Table 1

Examples of micronutrients often requiring supplementation in athletes (see Larson-Meyer et al 18 for additional information)

MicronutrientOverviewDiagnosis and outcomes of insufficiencyProtocols and outcomes of supplementation
Vitamin DIt is important in the regulation of gene transcription in most tissues, so insufficiency/deficiency affects many body systems.42
Many athletes are at risk of insufficiency at various times throughout the year.43
No consensus over the serum 25-hydroxyvitamin D concentration (the marker of vitamin D status) that defines deficiency, insufficiency, sufficiency and a tolerable upper limit.
The need to supplement depends on UVB exposure and skin type.
Supplementation of between 800 IU and 1000–2000 IU/day is recommended to maintain status for the general population. Supplementation guidelines are not yet established in athletes. Short-term, high-dose supplementation which includes 50 000 IU/week for 8–16 weeks or 10 000 IU/day for several weeks may be appropriate for restoring status in deficient athletes. Careful monitoring is necessary to avoid toxicity.44
IronSuboptimal iron status may result from limited iron intake, poor bioavailability and/or inadequate energy intake, or excess iron need due to rapid growth, high-altitude training, menstrual blood loss, foot-strike haemolysis, or excess losses in sweat, urine or faeces.45 Several measures performed simultaneously provide the best assessment and determine the stage of deficiency. Recommended measures: serum ferritin, transferrin saturation, serum iron, transferrin receptor, zinc protoporphyrin, haemoglobin, haematocrit  and mean corpuscular volume.46 Athletes who do not maintain adequate iron status may need supplemental iron at doses greater than their RDA (ie, >18 mg/day for women and >8 mg/day for men). Athletes with iron deficiency require clinical follow-up, which may include supplementation with larger doses of oral iron supplementation along with improved dietary iron intake.45 Numerous oral iron preparations are available and most are equally effective as long as they are taken.47 High-dose iron supplements, however, should not be taken unless iron deficiency is present.
CalciumAvoidance of dairy products and other calcium-rich foods, restricted energy intake and/or disordered eating increases risk of suboptimal calcium status.45 There is no appropriate indicator of calcium status. Bone mineral density scan may be indicative of chronic low calcium intake, but other factors including suboptimal vitamin D status and disordered eating are also important.Calcium intakes of 1500 mg/day and 1500–2000 IU vitamin D are recommended to optimise bone health in athletes with low energy availability or menstrual dysfunction.45
  • Note: Indiscriminate supplementation with any of the above nutrients is not recommended. Deficiencies should first be identified through nutritional assessment, which includes dietary intake and the appropriate blood or urinary marker, if available.17