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Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes
Open accessAbstract
Objective. Nutritional status is important for health and competitive achievement. This area remains understudied among elite-level female athletes and is appropriate for research. We examined nutritional status and cardiovascular health markers of two groups of female athletes of the same age and competition period, involved in weight-bearing and a non-weight-bearing sport: gymnasts (n = 17) and swimmers (n = 14); mean age 17.4 and 16.6 years. Methods. Body composition and dietary intake were assessed by bioelectrical impedance and Food Frequency Questionnaire. The concentrations of serum micronutrients (B12, 25-hydroxyvitamin D (25 (OH) D), calcium, magnesium, phosphorus, potassium, and iron), blood lipids, and blood pressure (BP) were measured. Setting and Participants. A cross-sectional study of 31 athletes from Slovenia. Results. Gymnasts had higher body mass index (21.5 vs. 20.1 kg/m2, p = 0.043 ) and lower fat free mass (42.4 vs. 46.6 kg, p = 0.024 ) than swimmers and comparable body fat percentage (22.5 vs. 22.8%). Both groups had low intake of carbohydrates, fibre, polyunsaturated fats, protein (only gymnasts), and micronutrients (11/13 micronutrients gymnasts and 4/13 swimmers) and high intake of free sugars and saturated fats. Both groups also had significantly lower-than-recommended serum levels of 25 (OH) D. All cardiovascular risk factors were within recommended ranges. Gymnasts had higher LDL cholesterol (2.7 vs. 2.2 mmol/L, p < 0.011 ), and swimmers had higher systolic BP (126 vs. 107 mmHg, p < 0.001 ). Conclusions. Dietary intake especially in gymnasts was suboptimal, which may reflect in anthropometric and cardiovascular marker differences between gymnasts and swimmers.
Overview
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TL;DR
In a cross-sectional study of 31 Slovenian elite female adolescent athletes, gymnasts had higher BMI and lower fat-free mass than swimmers, and both groups showed suboptimal dietary intake, especially gymnasts. Cardiovascular risk markers were mostly within recommended ranges, but gymnasts had higher LDL cholesterol and swimmers had higher systolic blood pressure.
Key findings
- Gymnasts (n = 17) had higher BMI than swimmers (n = 14) (21.5 vs. 20.1 kg/m², p = 0.043) and lower fat-free mass (42.4 vs. 46.6 kg, p = 0.024), with comparable body fat percentage (22.5% vs. 22.8%).
- Both groups had low intake of carbohydrates, fibre, and polyunsaturated fats; gymnasts also had low protein intake, and micronutrient intake was below recommendations for 11/13 micronutrients in gymnasts and 4/13 in swimmers. Both groups had high free sugar and saturated fat intake and low serum 25(OH)D.
- Gymnasts had higher LDL cholesterol than swimmers (2.7 vs. 2.2 mmol/L, p < 0.011), while swimmers had higher systolic blood pressure (126 vs. 107 mmHg, p < 0.001).
- All cardiovascular risk factors were, on average, within recommended ranges; energy availability was below recommended in both groups (23 ± 3 kcal/kg FFM/day in gymnasts and 33 ± 5 in swimmers vs. recommended 45 kcal/kg FFM/day).
Methods
- Cross-sectional study of 31 elite-level female indoor athletes from Slovenia: 17 artistic gymnasts (mean age 17.4 ± 4.1 years) and 14 swimmers (mean age 16.6 ± 3.1 years), assessed during the competition period within three days (April 4–6, 2018).
- Body composition was assessed by bioelectrical impedance; dietary intake by a 52-item qualitative Food Frequency Questionnaire; serum micronutrients, blood lipids, and blood pressure were measured after overnight fasting.
- Between-group comparisons used Mann–Whitney U tests; intake versus recommendations used one-sample Wilcoxon signed-rank tests; analyses performed in R 3.5.2.
Limitations
- The paper states the sample size was relatively small, results should be interpreted with caution, and replication in larger samples is needed.
- The paper acknowledges FFQ limitations: a planned 3-day weighed dietary protocol was not performed because coaches advised against it; the FFQ had limited items and a one-year recall period, was validated in a Dutch rather than Slovenian population, and dietary assessment may involve under- or misreporting, especially in elite female gymnasts.
- The paper notes blood assays were obtained from two national medical laboratories separately for gymnasts and swimmers, and that a single assessment does not allow definitive conclusions about anthropometry, diet, or cardiovascular health.
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Figures
![Figure 1 Dietary intake of elite-level artistic gymnasts and swimmers compared with recommendations [40–45].](/paper-figures/5ad33b0796a944b68973ea5c4e0a5345/nutritional-status-and-cardiovascular-health-in-female-adolescent-elite-level-figure-1.jpg)
Verification
Claims the paper makes
0 Valid · 0 Not valid · 75 Not checked · 98 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Gymnasts had higher LDL cholesterol (2.7 vs. 2.2 mmol/L, p < 0.011)”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > Abstract > Results
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All blood variables and BP were, on average for both groups, within recommended target ranges.”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 3. Results > 3.4. Cardiovascular (CV) Health and Safety Factors
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“However, only 53% of gymnasts and 79% of swimmers had S-vit B12 above the reference value of 258 pmol/L.”
- Also stated in: § 4.3. Dietary Intake and Serum Micronutrient Status · plain
“Of note, only 53% of gymnasts and 79% of swimmers had S-vit B12 above the reference value of 258 pmol/L [46].”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 3. Results > 3.3. Serum Micronutrient Status
What the sources say
- Not checked yetcites [46] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § 4.3. Dietary Intake and Serum Micronutrient Status · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no discernible differences between gymnasts and swimmers only for BF%.”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 4. Discussion > 4.1. Main Findings
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Between the studied groups, there were no significant differences in intake of macronutrients (e.g., for free sugars, total fat, saturated fatty acids or protein, expressed as % of daily energy intake, and for cholesterol expressed as mg/day).”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 3. Results > 3.2. Dietary Intake Status
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“in swimmers, it was 54% from carbohydrates, 38% from fat, and 13% from protein.”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 3. Results > 3.2. Dietary Intake Status
Reported 100 · recomputed 105
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 3. Results > 3.3. Serum Micronutrient Status
“whereas for swimmers, S-P and S-Mg were not in reference ranges.”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 3. Results > 3.3. Serum Micronutrient Status
“S-Mg was found to be within the reference range for all gymnasts and swimmers.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 5. Conclusion
“Both groups consumed too much of free sugars, total fat, and SFA”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 4. Discussion > 4.3. Dietary Intake and Serum Micronutrient Status
“Percentages of total fat intake were in the upper recommended range for both groups (40 and 38% of daily energy intake, respectively, for gymnasts and swimmers vs. the recommended 30–40% [40]).”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 4. Discussion > 4.4. Cardiovascular Health
“Higher LDL cholesterol in gymnasts could be associated with dietary patterns, including lower energy intake, higher overall total fat, SFA, and free sugar intake and lower fibre intake.”
§ Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes > 4. Discussion > 4.3. Dietary Intake and Serum Micronutrient Status
“(65 g/day, 17% of energy in gymnasts and 94 g/day, and 17% of energy in swimmers).”
Citations
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Cited by
Female Athlete Triad and Relative Energy Deficiency in Sport (REDs): Nutritional Management
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Self-citation
Metadata
- Authors
- Jakše, B., Jakše, B., Mis, N. F., Jug, B., Šajber, D., Godnov, U., & Čuk, I.
- Affiliations
- University of Ljubljana (SI)
- Ljubljana University Medical Centre (SI)
- University of Primorska (SI)
- Corresponding author
- Jakše, Boštjan
- Mis, Nataša Fidler
- Venue
- Journal of Nutrition and Metabolism
- Publisher
- Wiley
- Published
- 2021-01-12
- Volume
- 2021
- Pages
- 1-15
- ISSN
- 2090-0724 (ISSN-L)
- 2090-0732
- PMC
- PMC7815399
- OpenAlex
- W3121009498
- Semantic Scholar
- fdf8d6d4f4a1d39cae6421baf24c3b25d07e0fce
- Cited by
- 21
- References
- 79
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 5 · 2021: 6
- FWCI
- 2.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Nutrition and Metabolism (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Javna Agencija za Raziskovalno Dejavnost RS
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- nutritional status, cardiovascular health, adolescent female athletes, artistic gymnasts, swimmers, body composition, dietary intake, micronutrient deficiency, vitamin D, serum lipids, blood pressure, cardiovascular risk factors
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