Clinical Observations from Nutrition Services in College Athletics

Assessment of sports nutrition knowledge, dietary intake, and nutrition information source in female collegiate athletes: A descriptive feasibility study

Objective: This descriptive feasibility study aimed to assess dietary intake, sports nutrition knowledge, and nutrition information source in collegiate athletes. Participants: Fourteen indoor volleyball female collegiate athletes from a National Collegiate Athletic Association Division I university. Methods: Participants completed a Nutrition for Sports Knowledge Questionnaire (NSKQ) once and dietary and body composition assessments over four time points. Results: Pre-season mean energy and carbohydrate intake were lower than the American College of Sports Medicine Recommendations (25 ± 6.4 vs 37-41 kcal/kg BW/day and 3 ± 0.9 vs 6-10 g/kg BW/day; respectively). Off-season carbohydrate intake followed similar trends. The average score on the NSKQ was 45 ± 9.6% out of 100. Athletic trainers were identified as a top nutrition source followed by strength and conditioning coaches and nutritionists. Conclusion: Female volleyball athletes have inadequate dietary intake and sports nutrition knowledge and may benefit from nutrition education and counseling by trained sports nutrition experts.Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2021.1987919.

Nutritional counseling in athletes: a systematic review

Many studies report poor adherence to sports nutrition guidelines, but there is a lack of research on the effectiveness of nutrition education and behavior change interventions in athletes. Some studies among athletes demonstrate that nutrition education (NE), often wrongly confused with nutritional counseling (NC), alone is insufficient to result in behavior change. For this reason, a clear distinction between NC and NE is of paramount importance, both in terms of definition and application. NE is considered a formal process to improve a client's knowledge about food and physical activity. NC is a supportive process delivered by a qualified professional who guides the client(s) to set priorities, establish goals, and create individualized action plans to facilitate behavior change. NC and NE can be delivered both to individuals and groups. To our knowledge, the efficacy of NC provided to athletes has not been comprehensively reviewed. The aim of this study was to investigate the current evidence on the use and efficacy of nutritional counseling within athletes. A systematic literature review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. The search was carried out in: PubMed, Scopus, Web of Science, Science Direct, Cochrane Library between November 2022 and February 2023. Inclusion criteria: recreational and elite athletes; all ages; all genders; NC strategies. The risk of bias was assessed using the RoB 2.0 Cochrane tool. The quality of evidence checking was tested with the Mixed Methods Appraisal Tool system. From 2,438 records identified, 10 studies were included in this review, with athletes representing different levels of competition and type of sports. The most commonly applied behavior change theory was Cognitive Behavioral Theory. NC was delivered mainly by nutrition experts. The duration of the intervention ranged from 3 weeks to 5 years. Regarding the quality of the studies, the majority of articles reached more than 3 stars and lack of adequate randomization was the domain contributing to high risk of bias. NC interventions induced positive changes in nutrition knowledge and dietary intake consequently supporting individual performance. There is evidence of a positive behavioral impact when applying NC to athletes, with positive effects of NC also in athletes with eating disorders. Additional studies of sufficient rigor (i.e., randomized controlled trials) are needed to demonstrate the benefits of NC in athletes.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022374502.

Interassociation Consensus Statement on Sports Nutrition Models for the Provision of Nutrition Services From Registered Dietitian Nutritionists in Collegiate Athletics

Collegiate athletic programs are increasingly adding nutrition services to interdisciplinary sports medicine and sports performance departments in response to scientific evidence highlighting nutrition's integral role in supporting athletic performance and overall health. Registered Dietitian Nutritionists (RDNs) specializing in sports dietetics (ie, sports RDNs) and credentialed Board-certified Specialists in Sports Dietetics (CSSDs) are the preferred nutrition service providers for these programs. Their extensive training and proficiency in medical nutrition therapy, education and behavioral counseling, food-service management, exercise physiology, physical performance, and administration, as defined by the "Standards of Practice and "Standards of Professional Performance" for Registered Dietitian Nutritionists in Sports Nutrition and Human Performance," make these practitioners uniquely qualified to deliver the breadth of care required in the collegiate setting. Therefore, this document, guided by a multidisciplinary panel, introduces 4 sports nutrition models through which any collegiate athletic program can deliver sports RDN-directed nutrition services. In each model, the most effective staffing and scope of service are indicated and reviewed. In addition, recommended organizational structures for sports RDNs are provided that best support the delivery of the model's nutrition services in a variety of collegiate athletic programs and organizational settings. Lastly, future research initiatives and nutrition interventions to help improve the standard of care through these sport nutrition models are explored.

Significant differences in dietary intake of NCAA Division III soccer players compared to recommended levels

Objective: This study evaluated dietary intake patterns of NCAA Division III soccer players compared to recommended levels. Participants: NCAA Division III soccer players (n = 75). Methods: Actual dietary intake was determined by the analysis of a 3-day food record. Results: Results indicate that total energy, carbohydrate, and dietary fiber intake was significantly below the recommended levels. In addition, added sugar and total fat consumption were significantly above recommended levels. Potassium, magnesium, and vitamin D levels were consumed in levels significantly below the recommended levels. Sodium, iron, and vitamin C were consumed in significantly higher levels than the recommended target. Female athletes had significantly higher intakes of added sugar, saturated fat and vitamin C compared to male athletes. Female athletes had significantly lower intakes of calcium, potassium, sodium, iron, magnesium and vitamin D compared to male athletes. Conclusion: Based on the results of the present study, increased efforts should be put into development of nutrition education programs for NCAA Division III athletes.

Development and Initial Evaluation of the Athlete Eating Psychopathology Observation Questionnaire for Sport Professionals

Eating psychopathology symptoms are common in athletes; however, it is unknown which symptoms are detected and to what extent by sport professionals. This study aimed to develop and evaluate a self-report questionnaire to explore which features of eating psychopathology in athletes are detected by sport professionals, and how observation of these symptoms might vary. Thirty-one questions were developed and 232 sport professionals (56% male) participated in the study. Exploratory Factor Analysis revealed a 20-item, five-factor solution (Negative Affect, Dieting Practices, Fear of Eating in Social Contexts, Bingeing and Purging, and Compulsive Exercise). Participants most frequently reported observing athletes’ dieting practices, while symptoms of a fear of eating in social contexts were observed least frequently. This study has developed and preliminarily tested the Athlete Eating Psychopathology Observation Questionnaire (AEPOQ), which now requires further validation. The findings provide important directions for education initiatives with sport professionals regarding identification of eating psychopathology symptoms.

Implementation of an Educational Fueling Station for a National Collegiate Athletic Association Division III Athletic Program

ABSTRACT

Gomez-Hixson, K, and Brown, ML. Implementation of an educational fueling station for a NCAA division III athletic program. J Strength Cond Res 35(8): 2346-2350, 2021-The purpose of this project was to evaluate the effectiveness and sustainability of an educational fueling station for National Collegiate Athletic Association (NCAA) Division III student-athletes. Subjects included student-athletes participating in the fall 2018 athletic season (n = 82). Once the mobile fueling station was established, the athletes were informed of the mobile fueling station policies and educated on the appropriate use and timing of the fueling station. The fueling station remained in operation until the end of the 2018 fall athletic season, after which the effectiveness and athlete acceptance of the mobile fueling station was assessed. An anonymous online survey was used as the assessment tool and was created by the authors based on the information pertinent to our institution and mobile fueling station goals and objectives. An itemized inventory usage tracking system was used to calculate actual costs. Data analysis was limited to basic descriptive statistics including the overall response rate and the frequency and percentage of responses to the survey questions. Outcome assessment indicated that 97% of athletes found that the foods provided helped their performance; 95% felt they were properly oriented to the fueling station, and 51% used the fueling station 1-2 times per week on game days. Furthermore, inventory tracking revealed that the operational costs came in under the projected budget. Overall, the mobile fueling station was successfully implemented for student-athletes within a NCAA Division III university and demonstrated feasibility and sustainability within a low-budget athletic program. Establishing proof of concept led to the permanent adoption of the mobile fueling station.

Measurement, Determinants, and Implications of Energy Intake in Athletes

Appropriate energy intake is important for the health and performance of athletes. When an athlete's energy intake is not concordant with energy expenditure, short- and long-term performance can be compromised and negative health effects may arise. The energy intake patterns of athletes are subject to numerous effectors, including exercise response, time, and availability of food. To assess different determinants of energy intake in athletes, we reviewed recent literature regarding the response of appetite-regulating hormones to exercise, appetite perceptions following exercise, chronic exercise-induced adaptations regarding appetite, and social factors regarding energy intake. Additionally, we discussed consequences of aberrant energy intake. The purpose of this review is to clarify understanding about energy intake in athletes and provide insights into methods toward maintaining proper energy intake.

Creation of a Dual-Purpose Collegiate Athlete Nutrition Advising Program and Educational Curriculum

The intent of this article is to describe the process of creating a dual-purpose athlete nutrition advising program at the collegiate level. The first goal was to help student athletes enhance their performance through optimal fuel and hydration. The second goal was to provide experiential learning for nutrition students. This program provided a platform for nutrition students to gain hands-on experience assessing, monitoring, and educating athletes in relation to nutrition for performance. The implication for practice is based on recent growth and increased interest in the performance nutrition field that drives the need for more formal training programs.

Long-Distance Triathletes' Intentions to Manipulate Energy and Macronutrient Intake Over a Training Macrocycle

This study explored the information sources long-distance triathletes used to inform their training and nutrition plans, and evaluated these plans over a training macrocycle. Seventy-four long-distance triathletes completed the online survey. Coaches were the most popular training information source (69%), whereas nonprofessional sources (internet 65%, other athletes 53%) were more popular than nutritionists (29%) for nutrition information. Attributes valued most in an information source were: source prior personal experience, individualized advice, breadth of knowledge, and credibility. Sixty-five percent of participants reported previously manipulating dietary intake to improve performance. Forty-three percent reported carbohydrate loading previously, but only 29% planned to carbohydrate load for their upcoming event. Thirty-six percent of participants planned to reduce carbohydrate intake at some point in training, predominantly early (28%) and toward the end (22%) of their macrocycles. Twenty percent of participants planned to maintain energy intake early, and increase (14%) or maintain energy intake (15%) mid-cycle. Triathletes' training plans showed intentions for concurrent increases in volume and intensity, rather than a classical periodized training progression. Limitations of this study include the lack of diet intake and training data, quantitative comparison with dietary guidelines and high/low carbohydrate classification, and an overrepresentation of women in the study cohort. This research showed the popularity of the internet and other athletes to inform triathletes' nutrition plans, and revealed intentions to reduce carbohydrate intakes alongside training load increases, contrary to professional guidelines. Understanding athletes' intentions and sources of nutrition information is crucial to developing effective nutrition education strategies.

A Tale of Two Runners: A Case Report of Athletes' Experiences with Eating Disorders in College

Athletes are at higher risk than the general population for eating disorders, and risk is heightened for athletes in thin-build sports, including track. Collegiate athletes are particularly vulnerable to disordered eating when the transition from home to the college environment adds to the stress of performance pressures and the high demands of the sport environment. Male and female athletes who develop eating disorders share some common characteristics, yet their experiences can be quite different, in part as a consequence of their sex and how eating disorders develop, and are recognized, acknowledged, and treated, within the culture of sports. This case report describes the experiences of two track athletes, one male and one female, who were recruited to the same Division 1 collegiate track program. Both were elite athletes, freshmen in the same year, experiencing the same urban college environment, and experiencing an eating disorder characterized by restrictive eating, significant weight loss, injury, and compromised performance in sport. Both received treatment from a multidisciplinary team of professionals. Both athletes achieved weight restoration, recovery from the disorder, and success in their sport. In spite of the similarities, striking differences were apparent in clinical presentation, predisposing features, onset of symptoms, entry points to treatment, interventions received, and clinical courses through treatment that depict sex differences in how eating disorders present in athletes and are addressed in the sport environment. Findings endorse the need for research and inform prevention strategies, risk assessment, and intervention approaches for nutrition and sports medicine professionals and collegiate athletic departments.

Gender differences and access to a sports dietitian influence dietary habits of collegiate athletes

BACKGROUND

Limited research exists on the effect of a sports dietitian (SD) on athletes' dietary habits and nutrient periodization, which is the deliberate manipulation of macronutrient intake to match training goals. Further, the difference in dietary habits between men and women collegiate athletes has been understudied. A survey questionnaire examining dietary habits and practices was administered to athletes at two universities that employed a full time SD. Not all athletes used the SD as their primary source for nutritional guidance. The purposes were to examine the effect of a SD as a primary source of nutrition information, and the effect of gender on dietary habits in collegiate athletes.

METHODS

Three hundred eighty-three women (n = 240) and men (n = 143) student-athletes (mean ± SD: age = 19.7 ± 1.4 years) from 10 collegiate sports took a 15-min survey consisting of questions on dietary habits and practices. Topics queried included eating habits, breakfast habits, hydration habits, nutritional supplementation use, pre-workout nutrition, post-workout nutrition, nutrition during team trips, and nutrient timing. Data were sorted by the athlete's source of nutritional information (i.e., sport dietitian, other). Data analysis consisted of descriptive statistics and 2-way Pearson X2 analyses (p ≤ 0.10).

RESULTS

When a SD was indicated as the primary nutrition information source, athletes appeared to have a greater understanding of nutrient periodization (47.12 % vs. 32.85 %), were more likely to have school-provided boxed meals while on team trips (21.29 % vs. 6.77 %), and also less likely to consume fast food while on team trips (9.90 % vs. 19.55 %). Men athletes consumed fast food or restaurant meals more frequently, had higher weekly and more frequent alcohol intake during the competitive season. Women athletes were more likely to prepare meals, eat breakfast 7 days a week, and have school-provided boxed meals.

CONCLUSIONS

Positive effects on dietary habits were observed when a SD was the primary nutrition information source. Practitioners should be aware of the gender differences in alcohol intake, fast food consumption, and knowledge of nutrient periodization. Collegiate athletes and athletic staff members could benefit from SD access to safeguard against dietary habits detrimental to performance.

Effect of a Nutritional Intervention in Athlete's Body Composition, Eating Behaviour and Nutritional Knowledge: A Comparison between Adults and Adolescents

The objective of the present study is to evaluate and compare the effect of a nutritional intervention between adolescent and adult. In a before and after quasi-experimental clinical study, 32 athletes (21 adults, age range 20-32 years; 11 adolescents, age range: 12-19 years) participated in a nutritional counselling consisting of four consultations separated by an interval of 45 to 60 days. The athlete's eating behaviour, body composition and nutrition knowledge were evaluated at the beginning and at the end of the protocol. Both groups increased lean body mass and nutritional knowledge. Adolescents increased their mid-arm muscle circumference and improved meal frequency, and daily water intake. Athletes of both groups improved their ingestion of vegetables and fruits and decreased the ingestion of sweets and oils. Adolescents showed a higher prevalence of individuals that remained within or approached to the recommendations of sweets. This is the first study to evaluate and compare the effect of a nutritional intervention between adolescent and adult athletes body composition, eating behaviour and nutritional knowledge. The nutritional counselling has been effective in promoting beneficial changes on the athlete's eating behaviour, nutritional knowledge and body composition, however, some healthy changes were only experienced by adolescents, especially in the frequency of meals and the intake of sweets.

The Research on the High-Protein Low-Calorie Food Recipe for Teenager Gymnastics Athletes

In order to prevent teenager gymnastics athletes getting fat deposition, weight gain, they should supply a rational food. This paper considers the normal growth and development of athletes, body fat deposition proteins and hunger feel, configured high-protein low-calorie food recipe. Then analysis the composition and the essential amino acids of the recipe. In the final choiced 18 adolescent gymnastics athletes as subjects, to verify the validity of the formula. And analysis the experimental results. The experimental results analysis shows that this recipe basically meets the design requirements.

Validity of the Rapid Eating Assessment for Patients for assessing dietary patterns in NCAA athletes

Background

Athletes may be at risk for developing adverse health outcomes due to poor eating behaviors during college. Due to the complex nature of the diet, it is difficult to include or exclude individual food items and specific food groups from the diet. Eating behaviors may better characterize the complex interactions between individual food items and specific food groups. The purpose was to examine the Rapid Eating Assessment for Patients survey (REAP) as a valid tool for analyzing eating behaviors of NCAA Division-I male and female athletes using pattern identification. Also, to investigate the relationships between derived eating behavior patterns and body mass index (BMI) and waist circumference (WC) while stratifying by sex and aesthetic nature of the sport.

Methods

Two independent samples of male (n = 86; n = 139) and female (n = 64; n = 102) collegiate athletes completed the REAP in June-August 2011 (n = 150) and June-August 2012 (n = 241). Principal component analysis (PCA) determined possible factors using wave-1 athletes. Exploratory (EFA) and confirmatory factor analyses (CFA) determined factors accounting for error and confirmed model fit in wave-2 athletes. Wave-2 athletes’ BMI and WC were recorded during a physical exam and sport participation determined classification in aesthetic and non-aesthetic sport. Mean differences in eating behavior pattern score were explored. Regression models examined interactions between pattern scores, participation in aesthetic or non-aesthetic sport, and BMI and waist circumference controlling for age and race.

Results

A 5-factor PCA solution accounting for 60.3% of sample variance determined fourteen questions for EFA and CFA. A confirmed solution revealed patterns of Desserts, Healthy food, Meats, High-fat food, and Dairy. Pattern score (mean ± SE) differences were found, as non-aesthetic sport males had a higher (better) Dessert score than aesthetic sport males (2.16 ± 0.07 vs. 1.93 ± 0.11). Female aesthetic athletes had a higher score compared to non-aesthetic female athletes for the Dessert (2.11 ± 0.11 vs. 1.88 ± 0.08), Meat (1.95 ± 0.10 vs. 1.72 ± 0.07), High-fat food (1.70 ± 0.08 vs. 1.46 ± 0.06), and Dairy (1.70 ± 0.11 vs. 1.43 ± 0.07) patterns.

Conclusions

REAP is a construct valid tool to assess dietary patterns in college athletes. In light of varying dietary patterns, college athletes should be evaluated for healthful and unhealthful eating behaviors.

Prevention of eating disorders in female athletes

Eating disorders are serious mental diseases that frequently appear in female athletes. They are abnormal eating behaviors that can be diagnosed only by strict criteria. Disordered eating, although also characterized as abnormal eating behavior, does not include all the criteria for diagnosing eating disorders and is therefore a way to recognize the problem in its early stages. It is important to identify factors to avoid clinical progression in this high-risk population. Therefore, the purpose of this review is to discuss critical information for the prevention of eating disorders in female athletes. This review discusses the major correlates for the development of an eating disorder. We also discuss which athletes are possibly at highest risk for eating disorders, including those from lean sports and female adolescent athletes. There is an urgent need for the demystification of myths surrounding body weight and performance in sports. This review includes studies that tested different prevention programs' effectiveness, and the majority showed positive results. Educational programs are the best method for primary prevention of eating disorders. For secondary prevention, early identification is essential and should be performed by preparticipation exams, the recognition of dietary markers, and the use of validated self-report questionnaires or clinical interviews. In addition, more randomized clinical trials are needed with athletes from multiple sports in order for the most reliable recommendations to be made and for some sporting regulations to be changed.

Susceptibility to eating disorders among collegiate female student-athletes

CONTEXT

Research has suggested that the prevalence of young women with eating disorders (EDs) is increasing, but determining the exact prevalence of EDs within the female student-athlete (FS-A) population is difficult. Looking at certain traits may help us to identify their level of susceptibility to developing an ED.

OBJECTIVE

To determine the susceptibility of FS-As to EDs in relation to self-concept, including self-esteem and body image.

DESIGN

Cross-sectional study.

SETTING

Athletic training and health centers at National Collegiate Athletic Association Division I, II, and III institutions via e-mail questionnaire correspondence.

PATIENTS OR OTHER PARTICIPANTS

A total of 439 FS-As from 17 participating institutions completed the questionnaires. The sample was primarily white (83.1%) and underclass (61.8%).

MAIN OUTCOME MEASURE(S)

The questionnaire consisted of 4 parts: 3 subscales of the Eating Disorder Inventory-2, the Rosenberg Self-Esteem Scale, the Body Cathexis Scale, and demographic items.

RESULTS

A total of 6.8% of FS-As were susceptible to anorexia and 1.8% were susceptible to bulimia. The majority of FS-As (61%) reported normal self-esteem levels, whereas 29.4% had high self-esteem. Overall, 64.5% were satisfied and 23% were very satisfied with their body image.

CONCLUSIONS

These results are generally positive in that they suggest FS-As have high levels of self-concept and are at low risk to develop EDs. However, these findings do not mean that all concerns should be dismissed. Although more than 90% of the respondents were not susceptible to an ED, there are still FS-As who may be. Athletic departments should evaluate their FS-As' levels of self-concept so that their susceptibility to EDs can be addressed. The emotional aspect of health care should be included in providing holistic care for student-athletes. Athletic trainers often are the primary health care providers for FS-As, so they should be made aware of this concern.

The prevalence of disordered eating and possible health consequences in adolescent female tennis players from Rio de Janeiro, Brazil

The aim of this study was to estimate the prevalence of disordered eating and possible health consequences in adolescent female tennis players. This cross-sectional controlled study investigated the pubertal development (Tanner stages); body composition (dual energy X-ray absorptiometry-DXA); dietary intake (food record); presence of disordered eating (EAT-26, BITE and BSQ); menstrual status (questionnaire) and bone mineral density (DXA). The Female Athlete Triad (FAT) was divided into two severity stages. The study included 45 adolescents (24 athletes and 21 controls) at some pubertal developmental stage. The athletes exhibited better body composition profiles. We found that 91.7%, 33.3% and 25% of athletes and 71.4%, 9.5% and 33.3% of controls met criteria for disordered eating and/or low energy availability, menstrual irregularities and low bone mass, respectively. A greater percentage of athletes than controls presented with 1 and 2 FAT components (stage I), and 4.2% presented with the full syndrome. In conclusion, tennis players appear to present with more severe disorders than controls and should be monitored to avoid damage to their performance and health.

Exploring the feasibility of an academic course that provides nutrition education to collegiate student-athletes

The purpose of this article is to explore the delivery of nutrition education to collegiate student-athletes through an academic course. Existing literature has established the need for nutrition education among collegiate athletes. This article considers the collaboration of the university and the athletic department to better serve this population. Academic wellness courses for student-athletes can be used as models. Finally, benefits, barriers, and proposed course objectives are considered. This report proposes a potential solution to provide consistent, sustainable nutrition education to collegiate student-athletes.