NHD EXTRA: NUTRITION MANAGEMENT
CASE STUDY: SPORTS NUTRITION Helen Phadnis Freelance Dietitian and Sports Nutritionist Helen’s practice is underpinned by over 10 years of previous clinical experience at a senior specialist level and five years in private practice. She provides workshops for local clubs and teams and runs clinics in Brighton and Hove. helen@nomnomn e rd.com http://www.nomn o mnerd.com/
The effects on body composition of a K2 summit attempt by an experienced climber Climbing at altitude puts additional energy demands on climbers, estimated at an extra 536kcal/d just for acclimatising to altitude,1 and 1,610kcal/d for climbing activities.2 Alongside these demands come welldocumented changes in taste perception and reduced appetite,3 making weight loss inevitable when climbing above 5,000m. K2 is the second highest mountain in the world, at 8,611 metres above sea level. It is known as the ‘Savage Mountain’ due to the extreme difficulty of ascent.
Matt is a 38-year-old experienced mountain climber planning a second attempt at reaching the summit of K2. Matt was seeking nutritional advice in an attempt to minimise weight loss experienced during his previous attempted summit of K2 two years prior. His trip had resulted in 17% weight loss from 100kg to 83kg. After initial basic dietary advice was provided, Matt requested an in-depth body composition assessment pre- and post- K2 expedition out of curiosity, to see the anthropometrical effects on his own body of climbing at altitude.
Identification of Nutritional Need 1. Assessment Medical diagnosis: Susceptibility to cold sores Anthropometric measurements: Body fat and lean mass measurements were taken via multiple frequency bioelectrical impedance, using Body Composition Monitor (BCM), Fresenius Medical Care (see Table 1). Skinfold thickness measurements were taken at seven sites using Harpenden Skinfold Calipers. Girth measurements were taken with a tape measure. Takei 5001 hand grip dynamometer was used to assess muscle strength. Seven-point Subjective Global Assessment scale was used to assess nutritional status. Dietary Intake Analysis Planned daily intake during climbing is documented in Figure 1. This was based on previous experience of what is possible to carry with regards to weight during a climb, as well as what is palatable. This would provide approximately 2,500kcal, 64g protein. From previous experience, in keeping with what is commonly reported in climbers at altitude, Matt knew he could tolerate carbohydrates in preference to fat when eating during a climb. Recommended Body Weight: BMI 18-25kg/m2 = 64-88kg Recommended body composition based on published elite sport climbers and high altitude climber anthropometry data4,5 is recorded in Table 1. Estimated energy needs: Using actual body weight (as client is not obese) BMR (Schofield) 11.5 (101.7) +873 = 2042 x 1.9 PAL = 3880kcal/d Nitrogen (Elia) 0.17 x 101.7 = x6.25 = 108g/d Based on ACSM Nutrition in Sport Position stand6 Very high carbohydrate needs (mod-high intensity exercise over >4-5 hours). Target 8-12g/kg/d = 813-1229g carbohydrate = 3,089-4,670kcal Protein = 1.2-2g/kg/d = 122-203g protein = 488-812kcal Total discounting fat = 3,577-5,482kcal/d Medications: None Supplements: Centrum multivitamin and mineral supplement.
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www.NHDmag.com August / September 2016 - Issue 117