 0932 660459
Fax: +39 0932 660448 tipologie di latte sono state comparate sotto l’aspetto qualitativo tenendo
E-mail: catiapasta@corfilac.it conto delle caratteristiche intrinseche del prodotto (Latte Fresco di Alta

43
VOLUME 15

Qualità vs Latte Crudo). In entrambi gli esperimenti i consumatori sono


stati sottoposti ad un test triangolare. Oltre al prodotto diverso, la pref-
erenza, le abitudini di consumo e informazioni di tipo demografico veni-
vano rilevati a mezzo di un software. Risultati: L’abilità o l’inabilità di un
consumatore a saper distinguere il campione differente nel test triango-
lare, non veniva in alcun modo influenzata dalla preferenza o dalle abitu-
dini di consumo. I dati indicano che, in assenza di informazioni, i con-
sumatori riescono facilmente a discernere tra un prodotto di qualità
rispetto a un prodotto standardizzato o di massa. Infatti, quando i
prodotti messi a confronto erano entrambi di massa (UHT) ben il 64%
dei partecipanti non riesce a individuare il campione differente (p<0.01),
mentre nel confronto tra la qualità ben il 63% dei consumatori riesce a
distinguere il diverso (p<0.01) senza alcuna informazione. Conclusione:
La qualità è un fattore che influenza il consumatore quando non dispone
di alcuna informazione sul prodotto. Strategie di marketing nel settore
del latte fresco, dovrebbero essere maggiormente incentrate sulla valoriz-
zazione delle caratteristiche qualitative intrinseche dei prodotti stessi.

Introduction quality under uncertainty, such as consumers. Furthermore, accord-


purchase situation or lack of infor- ingly two different schools of
What makes a consumer to in- mation (7). Consumers tend to get thoughts, the subjective dimension
dentify a quality product? This is the best quality for a good price, has two approaches: holistic and
an issue that many marketers tend but finding out the best quality is excellence. For the holistic approach
to analyse everyday because quali- not so easy. Even supplying more quality concerns all the desirable
ty is one of those concepts to information to consumers the properties a product is perceived
which consumers attribute differ- problem can remain unsolved be- to have. The excellence approach
ent meanings. Many studies, fo- cause information may be not tak- goes along with the product-ori-
cused on the importance of food en into account or misinterpreted ented quality (8) and suggests that
quality, demonstrated that quality (7). Thus, consumers quality per- products have desirable properties
dimensions and considerations are ception is determinant for the that consumers do not consider as
really important in any food pur- purchase act. part of quality (7). The goal is to
chase (1-7). However, the way There is a general agreement that educate consumers to recognize
consumers make food choice is quality has an objective and subjec- these properties that most of the
complex. For this reason, market- tive dimension. Objective quality time are intrinsic to the product.
ing researchers are commonly in- includes product physical charac- Intrinsic characteristics are strong-
terested in understanding how teristics. Whereas Subjective quali- ly tied to food hedonic character-
consumers form judgments of ty is the quality as perceived by istics, including taste that repre-

44
PROGRESS IN NUTRITION 1/2013

sent a central dimension for con- their superiority respect to com- quality can differ from the effec-
sumers: the experience character- modity or conventional foods, es- tive ones (18). Thus quality evalu-
istic of a product that elicit expec- pecially for occasional consumers ation is for some aspects subjective
tations about the hedonic and in (13-14). This is the key point of and depends on many factors such
turns affect the purchase act (8). the present study: taste experience as context, environment and infor-
Thus, intrinsic quality cues rely to and quality recognition based on mation. However, we believe that
physical, technical, and physiolog- intrinsic cues rather than external some food products hold unmis-
ical characteristics of the product. ones. takable quality and for this reason
But, quality expectations are based In fact, it has been demonstrated are easy to recognize, independ-
also on information availability at that when products are presented ently from the presence of external
the moment of the purchase act without labels or brands, con- cues including visible information.
(9-10) representing the extrinsic sumers tend to evaluate products These products most of the time,
cues which are all other character- similarly even if products are dif- even if from a sensorial point of
istics such as brand name, packag- ferent, or even when consumers view might be more enjoyable
ing, price, and so on (8, 11). are testing their favourite ones than well known products, are in-
However, previous studies demon- (15). Why this happens? Because apt to elicit similar or strong emo-
strated that mass or standardized consumers before the purchasing tions during the conscious con-
productions exposed without act strongly rely on external cues sumption act (17), but can be
brand, packaging, or description for their decision making. Cues more appreciated during the un-
concerning internal cues, do not that are able to affect consumers conscious one.
have such as this intrinsic charac- decisions since youth (16) gener- Consumers in front of products
teristics able to induce consumers ating quality expectation (7), usu- without information are not able
to make a defined choice and a ally inferred but not actually expe- to spot their favourite food among
precise evaluation. Whereas, foods rienced. standardized quality of mass prod-
strongly tied to the biodiversity According to some studies, quality ucts, but they might be able to
factors are better evaluated and perception is addressed by four distinguish among products with
perceived in terms of quality universal dimensions: taste and high intrinsic quality. Therefore,
thanks to their intrinsic compo- appearance, health, convenience, this study will try to answer to the
nents, easy to recognize by con- and process (8) being quality a following research questions:
sumers in absence of information multidimensional concept arising Question 1: In absence of infor-
because of their sensory attributes from the variety of characteristics mation supply, meaning external
(12). and attributes that a product owns cues, are consumers able to recog-
Sensory attributes are perceived in (17). The key point is to under- nize the odd product in a compar-
different ways by consumers, but stand what consumers perceive as ison among standardized or mass
taste is the most relevant “experi- quality products. Indeed, in order products even when they are product
ence characteristic”. Organic con- to evaluate a product consumers frequent users?
sumers in a study showed a ten- rely on cues they might disagree in Question 2: In absence of infor-
dency to attribute a better taste to different contexts of consumption mation supply, meaning external
organic products, even if little sci- on the quality of an identical cues, are consumers able to spot
entific evidence exists concerning product because the perceived between standardized and not stan-

45
VOLUME 15

dardized products, characterized by ment in fact the WFHPQ milk we needed to strengthen the idea
intrinsic qualities, even when they undergoes to a gentle temperature that between mass milk types does
are not product users? pasteurization treatment that is the not exist any difference. To justify
closest as possible to raw milk type this hypothesis, it was necessary to
that indeed is supposed do not reduce the error by increasing the
Methodology have any type of heat treatment. number of participants in the first
For definition raw milk does not experiment (Exp 1).
Products undergo to any heat treatment In both experiments a triangle test
(Table 1). (α=0.05, β=0.10, pd =40%, π=0.33)
Milk types were chosen in order Thus two different milks also was performed by consumers. By
to satisfy two dimensions: the first branded differently were used in the master card of the Com-
dimension consider milk fat con- the second experiment. In order to pusense® version 4.6 (19) sets of
tent difference in mass standard- be sure about raw milk safety, raw three small plastic glasses were
ized milk, whereas the second di- milk before data collection under- prepared containing on average
mension consider quality differ- went to microbiological analysis. 25-30 ml of milk. Plastic glasses
ences between fresh pasteurised Salmonella, listeria monocytogenes were labelled with a 3-digits ran-
high quality milk and raw milk. In and E-coli in all replicates resulted dom numbers. Per each set two
the first experiment, standardized negative. Thus, raw milk safety glasses contained the same milk
or mass milks were those that un- was guaranteed before proposing and one was different. Milk sets
derwent to the same UHT (Ultra- the milk to consumers. were presented to consumers in a
High-Temperature) heat treat- randomized and counterbalanced
ment, with the same brand but Procedure and Measures order. No information at all was
with a different fat content whole provided on the type of milk un-
and semi-skimmed. For experiment 1 using standard- der analysis, as well as nobrand
Whereas in the second experiment, ized or mass milks, 4 replicates of showed.
not mass products was the raw 30 consumers for a total of 120 At the beginning of the session,
milk whereas standardized milk people were planned. For experi- written consent forms were gath-
was the whole fresh high-premium ment 2 using standardized and not ered from participants. People ei-
quality milk ( WFHPQ Milk) 1, standardized milks 3 replicates of ther suffering from allergies or dis-
both characterized by specific in- 33 consumers were planned. The liking milk were not included. In
trinsic qualities. These were chosen number of participants in the two group of six, milk drinkers were in-
in order to be as much similar as experiments was different because vited to enter in the sensory lab
possible. In fact, both products
were whole milks with equal fat Table 1 - Products in Comparison per Experiment
content, with a different heat treat-
Experiment Products Temperature C° % Fat
1
High premium-quality milk is not a Exp1 Standardized Whole UHT 130-150°C 20 sec 3.5%
commercial advertisement on the good- Standardized Semi-skimmed UHT 130-150°C 20 sec 1.8%
ness of the product but a specific mer-
chandise strictly ruled by the law n° 169 Exp 2 Standardized WFHPQ Milk 72-80°C 15 sec >3.2%
del 3/5/1989. Not Standardized Raw Milk < 40°C >3.2%

46
PROGRESS IN NUTRITION 1/2013

and to sit in front of a computer 113 (64% female, age= 29±11) and Results
station. On the table, a set tray of 97 (50% female, age= 37±10)
with 3 coded-plastic glasses con- milk consumers participated at the Variables such as sex, profession,
taining milk was already disposed. study. Only milk drinkers were in- and set order presentation did not
Participants were required to fol- cluded in the analysis. People were affect our results (chi-square<2.70;
low the instructions indicated on recruited to participate in the p>0.05). For this reasons these
the screen and to answer accord- study during a public event taken variables will not be taken into ac-
ingly. As first indication, partici- at the CoRFiLaC, a dairy research count.
pants were invited to smell and centre located in Ragusa (Italy).
taste milk samples in the order Question 1: Consumers ability to
provided from left to right, trying Analysis of the Data discern between standardized/mass
to spot the odd one, providing the milk types
only indication that only one type Data were collected by Com- Between UHT whole milk and
was different among the three pusense® version 4.6 (19) and an- UHT semi-skimmed milk overall
samples. Once the answer was alyzed using JMP 8.0.1 software consumers in the 64% of the cases
gathered, then on the screen it was (20). Data were analyzed accord- did not spot correctly the odd milk
required to indicate which milk ing to one tail triangle test to asses (π=0.50; p<0.01). Exactly the same
was the most preferred among the the ability to spot the different results were obtained in each repli-
three samples already tasted. Con- product and preference. Binomial cate as showed in table 2 (Triangle
sumers then indicated their con- statistics and chi-square tests were test α=0.05, β=0.10, p d =40%,
sumption habits in terms of milk applied to identify sensorial differ- π=0.33).
type use among “whole milk”, “se- ences, correspondence between Thus, consumers independently
mi-skimmed milk”, “skimmed preference and consumption from demographic factors and or-
milk” and “none of the above”. In habits. Analysis was performed der of set presentation were not
the second experiment this list raw per replicate set of consumers and able to spot the odd milk between
milk was also included. Finally, on the overall total number of the two UHT milk types in com-
consumers were required to insert consumers obtaining the same re- parison. Because this could de-
demographic information such as sults. Tests were considered signif- pend on habits of consumption
gender, age, and profession. Dum- icant at a level of α=0.05. this was gathered per single par-
my variables were used to analyse ticipant and taken into account.
data2.
Table 2 - Exp. 1 Ability of consumers to spot the odd product between stan-
Sampling
dardized whole UHT and semi-skimmed UHT milk (n=113) per replicate

In the first and in the second ex- Replicate N. Correct Incorrect Confidence p-value
periment respectively a total of Answers Answers
1 16 7 9 0.74 0.26
2
Procedural details for the present study 2 30 12 18 0.72 0.28
and copies of the measurement instru- 3 32 10 22 0.34 0.66
ments are available from the authors. 4 35 12 23 0.48 0.52

47
VOLUME 15

From declared consumption sumers this time were able to spot the odd milk between the two
habits, data showed that 65% of correctly the odd milk (π=0.50; p products in comparison.
participants consume the semi- < 0.01). Exactly the same results Once again, the further key point
skimmed milk, 23% are whole were obtained in each replicate as to demonstrate was the lack of re-
milk oriented, 8% indicate totally showed in Table 3 (Triangle test α lationship between preference and
skimmed milk and only 4% indi- = 0.05, β =0.10, pd = 40%, π=0.33). declared consumption habits. In
cate “none of the above options”. Even in this case ability to spot fact, when we asked consumers to
Therefore, on average consumers the odd milk was not related to indicate which milk they preferred
were products users of both whole demographic factors and to con- the most, 75% of the participants
and semi-skimmed milk, but were sumers habit of consumption. significantly indicated to prefer
not able to recognize the odd milk Consumers declared to be in 54% WFHPQ milk (n=97, π=0.50;
between the two in comparison. of the cases semi-skimmed milk p<0.01). Once again, looking at
The further key point was to users, 26% were skimmed milk the data per single triangle repli-
demonstrate that preference was users, 15% whole milk users and cate (α = 0.05, β =0.10, pd = 40%,
not related to declared consump- only 3% were raw milk users. The π=0.33) a similar result was found
tion habits. In fact, when we asked remaining 2% indicated “none of in all replicates (Table 3a).
consumers to indicate which milk the above options”. On average In the second experiment, in 94%
they preferred the most, taking in- consumers were not products users of the cases, habits of consump-
to account all participants in a but were able to recognize easily tion and preference did not match
blind condition, 63% significantly
(n=113, π=0.50; p<0.01) indicated Table 2a - Exp. 1 Consumers preference for UHT milk types (n=113) per
unconsciously UHT whole milk. replicate
Thus considering data from trian- Replicate N. Whole UHT Semi-skimmed Confidence p-value
gle test per single replicate (α=0.05,
β=0.10, pd =40%, π=0.33) a similar
Milk UHT Milk
1 16 8 8 0.90 0.10
result was found with the exception
2 30 19 11 0.99 <0.01‡
of the first one (Table 2a)
3 32 20 12 1.00 <0.01‡
Besides, in 64% of the cases, 4 35 24 11 1.00 <0.01‡
habits of consumption and prefer-

values are significantly different with a p<0.01
ence did not match (n=113,
π=0.50; p<0.01).
Table 3 - Exp. 2 Ability of consumers to spot the odd product between raw
milk and WFHPQ a milk with intrinsic qualities (n=97) per replicate
Question 2: Consumers ability to
discern between standardized and Replicate Number of Correct Incorrect Confidence p-value
not standardized milk characterized participants Answers Answers
by intrinsic qualities 1 35 25 10 1.00 <0.01‡
Between raw milk (not standard- 2 40 22 18 0.96 <0.01‡
ized) and Whole Fresh High-Pre- 3 22 14 8 0.99 <0.01‡
mium Quality Milk (standard- a
WFHPQ= Whole Fresh High-Premium Quality milk.
ized), overall 63% of the con- ‡
values are significantly different with a p<0.01

48
PROGRESS IN NUTRITION 1/2013

Table 3a - Exp. 2 Consumers preference for WFHPQ= Whole Fresh High- easier to digest. This is a miscon-
Premium (n=97) per replicate ception attributable to informa-
Replicate N. WFHPQ a Milk Raw Milk Confidence p-value tion misinterpretation. On the
base of consumers’ declarations,
1 35 27 8 1.00 <0.01‡
two comments at this key point
2 40 22 18 0.99 <0.01‡
are needed. First of all, consumers
3 22 12 10 0.96 <0.05 †
use semi-skimmed milk, declare to
a
WFHPQ= Whole Fresh High-Premium Quality milk.

values are significantly different with a p<0.01.
prefer it, but are not able to recog-

values are marginally significant with a p<0.05. nize it. Their declared preference
is mainly tied to habits of con-
(n=97, π=0.50; p<0.001), implying pasteurized fresh milk the 26%, sumption and credence informa-
that on average people were not and the remaining 6% was repre- tion rather than on experienced
product users but strongly tended sented by functional milk types4. actual taste pleasantness as showed
to prefer the premium quality As showed by national data con- in our analysis. In fact in both ex-
whole milk very far away in terms cerning Italy provided by CLAL periments, people preferred the
of quality from the semi-skimmed in 2011, the most frequent milk whole milk with a richer taste.
type. purchase and consumption is ori- This is attributable to the higher
ented to UHT type. The high presence of fat content that plays
market share of the UHT milk an important role in determining
Discussion might be attributed to the expec- flavour and palatability (22). Dairy
tation that consumers have on the fats are particularly palatable be-
Even though milk and milk prod- safety and quality of this type of cause of the large number of small
ucts intake in a sufficient amount milk especially in the semi- molecular size lipids. In specific,
is recommended for health of hu- skimmed form. There are several milk lipids contain a wide range of
mans, consumers’ fluid milk con- reasons explaining why consumers short-chain fatty acids (butirric,
sumption is bizarre. In Italy, in the prefer to purchase processed fluid capronic, caprilic, and caprinic)
last decade cow drinking milk milk rather than unprocessed fluid that are volatile molecules and
production and consumption de- milk. Usually, the preference is thus perceptible as aroma, flavour
creased respectively of 7% and driven by the cost. Processed fluid and mouth feel (23). Surely,
14%, respectively, although the milks are cheaper than processed flavour is the most crucial concept
magnitudes differ for specific fluid fluid milk as its supply involves for defining quality (24).
milk types 3 . In the first four fewer costs, because of its guaran- Once the fat content is reduced (as
months of 2010, family UHT tee of quality, long shelf-life and in the semi-skimmed milk), these
milk consumption represented the packaging to carry and store (21). molecules are not available any-
54% of total selling, the whole Participants in this study declared more and in general milk turns out
fresh premium-quality milk repre- to consume semi-skimmed milk less tasty than the whole (raw) one
sented the 14% of the total selling, reasoning that this type of milk is (25). Removal or reduction of
lipids lead to unbalanced flavour,
3
http://www.clal.it/index.php?section=quadro_italia
and according to Ingham et al. (26)
4
http://www.clal.it/index.php?section=consumi&p=latte this happens because the non-polar

49
VOLUME 15

volatiles are no longer dissolved in Besides, temperature treatment af- declarations. This represent a limit
the lipid phase and released from fects milk taste. The UHT treat- of the present study. To improve
the food product as soon as eating ment tend to reduce enzyme con- our results it would be interesting
begins (26). Milk fat has texture, tent, because protein denature up- to arrange a further experiment in
taste and flavour commonly per- on heating above 70°C, high tem- which also this aspect would be
ceived as positive, but for the pres- perature lead to a cooked milk taken into account.
ence of cholesterol and a large flavour formation typical of the Thus, information and marketing
quantity of saturated fatty acids it UHT milk. All this causes a lower communication strategies create
has acquired a negative health rep- presence of aromatic compounds consumers belief and expectations
utation for consumers (27) when (27, 30). as visible external cues, damaging
they are aware of it. The second comment we would in some cases quality products that
Consumers are not able to form like to make is that consumers until when products are not expe-
correct hedonic expectations of misconception about their capaci- rienced cannot be correctly appre-
food quality because they use cues ty to digest better semi-skimmed ciated. In order to help the market
which are weakly related to hedo- milk is strongly related to milk fat of fresh milk, producers should
nic quality and often strongly rely content knowledge. Actually, bet- identify the objective and subjec-
on misinterpreted information (8). ter digestion does not depend only tive categories of the intrinsic
The use of extrinsic cues depend on fat content. An healthy organ- quality and the connections be-
on the extent to which consumers ism is able to digest any kind of tween them in order to supply the
believe these to be a quality indi- food. Inability do digest milk con- market with food suitable to con-
cator, thus it depends on cues cerns a lactase deficit, an intestinal sumers wishes. Raw milk and
credibility (8). enzyme that allows to divide and high-quality fresh milk need a
For instance, in a study of food ex- to absorb the most important sug- market share enlargement, and this
pectation based on steak evalua- ar component in milk that is the might be obtained thinking about
tion, steaks with the highest ex- “lactose”. Lactose maldigestion af- new market communication strate-
pectations were the least liked. fects about 75% of the worldwide gies that might lead consumers to
Expectations were generated by population (31, 32). Lactose intol- buy good quality products. Con-
more visible fat presence uncon- erance is common in many adults sumers need to be educated to rec-
sciously associated by consumers and is caused by deficiency of in- ognize quality characteristics and
with lower quality (6-7) whereas testinal lactase (33). Thus the this will be the key strategy for
the most liked then resulted those most important thing for each food products valorisation (12, 17).
with higher fat content. In the person is to establish individual This study should be useful in un-
present study a similar result was milk tolerance in order to avoid to derstanding consumer preference
showed for preference which was totally eliminate milk from a diet. for fluid milk choices which will
also in favour of a higher fat milk Ingesting milk with a meal may be help sellers and marketing partici-
content. This result that might ap- a good thing to improve tolerance pants to formulate appropriate
pear unexpected is justified by the (33). Unfortunately consumers marketing strategies that success-
fact that higher degree of fat lead misconception about milk diges- fully can target segments of con-
to more taste (28-29) and this is tiveness was not gathered quanti- sumers looking for intrinsic quality
even true for whole fresh milk. tatively, but was based on verbal and not for appearance.

50
PROGRESS IN NUTRITION 1/2013

There exists a need of product Acknowledgments duction and their impact on buying
repositioning based on flavour intention: the role of positive sensory
A special thank goes to the participants of experience. Agribusiness 2004; 20 (1):
richness, higher quality and hedo- 95-107.
this study. We thank also Margherita Cac-
nic enjoyment supported by edu- 7. Grunert KG. Food quality and safety:
camo and Nicoletta Fucà for the useful
cational strategies on milk quality advices and Claudia Conte for her support Consumer perception and demand.
recognition. This might lead to in the execution of experimental sessions. European Review of Agricultural Eco-
Financial support was provided by the As- nomics 2005; 32(3): 369-91.
higher consumer involvement and 8. Brunsø K, Fjord TA, Grunert KG.
sessorato Agricoltura e Foreste della Re-
loyalty. Consumers’ food choice and quality
gione Siciliana (Palermo, Italy).
perception. (MAAP working paper
77) 2002. Aarhus: Aarhus School of
Business.
Conclusions References 9. Olson JC, Jacoby J. Cue utilization in
the quality perception process. Pro-
This study has revealed that con- 1. Aakkula J, Peltola J, Maijala R, Si- ceedings of the 2nd Annual Convention
sumers in blind conditions in lack ikamäki J. Consumer attitudes, underly- of the Association for Consumer Re-
ing perceptions and actions associated search, Chicago 1972; 2: 167-79.
of external cues are not able to with food quality and safety. Journal of 10. Steenkamp JBEM. Conceptual model
distinguish between mass stan- Food Products Marketing 2005; 11 (3): of the quality perception process. J Bus
dardized products with different 67-87. Res 1990; 21: 309-33.
fat content, but easily detect the 2. Barjolle D, Sylvander B. Some factors 11. Szybillo GJ, Jacoby J. Intrinsic versus
of success for “origin labelled products” extrinsic cues as determinants of per-
odd milk between standardized in agri-food supply chains in Europe: ceived product quality. J Appl Psychol
and not standardized quality Market, internal resources and institu- 1974; 59 (1): 74-8.
products. This implies that there tions.. In Sylvander B, Barjolle, D, Arfi- 12. Pasta C, Cortese G, Campo P, Licitra
are certain types of food that own ni F. (Eds): The socio-economics of ori- G. Do biodiversity factors really affect
gin labelled products in agrifood supply consumers preferences? Progress in
intrinsic quality characteristics chains: Spatial, institutional and coordi- Nutrition 2009; 11 (1): 3-11.
that people might appreciate and nation aspects. Paris: INRA, pp. 1–21. 13. Gambelli D, Naspetti S, Vario. Why
evaluate positively if no external Available at http://www.origin- buy organic meat and milk? A qualita-
cues are provided. Unconscious food.org/pdf/ ismea1102.pdf (accessed tive study on the Italian market. Pro-
8 August 2011). ceedings of 1st SAFO workshop, So-
preference and decision making 3. Bredahl L. Cue utilisation and quality cio Economic Aspects of Animal
differ from conscious ones. Thus, perception with regard to branded Beef. Health and Food Safety in Organic
to match these two it is necessary Food Qual and Prefer 2003; 15: 65-75. Farming Systems. Florence, Italy, Sep-
to educate consumers to distin- 4. Fotopoulos C, Krystallis A, Ness M. tember 2003.
Wine produced by organic grapes in 14. Naspetti S, Zanoli R. 2Organic food
guish among typical food charac- Greece: Using meansend chain analysis quality and safety perception through-
teristics because as it was found to reveal organic buyers’ purchasing out Europe. Journal of Food Products
out, in lack of information quality motives in comparison to the non-buy- Marketing 2009; 15: 249-66.
affects consumers milk preference ers. Food Qual Prefer 2003; 14: 549-66. 15. Ralph IA, Kenneth PU Influence of
5. Grunert KG, Bredahl L, Brunsø K. beer brand identification on taste per-
and attitude is quality. Therefore, Consumer perception of meat quality ception. J Mark Res 1964; 3: 36-9.
the sector needs to strengthen and implications for product develop- 16. Robinson TN, Borzekowski DLG,
quality characteristics in new mar- ment in the meat sector - A review. Matheson DM, Kraemer HC. Effect
keting strategies. Meat Sci 2004; 66: 259-72. of fast food branding on young chil-
6. Grunert KG, Bech-Larsen T, Lähteen- dren’s taste preference. Arch Pediatr
mäki L, Ueland Ø, Aström A. Attitudes Adolesc Med 2007; 161: 792-97.
toward the use of GMOs in food pro- 17. Cavicchi A. Qualità alimentare e

51
VOLUME 15

percezione del consumatore. Agrire- 23. Varnam AH; Sutherland JP. Milk and Relating consumer perceptions of pork
gionieuropa 2008;4(15): 1-8. Available Milk Products: technology, chemistry quality to physical product characteris-
at http://www.agriregionieuropa. and microbiology, 2 nd ed. Gaithers- tics. Food Qual Prefer 1998; 9: 273-
univpm.it/pdf.php?id _articolo=386 burg, MD 2001: Aspen Publishers. 81.
(accessed 7 August 2011). 24. Drake MA. Defining Dairy Flavours. 29. Verbeke W, Viaene J. Consumer atti-
18. Steenkamp JEBM Product quality. An J Dairy Sci 2004; 87: 777-84. tude to beef quality labelling and asso-
investigation into the concept and how 25. Fucà N. Confocal Laser Scanning Mi- ciations with beef quality labels. J Int
it is perceived by consumers, (1989); croscopy applied to diary science: de- Food Agribus Mark 1999; 10: 45-65.
Van Gorcum, Assen/Maastricht. vice and perspectives. 2010; PhD The- 30. Gandy AL, Schilling MW, Coggins,
19. Compusense Inc. Compusense five: sis in DACPA, University of Catania, PC, White CH, Yoon Y, Kamadia V..
sensory data collection software, re- Catania, IT. (2008), The Effect of Pasteurization
lease 4.6. 2003 Guelph, ON, Canada. 26. Ingham KE, Taylor AJ, Chevance Temperature on Consumer Accept-
20. SAS Institute Inc. (2009). JMP® 8.0.1 FFV, Farmer LJ. Effect of fat content ability, Sensor y Characteristics,
Release Notes. Cary, NC: SAS Insti- on volatile release from foods. In Tay- Volatile Compound Composition, and
tute Inc. lor, A.J. and Mottram, D.S.(Ed.) Shelf-Life of Fluid Milk. J Dairy Sci
21. Tiryaki GY, Akbay C. (2010). Con- Flavour Science: Recent Develop- 2008; 91: 1769-77.
sumers’ fluid milk consumption behav- ments 1996; Royal Society Chemistry, 31. Insel P, Turner RE, Ross D. Nutrition.
iors in TURKEY: an application of London, UK, pp. 386-91. (2nd Ed.) 2004; Jones and Barlett Pub-
multinomial logit model. Qual Quant 27. Mellena M, Bot A. Microstructural lishers, Sudbury, MA.
2010; 44 (1): 87-98. aspects of protein-based drinks. In Mc 32. Insel P, Turner RE, Ross D. Nutrition
22. Croissant AE, Washburn SP, Dean Clements J (Ed): 2007; Understanding (3rd Ed.) 2007; Jones and Barlett Pub-
LL, Drake MA, Chemical properties and controlling the microstructure of lishers, Sudbury, MA.
and consumer perception of fluid milk complex foods, Uniliver Research ad 33. Haug A, Hostmark AT, Harstad OM.
from conventional and pasture-based Development Vlaardingen, The Bovine milk in human nutrition-a re-
production systems. J Dairy Sci 2007; Netherlands, pp: 622-47. view. Lipids health Dis 2007; 6 (25):
90 (11): 4942-53. 28. Bredahl L, Grunert K G, Fertin, C. 1-16.

52
ORIGINAL A RT I C L E

F. CAPONIO, G. BRUNO, Monoacilgliceroli e loro influenza


V.M. PARADISO, C. SUMMO, sull’evoluzione dei fenomeni ossidativi
T. GOMES
in oli vegetali purificati

PROGRESS IN NUTRITION
VOL. 15, N. 1, 53-57, 2013 Summary
An experimental investigation was carried out in order to verify the in-
fluence of monoacylglycerols on the oxidative processes in different veg-
TITLE etable oils. With this aim, three oils (soybean, sunflower, peanut) were
Monoacylglycerols and their purified in laboratory, added with 0.5% and 1% of monoacylglycerols
influence on the evolution of obtained in purity by purified soybean oil and submitted to accelerated
the oxidation in purified oxidation at 60°C for 10 days. The results showed that monoacylglyc-
vegetable oils erols slowed down the rate of oxidation when added to sunflower oil and
peanut oil, while they acted as pro-oxidants in soybean oil, showing
KEY WORDS therefore a different behavior depending on the fatty acid composition of
Monoacylglycerols, oxidation, the oils they are added to.
vegetable oils
Riassunto
PAROLE CHIAVE Un’indagine sperimentale è stata effettuata con lo scopo di verificare
Monoacilgliceroli, ossidazione, oli l’influenza dei monoacilgliceroli sui processi ossidativi in oli vegetali di
vegetali diversa origine botanica. A tal fine gli oli considerati (soia, girasole, ara-
chide) sono stati purificati in laboratorio, addizionati dello 0,5% ed 1%
di monoacilgliceroli ottenuti in purezza da un olio di soia purificato e
sottoposti ad ossidazione accelerata a 60°C per 10 giorni. I risultati otte-
Dipartimento di Biologia e Chimica nuti hanno evidenziato che i monoacilgliceroli determinavano un rallen-
Agro-Forestale ed Ambientale tamento dell’ossidazione quando addizionati agli oli di girasole e di ara-
(DIBCA), Sezione di Scienze e chide, mentre nell’olio di soia agivano come pro-ossidanti, denotando
Tecnologie Alimentari – Università quindi un differente comportamento in funzione della composizione aci-
degli Studi di Bari “Aldo Moro”, Bari dica degli oli nei quali si ritrovano.
Lavoro presentato al 10° Congresso
Italiano di Scienza e Tecnologia degli
Alimenti. Ricerche e Innovazioni
nell’Industria Alimentare,
Milano, 9-10 maggio 2011 Introduzione loro prodotti di trasformazione,
come margarine, shortenings e ali-
Address for correspondence:
Dr. Tommaso Gomes
Gli oli vegetali sono parte inte- menti funzionali, in sostituzione
Università degli Studi, DIBCA grante della dieta e il loro consu- dei grassi di origine animale (2).
Sezione di Scienze e Tecnologie Alimentari mo è in continuo incremento (1). Oli e grassi, come è noto, se sotto-
Via Amendola 165/a, I-70126 Bari, Italy
Fax: +39 080 5443467
Ciò è dovuto all’aumento dell’im- posti ad una prolungata esposizio-
E-mail: tommaso.gomes@agr.uniba.it piego di grassi e oli vegetali e dei ne all’ossigeno atmosferico vanno

53
VOLUME 15

incontro a deterioramento. Per Materiali e metodi g di olio sono stati fatti passare at-
questo motivo, la valutazione della traverso una colonna cromatografi-
stabilità ossidativa rappresenta un Gli oli di soia, di arachide e di gira- ca (60 cm x 40 mm), in condizioni
fattore chiave per lo sviluppo di sole utilizzati per le prove speri- di vuoto parziale, impaccata con 75
nuove applicazioni nel settore degli mentali sono stati acquistati diret- g di silice, 37,5 g di una miscela di
oli e grassi alimentari. Il grado di tamente dal supermercato. Gli stes- zucchero e celite in rapporto 2:1,
insaturazione degli acidi grassi, la si sono stati sottoposti a purifica- 12,6 g di una miscela di carbone e
disponibilità di ossigeno, il calore, zione seguendo il metodo di Lee e celite in rapporto 2:1 e 75 g di sili-
la luce, i metalli, i pigmenti, i radi- Min (12). In particolare, circa 250 ce. L’olio purificato ottenuto risul-
cali, la presenza di fosfolipidi, acidi
grassi liberi, monoacilgliceroli e
Figura 1 - Cromatogrammi dell’analisi HPSEC dei composti polari degli oli
diacilgliceroli, antiossidanti, infatti,
di soia, girasole ed arachide purificati ed addizionati dell’1% di monoacilglice-
sono tutti fattori in grado di in- roli dopo 6 giorni di ossidazione forzata in stufa a 60 °C. (1, trimeri di oligo-
fluenzare la stabilità ossidativa di polimeri dei triacilgliceroli; 2, dimeri di oligopolimeri dei triacilgliceroli; 3,
una sostanza grassa (3-6), con con- triacilgliceroli ossidati; 4, diacilgliceroli)
seguenze sull’aroma, sul sapore e
sul valore nutrizionale (7).
Tra i fattori che influenzano la
stabilità ossidativa dei grassi, i
prodotti della degradazione idroli-
tica, e in particolare i monoacilgli-
ceroli, sono stati presi in conside-
razione in diversi studi, che ne
hanno dimostrato l’effetto pro-os-
sidante in olio di soia (8-10) ed
antiossidante in olio di oliva (11).
Tuttavia, tali risultati sono stati ot-
tenuti impiegando standard di
monoacilgliceroli di diversa origi-
ne e composizione.
Scopo del presente lavoro è stato
quello di verificare l’influenza di
monoacilgliceroli ottenuti me-
diante saponificazione parziale a
freddo dell’olio di soia purificato,
sui processi ossidativi in oli vege-
tali di diversa origine botanica
(olio di soia, olio di arachide e olio
di girasole preventivamente purifi-
cati).

54
PROGRESS IN NUTRITION 1/2013

tava privo di prodotti di ossidazio- ste, insieme a campioni controllo lonne erano impaccate con copoli-
ne e di idrolisi, oltre che di pig- non addizionati di MAG, ad un mero stirene-divinilbenzene aven-
menti ed antiossidanti. L’efficacia test di ossidazione forzata in stufa te diametro delle particelle 5 µm e
del processo di purificazione è stata a 60°C per 10 giorni. Gli oli, pre- diametro dei pori di 500 Å. Come
valutata mediante la determinazio- levati a 4, 6 e 10 giorni, sono stati rivelatore è stato utilizzato un ri-
ne dell’acidità, del numero di pe- poi sottoposti a separazione dei frattometro differenziale a defles-
rossidi (13) e l’analisi High Perfor- composti polari (PC) e ad analisi sione Series 200A (Perkin-Elmer,
mance Size-Exclusion Chromato- HPSEC degli stessi. Beaconsfield, UK) collegato ad un
graphy (HPSEC) dei composti po- I PC sono stati separati mediante sistema di acquisizione dati. Il sol-
lari preventivamente separati su co- cromatografia su colonna di gel di vente di eluizione utilizzato era te-
lonna di gel di silice (14). silice, come riportato dal metodo traidrofurano, al flusso di 1 mL/
I monoacilgliceroli (MAG) sono AOAC n. 982.27 (14). L’efficacia min. L’identificazione e la quanti-
stati ottenuti partendo da olio di della separazione è stata verificata ficazione dei singoli picchi è stata
soia purificato. In particolare, do- mediante cromatografia su strato effettuata come riportato in un
po saponificazione parziale a tem- sottile. La separazione delle singo- precedenti lavori (15, 16).
peratura ambiente per 3 minuti in le classi di sostanze costituenti i L’analisi della varianza (ANOVA)
presenza di una soluzione metano- PC è stata effettuata mediante a tre vie, seguita dal test di Tukey
lica di KOH 2N, come riportato analisi HPSEC. Il sistema croma- per le comparazioni multiple, è
in Caponio et al. (10), la reazione tografico era costituito da una stata effettuata sui dati analitici
è stata interrotta con acqua distil- pompa series 200 (Perkin-Elmer, ottenuti mediante software
lata e i MAG estratti con etere Beaconsfield, UK), un iniettore XLStat (Addinsoft, New York,
etilico. La purezza dei monoacil- 7125 S (rheodyne), un loop da 50 USA).
gliceroli è stata verificata mediante µL, una precolonna di 5 cm di
analisi HPSEC. I MAG sono sta- lunghezza e 7,5 mm di diametro
ti, quindi, addizionati agli oli ve- interno, una serie di due colonne Risultati e discussione
getali purificati in concentrazione PL-gel (Perkin-Elmer, Beacon-
dello 0,5% ed 1% (p/p). Le solu- sfield, UK) lunghe 30 cm x 7,5 In figura 1 sono mostrati i croma-
zioni ottenute sono state sottopo- mm di diametro interno. Le co- togrammi dei composti polari,

Tabella 1 - Risultati dell’ANOVA a tre vie seguita dal test di Tukey per le comparazioni multiple
Variabile PTAG TAG-ox DAG
F Pr > F F Pr > F F Pr > F
Tempo 692,983 < 0,001 2153,348 < 0,001 41,167 < 0,001
%MAG 2,541 0,140 13,037 0,003 4,711 0,044
Olio 138,993 < 0,001 567,144 < 0,001 10,179 0,006
Tempo*%MAG 3,103 0,081 1,874 0,208 1,372 0,325
Tempo*olio 34,692 < 0,001 74,041 < 0,001 1,792 0,224
%MAG*olio 5,672 0,018 6,109 0,015 5,823 0,017
MAG, monoacilgliceoli; PTAG, oligopolimeri dei triacilgliceroli; TAG-ox, triacilgliceroli ossidati; DAG, diacilgliceroli.

55
VOLUME 15

preliminarmente separati median- Figura 2 - Risultati delle interazioni tempo*olio e %MAG*olio per i parametri
te cromatografia su colonna di gel analitici esaminati. (PTAG, oligopolimeri dei triacilgliceroli; TAG-ox, triacil-
di silice, dei tre differenti oli vege- gliceroli ossidati; DAG, diacilgliceroli)
tali purificati oggetto di indagine
ed addizionati dell’1% di MAG
dopo 6 giorni di ossidazione for-
zata in stufa a 60°C. È possibile
constatare il diverso livello di
composti di degradazione dei tria-
cilgliceroli nei tre oli, in particola-
re riguardo al contenuto in trimeri
e dimeri di oligopolimeri dei tria-
cilgliceroli, evidenziandone per-
tanto una diversa suscettibilità al-
l’ossidazione.
In tabella 1 ed in figura 2 sono ri-
portati i risultati dell’analisi della
varianza (ANOVA) a tre vie dei
dati ottenuti relativi agli oligopoli-
meri dei triacilgliceroli (PTAG),
triacilgliceroli ossidati (TAG-ox) e
diacilgliceroli (DAG).
Il maggior contributo alla variabi-
lità di tutti e tre gli indici era do-
vuto alla variabile Tempo, con in-
crementi significativi nel corso
dell’ossidazione. Per i PTAG si
osservava un effetto significativo
del tipo di Olio, con valori più bas-
si per l’olio di arachide, e dell’inte-
razione Tempo*Olio. Ciò indica co-
me i diversi oli mostrassero una
differente suscettibilità ai processi
ossidativi meno marcata per l’olio
di soia. La dose aggiunta di MAG negli altri due un’azione opposta. per i PTAG seppure con una diver-
non aveva un effetto significativo, Il modello ANOVA relativo ai sità di comportamento dei diversi
tuttavia, l’interazione %MAG*olio TAG-ox, invece, risentiva significa- oli, più netta nei processi di poli-
presentava un valore di p inferiore tivamente del livello di MAG oltre merizzazione dei triacilgliceroli os-
a 0,05 evidenziando nell ’olio che dell’interazione %MAG*olio, sidati che nella loro formazione (fi-
di soia un effetto pro-ossidante e confermando quanto già osservato gura 2).

56
PROGRESS IN NUTRITION 1/2013

Quanto, infine, ai livelli dei pro- 2. Popkin MB, Gordon-Larsen P. The soybean oil in the presence of
dotti di idrolisi (rappresentati dai nutrition transition: worldwide obesity monoolein, stearic acid and iron. Food
dynamics and their determinants. Int J Chem 2006; 101: 724-8.
DAG), questi subivano incrementi Obesity 2004; 28: S2-S9. 11. Caponio F, Paradiso VM, Bruno G,
significativi durante l’ossidazione. 3. Tuberoso CIG, Kowaczyk A, Sarritzu Summo C, Pasqualone A, Gomes T.
Inoltre, nel solo olio di soia si os- E, Cabras P. Determination of antioxi- Do monoacylglycerols act as pro-oxi-
servava anche un effetto dell’ag- dant compounds and antioxidant ac- dants in purified soybean oil? Evi-
tivity in commercial oilseeds for food dence of a dose-dependent effect. Ital J
giunta di MAG che determinava use, Food Chem 2006; 103: 1494-501. Food Sci 2001; 23: 239-44.
un’accentuazione dell’idrolisi. 4. Ho C, Chen Q. Lipid in food flavors: 12. Gomes T, Caponio F, Bruno G, Sum-
In definitiva, il differente effetto an overview. In: Ho C, Hartman AM: mo C, Paradiso VM. Effect of mona-
dei MAG negli oli considerati po- Lipids in food flavors. Salem: Mas cylglycerols on the oxidative stability
Clearance Centre Inc, 1994: 2-114. of olive oil. J Sci Food Agric 2010; 90:
trebbe essere legato alla loro diver- 5. Krishna AGG, Prabhakar JV. Antioxi- 2228-32.
sa composizione acidica. Infatti, il dant efficacy of amino acids in methyl 13. Lee SH, Min DB. Effects, quenching
processo di purificazione, cui sono linoleate at different relative humidi- mechanism and kinetics of carotenoids
stati sottoposti gli oli prima del- ties. J Am Oil Chem Soc 1994; 71: in chlorophyll-sensitized photooxida-
634-7. tion of soybean oil. J Agric Food
l’aggiunta dei monoacilgliceroli, 6. Nawar WW. Chemistry. In: Bailey’s Chem 1990; 38: 1630-4.
determina l’allontanamento di tut- Industrial Oil & Fat Products, vol. 1, 14. Gazzetta Ufficiale delle Comunità Eu-
ti prodotti di ossidazione ed idro- 5 th ed. New York: Wiley 1996: 397- ropee. Regolamento CEE 2568/91,
lisi dei triacilgliceroli, oltre che dei 426. n.L. 248 del 5 settembre.
7. Min DB, Boff JM, Chemistry and re- 15. Association of Official Analytical
pigmenti e delle sostanze ad atti- action of singlet oxygen in foods. Chemists. Official methods of analysis
vità antiossidante, ottenendo Compr Rev Food Sci Food Safety of AOAC International. Horwitz W.
quindi una matrice praticamente 2002; 1: 57-72. Arlington, VA: AOAC Press 2003:
neutra e costituita quasi esclusiva- 8. Chung HJ, Colakoglu AS, Min DB. method 982.27.
Relationships among headspace, oxy- 16. Gomes T. Oligopolymer, diglyceride
mente da triacilgliceroli inalterati. gen, peroxide value, and conjugated and oxidized triglyceride contents as
diene content of soybean oil oxidation. measure of olive oil quality. J Am Oil
J Food Sci 2004; 69: 83-8. Chem Soc 1992; 69: 1219-23.
Bibliografia 9. Mistry BS, Min DB. Prooxidant ef- 17. Gomes T, Caponio F. Effort to im-
fects of monoglycerides and diglyc- prove the quantitative determination
1. Elmadfa I. European Nutrition and erides in soybean oil. J Food Sci 1988; of oxidation and hydrolysis compound
Health Report 2009. Basel: Karger, 53: 1896-7. classes in edible vegetable oils. J Chro-
2009. 10. Colakoglu AS. Oxidation kinetics of matogr A 1999; 844: 77-86.

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VOLUME 15
CASE R E P O RT

L. VIGNA1, C. BARBERI1, Obesità in post-trapianto di rene:


D. SOMMARUGA2, L. GHIO3,
M. BELINGHERI3, A. SALA3,
Efficacia e sicurezza di una dieta
L. RIBOLDI1 chetogenica

PROGRESS IN NUTRITION
Summary
VOL. 15, N. 1, 58-64, 2013
We illustrate a case report of a 26-year-old man with BMI about 40.36
kg/m², suffering from Interstitial idiopathic nephritis since he was 10, sub-
TITOLO mitted to kidney transplantation when he was 19; we treated him with a
Obesity in kidney post high-protein ketogenic diet (Very low calorie diet VLCD) for 11 weeks.
transplant: Efficacy and safety The patient lost weight during the treatment, keeping a good state of hy-
of a ketogenic diet dratation and without side effects. This clinical report indicate that VLCD
ketogenic diet, under c lose medical supervision, besides an efficient method
KEY WORDS to slim, is applicable also to patients with a complex clinical history.
Kidney transplantation, VLCD,
ketogenic diet, obesity, body Riassunto
composition. Viene illustrato il report clinico di un uomo di 26 anni con BMI di 40.36
kg/m², affetto da Nefrite Interstiziale Idiopatica dall’età di 10 anni e sotto-
PAROLE CHIAVE posto a trapiantato di rene a 19 anni, trattato con un programma di dieta
Trapianto di rene, VLCD, dieta proteica chetogenica (Very low calorie diet VLCD) per 11 settimane. Il sog-
chetogenica, obesità, composizione getto ha perso peso durante tutto il trattamento, mantenendo un buono sta-
corporea to di idratazione e senza effetti collaterali. Il soggetto, dopo una pausa di 5-6
mesi, si è sottoposto ad un nuovo ciclo di dieta proteica chetogenica con ul-
1
UO Medicina del Lavoro 1, teriore calo di peso pari a 8,9 kg. Questo report è un esempio di come, sotto
Fondazione IRCCS Ca’ Granda stretta sorveglianza medica, questo tipo di dieta oltre che efficace, come già
Ospedale Maggiore Policlinico, Milano dimostrato da altri lavori scientifici, si dimostra sicura anche in soggetti con
2
Servizio Dietetico Direzione un quadro clinico complesso.
Sanitaria di Presidio, Fondazione
IRCCS Ca’ Granda Ospedale
Maggiore Policlinico, Milano
Si riporta il caso clinico di un uomo un nuovo ciclo di trattamento arri-
3
UO Nefrologia e Dialisi Pediatrica,
Fondazione IRCCS Ca’ Granda di 26 anni con BMI di 40.36 kg/m², vando ad un’ulteriore perdita di peso
Ospedale Maggiore Policlinico, Milano affetto da Nefrite Interstiziale Idio- pari a 8,9 kg.
patica dall’età di 10 anni e sottopo-
Corrispondence:
sto a trapiantato di rene a 19 anni,
Dr Luisella Vigna
Centro Obesità e Lavoro - UO Medicina del trattato con un programma di dieta Storia Clinica
Lavoro 1 - Dip Medicina Prenventiva proteica chetogenica (Very low ca-
Fondazione IRCCS Ca’ Granda Ospedale
lorie diet VLCD) per 11 settimane, Nel 1995 diagnosticata Insuffi-
Maggiore Policlinico - Via S Barnaba 8,
20122 - Milano seguito da una interruzione di 5-6 cienza Renale Cronica a seguito di
E-mail: luisella.vigna@policlinico.mi.it mesi dopo la quale ha ricominciato Nefrite Interstiziale Idiopatica Dal

58
PROGRESS IN NUTRITION 1/2013

Tabella 1 - Esami di laboratorio eseguiti al primo accesso nel 2009


M v.n. F 31/08/2009
GB 4.8-10.8 5,31
GR 4.50-5.30 4.10-5.10 4,88
HGB 13.5-17.5 12.0-16.0 14,4
2002 al 2004 sottoposto a dialisi HCT 41.0-53.0 36.0-46.0 42,3
prima peritoneale poi extracorpo- Acido urico 2.4-5.7 7,0
rea. Nel 2004 trapianto renale da
Creatininemia 0.50-1.20 0.50-1.00 0,97
cadavere con buon out-come post-
operatorio. Dopo un anno dal tra- Trigliceridi <170 122
pianto comparsa di vescica neuro- Colesterolo <200 143
logica trattata da allora con ossi- Colesterolo HDL >65 33 *
butinina. Colesterolo LDL <130 99
Nel 2001: per circa 6 mesi il pz è
Onocisteina 0-10 10.64 *
stato sottoposto a terapia con GH
ricombinante per ipostaturismo da TSH 0.28-4.3 2.670
deficit di GH (sospeso per ineffi- Glicemia basale 55-115 96
cacia sulla crescita e dolori arti in- Insulina basale 2.6-25 10,9
feriori). Sempre nel 2001 inter- Hb glicata 3.5-5.9 5,1
vento di epifisiodesi correttivo di
ES URINE Normale
varismo tibia destra, nel 2003
comparsa di lesione osteomielitica Glucosio urine Neg
tibiale destra. Testosterone tot 2.80-8.0 2,89
Il soggetto da bambino è sempre Testosterone libero 8.8-27 4,38*
stato in lieve sovrappeso ed in DHEA S 1000-4200 4060
adolescenza ha avuto un aumento
ponderale; un ulteriore aumento di
peso è avvenuto dopo trapianto cm. I primi esami di laboratorio pril 2,5 mg 2/die, Norvasc 5 mg 1
renale nel 2004 forse anche a cau- hanno rilevato lieve iperomocistei- cp/die, Esomeprazolo 20 mg 1
sa di una terapia corticosteroidea nemia, lieve iperinsulinismo, bassi cp/die, Ossibutinina ½ cp 2 vol-
assunta per 3 anni motivo per cui livelli di testosterone libero e bassi te/die (vescica neurologica).
gli era stata prescritta dai Colleghi livelli di colesterolo HDL (Tab. È stata prescritta terapia con Orli-
nefrologi una dieta di 1200 Kcal 1). Spirometria ed ECG nella nor- stat 120 mg 1 cp a pranzo e cena,
che il paziente non aveva seguito ma. Non assumeva integratori, supplementazione con ac grassi
per scarsa compliance (riferita non galenici o anoressanti a scopo di- omega 3 (ESKIM 1000 1 cp x 2
sufficiente quantitativo di cibo). magrante e non svolgeva attività per 1 mese poi 1 cp per almeno 3-6
fisica regolare per algia ginocchio mesi), dietoterapia secondo lo sche-
sinistro. L’esame obiettivo rilevava ma preparato dalla dietista (1500
Il paziente giunge alla nostra os- lieve deficit di forza agli arti infe- kcal) e incremento dell’attività fisica.
servazione nel 2009 riori. Inoltre è stato consigliato un oppor-
Terapia nefrologica assunta nel tuno studio dell’asse ipotalamo-ipo-
La condizioni iniziale era: peso di 2009 e tuttora in corso: ciclospori- fisi-gonadi nel sospetto di ipogona-
96 kg, altezza di 1,57 m (BMI = na Neoral 100 mg 2 volte/die, mi- dismo (riscontro di bassi valori di
37,93 kg/m²), circonferenza vita = cofenolato mofetile Cell Cept 750 testosterone totale e libero) tale si-
110 cm, circonferenza collo = 46 mg 2 volte die (antirigetto), Uni- tuazione infatti potrebbe favorire

59
VOLUME 15

l’incremento di peso e di massa in atto: COLORDIET 1 bustina cato rispetto al protocollo stan-
grassa a scapito della massa musco- prima di pranzo e cena per 3 me- dard:
lare metabolicamente attiva. si, supplementazione con ac grassi • step 1 (alimentazione aminoaci-
Il paziente ha quindi assunto Or- omega 3 (ESKIM 1000 1 cp per dica) per 2 settimane assumendo
listat 120 mg x 2 die associato a almeno 3-6 mesi), dietoterapia se- 4-5 preparati, 1 compressa di
dietoterapia (1500 kcal) per circa condo lo schema preparato dalla potassio a mezzogiorno e 1 la
un anno con iniziale beneficio sul dietista (1500 kcal) e incremento sera (KCl Retard 600mg) e 1
calo di peso poi si è assistito ad un attività fisica, in attesa dei risultati compressa di multivitaminico al
nuovo progressivo incremento degli esami renali per prendere in giorno;
ponderale nonostante la terapia considerazione eventuale dieta • step 2 (alimentazione proteica)
antiobesità e la dieta. proteica, vista l’inefficacia dei trat- per terza e quarta settimana as-
Nel giugno 2011 vista la lamentata tamenti finora somministrati. sumendo 3 preparati più un
ipostenia associata all’incremento Gli esami ormonali suggeriti nel piatto di proteine a scelta fra
ponderale è stata prescritta misce- gennaio 2012 hanno evidenziato: quelle consentite, 1 compressa di
la aminoacidica con multivitami- lieve deficit di GH (0.08 ng/ml potassio a mezzogiorno e 1 la
nico e faseolamina (Colordiet 2 vn 0-3) con IGF-1 362 ng/ml sera (KCL Retard 600mg) e 1
buste die prima dei pasti principa- (114-492), insulinoresistenza ele- compressa di multivitaminico al
li) che per 3 mesi ha tolto la stan- vata con iperinsulinismo (glic 106 giorno; la quinta settimana ridu-
chezza e il senso di fame, dando insul 35.4) HOMA 9.3 (vn>2.5), zione di potassio ad 1 compressa
maggiore sazietà; anche questo se- ai limiti inferiori di norma SHBG al giorno (KCl Retard 600 mg)
condo trattamento dopo una ini- 13.2 (13-71), restanti esami ormo- per lieve incremento delle kalie-
ziale fase di efficacia è stato sospe- nali nella norma (TSH, PRL, mia e dieta step 1 e 2 a giorni al-
so dal paziente per non manteni- Test, Ftest, LH FSH cortisolo). terni;
mento dei risultati. Visto l’esito degli esami biochimi- • step 3 e 4 reinserimento graduale
Alla visita medica di gennaio 2012 ci e sentito il parere dei colleghi dei cibi prima eliminati:
la sua altezza era di 1,57 m e il suo nefrologi che seguono il paziente - sesta settimana una porzione
peso di 99.5 kg (aumento di 6 kg), si è concordato l’utilizzo di una di latticini o formaggi + un
BMI pari a 40.36 kg/m² (rispetto dieta proteica chetogenica VLCD piatto proteico + 2-3 preparati
a 37,93 iniziale) e circonferenza con una percentuale di proteine con una compressa al giorno
vita di 109 cm. L’analisi impeden- pari a 0,8g per chilo di peso ideale di potassio (KCl Retard 600
ziometrica, eseguita con impeden- (stimato per il paziente in 64 kg mg) e 1 di vitamine con ag-
ziometro InBody230 Wunder, ha pari ad un BMI di 25 kg/m²,) giunta di latticini;
rilevato: massa magra nella norma A marzo 2012 il peso era di 103,2 - settima settimana come sopra
49.0 kg (vn 39-49 kg) e massa kg (peso massimo raggiunto) e + aggiunta una porzione di
grassa 51,9 kg (vn 6.5-13), di con- l’altezza di 157 cm, BMI 40.36 carboidrati;
seguenza il calo di peso consiglia- kg/m², il paziente ha così iniziato - ottava settimana come sopra +
to risulterebbe di 40 kg per rag- un programma di dieta proteica, aggiunta di una porzione di
giungere il peso ideale. secondo il metodo newPenta. frutta;
Quindi al paziente è stato consi- Il soggetto in questione ha seguito - nona settimana come sopra +
gliato di continuare con la terapia il programma leggermente modifi- aggiunta di 2 porzioni di frutta.

60
PROGRESS IN NUTRITION 1/2013

Tabella 2 - Esami di laboratorio eseguiti dall’ inizio del primo ciclo di dieta proteica
M v.n. 30/1/2012 3/4/2012 20/4/2012 8/5/2012 22/5/2012
HCT 41.0-53.0 36,9 34,4 35,5 36,2
Acido urico 2.4-7.0 7,1* 8,15* 7,7* 6,65* 6,62*
Creatinina 0.50-1.20 1,11 1,19 1,03 1,25 1,2
Trigliceridi <170 172 167 # 152 100
Colesterolo <200 130 116 - 148 135
Colesterolo HDL >65 34 27* - 29* 32*
Colesterolo LDL <130 - 89 - 119 103
Glicemia basale 55-115 106 86 76 94 94
Sodio 135-145 140 - 141 - -
potassio 3,30-5,10 4,5 - 4 4,6 4
ES URINE
Glucosio urine 0-15 0 0 0 0 0
Corpi chetonici 0 -0,001 0 20* 50* 0 0

• step 5 Dalla decima settimana ri- durata del trattamento siano stati sono mantenuti a livelli pressoché
presa della dieta preparata se- tenuti sotto controllo, attraverso le costanti.
condo lo schema della dietista analisi impendenziometriche (In- Ovviamente anche durante il se-
(1500 Kcal) e sospensione della Body230 Wunder), sia il livello di condo ciclo di trattamento sono
supplementazione vitaminica e idratazione del soggetto e come stati eseguiti i relativi esami di la-
di potassio. questo sia rimasto pressoché co- boratorio, riportati nella tabella 5,
Per il suddetto periodo, data la de- stante in tutte le diverse fasi sia i in cui non si sono registrate varia-
licatezza del caso e le note proble- valori relativi alla massa muscolare zioni significative rispetto alla si-
matiche renali, il paziente è stato che hanno mostrato un lieve in- tuazione presentata durante il pri-
seguito con una frequenza assidua cremento solo nell’ultima fase del mo ciclo di terapia: valori di acido
sia il controllo degli esami biochi- percorso quando il paziente ha ini- urico e colesterolo HDL oscillan-
mici e clinici sia del peso presso il ziato una leggera implementazio- ti, mentre gli altri parametri si so-
nostro centro. Gli esami di labora- ne dell’attività fisica (Tab. 3). no mantenuti nella norma.
torio hanno mostrato un migliora- Dopo una pausa di 5-6 mesi, in cui
mento dei livelli di acido urico, ha seguito una dieta equilibrata e bi-
anche se restano leggermente al di lanciata (1500 kcal), il soggetto si è Il metodo VLCD
sopra del valore normale, valori di sottoposto ad un nuovo ciclo di die-
colesterolo HDL ancora sotto i li- ta proteica chetogenica secondo il Il programma di dieta proteica uti-
velli normali, livelli di potassio gli- protocollo descritto sopra, durante il lizzato si basa essenzialmente sul
cemia trigliceridi colesterolo totale quale il peso è calato progressiva- principio che un regime alimentare
e LDL nella norma, così come i mente di 8,9 kg in 5 settimane (Tab. che comporti una riduzione dei glu-
corpi chetonici nelle urine (Tab 2). 4). In particolare, come riportato cidi (al di sotto dei 50 g die) e dei
Il peso del paziente è calato pro- nella tabella 4, il BMI è calato ulte- lipidi (VLCD), associata al consu-
gressivamente (Tab. 3). A due me- riormente arrivando ad un valore di mo quasi esclusivo di proteine di al-
si e mezzo di follow-up aveva per- 34 kg/m², così come la massa grassa to valore biologico, o aminoacidi,
so 13,5 kg (BMI = 36,4 kg/m²,). (35,2%), mentre massa magra, me- permette di ridurre la massa del tes-
Si può poi notare come per tutta la tabolismo basale e acqua corporea si suto adiposo grazie al nuovo bilan-

61
VOLUME 15

Tabella 3 - parametri clinici e impedenziometrici rilevati alle visite di controllo durante il primo ciclo di terapia.
inizio 5 settimana 11 settimana
Peso kg 103,2 94 89,7
BMI kg/m² 41,9 38,1 36,4
Metabolismo basale kcal 1448 1397 1426
Massa grassa kg 53,3 46,5 40,8
Massa magra kg 49,9 47,5 48,9
di cui massa muscolare kg 27,7 26,1 27,1
Acqua kg 36,7 35 35,9
Integr. Potassio 2 compresse/die 1 compressa/die -
Intr. Multivitaminico 1 compressa/die 1 compressa/die -

ciamento insulina-glucagone che si dantemente nella giornata (almeno Se si analizzano nel dettaglio i vari
viene ad instaurare nell’organismo. 1,5-2L) per eliminare le scorie me- step è possibile notare come nel
Normalmente queste tipologie di taboliche che altrimenti si accumu- primo step della durata di 10-20
diete vengono utilizzate in quei lerebbero. giorni, definito alimentazione ami-
soggetti con BMI elevato (> 30 La durata del trattamento è varia- noacidica, il paziente deve alimen-
kg/m²) o leggermente inferiore ma bile e può essere adattata al pa- tarsi solo con un certo numero di
in presenza di comorbidità legate ziente a discrezione del medico. Il preparati uniti a verdura a foglia
all’obesità e comunque sotto stretto metodo Pentadiet è costituito da 5 verde, a cui dovranno essere asso-
controllo medico. Per raggiungere i fasi ed ogni fase può avere una du- ciati integratori di potassio e vita-
risultati suddetti si ricorre all’utiliz- rata personalizzata. In questo tipo mine data l’assenza totale di frutta
zo di prodotti dietetici ad apporto di approccio i carboidrati vengono e il ridotto apporto di verdura.
proteico prevalente per fornire ami- reintrodotti gradatamente nei vari Questa fase prevede il consumo di
noacidi bilanciati che salvaguardino step successivi, fino ad arrivare nel proteine ad alta qualità biologica
la massa magra. È necessaria inte- 5 step ad una dieta bilanciata, con per proteggere la massa magra ed
grazione con potassio, vitamine e il giusto apporto calorico da segui- indurre l’organismo ad utilizzare
sale ed è poi necessario bere abbon- re normalmente. come fonte energetica i grassi in
eccesso. In pochi giorni è possibile
ottenere una notevole perdita di
Tabella 4 - Parametri clinici e impedenziometrici rilevati alle visite di control- peso e la formazione dei corpi che-
lo durante il secondo ciclo di terapia.
tonici (come si può notare dai li-
inizio 5ˆ settimana velli di corpi chetonici presenti
Peso kg 92,6 83,7 nelle urine del nostro soggetto al-
BMI kg/m², 37,6 34 l’inizio del trattamento: tabella 2),
che a loro volta elimineranno il
Metabolismo basale kcal 1466 1418
senso di fame. Il secondo step, ali-
Massa grassa kg 41,8 35,2 mentazione proteica, prevede
Massa magra kg 50,8 48,5 l’introduzione di un piatto di pro-
di cui massa muscolare kg 28,2 26,9 teine animali al posto di un prepa-
Acqua kg 37,4 35,7 rato mentre tutto il resto rimane
inalterato: continua la produzione
Integr. Potassio 2 compresse/die 1 compressa/die
di corpi chetonici anche se aumen-
Intr. Multivitaminico 1 compressa/die 1 compressa/die

62
PROGRESS IN NUTRITION 1/2013

Tabella 5 - Esami di laboratorio eseguiti dall’ inizio del primo ciclo di dieta
proteica
M v.n. inizio 1ˆ mese 2ˆ mese
Acido urico 2.4-7.0 5,8 6,88 4,91
Creatinina 0.50-1.20 1,05 1,18 1,11
Trigliceridi <170 117 145 successivi (da 89,7 kg a 92,6 kg) il
Colesterolo <200 163 161 soggetto ha deciso di sottoporsi ad
Colesterolo HDL >65 41 33 un secondo ciclo di trattamento,
dopo 5-6 mesi di pausa dal ciclo
Colesterolo LDL <130 98 108
precedente. Dopo 5 settimane dal-
Glicemia basale 55-115 95 92 95 l’inizio del nuovo ciclo di terapia il
Sodio 135-145 141 138 141 soggetto presenta un calo di 8,9 kg
potassio 3,30-5,10 4,3 4,4 4,4 con un peso corporeo di 83,7 kg
ES URINE (peso inferiore di 6 kg rispetto a
quello raggiunto dopo 11 settima-
Glucosio urine 0-15 0 0 0
ne dal’inizio del primo ciclo di
Corpi chetonici 0 -0,001 0 20 0 dieta proteica chetogenica) con
mantenimento della massa massa
ta leggermente l’apporto calorico ciata definitiva, attraverso uno magra metabolicamente attiva.
(valori corpi chetonici ancora alti schema elaborato dalla dietista da
anche per il nostro paziente, come 1500 Kcal.
riportato in Tab. 2). La terza fase è O vviamente man mano che si Conclusioni e commenti
quella più importante perché per- procede con le diverse tappe del
mette di capire l’effettiva risposta metodo l’integrazione andrà mo- Evidenze scientifiche dimostrano
insulinica e l’effetto di adiposinte- dificata sia sulla base degli alimen- che dopo 6 mesi, pazienti che
si. In questo step avviene una pro- ti reintrodotti sia sui risultati degli hanno seguito diete povere di car-
gressiva reintroduzione dei carboi- esami di laboratorio: il soggetto boidrati hanno perso un peso su-
drati nell’alimentazione con termi- considerato ha ridotto l’assunzione periore rispetto a pazienti che
ne della fase chetogenica e non ha di potassio da 2 compresse al gior- hanno seguito diete a basso conte-
un limite temporale. Nel nostro no a 1 nella fase di passaggio tra il nuto di grassi, con miglioramenti
caso, nella prima settimana di que- secondo e il terzo step quando sta- anche relativi a parametri quali la
sta fase, è stata reintrodotta una vano per essere reintrodotti i car- pressione sistolica e diastolica, gli-
porzione di latticini, nella seconda boidrati ed analizzando i valori di cemia a digiuno, trigliceridi, cole-
una porzione di pane, nella terza a potassio ematico del soggetto nelle sterolo totale e HDL. In aggiunta
una porzione di frutta e nella setti- diverse fasi (4 – 4,6 – 4 riportati in a questo, i pazienti a cui sono state
mana successiva due porzioni di Tab. 2) sembra che la modalità di assegnate diete povere di carboi-
frutta. La progressività nella rein- intervento sia stata corretta. drati hanno avuto maggiore ade-
troduzione dei glucidi è molto im- A distanza di 6-8 settima- renza alla dieta riuscendo a seguir-
portante perché facilita la stabiliz- ne dall’inizio della dieta da 1500 la per più tempo (1, 2).
zazione della perdita di peso. Il Kcal il paziente aveva mantenuto Le VLCDs oltre ad essere diete a
quarto step, detto alimentazione il peso perso presentando un peso basso contenuto di carboidrati,
completa, porta all’inserimento di corporeo di 89 kg e una circonfe- forniscono al minimo 0.8 g di pro-
ulteriori porzioni di carboidrati renza vita di 102 cm. teine per kg di peso corporeo idea-
(compresi i legumi), il quinto step In seguito ad un leggero incre- le al giorno allo scopo di preserva-
prevede una l’alimentazione bilan- mento di peso verificatosi nei mesi re la massa magra. (3)

63
VOLUME 15

Attraverso l’ossidazione dei lipidi, termini di prevenzione di aumento rie diet for the treatment of severe
il senso di sazietà e un maggior di peso proprio modificando il loro obesity. MJA 2008; 188(6): 366-368.
3. Mustajoki P, Pekkarinen T. Very low
dispendio di energia questi tipi di modo di alimentarsi, imparando a energy diets in the treatment of obesi-
dieta promuovono la perdita di consumare i pasti più lentamente, ty. Obes Rev 2001; 2: 61-72.
peso senza essere associate ad ef- questo si è rivelato efficace in modo 4. J. Brehm et al. A Randomized Trial
fetti negativi sui fattori di rischio particolare nei soggetti con più di Comparing a Very Low Carbohydrate
Diet and a Calorie-Restricted Low Fat
cardiovascolari (4, 5) anzi sono in- trenta anni (12). Diet on Body Weight and Cardiovas-
vece stati dimostrati effetti benefi- Questo report è un esempio di co- cular Risk Factors in Healthy Women.
ci proprio sullo stato di salute car- me, sotto stretta sorveglianza me- J Clin Endocrinol Metab 2003; 88(4):
diovascolare. (1, 6) dica, questo tipo di dieta oltre che 1617-1623
5. Westerterp-Plantenga et al. Dietary Pro-
I vantaggi poi di questi tipi di ap- efficace (13,5 kg persi dal nostro tein, Weight Loss, and Weight Mainte-
procci sono anche dovuti al rapido soggetto in 11 settimane), come nance. Annu Rev Nutr. 2009; 29: 21-41
calo ponderale a cui portano che già dimostrato da altri lavori 6. Lewis MC, Phillips ML, Slavotinek
ha un effetto motivante sul pa- scientifici, si dimostra sicura anche JP, et al. Change in liver size and fat
content after treatment with Optifast
ziente il quale, unito alla praticità in soggetti con un quadro clinico very low calorie diet. Obes Surg 2006;
del pasto sostitutivo, porta ad una complesso. Rimane ancora da va- 16: 697-701.
migliore aderenza alla dieta (7) e lutare l’efficacia del metodo nel 7. Noakes M, Foster PR, et al. Meal re-
uno stato di chetosi che aiuta a mantenimento del peso nel lungo placements are as effective as structured
weight-loss diets for treating obesity in
sopprimere il senso di fame (8,9). periodo, sembra infatti utile il ri- adults with features of metabolic syn-
Sembra inoltre che diete ad alto petere cicli successivi di tratta- drome. J Nutr 2004; 134: 1894-1899.
contenuto proteico favoriscano il mento a distanza di 5-6 mesi per 8. Delbridge E, Proietto J. State of the
senso di sazietà e portino il pa- aiutare i soggetti nel mantenimen- science: VLED (very low energy diet)
for obesity. Asia Pac J Clin Nutr 2006;
ziente a percepire meno le preoc- to del peso raggiunto o per mi- 15 Suppl: 49-54.
cupazioni legate al cibo con conse- gliorare ulteriormente i risultati 9. Mcclernon et al. The effects of a low
guente maggiore aderenza al per- raggiunti. È però chiaro che que- carbohydrate ketogenic diet and a low-
corso di dimagrimento consigliato sto tipo di intervento potrebbe es- fat diet on mood, hunger, and other
self-reported symptoms. Obesity 2007;
(10). Inoltre anche il fatto di con- sere considerato un’alternativa me- 15: 182–187.
sumare cibi solidi influisce positi- no invasiva alla chirurgia bariatrica 10. Heather J. Leidy et al. The Effects of
vamente sul senso di sazietà ri- o comunque una fase che possa Consuming Frequent, Higher Protein
spetto al consumo di alimenti li- precedere questo tipo di interven- Meals on Appetite and Satiety During
Weight Loss in Overweight/Obese
quidi con un contenuto energetico to nel trattamento dell’obesità. Men. Obesity 2011; 19: 818–824.
simile (11). 11. Tieken et al. Effects of Solid versus
Risulta poi importante, per miglio- Liquid Meal-replacement Products of
rare i risultati che si andranno ad References Similar Energy Content on Hunger,
Satiety, and Appetite-regulating Hor-
ottenere, pensare di inserire nel per-
mones in Older Adults. Horm Metab
corso dietetico anche una fase in cui 1. Alain J. Nordman et al. Effects of low- Res. 2007; 39(5): 389–394.
venga insegnato il corretto modo in carbohydrate vs low-fat diets on weight 12. Tanihara et al. Retrospective longitudinal
loss and cardiovascular risk factors. Arch study on the relationship between 8-year
cui mangiare: sembra infatti che Intern Med 2006; 166: 285-293. weight change and current eating speed.
soggetti a rischio di sviluppare obe- 2. Priya Sumithran and Joseph Proietto. Appetite 2011; 57: 179–183.
sità possano beneficiare molto in Safe year-long use of a very-low-calo-

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