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Desta Getachew |1 Powering A Cross-Country Diet Desta Getachew’s Re-fueling Experience Desta Getachew |2 Presented By: Kelsey Wright, Lilian P. Garcia, Ramla Sahid & Qian Hu NUTR 304 Nutrition Throughout Life Span Prof. Linda Copp March, 8, 2010 Desta Getachew |3 Background Profile Desta Getachew comes from a very religious and traditional first generation immigrant Ethiopian family. He lives in the City Heights area, a very diverse, lower income, and immigrant community of San Diego California. Although, the majority of Ethiopian immigrants are Christian, Desta’s family practices Judaism. Moreover, the family is participating in public housing assistance and is experiencing economic hardships. The Getachew family comes from a small population of African Jews called the Falashas. They chose to live in San Diego because of its sunny Mediterranean like weather. As recent immigrants who have lived in the City Heights neighborhood for about one year, the family practices strict Kosher law whenever possible. Kosher law is observed for utensils, for example there must be a separate set of utensils used when handling meat or dairy products. The length of time between eating meat and dairy is also critical, kosher laws recommend waiting three to six hours after meat. Animals eaten must have been slaughtered in accordance with Kosher-laws by a rabbi and all blood must be drained before eating [1]. Additionally, Desta’s mother makes all the planning and meal preparations for the family. The foods she prepares are also traditional Ethiopian dishes that require refrigeration and main dish often consists of sauces or stews. As a consequence of the restrictions, he does not pack lunch, snacks, or follow strict kosher laws outside the home. His eating habits outside the home are mainly fast food restaurants. He enjoys restaurants such as In and Out Burgers®, McDonalds®, and Burger King®. He mostly drinks sodas and Gatorade® is his favorite sports drink. Desta drinks about eight ounces of water on the days he drinks water. In addition, his eating habits are also irregular; he usually skips breakfast and has a large lunch and dinner. Desta does snack throughout the day eating chips, sweets, or whatever is available and convenient for him. Introduction An initial nutritional assessment was done for Desta Getachew, an 18 year-old male cross-country runner at Crawford High School on June 26th 2009. An in depth evaluation of Anthropometric, clinical, and dietary data was collected during the first session. Desta was given instructions on how to approximate portion sizes with his hands and other examples from everyday objects like a baseball, a deck of cards, and a computer mouse. A simple 24-hour diet recall was used to assess dietary data. The dietary assessment revealed inadequate dairy intake, excessive sugar intake through liquids and sugary foods, and insufficient fruit, vegetable, and whole grain consumption. During the assessment Desta shared that he liked easy to pack traditionally American foods. Furthermore, questions were asked during the nutrition interview on clinical data to evaluate his dietary stance. The collected data did not present evidence of any health risks. Moreover, no physical signs of malnutrition were observed. Desta’s anthropometric data was used to calculate his Basal Metabolic rate to determined energy expenditure and accurate caloric need. Moreover, the Harris-Benedict formula was used to calculate Desta’s daily caloric needs. The confidentiality of all the information collected was explained to Desta before the interview began. All of the results were recorded in the participant’s electronic file. Nutritional needs were determined to be low calcium intake, micronutrient deficiencies, low fiber intake, high sodium intake, and high fat a sugar intake. To ensure accuracy of the portion sizes reported for the second nutrition assessment, Desta was given visual examples of food models and asked to demonstrate how to approximate portion sizes with his hands. It was explained that the next visit would require another 24-hour diet Desta Getachew |4 recall. He will also be given a menu plan to help achieve healthy goals that were developed using the information that he provided about the families Kosher Law restrictions. Because his mother will prepare all his meals, the menu will be planned in accordance with Kosher-law even though as an individual, he does not adhere to Kosher-law outside his home. Nutrient Requirements Optimal nutritional health for Desta Getachew is not only required for growth and development, but also for his athletic performance. Nutritional deficiencies in macronutrients such as carbohydrates, proteins, and fats could lead to a considerable effect on energy deficit, loss of muscle mass, failure to gain bone density, and an increased risk for fatigue, injury, or illness [2]. Meeting carbohydrate and protein intakes for Desta is especially important to help maintain proper body weight, replenish glycogen stores, and provide the adequate protein intakes for repairing and building tissue [3]. Additionally, fat intake of 25%-35% of total calories is recommended for adolescents. Dietary fat and the essential amino acids are required for normal growth development [4]. Moreover, Desta’s diet proved to be deficient in micronutrient intake, low fiber, high sodium intakes, and high sugar intakes. He is at a great risk for micronutrient deficiencies because he is consuming an unbalanced diet that is not micronutrient dense. Micronutrients play vital roles in energy production, maintenance of bone health, hemoglobin synthesis, synthesis and repair of muscle tissue during recovery from exercise or injury, and much more [3]. It is of importance that a menu plan high in fruit and vegetable intake is planned to help meet his micronutrient and macronutrient needs. Meeting micronutrient needs through a diet rich in fruits and vegetables will in-turn increase his fiber intake and meet the increased needs of building and repairing his lean body mass. Additionally, the menu plan will decrease the high sodium intake as Desta restricts eating fast foods and learns to eat healthier options through meal and snack planning. Moreover, Desta’s high sugar intake is contributed to the large quantity consumption of soda. A decrease in his consumption of soda and an increase of water is expected through the menu plan that is created. Water is critically important for an athlete such as Desta, as dehydration results in muscle cramping and fatigue [5]. Menu Plan Refer to Synthesized Menu Booklet Nutrient Analysis The biological, psychological, and cognitive changes associated with adolescence have direct effects on nutritional status [4]; especially when an adolescent is involved in extensive physical activity, like in the case of Desta Getachew. The dramatic physical growth and development experienced by adolescents significantly increases their needs for energy, protein, vitamins, and minerals [4]. The increase of lean body mass, skeletal mass, and body fat linked with this growth development results in energy and nutritive needs that exceed those of other age groups. There are several methods practiced to follow adequate intake levels and tolerable intake levels to ensure a proper nutrition. Recommended Dietary Allowance (RDA) are the levels of essential nutrient Desta Getachew |5 intake judged to be adequate to meet the known needs of practically all healthy people, while decreasing the risk of certain chronic diseases. Tolerable Upper Intake Levels (UL) are upper limits of nutrient intake compatible with health. These levels represent daily levels of nutrient intake from food, fortified foods, and supplements that should not be exceeded. It is imperative to measure the quantity of any give intake to prevent toxicity or any affects to well being. In order to determine Basal Metabolic Rate (BMR) which essentially measures energy expenditure in an individual and further calculates accurate calorie needs, several factors come into play such as height, weight, age, and sex. Because adolescent males experience greater increases in height, weight, and lean body mass, they have significantly higher caloric requirements than females [4]. The Harris-Benedict equation is a calorie formula that evaluates this information and makes the results more accurate than determining calorie needs base on total body weight alone. The formula is as follows for males: BMR = 66 + (13. 7 x weight in kg) + (5 x ht in cm) – (6.8 x age in years). Table 1A presents the data necessary to calculate Desta Getachew’s daily calorie needs using the Harris-Benedict formula, which is further represented in table 2A. According to the calculations, an approximate 3,400 calorie diet will be enforced to assure that Desta receives an adequate nutrition in order to enhance his physical activity’s potential. Another factor that influences the total calorie needs for a day is the activity level of a specific individual. In this case Desta Getachew is very active; therefore the following calculation was incorporated: BMR x 1.725 (hard exercise/ sports 6-7 days/wk), also presented in table 2A. Tables 3A through 12A give detail to Desta Getachew’s Recommended Daily Allowances (RDAs) for macronutrients and Tolerable Upper Intake Levels (ULs) for vitamins and minerals when evaluating one day’s nutrient intake. The tables also discuss the quantity in grams for carbohydrate, protein, fat and dietary fiber necessary to complete Desta’s daily nutrient needs. The composition of Desta’s diet and synthesis of his customized menu was based off of a 3,400 calorie diet previously calculated; refer to table 1A -2A. His vitamin and mineral needs were met by following the Recommended Daily Allowances and Tolerable Intake Levels. It is essential to meet all dietary needs to insure an accurate and balanced nutrition. Table 1A: Desta Getachew Personal Data Metric Conversion Age Height Weight 18 6 ft 2" 175 NA 187.96 cm 79.37 kg BMR results, plus activity multiplier (very active) data, yield Desta Getachew’s total calorie intake for one day which is 3,400 calories, explained in table 2A. Table 2A: Basal Metabolic Rate & Total Calorie needs for one day Desta Getachew |6 BMR 66+ (13.7 x 79.37 height) + (5 x 187.96 weight )- (6.8 x 18 age) = Activity Multiplier; Very Active TDEE 1970.76 x 1.725 = 3399.56 ~ 1970.76 3400 3400 calories per day Carbohydrates constitute the body’s primary source of dietary energy. Based on Desta’s physical activity, it is essential that he receives adequate amounts of carbohydrates exceeding those of an average adolescent. Table 3A explains how based on endurance and Desta’s height, his daily needs of carbohydrates range from 556 to 794 grams per day. Table 3A: Daily Carbohydrate Intake Based on a 3400 Calorie Diet Daily Carbohydrate Intake (7 x 79. 37 = 555.59 g) to (10 x 79.37 = 793.7g) Endurance 7 g to 10 g / kg 556 g to 794 g CHO/ day Protein needs of adolescents are influenced by the amount of protein required for maintenance of existing lean body mass, plus the allowances for the amount required to accrue additional lean body mass during the adolescent growth spurt [4]. Table 4A explains that based on endurance and height, Desta’s daily protein needs range from 95 to 111 grams per day. Table 4A: Daily Protein Intake Based on a 3400 Calorie Diet Daily Protein Intake (1.2 x 79. 37 = 95.3 g) to (1.4 x 79.37 = 111.1g) Endurance 1.2 to 1.4 g / kg 95 g to 111 g protein / day The human body requires dietary fat and essential amino acids for normal growth development [4]. Current recommendation suggest that adolescents consume no more that 25-35% of their total calories from fat, and ultimately no more than 10% of calories deriving from saturated fats. Table 5A explains Desta’s total fat intake ranges from 76 to 132 grams of fat per day. 20% and 35% of total kcal for fat were respectively factored out of the 3400 calorie diet. These results were divided by nine because fat provides 9 calories per gram of fat, leading to the total grams of fat per day. Table 5 A: Daily Fat Intake Based on a 3400 Calorie Diet Daily Fat Intake (20%-35% of total kcal) 20% of 3400 total kcal= 680 kcal 35% of 3400 total kcal= 119 kcal 76 g to 132 g fat/ day Desta Getachew |7 Fat= 9 kcal/gram 680 /9 = 75.5 g fat 1190 /9 = 132.22 g fat Dietary Fiber is important for normal bowel functions and may play a role in the prevention of chronic diseases [4]. The recommended intake for dietary fiber for adolescent males is set at 38 grams per day and there is no upper intake level reported; this is explained in table 6 A. Table 6 A: Daily Dietary Fiber Intake Daily Dietary Fiber Intake RDA Upper Intake Level (ULs) 38 g /day 38 g /day NA Achieving an adequate intake of calcium during adolescence is crucial to physical growth and development because about half of peak bone mass is accrued during adolescence, calcium intake is of great importance for the development of dense bone mass [4]. Table 7A explains RDA and UL intakes of calcium ranging from 1300 mg to 2500 mg per day. Table 7 A: Daily Calcium Intake Daily Calcium Intake RDA Upper Intake Level (ULs) 1300 mg –2500 mg day 1300mg /day 2500mg / day The rapid rate of linear growth and the increase in blood volume increases an adolescent’s need for iron; the needs in makes will be highest during the growth spurt [4]. Table 8A explains RDA and UL specifications for adolescents between 14-18 years ranging from 11 mg to 45 mg per day. Table 8 A: Daily Iron Intake Daily Iron Intake RDA Upper Intake Level (ULs) 11 mg – 45mg day 11mg /day 45mg / day Desta Getachew |8 Vitamin C is involved in the synthesis of collagen and other connective tissues; therefore it plays an important role during adolescent growth and development [4]. Table 9A explains RDA and UL specifications for adolescents between 14-18 years ranging from 75 mg to 1800 mg per day. Table 9A: Daily Vitamin C Intake Daily Vitamin C Intake RDA Upper Intake Level (ULs) 75 mg- 1800 mg day 75 mg /day 1800 mg / day Sodium serves in regulations of acid-base balances in body fluids, maintains water balance within body tissues, and activates muscles and nerves. Table 10A explains RDA and UL specifications for sodium intake ranging from 1500 mg to 2300 mg per day. Table 10 A: Daily Sodium Intake Daily Sodium Intake RDA Upper Intake Level (ULs) 1500 mg- 2300 mg day 1500mg /day 2300 mg / day Zinc is particularly important during adolescents because of its role in the synthesis of RNA and protein, and also in its role as a cofactor in many enzymatic reactions [4]. Table 11A explains RDA and UL specifications for adolescents between 14-18 years ranging from 75 mg to 1800 mg per day. Table 11 A: Daily Zinc Intake Daily Zinc Intake RDA Upper Intake Level (ULs) 11 mg – 50 mg day 11mg /day 50mg / day Folate is an integral part of DNA, RNA, and protein synthesis; therefore adolescents have an increased requirement for folate during puberty. Table 12A explains RDA and UL specifications for adolescents between 14-18 years for folate ranging from 400 mg to 800 mg per day. Table 12 A: Daily Folate Intake Daily Folate Intake RDA Upper Intake Level (ULs) 400 mg – 800 mg day 400 mg /day 800 mg / day Desta Getachew |9 A 3,400 calorie diet was composed for Desta Getachew’s calorie, macro and micro nutrient needs. Table 1B depicts Desta’s macronutrient intake for one evaluated day. Due to his high activity and vigorous exercise training, it is imperative he receives the majority of his calories from carbohydrates which expend high calories to supply his energy needs. After assessing one day’s worth of macro nutrients, 62 % of his calories came from carbohydrates, while protein accounted for 13 % and fat 25%. A visual distribution of the essential macronutrients is available in Figure 1. The table below shows the breakdown of these numbers, while also including important components like saturated, polyunsaturated, monounsaturated, and dietary fiber to consider when planning a diet. Table 1 B: Day One Nutrient Analysis Component Breakdown Grams Calories Fat Saturated Polyunsaturated Monounsaturated Carbohydrate Dietary Fiber Protein Calories 3,427 851 kcal 215 kcal 273 kcal 296 kcal 2,134 kcal NA 438 98.8 g 24.5 g 32.0 g 34.3 g 542.5 g 43 g 114.9 g % - Cal 25% 6% 8% 9% 62 % NA 13 % Table 2B depicts Desta’s vitamin intake for one day which was assessed. Due to his young age and high activity it is crucial for him to receive adequate intake of the particular vitamins described in table 2B. Desta’s overall intake exceeds the RDA suggestions over 100% for each vitamin listed below. Table 3B illustrates Desta’s overall mineral intake for day one evaluated, due to his young age it is vital he receives adequate calcium for bone strength and tissue composition. Desta receives 117% of the recommended daily allowance for calcium which is a major component of bones. Table 3B further examines his mineral breakdown and consumption for day one. Figure 2 provides a visual analysis of the micronutrient intake for the specific day evaluated. Table 2 B: Day One Vitamin Intake Assessment RDA % RDA D e s t a G e t a c h e w | 10 Vitamin A Vitamin B6 Vitamin B12 Vitamin C Vitamin D Vitamin E 1,096.6 mcg 3.6 mg 4.2 mcg 147. 1 mg 192. 7 IU 15.8 mg 900.0 mcg 1.3 mg 2.4 mcg 75.0 mg NA 15.0 mg 122 277 175 196 NA 106 Table3 B: Day One Mineral Intake Assessment Calcium Iron Folate Sodium Zinc Water 1,523.2 mg 21.3 mg 628.9 mcg 2,381.2 mg 17.0 mg 1,261.1 g RDA 1,300 mg 11.0 mg 400 mcg 1, 500.0 mg 11.0 mg NA % RDA 117 193 NA 159 155 NA Table 1C examines Desta’a macronutrient consumption for the second day evaluated. His diet for that specific day provided 61% of his calories from carbohydrates, 14% of his calories from protein, and 26 % of his calories from fat. As stated prior, his high activity calls for a larger consumption of carbohydrates and his dietary needs were properly met. The table below 1C as well as figure 2, which depicts a visual of the major macronutrients, further breaks down macronutrients plus others to consider when planning a meal. Table 1 C: Day Two Nutrient Analysis Component Breakdown Grams Calories Fat 107.6 g Calories 3,603 931 kcal % - Cal 26% D e s t a G e t a c h e w | 11 Saturated Polyunsaturated Monounsaturated Carbohydrate Dietary Fiber Protein 28.5 g 26.7 g 43.3 g 553.3 g 52.3 129 g 250 kcal 230 kcal 373 kcal 2,195 kcal NA 500 kcal 7% 6% 10% 61% NA 14% Table 2C illustrates Desta‘s vitamin intake for day two. He received 126% of his recommended daily allowance of vitamin A, 141 % of Vitamin B6, 146% of vitamin B12, 405% of vitamin C, and 78 % of vitamin E. All of these micronutrients are essential to ensure Desta reaches his potential training and activity performance. The tables below further illustrate the breakdown of these numbers. Table 3C examines Desta’s mineral intake for day two. He received 109 % of his recommended daily allowance for calcium, 228 % of Iron, and 123% of sodium. Once again due to his extremely high activity level it is imperative these intake levels are met. The table below further shows the breakdown of Desta‘s mineral intake. Figure 4 provides a visual of the micronutrient distribution for the second day evaluated. Table 2 C: Day Two Vitamin Intake Assessment Vitamin A Vitamin B6 Vitamin B12 Vitamin C Vitamin D Vitamin E 1,134.9 mcg 1.8 mg 3.5 mcg 304.4 mg 6.6 IU 11.7 mg Table3 C: Day Two Mineral Intake A RDA 900.0 mcg 1.3 mg 2.4 mcg 75.0 mg NA 15.0 mg % RDA 126 141 146 405 NA 78 D e s t a G e t a c h e w | 12 Calcium Iron Folate Sodium Zinc Water 1,134.4 mg 25.1 mg 538.1 mcg 1,849 mg 17.3 mg 1,256.1 g RDA 1,300 mg 11.0 mg 400 mcg 1,500 mg 11.0 mg NA % RDA 109 228 NA 123 157 NA Menu Costing USDA Food Cost Plan Selected: Low Cost Plan, Male 14-18 years old, Family of two Budget $55.00. Budgeted amount for one week: $ 55. 00/ week Budgeted amount for one day: $ 7.85 / day Table 1 D: Product Costing Food Item Brand Name Purchase Size Purchase Price Serving Size Cost / serving # of servings Total Cost Eggs Dozen $4. 04 1 egg .33¢ 3 .99 Corn Tortilla Eggland (Kosher) Mission 27.5 oz $1. 50 2 tortillas .06¢ 1 .o6¢ Cheddar Cheese Black Beans Tillamook (Kosher) Safeway 32 oz $7.99 1 oz cheese .25¢ 1 .25¢ 1 can = 15 oz .99¢ .5 cup 2 .56¢ . 28¢ D e s t a G e t a c h e w | 13 Peanuts (Dry Roasted/ Unsalted) Safeway 16 oz $3.39 NA .21¢/ oz 3 oz .52¢ Pineapple Pizza Crust Pizza Sauce Mozzarella Cheese Romaine Lettuce (prepackaged) Italian Dressing Grape fruit Fresh Orange Juice Long Grain Rice Stir Fry Vegetables (prepackaged) Vegetable Oil Sugar Kool Aide TOTAL: Safeway Boboli Ragu Precious (Kosher) Eating Right 1 can= 20 oz 12 “ crust 1 jar = 14 oz 1 loaf =32 oz 18 oz $1.00 $4. 59 $2.39 $8.99 .5 cup 1/8 .25 cup 1 oz .25¢ .57¢ .39¢ .28¢ 1.5 cup 2 .5 1.30 .75¢ $1. 14 .19¢ .36¢ $2.00 6 leaves .33¢ 1 .33¢ Safeway 16 fl oz $1.99 2 tbsp .12¢ 1 .12¢ Safeway 5 lb $4. 49 NA .90/ lb .45¢ Tropicana Safeway 64 fl oz 16 oz $2. 50 .79¢ 8 oz I cup .31¢ .40¢ ½ grapefruit 1 1 Safeway 16 oz $2.00 1 cup $1.00 1 $1.00 Safeway Safeway Kool Aide $7.66 48 fl oz 16 oz .16 oz $2.99 $1.23 .25¢ 1 tbsp 1tbsp .125 .03¢ .10¢ .03¢ 2 5 4 .06¢ .05¢ .12¢ .31¢ .40¢ Discussion and Summary The menu plan was created considering Desta’s unique deterrents to achieving healthier habits. During the initial nutrition assessment, an in-depth evaluation was done to evaluate nutritional status and food habits. It was determined that Desta’s food habits were related to convenience, storage barriers, lack of nutritional knowledge, and the families limited financial resources. The menu plan was created with considerations to nutritional value, an individualized food budget, convenience, family’s religious views, and attractiveness. The wide assortment of foods in the menu was chosen to appeal to Desta’s food preferences. Desta’s mom does all the cooking for the family and adheres to kosher law regarding preparation and selections of foods made at home. While Desta, complies with cultural and religious practices at home, he does not observe them outside the home because he enjoys American foods as well. The created menu plan attempts to appeal to his likes by incorporating selections of cultural, religious, and American food items. Furthermore, considerations were also made to his high Caloric needs and limited budget. Menu Costing With a total budget of $55.00 a week for a family of two, Desta’s planned menu was at times difficult to stay within budget because of his excess need of carbohydrates. A budget of $7.85 was allocated per day for cost of food to help ensure food products selected stayed within budget during the planning process. As D e s t a G e t a c h e w | 14 shown in table 1D, the total cost of food items for day 4 of the menu plan was $7.66; resulting in a total saving of $.19 for that day. Overall, staying within budget proved to be difficult but attainable for Desta’s athletic diet. Meeting RDA’s The total Recommended Dietary Allowance for fat is no more than 25%-35% of total Calorie intake. According to table 1B: Day One Nutrient Analysis Component Breakdown, Desta’s planned menu for that day met the RDA’s for fat consumption by not more than 25%. Moreover, the table also shows that RDA’s were met for Saturated fat consuming less than 10%. Furthermore, Table 1B demonstrates that a total Carbohydrate intake of 62% and Protein intake of 13% was consumed. The percentages are within the recommended ranges of 45%-65% and 10%-35% for Carbohydrate and protein intakes respectively. Additionally, Table 2B: Day One Vitamin Intake Assessment shows that the RDA’s were all met for Vitamins A, B6, B12, C, D, and E. Furthermore, table 3B: Day One Mineral Intake Assessment also shows that RDA’s for Desta were met for Iron, Folate, Sodium, Calcium, and Water. For the second day evaluated, Table 1C substantiates adequate intakes of Fat (26%), Carbohydrate (61%), and Protein (14%) by Desta. The fat, Carbohydrate, and Protein intakes were within the recommended ranges of 25%-35%, 45%-65%, and 10%-35% respectively. Moreover, a Saturated fat intake of 7% was achieved. Saturated fat intake of less than 10% is recommended. According to table’s 2C and 3C, Vitamin and Mineral intakes for Desta were met at adequate levels and below the Upper limit intakes. Refer to Nutrient Analysis section for Upper limit for Vitamins and Minerals discussed. In conclusion, the meal planned proved to be successful in appropriately meeting Desta’s unique needs. The group that synthesized Desta’s diet was able to meet his high energy needs, while creating the meal plans to be appropriate to his individual likes, nutritional needs, limited financial resources, religious, and cultural needs. It was important to meat religious and cultural needs for Desta because it was determined that his mother would be preparing all his meals. The importance of a balanced diet to meet Desta’s athletic nutritional needs was discussed with his mother who also participated in his diet performance. Overall it is imperative for any person, especially adolescents who participate in sports or any physical activity, to practice an adequate wellbalanced nutrition to ensure proper caloric, macro, and micronutrient needs. Appendices D e s t a G e t a c h e w | 15 Scholarly References 1. Rich T. Kashrut: Jewish Dietary Laws. Judaism 101. 2007. Available at http://www.jewfaq.org/index.htm. Accessed February 23, 2010 2. Hoch A, Goosen K, Kretschmer T. Nutritional Requirements of the Child and teenage Athlete. Physiscal Medicine and Rehabilitation Clinics of North America. [serial online]. 2008; 19: 373-398. Available from: Science Direct. Accessed February 25, 2010. 3. Rodriguez N, Dimarco N, Langley S. Position of Dietitians of Canada, The American Dietetic Association, and the American College of Sports Medicine: Nutrition and Athletic Performance. Canadian Journal of Dietetic Practice and Research [serial online] 2000; 61: 176-192. Available from: Science Direct. Accessed February 24, 2010. 4. Brow J. Nutrition Through the Life Cycle. 3rd ed. Belomont, Calif: Thomson/ Wadsworth; 2008. 5. Anderson J, Young L, Prior S. Nutrition for the Athlete. Extension [serial online] 2010; 9.362: 109-125. Available from: Colorado State University. Accessed February 24, 2010.