Energy Requirements of Paralympic Athletes: Insights from the Doubly Labeled Water Approach

PURPOSE: Advanced insight in energy requirements of Paralympic athletes is imperative for optimizing their nutritional counseling. Given the lack of accurate data on total daily energy expenditure (TDEE) of Paralympic athletes, this study aimed to assess energy expenditure and nutritional intake of a large cohort of Paralympic athletes, across different sports and disabilities. METHODS: In this cross-sectional study, 48 Dutch and Norwegian Paralympic athletes (19 male/29 female) with various disabilities, competing in Para cycling, wheelchair tennis, wheelchair basketball, Para Nordic skiing and alpine skiing participated. TDEE was assessed by the gold standard doubly labeled water method over a 14-day period, resting metabolic rate (RMR) by ventilated hood indirect calorimetry, energy intake (EI) by three unannounced 24 h-dietary recalls, body composition by dual energy x-ray absorptiometry and exercise training duration by a training log. RESULTS: Mean TDEE was 2908 ± 797 kcal/day, ranging from 2322 ± 340 kcal/day for wheelchair basketball players to 3607 ± 1001 kcal/day for Para cyclists. Regression analysis identified fat-free mass, exercise duration, and the presence of a spinal cord disorder as the primary predictors of TDEE, explaining up to 73% of the variance in TDEE. Athletes' EI (2363 ± 905 kcal/day) was below their TDEE, while their body mass remained constant, indicating underreporting. Carbohydrate intake (4.1 ± 1.9 g/kg body mass) was low, even when considering underreporting, while protein intake (1.8 ± 0.6 g/kg body mass) was relatively high. CONCLUSIONS: Paralympic athletes display moderate to high energy expenditure, varying across sports and individuals. Much of the variation in TDEE can be attributed to individual differences in fat free mass and exercise duration. This study establishes the benchmarks for energy requirements of Paralympic athletes, serving as the foundation for future dietary guidelines within this population.