Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review
Authors: Larrosa Mar , Gil-Izquierdo Angel , González-Rodríguez Liliana Guadalupe , Alférez María José Muñoz , San Juan Alejandro F , Sánchez-Gómez Ángela , Calvo-Ayuso Natalia , Ramos-Álvarez Juan José , Fernández-Lázaro Diego , Lopez-Grueso Raúl , López-León Inmaculada , Moreno-Lara Javier , Domínguez-Balmaseda Diego , Illescas-Quiroga Román , Cuenca Eduardo , López Teba , Montoya Juan José , Rodrigues-de-Souza Daiana Priscila , Carrillo-Alvarez Elena , Casado Arturo , Rodriguez-Doñate Belén , Porta-Oliva Mireia , Santiago Catalina , Iturriaga Támara , De Lucas Beatriz , Solaesa Ángela García , Montero-López María del Pilar , Benítez De Gracia Elvira , Veiga-Herreros Pablo , Muñoz-López Alejandro , Orantes-Gonzalez Eva , Barbero-Alvarez José Carlos , Cabeza-Ruiz Ruth , Carnero-Diaz Ángel , Sospedra Isabel , Fernández-Galván Luis Miguel , Martínez-Sanz José Miguel , Martín-Almena Francisco Javier , Pérez Margarita , Guerra-Hernández Eduardo J , López-Samanes Álvaro , Sánchez-Oliver Antonio Jesús , Domínguez Raúl 
Published: July 2024

Abstract

Context
Despite the progress toward gender equality in events like the Olympic Games and other institutionalized competitions, and the rising number of women engaging in physical exercise programs, scientific studies focused on establishing specific nutritional recommendations for female athletes and other physically active women are scarce.

Objective
This systematic review aimed to compile the scientific evidence available for addressing the question “What dietary strategies, including dietary and supplementation approaches, can improve sports performance, recovery, and health status in female athletes and other physically active women?”

Data Sources
The Pubmed, Web of Science, and Scopus databases were searched.

Data Extraction
The review process involved a comprehensive search strategy using keywords connected by Boolean connectors. Data extracted from the selected studies included information on the number of participants and their characteristics related to sport practice, age, and menstrual function.

Data Analysis
A total of 71 studies were included in this review: 17 focused on the analysis of dietary manipulation, and 54 focused on the effects of dietary supplementation. The total sample size was 1654 participants (32.5% categorized as competitive athletes, 30.7% as highly/moderately trained, and 37.2% as physically active/recreational athletes). The risk of bias was considered moderate, mainly for reasons such as a lack of access to the study protocol, insufficient description of how the hormonal phase during the menstrual cycle was controlled for, inadequate dietary control during the intervention, or a lack of blinding of the researchers.

Conclusion
Diets with high carbohydrate (CHO) content enhance performance in activities that induce muscle glycogen depletion. In addition, pre-exercise meals with a high glycemic index or rich in CHOs increase CHO metabolism. Ingestion of 5–6 protein meals interspersed throughout the day, with each intake exceeding 25 g of protein favors anabolism of muscle proteins. Dietary supplements taken to enhance performance, such as caffeine, nitric oxide precursors, β-alanine, and certain sport foods supplements (such as CHOs, proteins, or their combination, and micronutrients in cases of nutritional deficiencies), may positively influence sports performance and/or the health status of female athletes and other physically active women.

Systematic Review Registration
PROSPERO registration no. CRD480674.