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Sports nutrition recommendations for able-bodied athletes are well established. However, sports nutrition recommendations for para-athletes are still developing. Spinal cord-injured (SCI) hand cyclists face unique physiological and nutrition-related challenges compared with able-bodied athletes, complicating the extrapolation of recommendations. This paper aims to propose preliminary dietary recommendations for adult SCI endurance hand cyclists based on their unique challenges while considering existing sports nutrition recommendations for able-bodied and para-athletes. A two-phase approach was followed. Phase one involved a review of existing literature regarding the physiological and nutrition-related challenges experienced by SCI athletes, including their current dietary intake and body composition patterns, as well as existing sports nutrition recommendations. Phase two consisted of proposing dietary recommendations for SCI endurance hand cyclists, considering the information gathered during phase one. A total of 10 preliminary recommendations are proposed, focusing on general daily intake for carbohydrates, fibre, protein, fat, and micronutrients as well as exercise-specific guidelines covering carbohydrate, fluid, and protein intake before, during, and after exercise. These preliminary recommendations are based on current available literature but provide a starting point for developing dietary recommendations for SCI hand cyclists. Future research should rigorously test these recommendations and apply them to the broader paralympic community where applicable.

ObjectivesWhile ethics has been identified as a core component of health technology assessment (HTA), there are few examples of practical, systematic inclusion of ethics analysis in HTA. Some attribute the scarcity of ethics analysis in HTA to debates about appropriate methodology and the need for ethics frameworks that are relevant to local social values. The “South African Values and Ethics for Universal Health Coverage” (SAVE-UHC) project models an approach that countries can use to develop HTA ethics frameworks that are specific to their national contexts.MethodsThe SAVE-UHC approach consisted of two phases. In Phase I, the research team convened and facilitated a national multistakeholder working group to develop a provisional ethics framework through a collaborative, engagement-driven process. In Phase II, the research team refined the model framework by piloting it through three simulated HTA appraisal committee meetings. Each simulated committee reviewed two case studies of sample health interventions: opioid substitution therapy and either a novel contraceptive implant or seasonal influenza immunization for children under five.ResultsThe methodology was fit-for-purpose, resulting in a context-specified ethics framework and producing relevant findings to inform application of the framework for the given HTA context.ConclusionsThe SAVE-UHC approach provides a model for developing, piloting, and refining an ethics framework for health priority-setting that is responsive to national social values. This approach also helps identify key facilitators and challenges for integrating ethics analysis into HTA processes.

Nutritional practices and body composition of para-athletes can impact their health and athletic performance. There is a paucity of research on the nutritional practices, including dietary and supplement intake, body composition and bone health of spinal cord-injured (SCI) endurance hand cyclists. This study assessed the body composition and dietary and supplement intake of 12 national-level SCI endurance hand cyclists (age: 44.0 ± 9.3 years). Bone mineral density (BMD) was assessed in a sub-sample of participants (n = 4) using dual-energy x-ray absorptiometry (DXA). Estimated body fat percentage was healthy (18.4 ± 5.1%) and lumbar spine BMD for the sub-sample was adequate, however hip BMD was low (Z-score and/or T-scores < −2). Carbohydrate intake for male and female participants was below the recommended intake (3.8 (2.9–4.1) and 2.4 (2.0–2.7) g/kg BW, respectively). Overall protein intake was adequate, whilst fat intake was high for both males and females (39.7 (37.7–41.6) and 42.1 (39.0–45.3)% of total energy, respectively). The reported intakes for a few key micronutrients were also below the recommended dietary allowance (RDA) and/or adequate intake (AI) for males (vitamin D, calcium). The prevalence of supplement use before, during, and after training was 40%, 100%, and 60%, respectively. In conclusion, the hand cyclists could benefit from nutritional guidance to match their daily carbohydrate intake with exercise requirements and optimise their fat intake. Optimal vitamin D and calcium intake is also important especially in the light of poor bone health below the lesion level.

Objective. The aim of this study was to determine body composition, dietary intake and supplement use among Olympic and Ironman distance triathletes residing in the Western Cape. Methods. A descriptive, analytical, cross-sectional study design was conducted in Western Cape Province. Twenty-six triathletes registered with Triathlon South Africa were included. Percentage body fat was measured via multi-frequency bio-electrical impedance analysis and anthropometry. Dietary intake and supplement use were measured with an estimated 3-day food record and questionnaire. Results. The mean age of the men and women was 38±7 and 38±10 years respectively. The mean amount of training per week for men and women respectively was 15±4 and 15±5 hours. The percentage body fat (%BF) of men and women was 13±4% and 21±6%, respectively. The mean dietary macronutrient intake for men and women respectively was for total energy intake 14 535±4 510 kJ and 9 004±2 369 kJ, carbohydrate intake 5.3±1.9 g/kg and 3.5±1.0 g/kg, protein intake 2.0±0.5 g/kg and 1.2±0.2 g/kg and fat intake 35±10% and 30±6% of total energy intake. Seventy-three per cent of the triathletes used over-the-counter dietary supplements. Conclusion. Percentage body fat of the men and women was at the upper end of the range associated with elite athletes. Overall the athletes had a fairly good intake of macro- and micronutrients. Inadequate habitual carbohydrate intake was attenuated by the vast majority of the triathletes taking additional carbohydrate supplementation. Various supplements were used widely among the athletes.

Background. Rugby is a physically demanding body contact sport. Optimising dietary intake and body composition can positively affect the performance of rugby athletes.Objectives. To determine the body composition, habitual and game-specific nutritional practices of FNB Maties Varsity Cup (MVC) rugby players.Methods. A descriptive, cross-sectional study with an analytical component was conducted. Of all the MVC rugby players (N=35), 18 completed the sections on body composition and match-day dietary intake, while 11 completed the habitual dietary intake section. Body composition data were collected by an International Society for the Advancement of Kinanthropometry-accredited biokineticist. Habitual dietary intake data (via a self-administered 7-day food record) and match-day dietary strategies (via telephonic 24-hour recall interview) were collected and compared with nutritional requirements reported by the International Olympic Committee, the American Dietetic Association, the American College of Sports Medicine and the International Society of Sport Nutrition.Results. Forwards had significantly higher weight (p=0.01), sum of seven skinfolds (p=0.01), percentage body fat (p=0.02), fat mass (p=0.01) and fat-free mass (p=0.01) than backs. Compared with current recommendations, group habitual dietary intake (mean (stand­ard deviation)) was inadequate for total energy (45.4 (9.0) kcal/kg body weight (BW)), carbohydrate (4.3 (0.4) g/kg BW), polyunsaturated fatty acids (6.2 (1.7)% of total energy (TE)), calcium:protein ratio (6.5:1 (3.5:1)) and copper (2.3 (0.4) mg), while displaying higher-than-recommended intakes for total protein (2.4 (0.7) g/kg BW), fibre (37.7 (7.3) g/day), total fat (33.8 (4.3)% TE), saturated fatty acids (11.2 (13.1)% TE), cholesterol (766.3 (371.8) mg) and niacin (45.2 (6.9) µg). Habitual supplement use was high at 91% (n=10/11). Nutritional match-day strategies were excessive for protein (1.2 (0.6) g/kg BW) and fat (0.9 (0.4) g/kg BW) in the pre-event meal, inadequate for energy and carbohydrate during the game and excessive for alcohol (54.4 (59.9) g) after the game.Conclusion. Forwards and backs differed significantly in various body composition measurements. In relation to observed practices, hab­it­ual dietary intake and nutritional match-day strategies were suboptimal, with high reported supplement use. Players in this sport potentially could benefit from specialist input to optimise dietary strategies and body composition in order to enhance performance.

Background. Rugby is a physically demanding body contact sport. Optimising dietary intake and body composition can positively affect the performance of rugby athletes.Objectives. To determine the body composition, habitual and game-specific nutritional practices of FNB Maties Varsity Cup (MVC) rugby players.Methods. A descriptive, cross-sectional study with an analytical component was conducted. Of all the MVC rugby players (N=35), 18 completed the sections on body composition and match-day dietary intake, while 11 completed the habitual dietary intake section. Body composition data were collected by an International Society for the Advancement of Kinanthropometry-accredited biokineticist. Habitual dietary intake data (via a self-administered 7-day food record) and match-day dietary strategies (via telephonic 24-hour recall interview) were collected and compared with nutritional requirements reported by the International Olympic Committee, the American Dietetic Association, the American College of Sports Medicine and the International Society of Sport Nutrition.Results. Forwards had significantly higher weight (p=0.01), sum of seven skinfolds (p=0.01), percentage body fat (p=0.02), fat mass (p=0.01) and fat-free mass (p=0.01) than backs. Compared with current recommendations, group habitual dietary intake (mean (stand­ard deviation)) was inadequate for total energy (45.4 (9.0) kcal/kg body weight (BW)), carbohydrate (4.3 (0.4) g/kg BW), polyunsaturated fatty acids (6.2 (1.7)% of total energy (TE)), calcium:protein ratio (6.5:1 (3.5:1)) and copper (2.3 (0.4) mg), while displaying higher-than-recommended intakes for total protein (2.4 (0.7) g/kg BW), fibre (37.7 (7.3) g/day), total fat (33.8 (4.3)% TE), saturated fatty acids (11.2 (13.1)% TE), cholesterol (766.3 (371.8) mg) and niacin (45.2 (6.9) µg). Habitual supplement use was high at 91% (n=10/11). Nutritional match-day strategies were excessive for protein (1.2 (0.6) g/kg BW) and fat (0.9 (0.4) g/kg BW) in the pre-event meal, inadequate for energy and carbohydrate during the game and excessive for alcohol (54.4 (59.9) g) after the game.Conclusion. Forwards and backs differed significantly in various body composition measurements. In relation to observed practices, hab­it­ual dietary intake and nutritional match-day strategies were suboptimal, with high reported supplement use. Players in this sport potentially could benefit from specialist input to optimise dietary strategies and body composition in order to enhance performance.

Objective. The aim of this study was to determine body composition, dietary intake and supplement use among Olympic and Ironman distance triathletes residing in the Western Cape. Methods. A descriptive, analytical, cross-sectional study design was conducted in Western Cape Province. Twenty-six triathletes registered with Triathlon South Africa were included. Percentage body fat was measured via multi-frequency bio-electrical impedance analysis and anthropometry. Dietary intake and supplement use were measured with an estimated 3-day food record and questionnaire. Results. The mean age of the men and women was 38 ± 7 and 38 ± 10 years respectively. The mean amount of training per week for men and women respectively was 15 ± 4 and 15 ± 5 hours. The percentage body fat (%BF) of men and women was 13 ± 4% and 21 ± 6%, respectively. The mean dietary macronutrient intake for men and women respectively was for total energy intake 14 535 ± 4 510 kJ and 9 004 ± 2 369 kJ, carbohydrate intake 5.3 ± 1.9 g/kg and 3.5 ± 1.0 g/kg, protein intake 2.0 ± 0.5 g/kg and 1.2 ± 0.2 g/kg and fat intake 35 ± 10% and 30 ± 6% of total energy intake. Seventy-three per cent of the triathletes used over-the-counter dietary supplements. Conclusion. Percentage body fat of the men and women was at the upper end of the range associated with elite athletes. Overall the athletes had a fairly good intake of macro- and micronutrients. Inadequate habitual carbohydrate intake was attenuated by the vast majority of the triathletes taking additional carbohydrate supplementation. Various supplements were used widely among the athletes.