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Cited by 40Sports Performance and TrainingMuscle metabolism and nutritionSex and Gender in Healthcare

Fueling the Female Athlete: Auditing Her Representation in Studies of Acute Carbohydrate Intake for Exercise

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KUIKMAN, MEGAN A., SMITH, ELLA S., MCKAY, ALANNAH K. A., ACKERMAN, KATHRYN E., HARRIS, RACHEL, ELLIOTT-SALE, KIRSTY J., STELLINGWERFF, TRENT, BURKE, LOUISE M.·2023·Medicine & Science in Sports & Exercise
DOI 10.1249/mss.0000000000003056PMC PMC9924969
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Abstract

Purpose: The aim of this audit was to assess the representation of female athletes within the literature that has led to current guidelines for carbohydrate (CHO) intake in the acute periods surrounding exercise and the quality of this research. Methods: We conducted a standardized audit of research assessing CHO loading protocols, CHO mouth rinse, and CHO intake before, during, and after exercise. Results: A total of 937 studies were identified in this audit. There were a total of 11,202 participants across these studies, with only ~11% being women. Most studies involved male-only cohorts (~79%), with a mere 38 studies (~4%) involving female-only cohorts and 14 studies (~2%) including a methodological design for comparison of sex-based responses. The frequent use of incorrect terminology surrounding menstrual status and the failure of most studies (~69%) to provide sufficient information on the menstrual status of participants suggests incomplete understanding and concern for female-specific considerations among researchers. Of the 197 studies that included women, only 13 (~7%) provided evidence of acceptable methodological control of ovarian hormones, and no study met all best-practice recommendations. Of these 13 studies, only half also provided sufficient information regarding the athletic caliber of participants. The topics that received such scrutiny were CHO loading protocols and CHO intake during exercise. Conclusions: The literature that underpins the current guidelines for CHO intake in the acute periods around exercise is lacking in high-quality research that can contribute knowledge specific to the female athlete and sex-based differences. New research that considers ovarian hormones and sex-based differences is needed to ensure that the recommendations for acute CHO fueling provided to female athletes are evidence based.

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  • In a 2022 audit of 937 research studies evaluating acute carbohydrate intake recommendations, only 11% (n = 197) of participants were women, and only 31% of these studies utilized sufficient methodologies to define menstrual status.

    “Only 11% (n = 197 of 937 studies) of the participants in these studies were women, and of these studies, only 31% utilized sufficient methodologies to define menstrual status [4].”

    From Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review (2023) · cites this paper as [4]

    The Results report 937 studies and 11,202 participants, approximately 11% of whom were women. They identify 197 as the number of studies that included at least one woman, not the number of female participants. The Menstrual status and grade section reports that 61 of those 197 studies (about 31%) provided sufficient information to define menstrual status. (LLM, conf=0.94)

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Research works printed but not linked: 28

  1. [2]Sainz-De-baranda C Adá-Lameiras A Blanco-Ruiz M. Gender differences in sports news coverage on twitter. Int J Environ Res Public Health. 2020; 17(14): 5199. 32708468 PMC7400595
  2. [3]Costello JT Bieuzen F Bleakley CM. Where are all the female participants in sports and exercise medicine research? Eur J Sport Sci. 2014; 14(8): 847– 51. 24766579
  3. [4]Cowley ES Olenick AA Mcnulty KL Ross EZ. “Invisible sportswomen”: the sex data gap in sport and exercise science research. Women Sport Phys Act J. 2021; 29(2): 146– 51.
  4. [6]Burke LM Hawley JA Wong SH Jeukendrup AE. Carbohydrates for training and competition. J Sports Sci. 2011; 29(1 Suppl): S17– 27. 21660838
  5. [11]Campbell SE Febbraio MA. Effects of ovarian hormones on exercise metabolism. Curr Opin Clin Nutr Metab Care. 2001; 4(6): 515– 20. 11706286
  6. [12]Moore DR Sygo J Morton JP. Fuelling the female athlete: carbohydrate and protein recommendations. Eur J Sport Sci. 2022; 22(5): 684– 96. 34015236
  7. [14]Elliott-Sale KJ Minahan CL de Jonge XAKJ,. Methodological considerations for studies in sport and exercise science with women as participants: a working guide for standards of practice for research on women. Sports Med. 2021; 51(5): 843– 61. 33725341 PMC8053180
  8. [15]Smith ES McKay AKA Ackerman KE,. Methodology review: a protocol to audit the representation of female athletes in sports science and sports medicine research. Int J Sport Nutr Exerc Metab. 2022; 32(2): 114– 27. 35168200
  9. [20]Tarnopolsky MA Zawada C Richmond LB,. Gender differences in carbohydrate loading are related to energy intake. J Appl Physiol (1985). 2001; 91(1): 225– 30. 11408434
  10. [21]Walker JL Heigenhauser GJ Hultman E Spriet LL. Dietary carbohydrate, muscle glycogen content, and endurance performance in well-trained women. J Appl Physiol (1985). 2000; 88(6): 2151– 8. 10846030
  11. [22]Pettersson S Edin F Bakkman L McGawley K. Effects of supplementing with an 18% carbohydrate-hydrogel drink versus a placebo during whole-body exercise in −5°C with elite cross-country ski athletes: a crossover study. J Int Soc Sports Nutr. 2019; 16(1): 46– 6. 31655603 PMC6815417
  12. [24]Tremblay J Peronnet F Massicotte D Lavoie C. Carbohydrate supplementation and sex differences in fuel selection during exercise. Med Sci Sports Exerc. 2010; 42(7): 1314– 23. 20019632
  13. [26]Nuzzo J. Volunteer bias and female participation in exercise and sports science research. Quest. 2021; 73(1): 82– 101.
  14. [27]Hawley JA Schabort EJ Noakes TD Dennis SC. Carbohydrate-loading and exercise performance. Sports Med. 1997; 24(2): 73– 81. 9291549
  15. [29]Brown MA Green BP James LJ Stevenson EJ Rumbold PLS. The effect of a dairy-based recovery beverage on post-exercise appetite and energy intake in active females. Nutrients. 2016; 8(6): 355. 27338460 PMC4924196
  16. [30]Jensen R Skjærbæk MC Plomgaard P,. Glycogen supercompensationis due to increased number, not size, of glycogen particles in human skeletal muscle. Exp Physiol. 2021; 106(5): 1272– 84. 33675088
  17. [31]Brewer J Williams C Patton A. The influence of high carbohydrate diets on endurance running performance. Eur J Appl Physiol Occup Physiol. 1988; 57(6): 698– 706. 3416854
  18. [32]Burke LM Cox GR Culmmings NK Desbrow B. Guidelines for daily carbohydrate intake: do athletes achieve them? Sports Med. 2001; 31(4): 267– 99. 11310548
  19. [36]Gaskell SK Rauch CE Costa RJS. Gastrointestinal assessment and therapeutic intervention for the management of exercise-associated gastrointestinal symptoms: a case series translational and professional practice approach. Front Physiol. 2021; 12: 719142. 34557109 PMC8452991
  20. [37]Datz FL Christian PE Moore J. Gender-related differences in gastric emptying. J Nucl Med. 1987; 28(7): 1204– 7. 3598704
  21. [40]Burke LM Maughan RJ. The governor has a sweet tooth—mouth sensing of nutrients to enhance sports performance. Eur J Sport Sci. 2015; 15(1): 29– 40. 25345670
  22. [41]Hawkins KR Krishnan S Ringos L Garcia V Cooper JA. Running performance with nutritive and non-nutritive sweetened mouth rinses. Int J Sports Physiol Perform. 2017; 12(8): 1105– 10. 28095077 PMC5513783
  23. [42]Pereira PEA Azevedo P Azevedo K Azevedo W Machado M. Caffeine supplementation or carbohydrate mouth rinse improves performance. Int J Sports Med. 2021; 42(2): 147– 52. 32851636
  24. [43]Tiller NB Elliott-Sale KJ Knechtle B Wilson PB Roberts JD Millet GY. Do sex differences in physiology confer a female advantage in ultra-endurance sport? Sports Med. 2021; 51(5): 895– 915. 33502701
  25. [45]Kirwan JP O’Gorman D Evans WJ. A moderate glycemic meal before endurance exercise can enhance performance. J Appl Physiol (1985). 1998; 84(1): 53– 9. 9451617
  26. [48]Mock MG Hirsch KR Blue MNM Trexler ET Roelofs EJ Smith-Ryan AE. Post-exercise ingestion of low or high molecular weight glucose polymer solution does not improve cycle performance in female athletes. J Strength Cond Res. 2021; 35(1): 124– 31. 29489721 PMC6110985
  27. [49]Fallowfield JL Williams C. The influence of a high carbohydrate intake during recovery from prolonged, constant-pace running. Int J Sport Nutr. 1997; 7(1): 10– 25. 9063761
  28. [50]Tarnopolsky MA Bosman M MacDonald JR Vandeputte D Martin J Roy BD. Postexercise protein–carbohydrate and carbohydrate supplements increase muscle glycogen in men and women. J Appl Physiol (1985). 1997; 83(6): 1877– 83. 9390958

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Authors
KUIKMAN, M. A., SMITH, E. S., MCKAY, A. K. A., ACKERMAN, K. E., HARRIS, R., ELLIOTT-SALE, K. J., STELLINGWERFF, T., & BURKE, L. M.
Affiliations
  • Australian Catholic University (AU)
  • Boston Children's Hospital (US)
  • Manchester Metropolitan University (GB)
  • University of Victoria (CA)
ORCID
Venue
Medicine & Science in Sports & Exercise
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2022-10-13
Volume
55
Issue
3
Pages
569-580
ISSN
  • 0195-9131 (ISSN-L)
  • 1530-0315
DOI
10.1249/mss.0000000000003056
PMC
PMC9924969
OpenAlex
W4306662500
Cited by
40
References
23
Citations by year
2026: 7 · 2025: 15 · 2024: 11 · 2023: 6 · 2022: 1
FWCI
8.54
Type
journal article
Language
en
Open access
Licence
Locations
  • Medicine & Science in Sports & Exercise (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • e-space (Manchester Metropolitan University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
Keywords
female athletes, carbohydrate intake, sex differences, menstrual status, ovarian hormones, carbohydrate loading, carbohydrate mouth rinse, methodological quality
MeSH terms
Carbohydrates, Dietary Carbohydrates, Female, Hormones, Humans, Male, Sports, Exercise, Athletes

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