Brazilian

International Journal of Sport Nutrition and Exercise Metabolism, 2004, 14, 81-94 Elite Swimmers / 81
2004 Human Kinetics Publishers, Inc.

Nutritional Status of Brazilian Elite Swimmers

Valria Cristina Provenza Paschoal

and Olga Maria Silverio Amancio

The purpose of this study was to evaluate the body composition, dietary intake,
use of nutritional supplements, and biochemical status of 8 Brazilian male elite
swimmers, aged 1821 years, participants at a national swimming competition.
Data from the athletes were obtained through a 4-day food record, a fasting
blood sample, and anthropometric measurements. The anthropometric results
showed that body composition was compatible with sport category. The dietary
assessment showed an adequate ingestion of calories, vitamins, and mineral,
with the exception of calcium, for which only half of the sample reached the
recommendation. The results also indicated low carbohydrate and high protein
and cholesterol intakes. Of the swimmers, 62.5% and 25% consumed synthetic
aminoacids and antioxidants supplements, respectively. The biochemical indi-
ces of the nutritional status were within normal limits in all swimmers, with the
exception of creatine-kinase, which was above the recommended level, indicat-
ing muscle degradation probably due to poor carbohydrate intake. In conclu-
sion, the results suggest the importance of nutritional education to promote a
balanced intake, provide all nutrients in optimal amounts, inhibit unnecessary
ingestion of nutritional supplements, maintain ideal performance, and improve
the swimmers health status.

Key Words: food patterns, nutritional supplements, sports, anthropometry, bio-

chemical evaluation

Introduction
Competitive swimming is presently one of the most practiced sports in Brazil.
However, organized swimming competitions preceded organized training programs
for swimmers. During the 70s, the number of organized programs for competitive
swimming grew, and training volume increased. At the same time, resistance train-
ing started to be incorporated into the training program. Greater volumes of training
were reached at the end of this decade, and this increase seems to have contributed to
the performance improvement of Brazilian swimmers.
Nevertheless, not only in Brazil but in other countries as well, swimmers
consume diets that are characteristic of their cultures, although usually their nutri-
tional requirements are rather different from the needs of non-athletes belonging to
the same culture. The typical diet of the majority of swimmers is rich in fats and

The authors are with the Departament of Pediatrics at the Federal University of So
Paulo/Escola Paulista de Medicina, 04023-062, So Paulo, Brazil.

81
82 / Paschoal and Amancio

proteins and poor in carbohydrates, inadequate dietary characteristics to achieve the

swimmers needs during training periods (1). However, this nutritional pattern shows
no interference with the body composition of the swimmers, who are usually thin
and tall, with broad shoulders, and muscular mass mainly regionalized in the central
and upper part of the torso (2).
Although these food patterns do not lead to an inadequate calorie intake, they
may contribute to an insufficient intake of micronutrients due to a limited selection
of foods (fast foods, snacks). In this way, they can lead to some marginal deficien-
cies of some vitamins and minerals. Most of the studies with adolescent athletes
report inadequate intake of calcium (3), which can be particularly serious to swimmers,
as the swimming practice may contribute to the progressive loss of bone mass (4).
In face of this nutritional behavior, many athletes make use of nutritional
supplementation without adequate professional counseling. On the other hand, ath-
letes with an adequate nutrition are stimulated, either by the media or by non-
qualified professionals, to consume nutritional supplements.
Many authors have evidenced that vitamin and mineral supplementation does
not present any benefit to increase the performance when athletes ingest adequate
diets (4). For this reason, the dietary evaluation of swimmers becomes fundamental,
including, whenever possible, the biochemical analysis of the nutrients. During the
last two decades, many studies were performed to evaluate the nutritional status of
swimmers through biochemical tests, most conducted with international athletes,
and investigating only the nutritional status related to iron (5,6). In this way, few
studies related dietary intake with biochemical values, justifying the development
of this study, which has as its objective to evaluate the nutritional status of elite
swimmers through anthropometry and dietary and biochemical evaluations.

Methods
Subjects
This cross-sectional study was conducted at the Municipal Olympic Center of So
Paulo, Brazil, with eight male senior swimmers, seven from the Brazilian Team,
participating in the Brazil Trophy swimming contest of 1998. The swimmers trained
approximately three hours daily, six days a week. Previous written consent was
obtained from parents or athletes, and the Committee of Ethics in Research of the
So Paulo Hospital/Federal University of So Paulo approved this study.

Anthropometric Evaluation
Weight and height were determined according to recommended techniques (7), and
the Body Mass Index calculated (8). The percentage of body fat was evaluated by the
Faulkner (9) equation, which takes into account four skinfolds: triceps, biceps,
subscapular and suprailiac, using a Harpender skinfold caliper.

Dietary Evaluation
The calculated dietary evaluation of all nutrients was determined from a four-
consecutive-days food record (10), with one of the days, a weekend day. The vali-
dated and standardized Virtual Nutri software (11) was used to calculate calories,
 Brazilian Elite Swimmers / 83

macronutrients, cholesterol, calcium, magnesium, iron, zinc, vitamins A, E, C and

complex B intakes. The calculated dietary intake of vitamins and minerals was
analyzed according to the Dietary Reference Intakes (12,13,14); cholesterol intake
was compared to the National Cholesterol Education Program recommendations
(15). The intakes considered as adequate were: 45 to 80 kcal/kg weight (16), 8 to 10
g of carbohydrate/kg weight (17), and of 1.4 to 1.8 g proteins/kg weight (18). Nutri-
tional supplements (amino acids, antioxidants, vitamins, and minerals) intake in the
last three months was also evaluated.

Biochemical Evaluation
A blood sample (10 ml) was collected in the morning after 12 hours of fasting and 48
hours of resting from sports practice.
Triacylglycerols and total cholesterol were measured by the Trinder Enzimatic
Colorimetric method, using enzymatic reagents (Sera-pak, Bayer Diagnostic, USA)
that were automatically quantified (Opera Analyser, Technicon, USA).
HDL-Cholesterol by the Labtest Diagnstica-kit (Labtest Disgnstica S.A,
Lagoa Santa, Brazil).
LDL-Cholesterol and VLDL-Cholesterol, determined by the Friedwald equa-
tion (19).
For serum ferritin, a Microparticles Imunoenzimatic Essay (MEIA) by auto-
mation (Abbott Laboratories, Diagnostic Division, Illinois, USA) was used.
Serum creatinine was measured by the Labtest Diagnstica-kit (Labtest
Diagnstica S.A, Lagoa Santa, Brazil).
Hemoglobin (Hb), Hematocrit (Ht), Mean Corpuscular Hemoglobin (MCH)
and Mean Corpuscular Volume (MCV) performed by the Cell-Dyn 3000
apparatus, Abbott Diagnostics, Illinois, USA.
Serum creatine-kinase measured by the kinetic method in UV (20).
All analyses were simultaneously made with control-serum (Sera-Norm and
Sera-Path, Serapack, Tarrytowm, USA).

Statistical Analysis
Spearman Correlation Coefficientfor comparison of dependent samples (21);
adopting 0.05. The results are expressed as means and standard deviations.

Results
Two swimmers had BMIs above the standard for non overweight/obese individuals,
25.09 kg/m2 and 26.53 kg/m2 (Table 1), however, the fat percentage of these athletes
was within the recommended standard for the sports modality, 10.3% and 11.7%,
respectively. Furthermore, the swimmer with the lowest BMI (20.63 kg/m2) was
10.3% of body fat, similar to the second greatest BMI (25.09 kg/m2). In this way,
relating the BMI with lean mass value, it can be observed that the athletes are thin,
with the exception of one swimmer, who had 20.8% of body fat.
The mean calories and macronutrients intake is shown in Table 2. In regard to
the mean caloric intake per kilogram of body weight, only one swimmer did not
reach the recommendation, having consumed on average, 39.18 kcal/kg weight, and
84 / Paschoal and Amancio

Table 1 Characteristics of Brazilian Male Elite Swimmers

Variation of
Characteristics Mean SD the found values

Age (years) 19.12 1.25 (1821)

Weight (kg) 71.4 6.37 (63.783.1)
Height (cm) 175. 38 4.44 (170183)
BMI (kg/m2) 23.22 1.96 (20.6326.53)
Fat (%) 11.49 4.81 (5.920.8)
Lean mass (Kg) 61.75 11.41 (44.5082.50)

Note. Sports practice time > 3 years.

Table 2 Mean Intake of Calories, Macronutrients, and Cholesterol By

Brazilian Male Elite Swimmers, Evaluated By the 4-Day Food Register

Elite Variation
swimmers of the found Recommen-
Nutrients (n = 8) values dations

Calories 53.36 10.25 39.1872.15 45801

(kcal/kg weight)
Carbohydrate 7.13 1.50 5.189.75 7102
(g/kg weight)
Proteins 2.27 0.50 1.302.85 1.41.83
(g/kg weight)
Cholesterol 397.19 123.30 179.58579.98 3004
(mg/kg peso)

Note. 1Costill, 1988b; 2Sherman, 1988; 3Lemon, 1991; 4American Heart Association, 1998.

consequently presented a lower body weight (63.7 kg) in comparison to the other
swimmers, although within the normal range. The evaluation of the mean carbohy-
drate/kg body weight intake shows that the majority of swimmers (n = 6) present
intake below the recommended. Conversely, the mean protein intake of the swim-
mers was greater (2.27g PRO/kg bd wt) than the recommended, with the majority
(n = 6) of swimmers being over the recommended intake. In reference to cholesterol,
only one swimmer shows a mean intake in accordance with the recommended,
while the others present an intake above 300 mg, with the mean value of 397 mg.
 Brazilian Elite Swimmers / 85

Table 3 Mean Intake of Seven Vitamins, Niacin, Folic Acid, Calcium,

Magnesium, Iron, and Zinc By Brazilian Male Elite Swimmers, Evaluated
By the 4-Day Food Register

Variations in
Nutrients Mean (SD) found values

Vitamin A (g) 1376.97 624.30 594.972547.99

Vitamin C (mg) 682.33 519.79 82.501613.13
Vitamin E (mg) 17.14 7.62 7.6830.14
Vitamin B1 (mg) 4.66 5.28 2.2717.72
Vitamin B2 (mg) 4.21 4.58 2.0015.45
Vitamin B6 (mg) 2.77 0.97 0.894.41
Vitamin B 12 (g) 7.38 3.09 1.3512.46
Niacin (mg) 34.17 9.27 21.9349.51
Folic acid (g) 437.46 165.54 160.48482.83
Calcium (mg) 1112.12 461.73 647.992141.77
Magnesium (mg) 322.57 76.17 162.06417.76
Iron (mg) 21.81 3.99 15.0326.10
Zinc (mg) 16.96 5.8 4.7725.52

Table 3 shows the mean intake of the vitamins and minerals evaluated and the
variation of the observed values. Among the eight elite swimmers, seven of them
present adequate intakes of magnesium, niacin, vitamin B1 and B6, with a confi-
dence interval (CI) of 98%. The vitamin B2 intake was adequate for 6 swimmers
with 98% of CI and for two swimmers with 95% of CI. In the uncertainty region,
there is one swimmer for the magnesium intake and one for the vitamin B6 intake,
with a CI of 50% and 70%, respectively. None of the swimmers present intakes in
the inadequate region (Table 4).
Table 5 presents the distribution of the elite swimmers in regard to adequate
intakes of folic acid; vitamins B12, A, and E; iron; and zinc, considering as the cut-
off points the EAR and RDA values for the age range of the athletes. Considering as
inadequate the intake below the EAR, it can be verified that the majority of swim-
mers presented adequate intake of these nutrients, with an iron intake adequate to all
of them.
According to the qualitative interpretation of calcium intake in relation to
adequate intake (AI) (Table 6), it was found that four swimmers presented probable
adequate intake, that was, AI. For the other swimmers the adequacy of their intake
cannot be determined as they are < AI.
Figure 1 shows the percentage of swimmers who use the various types of
nutritional supplements. It can be observed that amino acids are the main supple-
ments used. It is worthwhile to stress that some swimmers use concomitantly differ-
ent types of supplements.
Table 4 Distribution of the Brazilian Male Elite Swimmers in Relation to Adequate Intake of Magnesium, Niacin, Vitamins B12,
86 / Paschoal and Amancio

B2, and B6, According to the Dietary Reference Intakes

Variable Inadequate Uncertainty region Adequate

Group 98% 95% 93% 85% 70% 50% 70% 85% 93% 95% 98%
Magnesium 1 7
Niacin 1 7
Vitamin B6 1 7
Vitamin B2 2 6
Vitamin B1 1 7
 Brazilian Elite Swimmers / 87

Table 5 Distribution of the Brazilian Male Elite Swimmers in Relation

to the Adequate Intake of Folic Acid, Three Vitamins, Iron, and Zinc,
Considering As the Cut-Off Points the EAR and RDA Values for Age
and Gender

<EAR EAR-RDA RDA

Group (inadequate) (uncertainty region) (adequate)

Folic acid 2 6
Vitamin B12 1 7
Vitamin A 1 2 5
Vitamin E 2 2 4
Iron 8
Zinc 1 7

Note. EAR: estimated average requirement; RDA: recommended dietary allowances.

Table 6 Distribution of the Brazilian Male Elite Swimmers in Regard

to the Qualitative Interpretation of Calcium Intake in Relation
to the Adequate Intake (AI)

Adequate Elite
intake swimmers Qualitative interpretation

AI 4 Mean intake probably adequate

<AI 4 Intake adequation not possible to determine

Figure 1 Percentage of Brazilian male elite swimmers according to type of nutritional

supplement used.
88 / Paschoal and Amancio

Although iron intake by the swimmers was adequate and blood levels were
within normal levels, there was no significant statistical correlation between the
evaluated iron intake and biochemical levels (Table 7).
Table 8 presents the correlation between cholesterol dietary intake and blood
levels of total cholesterol, HDL, LDL and VLDL. In spite of the high cholesterol
intake, which averaged 397.19 mg/day, blood levels of total cholesterol and its
fractions were within normal levels, and no statistically significant correlations
between intake and biochemical levels occurred.
Although daily mean intake of carbohydrates was inadequate for six swim-
mers (539.81 134.17), mean blood levels of creatine-kinase were elevated in seven
of them (173.63 119.16). There was no significant statistical correlation between
carbohydrate intake and blood creatine-kinase (Table 9).

Discussion
Body Composition Evaluation
The mean BMI value (23.22 1.96kg/m2) was within the limit considered as normal
and was similar to other results (22). The fat percentage result (11.49 4.81) was
similar to the results from Carter and Ackland (2) . Swimmers of a high competitive
level tend to have a greater fat percentage than runners and cyclists of the same
competitive level and identical training volumes. This fact can be an advantage due
to the friction reduction caused by a greater fluctuation, especially in long distance
swimmers (23).

Dietary Evaluation
Seven swimmers reached the recommendation of caloric intake per kilogram of
body weight, 53.36. This result was similar to the findings reported by Hawley and
Williams (24), (55 kcal/kg weight); and inferior to Berning et al. (1), (60.2 kcal/kg
weight). This caloric intake is fundamental for the athletes to maintain a body
composition adequate to their sports modality, as swimmers in the same age range
training three hours daily, have an observed daily caloric expenditure between
51.88 and 55.34 kcal/kg of body weight (25).
Carbohydrate intake (7.13 1.50 g/kg of body weight) was below the recom-
mendation for seven swimmers. All studies conducted with swimmers of the same
age range and same training volume observed similar carbohydrate intake (1, 24).
As a consequence of an inadequate carbohydrate intake, the swimmer may be prone
to overtraining accompanied by great muscle degradation. This state could hinder,
good athletic performance, as Cade et al. (26) have shown when studying swimmers
from the team of the University of Florida, that ingestion of a solution of carbohy-
drates, presented a lesser increase of creatine-kinase immediately after exercise and
24 hours after its conclusion. These results suggest that this solution, consumed
before and during exercise, protects the muscle from the exercise-induced degrada-
tion. This is probably true because proteolysis is diminished by carbohydrate re-
placement (27).
Although in the present study the carbohydrates intake and creatine-kinase
serum levels did not show significant correlation at a 5% level (Table 9), only one
athlete presents creatine-kinase levels within normal levels (5 to 70 /L). This can
Table 7 Correlation Between Iron Dietary Intake and Blood Levels of Ferritin, Hemoglobin (Hb), Hematocrit (Ht),
Mean Corpuscular Hemoglobin (MCH), and Mean Corpuscular Volume (MCV)

Dietary iron Ferritin Hb Ht MCH MCV

(mg) (ng/ml) (ml/dl) (%) (pg) (fL)

21.81 3.99 96.63 28.51 15.45 0.60 46.06 2.14 28.90 1.868 6.30 4.36
(15.0326.10) (55139) (14.916.4) (4350) (2632) (8093)
r 0.04 0.19 0.36 0.07 0.12

Note. ( ) variation of the found values. r = Spearman Correlation Coefficient. Critic r = 0.71.
Brazilian Elite Swimmers / 89
90 / Paschoal and Amancio

Table 8 Correlation Between Dietary Cholesterol Intake and Blood Levels

of Total Cholesterol, HDL, LDL, and VLDL (in mg/dl)

Dietay COL CO HDL LDL VLDL

(mg) (mg/dl) (mg/dl) (mg/dl) (mg/dl)

397.19 126.30 149.99 23.22 45.50 7.43 93.36 36.65 14.25 4.56
(179.58579.98) (130188) (3754) (55158) (924)
r 0.31 0.71 0.25 0.30

Note. ( ) variation of the found values. r = Spearman Correlation Coefficient. Critic r = 0.71.

Table 9 Correlation Between Dietary Carbohydrate (CHO) Intake

and Blood Levels of Creatine-Kinase (CK)

Dietary CHO
(mg) CK (u/L)

539.81 134.17 173.63 119.16

(363.81679.64) (54.00378.00)
r 0.48

Note. ( ) variation of the found values. r = Spearman Correlation Coefficient. Critic r = 0.71.

imply that the other athletes are using muscle protein to supply energy during
training.
Proteins intake is greater than the recommendation (2.27 g/kg of body weight),
but similar to previous results with swimmers (28). This high consumption of pro-
tein, especially in association with the intake of synthetic amino acids (Figure 1) can
have negative consequences on the intake of the other nutrients, such as calcium,
which is below adequate in half of the studied sample (Table 6). This high protein
intake can result in an imbalance of the homeostatic mechanism of calcium retention,
reflecting in an abnormal increase in renal excretion of the mineral, not compen-
sated for by a proportional increase of its re-absorption. This effect is a consequence
of sulphured amino acids oxidation, which reduces renal pH, increasing the glom-
erular filtration process (29).
In addition to this, most of the scientific researches do not show ergogenic
benefits by synthetic amino acids utilization (30). Thus, not only could the amino
acid intake be a negative, but it provides no positive aspects.
Adequate mean serum levels of total cholesterol and its fractions, observed in
the studied athletes, is probably due to their physical activity practice, regardless of
 Brazilian Elite Swimmers / 91

their high dietary cholesterol intake, 397.19 mg (Table 8). Exercise alters the activ-
ity of cholesterol regulatory enzymes in a favorable way, that is, there are some
enzymes, such as lipoprotein lipase, present on the artery walls, which degrade
triacylglycerols during exercise, allowing the muscles to capture lipids for energy
production. The final result is that aerobically trained individuals, compared to non-
trained individuals, eliminate more rapidly the triglycerides from the blood stream,
producing a greater quantity of HDL-cholesterol, which stays in the blood stream
for a longer period of time (31). During these last three decades, some studies have
also shown a positive correlation between exercise and HDL-cholesterol levels
increase (32).
Half of the swimmers have intakes below adequate intake (AI) as a result of
low consumption of calcium food sources (milk and derivatives). This food habit is
even more aggravated by the high protein intake identified in these athletes, as
previously discussed. Almost all of the studies in the literature that evaluate calcium
intake by adolescent athletes of high competitive level report an inadequate intake
(1, 3, 4).
This fact may be very compromising for the swimming athletes; as some
believe that the floating environment during swimming training may have a nega-
tive effect on bone mineral density (33).
In spite of dietary iron intake analysis having shown that it was adequate, it is
important to highlight that the mean value (21.81 3.99 mg) is, in absolute terms,
much above the recommended (12 mg). The high iron intake results in normal
values of Ht, Hb, MCH, MCV, and ferritin (Table 7) and corroborates the literature,
both with aerobic (34) and anaerobic athletes (35).
Magnesium, zinc, vitamins A, C, E, B1, B2, B6, B12, niacin, and folic acid
intakes were all adequate. Considering that 37.5% of the swimmers customarily
consume nutritional supplements containing 1000 mg of vitamin C (Graph 1), an
exaggerated intake of this vitamin can be observed.
The majority of the studies show no relationship between vitamin C and
performance improvement, both in high (36) and low doses (37). High doses do not
enhance aerobic capacity (38) and do not increase lesion incidence (39). On the
contrary, megadoses can increase oxidative stress (40), diminish copper
bioavailability, cause diarrhea, lead to the development of renal calculus in predis-
posed people and interfere in laboratorial results of glucose, uric acid, creatinine and
fecal occult blood tests (41).

Conclusion
The studied swimmers present adequate body composition for their sports modality
and satisfactory levels of total cholesterol and its fractions, even with an energetic
intake predominantly of fatty foods. It is important to highlight that, although the
caloric intake was adequate, macronutrients intake was inadequate due to the high
consumption of proteins and lipids, and low consumption of carbohydrates. The
protein-rich dietary pattern, including synthetic amino acids is worrisome in these
athletes, only half of the sample has an adequate mean intake of calcium. This excess
protein increases urinary calcium excretion, with the possibility of compromising
bone mineralization, especially in swimmers, athletes, who already present bone
mineral density inferior to athletes of other modalities. In relation to the low carbo-
hydrate intake, high serum levels of creatine-kinase were observed, evidencing the
92 / Paschoal and Amancio

occurrence of muscle degradation, that could compromise the swimmers perfor-

mance during training. For most athletes the micronutrients intake was adequate,
not justifying the use of nutritional supplements (vitamin C, complex B vitamins
and zinc). In conclusion, the results suggest the importance of nutritional education
to promote a balanced intake, provide all nutrients in optimal amounts, inhibiting
unnecessary ingestion of nutritional supplements, and maintain ideal performance
and improve the swimmers health status.

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