Eur J Pediatr (2017) 176:4150

DOI 10.1007/s00431-016-2803-x

ORIGINAL ARTICLE

Comparison of body composition and nutrients deficiencies

between Portuguese rink-hockey players
Maria-Raquel G. Silva 1,2,3 & Hugo-Henrique Silva 4

Received: 11 July 2016 / Revised: 24 October 2016 / Accepted: 28 October 2016 / Published online: 12 November 2016
# Springer-Verlag Berlin Heidelberg 2016

Abstract We evaluated dietary intake and body composition
of child and adolescent rink-hockey players and controls.
Seventy-two male rink-hockey players (38 children and 34
adolescents) and 79 male controls (43 children and 36 adoles-
cents) were evaluated in order to collect training data, detailed
dietary intake and body composition. Rink-hockey players
presented significantly lower body fat (BF) and higher fat-
free mass (FFM) than controls. Mean intakes of carbohydrate
and protein were considered to be adequate, but mean intakes
of fat were above the recommended levels in athletes.
Significant differences were found for energy intake (EI) and
exercise energy expenditure (EEE) between athletes and con-
trols (P < 0.05), resulting in some cases of low energy avail-
ability in rink-hockey players. Significant group differences
(P < 0.05) were also observed for vitamins and mineral intakes
in child and adolescent rink-hockey players due to higher
mean intakes in control groups. Low intakes of vitamins D,
Revisions received: 10 October 2016; 25 October 2016
Communicated by Mario Bianchetti
E and K, calcium, iron, boron and magnesium were reported
in athletes, with exception for thiamine (P = 0.449), riboflavin
(P = 0.246), pantothenic acid (P = 0.065), magnesium
(P = 0.061) and phosphorus (P = 0.051) in children and for
niacin (P = 0.652), vitamin D (P = 0.406) and zinc (P = 0.783)
in adolescents.
Conclusion: Nutritional deficiencies in macronutrients and
micronutrients observed in very young rink-hockey players
can impair their growth and development with negative con-
sequences upon athletic performance.
What is Known:
Adequate dietary intake is an important resource for athletesshort- and
long-term health, performance and recovery.
There are no published studies in rink-hockey players energy
availability.
What is New:
This study provides the first data on significant differences in energy
intake between very young athletes and controls, resulting in low energy
availability in rink-hockey players.
Mean intakes of fat were above the recommended levels, and
micronutrients intakes were inappropriate in athletes with
consequences for their health and performance.

* Maria-Raquel G. Silva
raquel@ufp.edu.pt
Keywords Body composition . Energy . Children .
Hugo-Henrique Silva Adolescents . Athletes . Rink-hockey
hugohsilva@hotmail.com

1
Faculty of Health Sciences, University Fernando Pessoa, Abbreviations
Oporto, Portugal BMR Basal metabolic rate
2
Research Centre for Anthropology and Health, University of BF Body fat
Coimbra, Coimbra, Portugal BMI Body mass index
3
Scientific Commission of the National School of Gymnastics, DHA Docosahexaenoic acid
Gymnastics Federation of Portugal, Lisbon, Portugal EA Energy availability
4
Portuguese Ministry of Education, Lisbon, Portugal EI Energy intake
42
EEE Exercise energy expenditure
EPA Eicosapentaenoic acid
FFM Fat-free mass
FNB/IM Food and Nutrition Board/Institute of Medicine
RDA Recommended Dietary Allowances
R-H Rink-hockey
Introduction
Rink-hockey (R-H) is a team sport, considered a highly spe-
cialized and physiologically demanding discipline, involving
the use of a stick to play the ball, and players must wear four-
wheeled quad skates, thus requiring a high-intensity effort
with a unique dexterous manipulation of skates and the stick
[13, 49].
R-H is played on a rectangular rink of 20 40 m, with a
wall around its perimeter, between two teams of five players
each, one of which is the goalkeeper. The effective playing
time varies according to athletes categories, as follows:
40 min, divided over two periods of 20 min each, in the cat-
egories of senior male, senior female, under-20 male, under-
18 female and under-17 male, and 30 min, divided over two
periods of 15 min each, in the category of under-15 male. An
interval of 10 min is applied between the end of the first period
and the start of the second period of play. However, it is
allowed in national and international clubs events and com-
petitions to play with different playing times than mentioned
before, since the maximum of 50 min effective playing time,
divided over two periods of 25 min each, is not to be exceeded
[14]. Independently of the athletes category, dynamic and
static balance is necessary in balance positions and multiple
sprints; explosive strength is a determinant for dynamic ele-
ments with rotation and shooting [13]; intra-muscular, inter-
muscular and neuromuscular coordination is a determinant for
skating in combination with stick handling and mastery [3]
and flexibility is especially important for the goalkeeper [36],
who should be fast and resilient. Adequate cardiovascular and
musculoskeletal systems, regular endurance training to toler-
ate strenuous exercise and aerobic and anaerobic metabolism
(high energy phosphate and glycolysis) seem to be the deter-
minants of this intermittent high-intensity sport [49].
However, inadequate energy intake (EI) might compromise
adequate energy levels for athletes growth, daily activities
and athletic performance and can cause a decrease in the basal
metabolic rate and a relative increase in fat storage [10], i.e. it
functions in a way opposite to that required [42]. Therefore,
depending on the intensity, type and duration of physical ex-
ercise [27], carbohydrates are the recommended main energy
source [37], ensuring in that way adequate levels of blood
glucose and of muscle and hepatic glycogen [42].
In Portugal, the interest in R-H is heightened with the na-
tional R-H team being one of the most successful teams in the
Eur J Pediatr (2017) 176:4150
world along with Spain, Italy and Argentina. In fact, Portugal
is the current European Champion of R-H [6]. Therefore, it
attracts a passionate interest in Portuguese children and ado-
lescents. During childhood and adolescence, significant
changes in body size occur, influencing physiological and
physical performance [41]. When puberty begins, many ex-
trinsic factors such as time availability and social activities do
change simultaneously [44], influencing adolescents food
habits and, consequently, body composition [42]. In addition,
food habits may be influenced by strong factors embedded in
life course such as family, beliefs, ideals, social environment
and access to food [41, 44]. In athletes, sport characteristics as
well as specific training sessions and competition events also
influence energy and nutrient intakes [38, 42].
Despite the fact that hockey is quite popular worldwide,
there is a lack of published studies evaluating dietary intakes
in hockey players, especially in young athletes. Thus, the main
purpose of this study was to evaluate energy and nutrient
intake and body composition in Portuguese children and ado-
lescent players of R-H.
Methods
Participants
Seventy-two male R-H players (38 children and 34 adoles-
cents) and 79 male controls (43 children and 36 adolescents)
were included in this study. Athletes spent a mean of
8.5 3.5 h of physical exercise per week (including training
and matches on the weekend), whereas controls spent a mean
of 2.0 0.5 h of physical exercise per week.
The participants and parents were given a thorough expla-
nation of the study, and all provided an informed assent and
consent, respectively. Young athletes were recruited from two
national R-H clubs and competed at a regional level. Control
subjects, recruited from two local schools, were only involved
in Physical Education lessons.
Participants were evaluated in order to collect training data,
medical history, body composition and typical dietary intake.
Study design was approved by the Ethical Committee of the
University Fernando Pessoa (Oporto, Portugal), and written
informed consent was obtained from all participants parents.
Due to biological maturation, participants were subdivided in
two subgroups: from 8 to 11 years (children) and from 12 to
16 years (adolescents).
Training data and medical history
Several parameters were obtained: the number of training ses-
sions and physical education lessons per week and the number
of hours of training sessions and physical education lessons
per day from which the number of hours of training or
Eur J Pediatr (2017) 176:4150
physical education lessons per week was calculated. Any kind
of disease, medication or vitamin or mineral supplement, or
any other type of supplement, was collected.
Body composition and sexual maturation
Body mass was measured by a digital scale (SECA-872,
Hamburg, Germany) to the nearest 0.01 kg wearing T-shirt
and gym shorts before training. Height was determined with
a portable stadiometer (SECA-213, Hamburg, Germany) to
the nearest 0.1 cm. Procedures were conducted as recom-
mended by the International Society for the Advancement of
Kinanthropometry [33]. Body mass index (BMI) was calcu-
lated as a ratio of weight to the squared height (kg/m2).
Anthropometric standards from Frisancho [22] were used for
BM, height and BMI. The sum of the two skinfold thicknesses
(triceps and subscapula) was used to calculate percent body fat
(BF) [46]. Skinfold thicknesses were measured three times
each (0.1-mm increments), and the mean value of the three
readings (all within 1.0 mm for one site) was used.
Fat-free mass (FFM) was calculated as the difference be-
tween BM and BF. The same investigator completed all an-
thropometric testing in order to eliminate inter-observer vari-
ability (intra-observer reliability = 0.91).
The participants biological (sexual) maturation stage was
evaluated by self-assessment, using drawings, according to
secondary sexual characteristics (genital and pubic hair)
[48]. The theoretical range of maturation points for each var-
iable was from 1 to 5.
Dietary assessment
Energy and nutrient intake was assessed from a 3-day dietary
record, comprising 2 days of training and a weekends day.
Participants were asked to record all foods and beverages typ-
ically consumed, including time of day and meal type (e.g.
breakfast). Parents were encouraged to help their children in
keeping the record. All food records were checked by a sports
nutrition specialist, and unclear recordings were clarified in-
dividually together with the subject. Foods were expressed in
household measurements. The household measurements were
converted to grams and millilitres for a quantitative analysis
[42]. Nutrient data were coded and analysed with Food
Processor SQL. Foods and preparations not included in the
database provided by the programme were included by a com-
plementary nutritional information table or based on informa-
tion contained on the labels of the industrialized products. The
daily dietary analyses included energy, carbohydrates and pro-
teins based on body size, percentage of fat, thiamine, ribofla-
vin, niacin, pantothenic acid, vitamin B-6, folate, vitamin
B-12, vitamin A, vitamin C, vitamin D, vitamin E, vitamin
K, calcium, iron, boron, magnesium, manganese, phosphorus,
zinc, fibre and water. The recommended level of protein intake
43
by the American College of Sports Medicine [34] was
1.21.6 g/kg/day. Using the recommendations of the
American Dietetic Association, the Dietitians of Canada, the
American College of Sports Medicine [37] and Manore, Kam,
Loucks, and International Association of Athletics Federations
[32], the recommended levels of carbohydrate intake were
610 g/kg/day or a minimum of 55 and 2035% of fat daily
intake. The Recommended Dietary Allowances (RDA) from
the Food and Nutrition Board/Institute of Medicine (FNB/IM),
considering the values of the estimated average requirement,
were applied for the micronutrients. As suggested [37], the
basal metabolic rate (BMR) was calculated using the
Cunningham equation [8]. Energy availability (EA) is defined
as the amount of EI minus exercise energy expenditure (EEE)
normalized to FFM [27, 29, 34]. EEE was calculated using the
2011 Compendium of Physical Activities [1]. These calcula-
tions accounted for exercise duration, the intensity of the hock-
ey training or Physical Education lessons and BM, which were
collected using a characterization questionnaire. Low EA was
defined as EA below 45 kcal/kg FFM/day [26].
Statistical analysis
The characteristics of the participants are described with pro-
portions for categorical variables and with mean and standard
deviation values for continuous variables. To test differences
in training, body composition, energy and macronutrient con-
tribution separated by physical activity groups and biological
maturation, t tests were applied. The significance level was
5% (P < 0.05). Data was analysed using IBM SPSS statistical
software version 21.0 for Windows (New York, USA).
Results
R-H players BMI was significantly lower in athletes than in
controls, since players BM was lower and height was higher
than in controls (Table 1). As expected, both groups of athletes
also presented significantly lower BF and higher FFM than
controls (Table 1). In accordance with Tanner et al. (1962),
children were pre- or early-pubertal and adolescents were late-
pubertal.
Fifteen (10.8%) athletes were taking medication for injury
recovery, asthma or allergies. The use of vitamin or mineral
supplements was not mentioned.
In an inter-group analysis, mean intakes of carbohy-
drate and protein were considered to be adequate, but
mean intakes of fat were above the recommended levels
in both groups of athletes in accordance with internation-
al recommendations [37] (Table 2). No protein or amino
acid supplements were mentioned by participants.
Although all groups demonstrated fibre intakes below
the recommended RDA (2531 g/day for fibre in
44 Eur J Pediatr (2017) 176:4150

Table 1 Age, body composition

and pubertal stage of rink-hockey Characteristics Rink-hockey players Controls P
players (n = 72) and controls Mean SD Mean SD
(n = 79), according to age strata
Children n = 38 n = 43
Age (years) 10.1 0.3 10.2 0.4 0.775
BM (kg) 33.6 4.1 39.8 5.0 0.021*
Height (m) 1.48 0.1 1.42 0.9 0.041*
BMI (kg/m2) 17.8 4.2 18.7 1.0 0.039*
BF (%) 18.6 2.1 22.3 1.8 0.001**
FFM (kg) 35.2 3.6 28.9 5.7 0.031*
BMR (kcal/day) 1261.9 121.8 1035.6 91.2 0.006**
Pubertal stage (IV)a 25, 13, 0, 0, 0 24, 19, 0, 0, 0 0.840
Adolescents n = 34 n = 36
Age (years) 14.3 0.7 14.5 0.4 0.814
BM (kg) 59.4 6.1 63.7 9.4 0.029*
Height (m) 1.75 0.2 1.69 0.8 0.013*
BMI (kg/m2) 20.1 1.4 22.7 1.1 0.024*
BF (%) 12.4 2.2 17.1 3.9 0.001**
FFM (kg) 53.1 4.6 46.4 5.5 0.002**
BMR (kcal/day) 1795.9 201.7 1417.4 103.2 0.016*
Pubertal stage (IV)a 0, 0, 0, 12, 22 0, 0, 0, 8, 28 0.625

BM body mass, BMI body mass index, BF body fat, FFM fat-free mass, BMR basal metabolic rate
*Significant difference at P < 0.05; **significant difference at P < 0.01
a
Numbers indicate the number of participants in each of the five pubertal stages within each group.

Table 2 Daily energy and

macronutrient intakes, EA, EI and Energy and macronutrients Rink-hockey players Controls P
EEE of rink-hockey players Mean SD Mean SD
(n = 72) and controls (n = 79),
according to age strata Children n = 38 n = 43
Energy (kcal/kg FFM/day) 61.4 13.8 64.9 16.1 0.462
Carbohydrate (g/kg/day) 7.0 3.5 9.4 5.2 0.041*
Protein (g/kg/day) 1.5 .4 1.7 0.4 0.036*
Fat (%/day) 37.1 5.9 37.8 5.7 0.864
Fibre (g/day) 18 4 23 6 0.019*
EA (kcal/kg FFM/day) 47.8 8.7 53.8 9.1 0.021*
EI (kcal/day) 2101.8 114.8*** 2474.6 489.8 0.001**
EEE (kcal/day) 595.7 103.1*** 256.1 79.6 0.02*
Adolescents n = 34 n = 36
Energy (kcal/kg FFM/day) 68.6 15.9 76.6 22.4 0.03*
Carbohydrate (g/kg/day) 7.9 4.1 9.2 4.9 0.021*
Protein (g/kg/day) 1.7 0.9 2.3 0.8 0.011*
Fat (%/day) 37.2 6.8 38.4 8.1 0.772
Fibre (g/day) 22 5 31 6 0.001**
EA (kcal/kg FFM/day) 49.8 11.2 55.3 18.3 0.001**
EI (kcal/day) 2602.1 316.2*** 2992.7 304.1 0.005**
EEE (kcal/day) 905.3 321*** 472.5 209.1 0.002**

EA energy availability, EI energy intake, EEE exercise energy expenditure

*Significant difference at P < 0.05; **significant difference at P < 0.01; ***significant difference between
athletes groups at P < 0.05
Eur J Pediatr (2017) 176:4150
children and 31-38 g/day for fibre in adolescents; FNB/
IM) [19], athletes presented significant lower intakes
than controls (P < 0.05, Table 2). In addition, significant
differences were found for EI and EEE between athletes
and controls, respectively (P < 0.05, Table 2).
Among children, R-H players presented slightly, but still
significantly lower carbohydrate and protein intakes than con-
trols (P = 0.041 and P = 0.036, respectively, Table 2).
Although players showed significantly (P = 0.001) lower av-
e r a g e E I t h a n c o n t r o l s ( 2 1 0 1 . 8 11 4 . 8 v e r s u s
2474 489.8 kcal/day), they demonstrated significant
(P = 0.02) higher EEE (595.7 103.1 versus
256.1 79.6 kcal/day), resulting in significant lower EA
(47.8 8.7 versus 53.8 9.1 kcal/kg FFM/day, Table 2).
The average EI of children was 1934.1 309.8 kg/day, where
16.7% presented EI below 1800 kcal/day.
Regarding adolescents, significant differences
(P < 0.05) for energy and macronutrients were observed
between groups with exception for fat contribution
(Table 2). Furthermore, R-H players presented signifi-
cantly lower average EI than controls (2602 316.2 ver-
sus 2992.7 304.1 kcal/day, P = 0.005) and significant
higher EEE (905.3 321 versus 372 109.1 kcal/day,
P = 0.002), resulting in significant lower EA than con-
trols (46.8 11.2 versus 55.3 18.3 kcal/kg FFM/day,
Table 2); 10.1% of adolescent R-H players presented an
EA below 45 kcal/kg FFM/day.
The majority of athletes reported low intakes of important
vitamins including vitamins D, E and K and minerals, includ-
ing calcium, iron, boron and magnesium, according to the
FNB/IM recommendations [17, 18, 21] (Tables 3 and 4).
Children showed significant group differences in vitamin in-
takes, with exception for thiamine (P = 0.449), riboflavin
(P = 0.246) and pantothenic acid (P = 0.065), due to higher
mean intakes in the control group (Table 3). Significant group
differences were also observed for all vitamin intakes in ado-
lescents, with exception for niacin (P = 0.652) and vitamin D
(P = 0.406), due to higher mean intakes in the control group
(Table 3).
Athletes mineral intakes did not meet the recommenda-
tions of the FNB/IM [1618], with exception for magnesium
(P = 0.061) and phosphorus (P = 0.051) in children and zinc in
adolescents (P = 0.783, Table 4). Surprisingly, no significant
differences were observed for the abovementioned minerals
according to age strata, i.e. magnesium (P = 0.615) and phos-
phorus (P = 0.235) in children and zinc in adolescents
(P = 0.178, Table 4).
Furthermore, although all groups demonstrated water in-
takes below the recommended RDA (1.72.4 L/day for water
in children and 2.43.3 L/day for water in adolescents) [20],
significant group differences (P < 0.05) were found, due to the
very low mean intake in controls (0.5 0.4 and 1.1 0.4 L/
day, respectively, Table 4).
45
Discussion
To our knowledge, this is the first study evaluating dietary
intakes and body composition of young R-H players; previous
studies were mostly conducted in ice and field hockey using
adult players. Additionally, our study is one of the few to
present adequate mean intakes of carbohydrates and protein,
but high mean intake of fat in hockey players. No published
studies evaluating EA in rink, ice or field hockey players were
found.
In a study conducted with 46 ice hockey players (25
boys in the intervention group; mean age, 13.4 years; and
21 boys as a control group; mean age, 13.2 years), it was
demonstrated that spontaneous physical activity was induc-
ible with resistance training; however, this effect seemed to
be independent of changes in body composition [12]. We
demonstrate a considerable inconsistency in our study.
Independently of participants pubertal stage and age activ-
ity, R-H players presented a significantly lower BF and
higher FFM than controls; these results are similar to those
observed in 50 boys playing ice hockey and controls [15].
These findings may suggest that training and playing can
be responsible for an adequate body composition. Although
optimal body composition varies between sports [38], it is
well known that high levels of BF are associated to a
reduced acceleration and a low power to weight ratio, while
the opposite applies to high levels of FFM [47]. It has been
known that in contact sports, a high body mass may help
the athlete in generating absolute force and power, which is
important for effective skating, physical contact between
players and puck handling [35]; however, these collision-
based sports (where R-H is included) are likely to benefit
more from greater levels of FFM rather than a greater total
body mass [9]. Indeed, data from a 26-year physiological
study with 703 male hockey players (mean age 24 4 years)
confirmed that players on the successful teams had lower
BF content and greater combined grip strength than the
non-successful teams [35]. In addition, a study conducted
with 55 male ice hockey players over 8 seasons, with a
mean of 16.5 injuries per season (range, 1221 injuries;
132 total injuries) showed that those players, who weighed
more and potentially had an increase in BF, were less fit
and were therefore more likely to be injured [25]. Thus, an
appropriate body composition is a valuable prerequisite for
a good general health, an adequate nutritional status and an
athletic performance [3, 38, 41, 42, 44]. Therefore, differ-
ences observed in body composition between activity
groups might be a marker of change in health and nutri-
tional status [47].
R-H players mean intakes of carbohydrate were consid-
ered to be adequate. Although young athletes carbohydrate
intake recommendations highly depend on the type, duration
and intensity of physical exercise performed [42], 16.7% of
46 Eur J Pediatr (2017) 176:4150

Table 3 Vitamin intakes of both

groups of rink-hockey players Vitamins Rink-hockey players Controls P
(n = 72) and controls (n = 79),
according to age strata and RDA Mean SD P Mean SD P
compared with the RDA from the
FNB/IM Children n = 38 n = 43
Thiamine (mg/day) 0.60.9 1.4 1.0 0.000 1.6 1.2 0.000 0.449b
Riboflavin (mg/day) 0.60.9 2.0 1.6 0.000 2.1 1.5 0.000 0.246b
Niacin (mg/day) 812 34 13 0.000 19 8 0.003 0.001
Pantothenic acid (mg/day) 34 31 0.558a 52 0.634a 0.065b
Vitamin B-6 (mg/day) 0.61.0 2.5 1.4 0.000 0.9 0.5 0.802a 0.002
Folate (g/day) 200300 182 120 0.008 264 125 0.462a 0.031
Vitamin B-12 (g/day) 1.21.8 3.1 1.1 0.002 1.4 1.3 0.659a 0.003
Vitamin A (g/day) 400600 968 805 0.000 532 192 0.751a 0.001
Vitamin C (mg/day) 2545 44 26 0.785a 35 21 0.891a 0.008
Vitamin D (g/day) 5 22 0.000 52 0.069a 0.026
Vitamin E (mg/day) 711 54 0.001 93 0.602a 0.014
Vitamin K (g/day) 5560 22 9 0.000 46 9 0.024 0.001
Adolescents n = 34 n = 36
Thiamine (mg/day) 0.91.2 2.2 1.3 0.000 1.3 0.3 0.658a 0.021
Riboflavin (mg/day) 0.91.3 3.2 1.8 0.000 1.1 1.0 0.894a 0.005
Niacin (mg/day) 1216 28 14 0.000 29 11 0.000 0.652b
Pantothenic acid (mg/day) 45 53 0.000 41 0.000 0.038
Vitamin B-6 (mg/day) 1.01.2 2.3 1.6 0.001 1.0 0.8 0.687a 0.018
Folate (g/day) 300400 384 138 0.063a 349 178 0.265a 0.04
Vitamin B-12 (g/day) 1.82.4 3.6 2.6 0.000 2.3 1.0 0.784a 0.035
Vitamin A (g/day) 600900 1001 532 0.026 860 261 0.426a 0.026
Vitamin C (mg/day) 4575 81 59 0.011 60 35 0.395a 0.037
Vitamin D (g/day) 5 32 0.065a 42 0.126a 0.406b
Vitamin E (mg/day) 1115 73 0.024 12 4 0.840a 0.031
Vitamin K (g/day) 6075 45 6 0.017 65 8 0.649a 0.002

FNB/IM Food and Nutrition Board/Institute of Medicine, RDA Recommended Dietary Allowances
a
No significant differences were observed between vitamins and the RDA (P > 0.05)
b
No significant differences were observed in vitamin intakes between the two groups of participants (P < 0.05).
The data do not include vitamin supplements

child H-R players had an EI below 1800 kcal/day, which is a
recommended minimum value to maintain a positive energy
balance [37, 42]. In addition, a diet providing 60% of carbohy-
drates may not be sufficient to maintain ideal carbohydrate
stores if EI is lower than 2000 kcal/day [37]; thus, some child
R-H players may be at risk to maintain ideal carbohydrate stores.
R-H players mean intakes of protein were also considered to
be adequate (1.7 0.9 g/kg); however, adolescent R-H players
intakes were slightly lower than those observed in a group of
adolescents playing ice hockey (mean age, 14.5 years; protein
intakes, 1.89 g/kg) [15]. On the other hand, mean intakes of fat
were 2 to 3% above the maximum limit recommended level in
accordance with ADA recommendations (2035%).
Despite of the cold environment of the rink in ice hockey, the
use of protective equipment that covers the whole body has
been shown to inhibit the normal thermoregulatory benefits of
a cool environment [30]. In addition, Linseman et al. [30]
conducted a study with 14 skilled ice hockey players (age,
21.3 0.2 years) and concluded that the consumption of a
carbohydrate-electrolyte solution to maintain BM throughout
a 70-min hockey scrimmage resulted in improved hockey per-
formance and thermoregulation, since the core temperature de-
creased, suggesting that there was increased heat transfer from
the core of the body to the periphery and decreased fatigue as
compared with drinking no fluid and dehydrating by approxi-
mately 2%. No published studies were found concerning ther-
moregulation in R-H. However, R-H players wear minimal
clothing, being more vulnerable to cold environments, but more
protected from hot environments, with exception for the goal-
keeper, who must wear heavy protective equipment covering
the whole body (similar to ice hockey). Physiological profile of
R-H players may vary according to hockey position. Therefore,
R-H goalkeepers might be at a greater risk to sustain a balanced
body temperature during practices and games in both hot and
Eur J Pediatr (2017) 176:4150 47

Table 4 Mineral intakes of both

groups of rink-hockey players Minerals Rink-hockey players Controls P
(n = 72) and controls (n = 79),
according to age strata and RDA Mean SD P Mean SD P
compared with the RDA from the
FNB/IM Children n = 38 n = 43
Calcium (mg/day) 8001300 622 187 0.002 1055 394 0.521a 0.001
Iron (mg/day) 810 64 0.001 97 0.316a 0.023
Boron (mg/day) 611 52 0.034 83 0.671a 0.026
Magnesium (mg/day) 130240 212 73 0.061a 195 108 0.182a 0.615b
Manganese (mg/day) 1.51.9 2.4 1.8 0.000 1.8 4.4 0.220a 0.004
Phosphorus (mg/day) 5001250 754 346 0.051a 946 380 0.861a 0.235b
Zinc (mg/day) 58 13 6 0.001 95 0.542a 0.003
Water (L/day) 1.72.4 1.0 0.6 0.001 0.5 0.4 0.000 0.002
Adolescents n = 34 n = 36
Calcium (mg/day) 1300 826 219 0.000 1064 269 0.000 0.016
Iron (mg/day) 811 12 9 0.042 11 5 0.051a 0.042
Boron (mg/day) 1117 54 0.002 93 0.031 0.001
Magnesium (mg/day) 240410 218 61 0.001 306 197 0.083a 0.003
Manganese (mg/day) 1.92.2 3.3 8.4 0.000 2.0 1.1 0.902a 0.004
Phosphorus (mg/day) 1250 1402 207 0.002 1206 345 0.037 0.006
Zinc (mg/day) 811 11 2 0.783a 95 0.648a 0.178b
Water (L/day) 2.43.3 1.5 0.5 0.000 1.1 0.4 0.000 0.001

FNB/IM Food and Nutrition Board/Institute of Medicine, RDA Recommended Dietary Allowances
a
No significant differences were observed between vitamins and the RDA (P > 0.05)
b
No significant differences were observed in vitamins intakes between the two groups of participants (P < 0.05).
The data do not include mineral supplements

cold environments. Nevertheless, hydration strategies such as a
carbohydrate-electrolyte drinking solution should be imple-
mented in R-H players, with special attention for goalkeepers.
Coaches even should stop the training session for about 30 s in
order to allow players good hydration.
Although R-H players presented significantly less BF
than non-athletes which may be due to sport demands, their
fat intakes were already above the maximum limit of the
international recommendations. Thus, increasing EA in ath-
letes by increasing carbohydrate intakes or decreasing EEE
by reducing training volume should be addressed.
International guidelines should be also considered for a re-
duced contribution of fat (2035%) in order to reduce the
risk of chronic diseases and to prevent increase of adipose
tissue in non-athletes [37, 42].
Complex carbohydrate intake, such as rice, pasta, whole-grain
breads, fortified cereals and low-fat dairy, should be especially
emphasized, instead of cookies, biscuits, chips, croissants, choc-
olates and sweetened beverages. Plain water should be the athlete
or non-athletes favourite drink, and vegetables and fruit should
be eaten during in-between-meal snacks to improve adequate
fibre intake and mostly to avoid energy-dense foods rich in sugar.
In a study conducted with 30 children (6.4 1.3 h of train-
ing/week) and 31 adolescent ice hockey players (6.5 1.6 h of
training/week), 56 soccer players and 65 controls, it was found
that total daily EI of children ice hockey players
(1878 501 kcal/day) was significantly lower than in adoles-
cents (2384 731 kcal/day, P < 0.05) [13]. Despite differences
in the mentioned study, namely concerning sport disciplines,
the similarity of results in what concerns the EI differences
between children and adolescent ice hockey players and our
results (an average of 502 kcal/day in ice hockey players and an
average of 500.3 kcal/day in our study) is impressive. In spite
of a higher mean EI observed in our players, they also trained in
average more hours per week (8.5 3.5 h/week), as demon-
strated in another study with young ice hockey players [15].
Indeed, it should be highlighted that our adolescent R-H
players (10.1%) showed a worrying low EA (<45 kcal/kg
FFM/day) [42]. These findings may compromise athletes en-
ergy needs for growth, maturation and athletic performance
[34]. We should assume that some of them might be at a greater
risk for developing health and physical performance hazards
than the oldest players, such as negative musculoskeletal ef-
fects, bone stress injuries and low bone mineral density [37, 40]
and performance impairment [32, 4345], which can be caused
by macronutrient and micronutrient deficiencies, and the sport
practice with a demanding training volume, which may not
allow adequate time for children to recover [40].
Micronutrient intake was higher among adolescent R-H
players. However, both groups of athletes have significantly
48
inadequate intakes of essential micronutrients that may impact
on their growth and maturation, skeletal development and
reproductive function [42, 44, 45]. The most significantly
compromised micronutrients in child R-H players were vita-
mins (D, E and K), calcium, iron and boron, and vitamins (E
and K), calcium, boron and magnesium in adolescent R-H
players. Although adequate intake of two important trace ele-
ments iron (12 9 mg/day) and zinc (11 2 mg/day) during
puberty was observed in our adolescent participants, these
were slightly lower than those demonstrated by a group of
adolescents playing ice hockey, respectively (mean age,
14.5 years; iron intake, 18.2 mg/day; zinc intake, 15.7 mg/
day) [15]. In a study with 70 Polish hockey players (23
35 years old), inadequate intakes of micronutrients were also
observed, as follows: excessive supply of vitamins (A and E)
and phosphorus and deficits of vitamin C, riboflavin and cal-
cium [23]. It is possible that some of our athletes may be at
risk for the presence of anaemia associated with bone and
growth impairment, sport injuries and other health hazards
mentioned before.
In a study with 40 male hockey players (12.3 0.5 years
old) who were measured for urine specific gravity (via refrac-
tometry) immediately pre- and post-tournament under tropical
weather conditions, 97.5% already showed signs of dehydra-
tion when arriving at the tournament site [5]. Indeed, urine
specific gravity increased to 100% after the tournament and
BM changed to 3.25% (P < 0.05) demonstrating significant
dehydration among players. Despite that the evaluation of
hydration status was not a goal of our study, and no expert
guidelines are available on the hydration status of players
competing in youth hockey [5], the consumption of water in
our R-H players was below the recommended level [20], as
well as of fibre [19]. In addition, our participants did not report
consumption of beverages containing carbohydrates or elec-
trolytes before, during or after training sessions. Players
should be eu-hydrated before training or competition, since
aerobic performance and decision-making are important in
team sports, which can be much influenced by the athletes
hydration status [5]. According to the wide inter- and intra-
variability in work rate among players in the same sport, fluid
hydration and rehydration strategies should be individualized
with a special care for R-H goalkeepers, whose equipment and
specific play position might greatly increase sweat. Therefore,
R-H players should be encouraged to drink enough fluid be-
fore, during and after training or matches and informed that
thirst is a poor indicator of fluid needs [27, 42, 44, 45]. Chilled
bottled mineral water and sport drinks should be provided [44,
45]. Casa, Armstrong and Hillman [4] recommend that ath-
letes should drink 2550% more than sweat. R-H players
should be also informed about the importance of adequate
fibre intakes to minimize gastrointestinal distress and to regu-
late appetite [42, 44]. Thus, fruit intake, such as fruit juices,
dried fruit or peeled fruit [41, 45], preferably eaten during in-
Eur J Pediatr (2017) 176:4150
between-meal snacks and during practices, is an important
strategy to prevent athletes gastrointestinal discomfort, be-
cause of its high levels in fibre [42], and it is an easy way
for athletes to consume vitamins, mineral salts and water [45].
In accordance with the participants dietary assessment,
it is important to highlight two major nutritional rules that
every athlete should follow: to read food labelling in or-
der to make healthy dietary choices, including sodium
content, and to eat and drink regularly in order to avoid
excessive hunger and thirst. The breakfast should be com-
plete, varied and balanced; it should include fruit, whole
grains and low-fat milk or milk products [41]. Skipping
meals increases the consumption of energy-dense foods
[41] and increases BMI [9] and the risk of being over-
weight and obese [7]. Soup is an intelligent resource to
eat vegetables twice a day, at the beginning of two impor-
tant meals (lunch and dinner), and it also helps in regu-
lating the appetite for the rest of the meal. However, veg-
etables and fruit should be eaten during in-between-meal
snacks to improve adequate fibre intake and mostly to
avoid energy-dense foods rich in sugar and fat [41]. A
young athletes favourite drink should be plain water; it
has predicted a lower energy density of the foods con-
sumed. Instead, high consumption of sweetened bever-
ages can contribute to an increase in EI and consequently
body weight gain [31] and has predicted higher energy
density of foods consumed [28]. Fish is preferable than
meat, since it can be richer in long-chain omega-3 poly-
unsaturated fatty acids, namely EPA and DHA, which
have beneficial effects as ergogenic aids, decreasing fa-
t i g ue a n d i nf l a m m a t o r y p r oc e s s a nd i m p r o v i n g
neuromotor function and muscle pain relief [39]. On the
other hand, lean meat contributes to the prevention of
some micronutrient deficiencies (e.g. iron, vitamin B-12,
pantothenic acid) [41]. In summary, foods such as lean
meat, vegetables, fruit, whole grains and low-fat dairy
are all healthy food choices, because all contain beneficial
nutrients such as protein, fibre, iron, zinc, calcium and
folate, which are crucial for any healthy and competitive
athlete.
Education programmes to increase R-H players, coaches
and parents knowledge about health, basic nutrition and ath-
letic performance should be implemented as a preventive
strategy.
The limitations of this study should be taken into account
when interpreting these results. First, athletes were also very
time limited between and within training sessions and school
demands; therefore, applying for more than 3 days of dietary
intakes was difficult. Nevertheless, in the current study, par-
ticipants were asked to provide information about typical diet
and the results were in accordance with the overall trend for
young hockey players [13, 15], so we believe in the reliability
of the results. Second, although participants were motivated
Eur J Pediatr (2017) 176:4150
and willing to reliably report habitual intake, estimating die-
tary intakes is difficult [2, 11] and all techniques for estimating
energy and nutrient intakes have the problem of
underreporting food intake [35, 50]. Considering the recom-
mendations of Goldberg et al. [24], participants daily EI un-
derestimation might have been avoided, since the minimum
level of energy expenditure obtained was 1461 kcal. The dou-
bly labelled water technique is considered as the gold standard
for measuring EE under free-living conditions which might be
used to estimate accuracy of self-reported EI in future studies
[35]; however, we emphasize that laboratorial facilities were
not available to evaluate our participants.
Conclusion
R-H players presented lower BF and higher FFM than con-
trols; however, macronutrient and micronutrient deficiencies
were observed, including low energy availability in some
players; thus, athletes physiological and training/
competition needs may be compromised. Coaches and parents
should regulate and control athletes diet and also educate
them to be self-responsible for their health. Specialized inter-
vention is needed in order to support daily physical activities,
including R-H training regime, growth and maturation
through ensuring adequate energy and nutrients availability.
Acknowledgements Authors thank the rink-hockey players and con-
trols for their participation in this study and coaches and parents for their
collaboration. The authors are also grateful to the reviewers for their
valuable comments. This study was carried out at the Faculty of Health
Sciences, University Fernando Pessoa, Oporto, Portugal, and at the
Research Centre of Anthropology and Health, University of Coimbra,
Coimbra, Portugal. This work was supported by National Founds from
FCTFoundation for Science and Technology under Grant PEst-OE/
SADG/UI0283/2015.
Authors contribution Both authors were responsible for the concep-
tion, design, data analysis and data interpretation of the study and writing
of the manuscript; M.-R.G. Silva was also responsible for data collection.
Both authors approved the final version of the manuscript.
Compliance with ethical standards Informed written consent from
each participant was obtained in accordance with the principles expressed
in the Declaration of Helsinki guidelines for human subjects. The current
study was reviewed and approved by the Ethical Committee of the
University Fernando Pessoa (Oporto, Portugal). All procedures per-
formed in studies involving human participants were in accordance with
the ethical standards of the institutional and/or national research commit-
tee and with the 1964 Helsinki Declaration and its later amendments or
comparable ethical standards.
Conflict of interest The authors declare that they have no conflict of
interest.
Informed consent Informed consent was obtained from all individual
participants included in the study.
49
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