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

Elite collegiate swimmers do not meet sport nutrition recommendations during heavy training: effects of sex and within-day nutrient timing

BACKGROUND

Compared to the general population, athletes experience high energy expenditures requiring increased energy and macronutrient intakes to sustain training and optimize performance. While the International Olympic Committee (IOC) and International Society for Sports Nutrition (ISSN) have established recommendations for nutrient intakes, many athletes do not meet the recommended daily allowance (RDA) for the general population, and sport and sex-specific differences are not well documented. Exploration of within-day energy balance (WDEB) shows athletes may achieve energy balance by the end of the day but may present with poor WDEB. Data support that female athletes are at greater risk of nutrient deficiencies than their male counterparts, and it is unclear whether swimmers meet sport-specific nutrient intake and timing recommendations. Following our previous WDEB analysis, the purpose of this investigation was to assess dietary macronutrient intake as related to RDAs (USDA and IOC/ISSN), within-day macronutrient timing, and associated sex differences in swimmers.

METHODS

In elite male and female swimmers (n = 25; 18-22 yr), we assessed energy intake (EI), total daily energy expenditure (TDEE), macronutrient intake (fat (FAT), protein (PRO), carbohydrate (CHO)) and timing during heavy training. Frequency analysis was utilized to determine the number of athletes meeting general and athlete-specific RDAs. Repeated-measures ANOVA was used to assess nutrient timing across sex groups.

RESULTS

When compared to IOC/ISSN daily recommendations, only 6/25 swimmers met FAT intake, 7/25 met CHO intake, and 24/25 met PRO intake IOC/ISSN daily recommendations.Males had greater EI and TDEE compared to females (p < 0.05). PRO consumption (% of EI) was a larger percentage of total intake in male vs females (28 ± 5% vs 23 ± 3%; F = 2.996; p = 0.014). No swimmers met CHO recommendations (g⋅kg-1) pre- or during exercise for the first daily training session. 13/25 met pre-exercise CHO recommendations, while 6/25 and 11/25 met during and post-exercise CHO recommendations for the second training session. Repeated measures ANOVA revealed effects of sex and time on intake (g⋅kg LBM-1⋅hr-1) for FAT (Sex; F = 5.659, p = 0.26; time; F = 12.068, p = 0.006) and PRO (Sex; F = 6.719, p = 0.016; time; F = 13.177, p = 0.011). There was a significant sex*time interaction for CHO consumption (F = 6.520, p = 0.017).

CONCLUSION

The results from this study demonstrate significant sex-differences, indicating that most swimmers meet athlete-specific recommendations for PRO, but not CHO or FAT intake. CHO timing for pre-, during, and post-exercise was met by only 52% swimmers. Results suggest that swimmers should prioritize CHO intake, emphasized around and during training bouts.

Sports Supplement Use in Road Cycling: A Comparative Analysis by Sex and Competitive Category

This study analyzes and compares sports supplement (SS) consumption among federated road cyclists, considering sex and competition category. The aim is to identify key factors influencing SS use and provide insights for developing nutritional strategies in cycling. A cross-sectional, descriptive study was conducted, involving 1503 cyclists (1231 men and 272 women). Data were collected through a validated questionnaire assessing anthropometric data, training habits, SS consumption patterns, and sources of information. Results indicate that 64.3% of cyclists currently use SS. Women reported a significantly higher consumption rate (88.2%) compared to men (59.1%), although men had a higher average SS intake than women (8.28 ± 9.36 vs. 6.76 ± 5.96). Additionally, SS use decreased with age and competition level, with elite cyclists showing the highest prevalence (76.3%) and master 50 the lowest (58.4%). Group A supplements (scientifically supported) were the most frequently used, while Group C supplements (limited evidence) and Group D substances (prohibited) were more commonly consumed by men. Findings highlight significant differences in SS consumption based on sex and competition level, with elite cyclists and women reporting higher prevalence. However, men reported a higher average number of SS consumed. The study underscores the need for targeted nutritional education, particularly among master cyclists, to promote evidence-based SS use and minimize the risks of ineffective or unsafe supplementation. Future research should explore the long-term effects of SS consumption in cycling and the effectiveness of educational interventions for safe and optimized supplementation practices.

Comparative determination of factors affecting attitude level towards healthy nutrition

Healthy eating habits are critical to the health and well-being of future generations. Many people worldwide do not receive enough vitamins and minerals due to malnutrition To eliminate these, it is necessary to determine the factors that support people's healthy eating habits. This study was conducted to determine the factors that affect healthy eating habits. There are three external factors to the study: (1) being an expert in food and drink, (2) having received formal education in health, and (3) receiving professional support (dietician support) in nutrition. The level of healthy eating was evaluated based on nutritional knowledge, feelings about nutrition, positive eating habits, and poor eating habits. In this context, an online survey was applied to 425 employees in the health sector (202 people) and the food and beverage sector (223 people). The data obtained were analyzed comparatively. The study results showed that the level of nutritional knowledge was equal in both groups. However, it was concluded that food and beverage sector employees were more sensitive to feelings about nutrition, positive eating, and poor eating habits than healthcare sector employees. While food and beverage sector employees are expected to constantly deal with food, which causes desensitization, it has been observed that they are stable and resistant to healthy eating. It has been concluded that although they have not received any formal health training, the information they have obtained through professional support (dietician) accelerates the process of developing healthy eating behaviors. This result has strengthened the power of the education variable affecting healthy nutrition. In addition, sensitivity to healthy nutrition is catalyzed by the professional profession. Dietician support indirectly reinforces this attitude. Thus, it has contributed to the development of healthy nutrition literature.

The measurement of college athletes' knowledge and behavior on pre- and post-workout nutrition utilizing a text message intervention

Objective: The purpose of this study was to measure college student athletes' nutrition knowledge and behavior before and after a text message-based educational intervention. Participants: Athletes (n = 35) participated by completing a pre- and post-intervention survey. Methods: This survey gathered information on ability to identify carbohydrate and protein food sources, pre-and post-workout intake, and behavior. Text messages were sent during the 4-week intervention and included information regarding the importance of carbohydrate consumption before training, and a carbohydrate-protein mixture for recovery. Results: Dependent t-tests revealed a lack of statistically significant increases in total knowledge (p = 0.156) or behavior (p = 0.177), but an increase in the behavior questions regarding efficacy of carbohydrate before training (p = 0.026) and carbohydrate and protein after training (p = 0.016). Conclusion: This suggests the text message educational intervention did influence behavioral outcomes. Future research should focus on the effectiveness, length, and frequency of the text message intervention, and investigate the athletes' willingness to change dietary behaviors.

Nutrition Knowledge and Perceived Dietary Requirements of Adolescent Student-Athletes: A Pilot Study

BACKGROUND/OBJECTIVES

Adherence to sports-specific nutritional guidelines can help optimize athlete performance and health. However, adolescent athletes may not have adequate nutrition knowledge and understanding of specific nutritional requirements. The objective of the current study was to examine the nutrition knowledge and perceived dietary requirements of adolescent athletes.

METHODS

Male (n = 29, age: 15.7 ± 1.3 yrs.; height: 178.9 ± 8.3 cm; body mass: 74.7 ± 17.2 kg; body fat %: 13.9 ± 7.9%) and female (n = 15, age: 16.5 ± 1.4 yrs.; height: 169.9 ± 6.5 cm; body mass: 63.3 ± 4.5 kg; body fat %: 23.7 ± 3.8%) secondary school student-athletes completed body composition testing (hydrostatic weighing) and electronic surveys (Abridged Sports Nutrition Knowledge Questionnaire (ASNKQ); self-perception of dietary energy and macronutrient requirements).

RESULTS

Athletes demonstrated poor sports nutrition knowledge, with no differences observed between sexes for the number of questions answered correctly (males: 45.1 ± 9.8% vs. females: 43.1 ± 12.7%; p = 0.57). No relationships were observed between ASNKQ scores and body composition parameters or between ASNKQ scores and self-reported perception of dietary energy and macronutrient requirements (p > 0.05). Athletes self-reported a lower perceived energy (-560 ± 1272 kcal/d; p = 0.014) and carbohydrate intake (-73 ± 376 g/d; p = 0.014) requirement compared to calculated nutritional recommendations. Athletes self-reported a higher perceived protein intake (263 ± 586 g/d; p = 0.026) requirement compared to calculated nutritional requirements.

CONCLUSIONS

The current sample of adolescent athletes from the secondary school level appears to have a poor level of sports nutrition knowledge and understanding of energy and macronutrient requirements.

Differences in perceived energy and macronutrient requirements across divisions in NCAA athletes

BACKGROUND

Sports nutrition is an impactful component to sports performance. The purpose of the current study was to investigate the sports nutrition knowledge of National Collegiate Athletic Association collegiate athletes and assess self-reported perceived requirements for energy and macronutrient intake. A secondary aim was to evaluate the awareness of physical and emotional perceptions associated with mindful eating.

METHODS

Participants included NCAA Division I (DI, n = 45), II (DII, n = 31), and III (DIII, n = 47) athletes. Athletes completed a validated questionnaire designed to assess sports nutrition knowledge and were asked questions about their perceived dietary energy and macronutrient requirements. Daily energy intake values were calculated using a recommended relative energy intake value of 40, 50, and 60 kcal/kg/day for low, moderate, and high activity levels, respectively. Carbohydrate recommendations were calculated using 4, 6, and 8 g/kg/day, protein recommendations were calculated using relative intakes of 1.4, 1.6, and 1.8 g/kg/day, and fat recommendations were calculated from a relative percentage of total predicted daily energy requirements, equating to 15, 25, and 30% of daily energy. Additionally, athletes completed a questionnaire to assess mindfulness regarding eating habits.

RESULTS

Overall, athletes answered 45.5 ± 13.5% of questions correctly on the nutrition questionnaire with significant differences observed between male (48.6 ± 13.6%) and female athletes (43.6 ± 13.2%; p = 0.044), as well as significant differences observed between DI athlete scores (38.8 ± 14.1%) and DII athletes (47.7 ± 11.4%; p = 0.002), and DI athletes and DIII athletes (51.71 ± 11.83%; p =  <0.001). All athletes significantly (p < 0.001) underestimated daily energy intake requirements (female, 2,112 ± 575 kcal/day; male, 3,283 ± 538 kcal/day). The mindfulness eating habits total score was significantly higher in male athletes (65.1 ± 6.5) compared to female athletes (60.9 ± 9.5; p = 0.009).

CONCLUSIONS

Division I, II, and III collegiate athletes have poor sports nutrition knowledge, with Division I athletes having exhibited lower scores compared to Division II and III athletes on the sports nutrition knowledge questionnaire. Athletes from all levels of collegiate sports underestimated their energy and macronutrient requirements. Differences in mindful eating habits among female and male athletes were also evident.

Sex and gender in sports nutrition research: bridging the gap

The Olympic Games have grown to be the largest, gender-equal sporting event in the world, and the International Olympic Committee is committed to gender equality in sports encouraging and supporting the promotion of women in sports at all levels and in all structures with a view to implementing the principle of equality of men and women (IOC, 2023). Women competed for the first time at the 1900 Olympic Games in Paris, and the number of women competing has grown exponentially over the last 100 years, so an estimated 5494 female athletes (48 %) competed in the Summer Olympic Games 2021 in Tokyo. Supporting women (alongside men) in achieving optimum performance is crucial, and understanding that there are sex and gender gaps in sports nutrition research is important. One reason for this gap is the historical bias in sports and exercise science research towards male participants. This has led to a poor understanding of the unique physiological and nutritional needs of female athletes. In summary, a balanced approach is crucial to address the nutritional needs of both male and female athletes. Researchers should continue exploring this important area to optimise performance and health for all athletes. The aim of this review is to summarise current sports nutrition literature and highlight research that seeks to understand and address where the gaps are with respect to several key areas in sports nutrition recommendations that can impact advice and practice with both males and females.

Socio-Demographic Influences on Dietary Habits and Nutritional Awareness: A Case Study of Polish Biathlon Association National Team Members

INTRODUCTION

This study investigated the influence of sociodemographic factors on the dietary habits of athletes of the Polish Biathlon Association. Focusing on age, education, employment status, and gender, this research assesses food choices, meal preparation, and nutritional awareness within a structured sports environment. A cross-sectional survey of 54 athletes was conducted using a modified "Eating Habits of Poles" questionnaire to explore food selection, preparation methods, consumption patterns, and nutritional perspectives. This focus on biathletes emphasizes their distinct dietary needs, which arise from the demanding combination of endurance and precision in their sport, providing valuable insights for tailored dietary strategies to enhance their performance and overall health.

RESULTS

The results indicate that age, education, and employment status significantly influence Polish biathletes' dietary habits and nutritional awareness. Older athletes (under 23 years) demonstrated significantly higher nutritional awareness regarding modern dietary trends (p = 0.015). In contrast, 50% of higher-education athletes were more engaged in meal planning and healthier food choices than those with elementary education (p = 0.031). Employment status also played a role; 70% of the athletes were students who exhibited more convenience-based food choices, whereas 30% were employed and maintained more structured eating patterns (p = 0.008). Minimal gender differences were found, with 50% of male and 50% of female athletes showing similar dietary habits, likely due to standardized nutrition programs provided to all athletes.

CONCLUSIONS

This indicates a potential need for further research to determine whether professional dietary support can effectively address typical gender-related variations in food behavior and lead to improvements in dietary outcomes. This study highlights the importance of targeted nutrition education and professional support for optimizing the nutritional habits of professional athletes. This emphasizes that socio-demographic factors such as age, education, and employment status significantly shape these behaviors, underscoring the need for personalized nutritional strategies within athletic programs.

Dietary Intake and Diet Quality of Female and Male NCAA Division I Cross Country Runners from a Single University

Background

Collegiate student-athletes have unique nutritional requirements to support their athletic performance and health. Few studies have comprehensively characterized the diets of National Collegiate Athletic Association (NCAA) Division I student-athletes.

Objectives

To characterize dietary intake and diet quality during a competitive season in female and male NCAA Division I cross country student-athletes from a single university.

Methods

Females and males (n = 14/sex) from the Florida State University cross country teams completed 9-d of food records across their competitive season. Nutrient intakes were compared to the Dietary Reference Intakes for the United States population [e.g., Recommended Daily Allowances (RDAs)] and athlete-specific guidelines. Diet quality was assessed according to the Dietary Guidelines for Americans (DGAs) using the 2020 Healthy Eating Index (HEI-2020). Total daily energy expenditure was estimated from training records.

Results

Carbohydrate intakes were below athlete guidelines in 43% of females (mean ± SD, 5.67 ± 1.16 g·kg-1·d-1) and 29% of males (4.95 ± 1.05, P sex = 0.096). All participants met or exceeded athlete recommendations for protein (2.09 ± 0.425 g·kg-1·d-1, 1.92 ± 0.519, P sex = 0.36) and fat (32.8 ± 5.1% kcal, 34.4 ± 3.4%, P sex = 0.36). No participants met the RDA for vitamin D (5.14 ± 1.78 μg/d, 4.91 ± 3.24, P sex = 0.83). Only 79% of females and 36% of males met the RDA for calcium (1220 ± 307 mg/d, 1010 ± 296, P sex = 0.83). Most females (n = 13) and males (n = 11) consumed iron supplements where total intakes exceeded the tolerable upper intake level (110 ± 60.1 mg/d, 66.8 ± 36.3, P sex = 0.029). HEI-2020 indicated poor adherence to the DGAs, with better diet quality in females (65.3 ± 13.7) than males (50.6 ± 10.1, P sex = 0.0034). Participants failed to meet guidelines for all HEI-2020 food group components except total protein foods. Total daily energy expenditure was greater in males and declined across the competitive season (P sex < 0.0001, P time < 0.0001, P sex∗time = 0.25).

Conclusions

NCAA Division I cross country student-athletes consumed inadequate carbohydrates, calcium, and vitamin D but met or exceeded intake guidelines for protein, fat, and iron. Diet quality was poor; HEI-2020 component scores may indicate food groups to target to improve diet quality and intake of nutrients important to runners.This trial was registered at clinicaltrials.gov as NCT04079322.

Sports Supplement Consumption in 316 Federated Female Road Cyclists

Although the extensive use of sports supplements (SSs) is prevalent among cyclists, this area has been poorly explored; in fact, no studies have been conducted on this topic regarding women cyclists to date. This descriptive, cross-sectional study, which included 316 federated female road cyclists, aimed to analyze SS consumption patterns in relation to scientific evidence and various categories. SSs were categorized according to the groups and subgroups established by the Australian Sport Institute (AIS, 2023) based on the level of evidence supporting their use. The analysis found that 85.1% of the female road cyclists surveyed used SSs, with an average consumption of 7 ± 6 supplements per individual. Pharmacies (60.8%), dietitian-nutritionists (58.9%), and health status (60.1%) were the primary purchase location, source of information, and reason for use, respectively. The most frequently consumed supplements were sports bars (77.5%), sports gels (61.4%), and caffeine (49.1%). Significantly, 80% of the ten most commonly used supplements were from the group with the highest evidence level, as classified by the AIS, with an average intake of 5 ± 3 supplements per cyclist. In summary, the use of SSs is prevalent among female road cyclists, with reliable sources for both purchasing and obtaining advice on supplements.

Analysis of Sports Supplement Consumption of Elite Referees of the Spanish Professional Fotball League

BACKGROUND

Sports supplements (SSs) are widely used among team sport athletes; however, evidence supporting the use of SSs among football referees at the elite level is scarce. The aim of the present study was to analyze the consumption of SSs among referees with respect to their level of competition and referee type (main referees (MRs) vs. assistant referees (ARs)).

METHODS

A total of 106 football referees participated in this study, with 46.2% from the First Spanish Division and 53.8% from the Second Spanish Division, representing 84.13% of the total number of referees. Each participant completed a validated questionnaire about SS consumption, with the SSs classified according to the Australian Institute of Sport (AIS) ABCD system: Group A has strong evidence for enhancing athlete health and performance, Group B shows potential benefits but needs more evidence, Group C has inconclusive evidence against use, and Group D includes prohibited substances.

RESULTS

A total of 84.0% of the MRs and ARs reported the consumption of at least one SS. Differences were found only in the consumption of medical supplements between division (p = 0.016) and type of referee (p = 0.041), though no significant differences were found among the remaining AIS SS categories (p > 0.05). Sport performance (49.6%), Internet (41.0%), and dietitian-nutritionists (31.7%) were the primary reason for SS consumption, purchase location, and source of information, respectively. The most frequently consumed SS were whey protein (45.3%), followed by creatine (33.0%), sport bars and sports drinks (28.3%), and caffeine (19.8%).

CONCLUSIONS

MRs and ARs reported a high prevalence of dietary supplement (SS) consumption, with significant differences between division and referee type observed only in medical supplement consumption.

Seasonal health tracking of Australian Football League Women's athletes

BACKGROUND

Studies evaluating the dietary intake of Australian Football League Women's (AFLW) athletes are few and limited to the preseason. This prospective observational study aims to evaluate seasonal changes in dietary intake and health parameters of professional AFLW athletes.

METHODOLOGY

Dietary intake (3-day weighed food records), body composition (bioelectrical impedance analysis, skinfolds), physical performance (global positioning system, GPS), and iron status (fasted blood sample) were assessed in 19 athletes (24 ± 5 years, 170 ± 6 cm, 22.8 ± 2.1 kg/m2) at three timepoints: start of preseason, end of preseason, and end of competition season. Sociodemographic information, sports nutrition knowledge (SNK), and risk of low energy availability (LEA) questionnaires were completed at the start of preseason.

RESULTS

Mean daily energy and carbohydrate (CHO) intakes were lower than recommendations across all seasons (p < 0.05). Mean daily CHO intake was highest at start of preseason (3.6 g/kg/day), decreased during preseason (3.1 g/day) and remained low during competition (3.2 g/day); >80% of players did not meet minimum recommendations at each timepoint (all, p < 0.05). The sum of seven skinfolds and fat mass (%) decreased during preseason (both, p < 0.05). Serum iron fell within recommended ranges for 95% of athletes at all timepoints. The total distance (m) and number of Very High Intensity (>21 km/h) efforts significantly increased across preseason and decreased during competition (all, p < 0.05). Nutrition knowledge was 'poor', and 42% of athletes were at risk of LEA.

CONCLUSIONS

AFLW athletes do not meet energy and carbohydrate requirements across the preseason and competition seasons, which may impact health and performance if deficits are sustained.

The effect of last meal "Suhoor" timing on diurnal variations in cognitive performance during Ramadan fasting among female athletes

The present study aimed to investigate the effect of the timing of the last meal, "Suhoor", on diurnal variation in cognitive performance during Ramadan intermittent fasting (RIF). In a randomized order, 26 adolescent female athletes (aged 15.9 ± 0.9 y) were tested in three sessions at 7:00 a.m., 12:00 p.m., and 5:00 p.m. across four different conditions: the 10 days preceding Ramadan (PR); the final 12 days of Ramadan (RO): two different conditions: Early Suhoor (SEarly), and Late Suhoor (SLate); and, ultimately, the 10 days immediately after Ramadan (AR) with an in-between recovery period of ≥24 h. During each test session, the oral temperature (OT), simple reaction time test (SRT), choice reaction time test (CRT), attention test (ATT), and mental rotation test (MRT) were evaluated. The Pittsburgh Sleep Quality Index (PSQI) and daily diary intake were assessed across the three periods. Compared to PR, the sleep parameters assessed by the PSQI were significantly lower during the RO and AR periods. However, neither total dietary intake nor OT showed any changes due to RIF. Compared to PR, the afternoon performances of SRT, CRT, ATT, and MRT significantly declined under both the SEarly and SLate conditions. Notably, midday performance decreased only during SLate, while morning performance remained unaffected in both conditions. Additionally, compared to SEarly, these performances were better during SLate in the afternoon and at midday. In summary, nutrient intake timing had a significant effect on the diurnal fluctuations in cognitive functions during Ramadan fasting, particularly around noon and in the afternoon. Our results illustrate the benefits of a late last meal (Suhoor) in preserving optimal morning cognitive abilities and preventing any impairment during the fasted state at midday or in the afternoon, which could affect overall athletic performance.

Analysis of Sports Supplement Consumption in 1688 Federated Road Cyclists

The widespread use of sports supplements (SS) to enhance athletic performance extends to cyclists, although little research has been conducted on this subject within this sport. This descriptive and cross-sectional study involved 1688 federated road cyclists, aiming to analyse the pattern of SS consumption concerning the degree of scientific evidence and different categories. This study categorised SS based on the groups and subgroups established by the Australian Sport Institute (AIS, 2023) based on the level of evidence. Our results showed that 62.5% of the sample cyclists used SS, with an average of 12.2 ± 8.6 supplements consumed per participant. Health status (78.2%), pharmacies (62.5%), and medical doctors (45.7%) were the main reasons, purchase sites, and sources of information for SS consumption, respectively. The most prevalent SS consumed were Sports Gels (94%), Sports Bars (89.3%), and Sports Drinks (73.8%). Notably, 80% of the top ten most consumed SS belonged to the group with the highest level of evidence according to the AIS, with an average of 6.9 ± 3.2 supplements per participant. However, 23.3% of the total SS consumers used prohibited substances. In conclusion, while the prevalence of SS consumption among road cyclists is considerable and the primary sources for purchasing SS and obtaining advice are reliable, there is a notable prevalence of prohibited substance use within the sample.

A Behaviourally Informed Approach to Reducing the Risk of Inadvertent Anti-doping Rule Violations from Supplement Use

For many reasons, athletes' use of supplements is highly prevalent across sports and competitive levels, despite the risk of these products containing a substance on the World Anti-Doping Agency Prohibited List. Contravening anti-doping rules through supplement use could have serious consequences for competitive athletes (e.g., ineligibility from major competitions, loss of medals and funding) due to the principle of strict liability. Indiscriminate supplement use also poses a risk to athlete health. To reduce the possibility of ingesting a supplement containing prohibited substances, independent quality assurance and certification programs have been established (e.g., Informed Sport). However, these programs do not completely eliminate risk, leading to some anti-doping organisations promoting a 'just say no' to supplements stance. Yet, this approach can be problematic as a small number of supplements may be necessary for athletes to consume, in certain situations. Recognising that athletes will continue to use these heavily marketed products, this narrative review describes a theoretically underpinned and systematic approach to preventing inadvertent doping by considering the barriers to and enablers of athlete adherence to risk minimisation supplement use guidelines (RMSUG). By outlining a conceptual shift towards a behaviourally informed approach, this review serves to stimulate the development of multifaceted interventions to prevent inadvertent doping through supplement use. Recognising that risk-minimised supplement use involves a myriad of behaviours, the problem of inadvertent doping through supplement use is framed, and research appraised, through the lens of the Behaviour Change Wheel.

Sports Nutrition Knowledge Questionnaires Developed for the Athletic Population: a Systematic Review

PURPOSE OF REVIEW

Sports nutrition (SN) is pivotal in aiding athletes to reach peak performance, minimize sport-related injuries, enhance career longevity, and improve general health. An accurate assessment of athletes' sports nutrition knowledge (SNK) is required to design targeted nutrition education programs aimed at enhancing both nutritional knowledge and dietary practices. This review systematically evaluates studies that use questionnaires to assess the SNK of athletes engaged in athletics.

RECENT FINDINGS

The literature search was conducted in PubMed®, Web of Science®, and Scopus®, and 375 potentially relevant articles were identified. The total number of articles included in the present review is 11, with eight studies involving only athletic disciplines and three involving athletics and other sports. The majority (n = 8) of the questionnaires included general and SN aspects, with SN covering endurance athletes' knowledge of competition carbohydrate guidelines, gastrointestinal symptoms associated with exercise, and ultra-endurance athletes' sodium beliefs and practices. Questionnaires were either delivered online (n = 7) or self-administered in hard copy (n = 1). The three major strategies identified for developing questionnaires were based on previous literature and recent SN guidelines (n = 6), consultation with a panel of experts (n = 7), and the use of a previously developed sports nutrition knowledge questionnaires (SNKQ) (n = 4), with more than one approach used in five studies. Similarly, up to three validation approaches were used, including content, face, and construct validity. Seven studies used a test-retest procedure to ensure external reliability, and eight used Cronbach's alpha or kappa coefficient to assess internal consistency. Endurance and ultra-endurance athletes are the populations of interest for the majority of questionnaires developed for athletics, with most questionnaires incorporating general and SNK topics.

Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions

BACKGROUND

Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers).

OBJECTIVE

The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes' and sport professionals' perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality.

METHODS

An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022.

RESULTS

Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. "Health" and "sports performance" were the highest scoring motivators, while the highest scoring barriers were "cost of food," "easy access to unhealthy food," and "time to cook or prepare food." Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography.

CONCLUSIONS

The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance.

Use of Instagram to convey nutrition information to collegiate athletes

Background: Nutrition professionals, who work with collegiate athletes, use Instagram to provide nutrition information. Although, limited focus is on the engagement of these athletes. The purpose of this descriptive study was to investigate collegiate athletes' engagement, as indicated by the total number of likes received on posts, based on the nutrition content posted on Instagram. Methods: Over a five-week period, 15 randomly selected accounts were examined daily for posts made within specific research-defined categories (n = 12). The number of posts and subsequent post likes were summed and tabulated per category. Results: The food feature post category received the highest number of likes (n = 1,130) and posts (n = 33), whereas the macronutrient post category received the fewest number of likes (n = 43) and posts (n = 2). A two-sample t-test assuming unequal variances was conducted to compare account engagement as defined by the mean number of post likes within the same conferences. Two conferences had differences in the number of posts (p < 0.05). Discussion: Posting on a weekly basis and within specific categories appeared to produce a higher degree of engagement on collegiate sports nutrition Instagram accounts. Future research is needed to determine the percentage of athletes following these Instagram accounts and the impact these nutrition posts influences dietary behaviors.

Do Spanish Triathletes Consume Sports Supplements According to Scientific Evidence? An Analysis of the Consumption Pattern According to Sex and Level of Competition

Background: The use of sports supplements (SS) to improve sports performance is very common in athletes. In the case of triathletes, the physiological characteristics of the sport may require the use of certain SS. Although the consumption of SS is widespread in this sport, very few studies have investigated it thus far. The aim is to analyze the pattern of SS consumption by triathletes according to sex and the competitive level. Methodology: This is a descriptive cross-sectional study on the consumption and habitual use of SS of 232 Spanish-federated triathletes. Data were collected through a validated questionnaire. Results: Overall, 92.2% of the athletes consumed SS, but no significant differences were found in terms of competition level or sex. Yet, significant differences were found regarding the level of competition for total SS (p = 0.021), the total number of Group A supplements from the AIS classification (p = 0.012), and for the ergogenic aids (p = 0.003). The most-consumed SS were bars, sports drinks, sports gels, and caffeine (83.6%, 74.1%, 61.2%, and 46.6%, respectively). Conclusions: The consumption of SS by triathletes is high, and the number of SS consumed rises from the regional to the national and international levels. The four SS most consumed were included in category A of the AIS (greatest scientific evidence).

The five most significant barriers to healthy eating in collegiate student-athletes

The objective of the present study was to elucidate what student-athletes believe are the most significant barriers to consuming a healthy diet. 418 student-athletes at an NCAA Division 1 university were invited to complete a survey on their nutritional habits and barriers to healthy eating. The survey was designed utilizing the current literature in student-athletes and young adults and underwent a professional review and pilot study before use in data collection. 169 student-athletes (40%) fully completed the survey. Responses indicate the five most significant barriers are lack of time, easy access to unhealthy foods, cost of healthy foods, lack of knowledge about what foods are healthy, and lack of knowledge and skills to cook healthy foods, respectively. Further, data show significant relationships between several variables and the rate of selection of various barriers. Overall, these findings lay the groundwork for future interventions while also presenting initial, usable information for professionals.

Validation of a sports nutrition knowledge questionnaire for athletes in the United Kingdom and Ireland

Sound general and sports nutrition knowledge in athletes is essential for making appropriate dietary choices. Assessment of nutrition knowledge enables evaluation and tailoring of nutrition education. However, few well-validated tools are available to assess nutrition knowledge in athletes. The objective of the present study was to establish the validity of the Platform to Evaluate Athlete Knowledge Sports - Nutrition Questionnaire (PEAKS-NQ) for use in the United Kingdom and Irish (UK-I) athletes. To confirm content validity, twenty-three sports nutritionists (SNs) from elite, UK-I sports institutes provided feedback on the PEAKS-NQ via a modified Delphi method. After minor changes, the UK-I version of the PEAKS-NQ was administered to UK-I SN from the British Dietetic Association Sport and Exercise Nutrition Register, and elite athletes (EA) training at elite sports institutes in the UK and Ireland. Independent samples t-test and independent samples median tests were used to compare PEAKS-NQ total and subsection scores between EA and SN (to assess construct validity). Cronbach's alpha (good ≥ 0⋅7) was used to establish internal consistency. The SN achieved greater overall [SN (n 23) 92⋅3 (9⋅3) v. EA (n 154): 71⋅4 (10⋅0)%; P < 0⋅001] and individual section scores (P < 0⋅001) except Section B, Identification of Food Groups (P = 0⋅07). Largest knowledge differences between SN and EA were in Section D, Applied Sports Nutrition [SN: 88⋅5 (8⋅9) v. EA: 56⋅7 (14⋅5)%; P < 0⋅00]. Overall ES was large (2⋅1), with subsections ranging from 0⋅6 to 2⋅3. Cronbach's alpha was good (0⋅83). The PEAKS-NQ had good content and construct validity, supporting its use to assess nutrition knowledge of UK-I athletes.

The Evaluation of Videos about Branched-Chain Amino Acids Supplements on YouTube™: A Multi-Approach Study

Branched-chain amino acids (BCAAs) are one of the most controversial ergogenic aids in terms of effectiveness and safety. This study aimed to evaluate the quality and reliability of BCAA supplements related to English videos on YouTube^™ and to synthesize with the sentiment-emotion analysis of comments on videos. The content analysis of the information on videos was evaluated with the use of DISCERN, Journal of American Medical Association (JAMA) benchmark criteria, and Global Quality Score (GQS). In addition, word cloud and sentiment and emotional analysis of comments in videos were performed with the R package. As a result, the mean ± standard error values of DISCERN, JAMA, and GQS scores of all videos were 29.27 ± 1.97, 1.95 ± 0.12, and 2.13 ± 0.17, respectively. It was found that advertisement-free videos have a significantly higher DISCERN and GQS score than advertisement-included videos (p < 0.05). A moderately significant positive correlation was determined between DISCERN score of video content and the positive sentiment of video comments (rs: 0.400, p = 0.002). In conclusion, it was determined that BCAA-related YouTube^™ videos have mostly very poor quality in terms of content and that videos with higher quality may receive positive comments from viewers according to the DISCERN instrument.

How Sports Health Professionals Perceive and Prescribe Nutritional Supplements to Olympic and Non-Olympic Athletes

BACKGROUND

A wide range of sports health professionals provide nutritional supplement advice. We aimed to better understand the expertise, knowledge, and attitudes of sports health professionals toward nutritional supplements and third-party supplement testing.

METHODS

A web-based questionnaire was used to ask questions about nutritional supplement knowledge and attitudes toward the Dutch third-party supplement testing system (NZVT), about supplement efficacy, and if professionals advise these supplements, as well as which profession can be deemed the expert on nutritional supplements.

RESULTS

A total of n = 320 sports health professionals delivered input, of which 45% worked with Olympic athletes and 18% were sports dietitians. Sports dietitians were ranked as the most knowledgeable professionals about sports nutrition (80%) and nutritional supplements (74%), and a literature-based comparison showed the most favorable knowledge, attitudes, and ergogenic classifications of supplement scores for sports dietitians compared with other sports health professions. Sports health professionals working with Olympic athletes scored similar but slightly lower trends on self-reported knowledge, attitude and third-party supplement testing than sports dietitians but substantially better than professionals not working with Olympic athletes.

CONCLUSION

Sports dietitians are seen as the absolute expert on supplements by other sports health professionals, with professionals working with Olympic athletes reporting similar trends, and other sports health professionals do have lower self-reported knowledge and preferred attitudes toward effective and safe use of dietary supplements.

Dietary Supplement Use of Turkish Footballers: Differences by Sex and Competition Level

This study aimed to evaluate the consumption of dietary supplements (DS) and to determine related topics in Turkish football players of different sexes and competition levels. A total of 117 footballers (79 males and 38 females) completed a specific survey regarding DS consumption in athletes. The type of DS ingested was classified based on the level of scientific evidence by the Australian Institute of Sport (AIS): group A (high level of scientific evidence), group B (DS that could have a positive effect, but require more evidence), group C (evidence is against their use), and group D (prohibited substances). After a Kolmogorov−Smirnov test, a t-test or Mann−Whitney U test was performed for quantitative variables, while Pearson’s chi-square and odds ratio (with the confidence interval) were performed for qualitative variables. Of the sample, 87.2% reported having consumed DS, with a higher consumption rate in males (males: 93.7%, females: 73.7%; p = 0.006; OR = 5.3 [1.7−16.8]) and professional players (professional: 98.2%, non-professional: 77.4%; p < 0.001; OR = 7.9 [1.2−52.3]). Males and professional players consume more sports foods (p < 0.001), performance supplements (p < 0.001), and total group A supplements (p < 0.001) compared to females and non-professionals. In addition, males consume more medical supplements (p = 0.012) and total group C supplements (p < 0.001) than female footballers. The most consumed DS were sports drinks (63.2%), magnesium (52.1%), vitamin C (51.3%), vitamin D (46.2%), caffeine (38.5%), sports bars (37.6%), whey protein (28.2%), meat protein (25.6%), vitamin E (24.8%), and omega-3 fatty acids (24.8%). The supplement consumption was higher in male and professional footballers. According to the AIS classification, there were significant differences in the consumption of sports foods, medical supplements, performance supplements, and the total number of group A and group C supplements according to sex, and there were significant differences in the consumption of sports foods, performance supplements, and the total number of group A supplements according to competition level.

Runner's health choices questionnaire: female collegiate cross-country runners' perspectives on health and eating

OBJECTIVE

To assess female collegiate cross-country runners' perspectives regarding sport-related health and the factors impacting eating behaviors.

PARTICIPANTS/METHODS

The Runner's Health Choices Questionnaire, a previously validated survey, was electronically distributed to female collegiate cross-country runners. Quantitative descriptive analysis was performed on all questions.

RESULTS

A total of 353 female collegiate cross-country runners completed the survey. The most common intrinsic factors that impacted overall diet type were makes you feel healthy, enjoyment of food, and athletic performance enhancement. Extrinsic factors such as practice/race that day, creating a balanced diet, and choices in the cafeteria were the top factors influencing daily meal decisions. Seventy-seven percent of athletes reported that they would be likely to apply information from a healthcare professional if they had access.

CONCLUSION

Female cross-country runners appeared willing to apply nutritional information; therefore, it is important that generalized nutrition education with an emphasis on intrinsic and extrinsic factors for food choices be considered for female collegiate cross-country runners.

Female Endurance Runners Have a Healthier Diet than Males-Results from the NURMI Study (Step 2)

Sex has been recognized to be an important indicator of physiological, psychological, and nutritional characteristics among endurance athletes. However, there are limited data addressing sex-based differences in dietary behaviors of distance runners. The aim of the present study is to explore the sex-specific differences in dietary intake of female and male distance runners competing at >10-km distances. From the initial number of 317 participants, 211 endurance runners (121 females and 90 males) were selected as the final sample after a multi-level data clearance. Participants were classified to race distance (10-km, half-marathon, marathon/ultra-marathon) and type of diet (omnivorous, vegetarian, vegan) subgroups. An online survey was conducted to collect data on sociodemographic information and dietary intake (using a comprehensive food frequency questionnaire with 53 food groups categorized in 14 basic and three umbrella food clusters). Compared to male runners, female runners had a significantly greater intake in four food clusters, including “beans and seeds”, “fruit and vegetables”, “dairy alternatives”, and “water”. Males reported higher intakes of seven food clusters, including “meat”, “fish”, “eggs”, “oils”, “grains”, “alcohol”, and “processed foods”. Generally, it can be suggested that female runners have a tendency to consume healthier foods than males. The predominance of females with healthy dietary behavior can be potentially linked to the well-known differences between females and males in health attitudes and lifestyle patterns.

Recent Developments in the Assessment of Nutrition Knowledge in Athletes

PURPOSE OF REVIEW

Adequate nutrition knowledge may influence dietary behaviour, and the performance and health of athletes. Assessment of the nutrition knowledge of athletes can inform practice and provide a quantitative way to evaluate education interventions. This article aims to review nutrition knowledge questionnaires published in the last 5 years to identify advances, possible improvements in questionnaire development and design, and challenges that remain.

RECENT FINDINGS

Twelve new or modified questionnaires were identified. All had undergone validity and reliability testing. Advancements included quantitative measures of content validity and Rasch analysis. Online questionnaires were common, with at least seven using this format. Advances included use of images (n = 2), automated scored feedback (n = 1), and use of applied questions. While advancements have been made in validation and reliability testing and electronic delivery, new questionnaires would benefit from interactive and attractive features including images, provision of electronic feedback, and applied questions.

Dietary Intakes, Knowledge, and Perceptions of Semi-professional Rugby Athletes in Scotland

Background

Adequate nutritional intake plays a pivotal role in optimizing performance, recovery, and body composition goals. This study aimed to investigate the dietary intakes (DIs); nutritional knowledge (NK); and attitudes, perceptions, and challenges (APC) of semiprofessional rugby players in Scotland.

Methods

Dietary intakes and NK of 24 male semiprofessional rugby players of a Super6 club were evaluated using validated questionnaires. Players were categorized as having good or poor NK according to NK scores. Diet-related APCs were assessed using researcher-developed questionnaires and 1-1 semi-structured interviews.

Results

Mean ± SD total NK% was poor, 53.7 ± 11.9%. The ‘Good’ NK group scored significantly higher in the Weight Management (p = 0.014), Macronutrients (p < 0.001), Micronutrients (p = 0.001), and Sports Nutrition (p < 0.001) sections. Mean DIs from food sources were 26.3 ± 9.2 kcal/kg/day energy, 1.4 ± 0.4 g/kg/day protein, and 21.7 ± 10.1 g/day fibre. Median (25th,75th) carbohydrate intake was 3.0 (2.0, 3.0) g/kg/day, and 6.3 (2.3, 10.6) units/week alcohol. Mean ± SD fat and saturated fat (SFA) % total energy intake (EI) were 36.2 ± 3.7% and 12.8 ± 1.9%, respectively, and SFA %EI exceeded recommendations (p < 0.001). The ‘Good’ NK group had significantly higher intakes of all macronutrients (p < 0.05). Total NK% positively correlated with intakes of meat (r = 0.556, p = 0.011), cereals (r = 0.458, p = 0.042), dietary fat (r = 0.477, p = 0.034), vegetables (r = 0.487, p = 0.030), and alcoholic beverages (r = 0.541, p = 0.014). Supplement use was 68%. Players felt diet affected performance (94%) but 31% of them were unaware of any specific nutritional strategies. A healthy diet was perceived to be ‘balanced’ with ‘variety from all food groups. Lack of time for preparation was described as the main barrier to healthy eating.

Conclusions

Overall, players had poor NK, their fibre and carbohydrate intake was suboptimal, whereas saturated fat intake exceeded recommendations. Many lacked awareness of current sports nutrition guidelines. Further nutrition education may be needed to improve diet quality and aid performance goals.

Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating

Relative Energy Deficiency in sport is experiencing remarkable popularity of late, particularly among female athletes. This condition is underpinned by low energy availability, which is a byproduct of high energy expenditure, inadequate energy intake, or a combination of the two. Several contributing factors exist that may predispose an athlete to low energy availability, and therefore a holistic and comprehensive assessment may be required to identify the root causes. The focus of the current narrative review is to discuss the primary contributing factors as well as known risk factors for low energy availability among female athletes to help practitioners increase awareness on the topic and identify future areas of focus.

Runner's Health Choices Questionnaire: Male College Cross-Country Runners' Perspectives on Health and Eating

CONTEXT

Competitive cross-country runners train at much higher loads and with greater demands than recreational runners, posing a unique set of physiological and psychological challenges. Thus, identification of factors influencing health and nutritional choices in male cross-country runners is needed to help combat energy-related health issues.

PURPOSE

To assess male college cross-country runners' perspectives regarding sport-related health and the factors impacting their eating behaviors.

DESIGN

Cross-sectional survey.

PARTICIPANTS/METHODS

The Runner's Health Choices Questionnaire was distributed to male college cross-country runners. Responses were analyzed using quantitative descriptive statistics.

RESULTS

One hundred nineteen runners completed the survey. Runners reported a diverse range of factors impacting eating and health behaviors from athletic performance enhancement to enjoyment of food. Less than 6% of athletes ranked athletic trainer, registered dietitian, or physician as often consulted for nutrition/health information. However, 75% of runners said they would be somewhat likely or very likely to make dietary or health changes if given new or additional information by a health care provider.

CONCLUSION

Male cross-country runners appear to try to balance a global desire to be healthy with individual preferences. Athletes may be receptive to nutritional education that utilizes a biopsychosocial model with mental and psychological health support, and intentional effort is needed to support runners' overall health.

The Mediterranean dietary pattern for optimising health and performance in competitive athletes: a narrative review

Nutrition plays a key role in training for, and competing in, competitive sport, and is essential for reducing risk of injury and illness, recovering and adapting between bouts of activity, and enhancing performance. Consumption of a Mediterranean diet (MedDiet) has been demonstrated to reduce risk of various non-communicable diseases and increase longevity. Following the key principles of a MedDiet could also represent a useful framework for good nutrition in competitive athletes under most circumstances, with potential benefits for health and performance parameters. In this review, we discuss the potential effects of a MedDiet, or individual foods and compounds readily available in this dietary pattern, on oxidative stress and inflammation, injury and illness risk, vascular and cognitive function, and exercise performance in competitive athletes. We also highlight potential modifications which could be made to the MedDiet (whilst otherwise adhering to the key principles of this dietary pattern) in accordance with contemporary sports nutrition practices, to maximise health and performance effects. In addition, we discuss potential directions for future research.

Sex Differences in Supplement Intake in Recreational Endurance Runners-Results from the NURMI Study (Step 2)

It has been well-documented that female and male athletes differ in many physiological and psychological characteristics related to endurance performance. This sex-based difference appears to be associated with their nutritional demands including the patterns of supplement intake. However, there is a paucity of research addressing the sex differences in supplement intake amongst distance runners. The present study aimed to investigate and compare supplement intake between female and male distance runners (10 km, half-marathon, (ultra-)marathon) and the potential associations with diet type and race distance. A total of 317 runners participated in an online survey, and 220 distance runners (127 females and 93 males) made up the final sample after a multi-stage data clearance. Participants were also assigned to dietary (omnivorous, vegetarian, vegan) and race distance (10-km, half-marathon, marathon/ultra-marathon) subgroups. Sociodemographic characteristics and the patterns of supplement intake including type, frequency, dosage, and brands were collected using a questionnaire. One-way ANOVA and logistic regression were used for data analysis. A total of 54.3% of female runners and 47.3% male runners reported consuming supplements regularly. The frequency of supplement intake was similar between females and males (generally or across dietary and distance subgroups). There was no significant relationship for sex alone or sex interactions with diet type and race distance on supplement intake (p < 0.05). However, a non-significant higher intake of vitamin and mineral (but not CHO/protein) supplements was reported by vegan and vegetarian (but not by omnivorous) females compared to their male counterparts. In summary, despite the reported findings, sex could not be considered as a strong modulator of supplement intake among different groups of endurance runners.

The Impact of a Nutritional Intervention Program on Eating Behaviors in Italian Athletes

A balanced diet is a fundamental component of athletes’ health, training, and performance. The majority of athletes choose adequate quantities of macronutrients but, at the same time, do not respect World Health Organization dietary guidelines, eating a lot of discretionary food and not drinking enough water. Athletes need more nutritional education to improve the quality of their food choice. By modifying their eating habits, they could also enhance their performance. Our study aimed to evaluate the impact of nutritional intervention on eating habits in a group of Northern Italian athletes. A sample of 87 athletes (41 males and 46 females) aged 16.5 ± 2.9 was enrolled. We organized meetings and detected eating habits (before and after the meetings) using a food frequencies questionnaire. We found that nutritional intervention positively affected participants consumption of vegetables (p < 0.05), nuts (p < 0.001), legumes (p < 0.001), and fish (p < 0.05). Other aspects of the athletes’ eating habits were not significantly improved. Some gender differences were found; males increased their consumption of vegetables (p < 0.05) and nuts (p < 0.001), while females increased their intake of legumes (p < 0.001). Our finding suggested that nutritional intervention could promote healthy eating habits among athletes. If sports nutrition experts, coaches, personal trainers, sports medicine experts, and athletes cooperated, they could guarantee athletes’ health status.

Measuring the sports nutrition knowledge of elite Australian athletes using the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire

AIMS

To evaluate the nutrition knowledge of elite Australian athletes, and to obtain feedback from sports dietitians on the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaires' (PEAKS-NQ) suitability.

METHODS

Sports dietitians from the National Institute Network across Australia recruited athletes to complete the online, 50-item PEAKS-NQ which contained two sections (General Nutrition and Sports Nutrition). Sports dietitians provided feedback on the PEAKS-NQ using a 14-item questionnaire (with two open-ended items). The main outcome measures were nutrition knowledge score and tool suitability (usefulness, acceptability and feasibility) scores. For knowledge scores, independent t-tests, ANOVA and Chi-square tests were used to evaluate differences between groups. Suitability was evaluated using descriptive statistics.

RESULTS

Twelve sports dietitians from the National Institute Network in Australia recruited a convenience sample of 240 athletes (21.3 ± 4.3 years, 63.5% female, 63.3% competed internationally). Athletes scored 70.7 ± 10.5%, with better general vs sports nutrition knowledge. Females had higher overall scores (P < .001) with no differences for age or sport played. University-educated athletes scored higher than non-tertiary educated athletes (P = .004). Knowledge gaps were identified in fats (role and food sources), recovery nutrition and managing body composition. Sports dietitians rated suitability of PEAKS-NQ positively with complete agreement on 8 of 12 items.

CONCLUSIONS

Athletes have greater understanding of general nutrition compared to sports nutrition concepts and may benefit from education on applying nutrition in sports-specific contexts. Sports dietitians' responses showed PEAKS-NQ was a highly acceptable, feasible and useful measure.

Nutrition Knowledge of Collegiate Athletes in the United States and the Impact of Sports Dietitians on Related Outcomes: A Narrative Review

In the last decade, the number of full-time registered dietitians (RDs) serving intercollegiate athletes in the United States has more than quadrupled. However, many student athletes may be at increased risk of nutrition-related problems that impact physical and academic performance, which include inadequate macronutrients, inadequate micronutrients, and excessive macronutrients. This narrative review reports the current literature to date on nutrition-related knowledge in collegiate athletes and the impact of sports RDs on student athletes’ nutrition knowledge and behaviors. To date, only observational and quasi-experimental studies have been published with regard to changes in nutrition knowledge and behaviors in NCAA athletes. While these studies report benefits of the RD as a member of the interdisciplinary student athlete support team, more well-designed randomized control trials are warranted to determine benefits related to health outcomes and sport-specific performance outcomes.

Sports nutrition knowledge and perceptions among professional basketball athletes and coaches in Lebanon-a cross-sectional study

BACKGROUND

Basketball is the most popular sport in Lebanon. Adequate nutrition has been established to be a key component of optimal athletic performance, recovery from exercise and exercise-induced injury and documented to be associated with adequate nutrition knowledge (NK). In Lebanon, nutrition education is not incorporated into the basketball player training program and there is no established position for sports nutritionists in basketball clubs. To our knowledge, the present study is the first to evaluate the NK status of Division I Basketball (D1B) players /coaches in Lebanon. The objectives of this study are to assess the prevalence of inadequate NK; identify the gaps in NK, main sources of nutrition information, perceptions on sports nutrition and independent predictors of inadequate NK among D1B players and coaches in Lebanon.

METHODS

All D1B players (n = 184) and coaches (n = 16) in Lebanon were invited to participate in the study. Study participants were asked to complete a questionnaire that included questions on NK, resources and perceptions. A percentage of ≥60% of NK questions answered correctly was used as indicative of having adequate NK. Descriptive statistics were used to summarize the sample characteristics. The T-test and chi square test were used for comparisons of means and proportions, respectively. Logistic regression was used to explore the predictors of inadequate NK in D1B players.

RESULTS

The sample consisted of 178 D1B players (nM = 126; nF = 52) and 11 male coaches, resulting in survey response rates of 97 and 69%, respectively. Inadequate NK was found among about 80 and 54% of D1B players and coaches, respectively. Inadequate NK was found to be independently associated with lack of nutrition education in D1B players.

CONCLUSIONS

Despite widespread lack of adequate NK among D1B players and coaches in Lebanon, our sports clubs do not have dietitians. Basketball sports clubs in Lebanon should start to budget for hiring a dietitian or carrying out nutrition education campaigns that are based on analyses of incorrect responses of our study participants. Findings of this study are of tremendous significance to D1B players in Lebanon in terms of improving the athletes' physical health and performance.

A Qualitative Investigation of Factors Influencing the Dietary Intakes of Professional Australian Football Players

(1) Background: Many professional Australian Football (AF) players do not meet recommended sports nutrition guidelines despite having access to nutrition advice. There are a range of factors that can influence players′ ability to meet their nutrition goals and awareness of the barriers players face is essential to ensure that dietary advice translates into practice. Therefore, this qualitative research study aimed to explore the factors influencing AF players’ dietary intakes and food choice. (2) Methods: Semi-structured interviews were conducted with twelve professional male AF players. (3) Results: Less experienced players restricted their carbohydrate intake to meet body composition goals, particularly during preseason and surrounding body composition assessment. During the competition season players had a greater focus on performance and placed more emphasis on carbohydrate intake in the lead up to matches. Players felt nutrition goals were easier to achieve when dietary choices were supported by their families and peers. One-on-one consultations provided by a sports dietitian were players′ preferred mode of nutrition intervention. Individualized nutrition advice is required for less experienced AF players who may be vulnerable to unsustainable dietary habits. Experienced AF players can support junior teammates by promoting positive team culture related to body composition, nutrition and performance.

A Survey on Dietary Supplement Consumption in Amateur and Professional Rugby Players

Purpose: the aim of the present study was to analyse the pattern of dietary supplements (DS) consumption on federated rugby players, including the analysis of differences based on the sex and competitive level (professional vs. amateurs). Material and methods: 144 rugby players (83 male and 61 female), of whom 69 were professionals and 75 amateurs, were recruited for the study. All the participants filled out a specific questionnaire about DS consumption including questions related to the consumption of DS and their effects on sport performance and health status. Results: 65.3% of participants declared consuming at least one DS, with a higher prevalence in males than females (77.1% vs. 49.2%) and in professionals thanin amateur players (79.7% vs. 52.0%). The main reason for consumption was to enhance sport performance (62.3%) with differences only based on sex (74.3% males vs. 43.2% females). The most common purchase sites were the Internet (45.6%) and specialised stores (39.8%). As to the moment of ingestion, professionals did this most frequently during competition and training (56.4% vs. 28.2%), whereas amateur players did so only during competition (20.5% vs. 3.6%). Moreover, professional player intake most frequently in post-exercise (65.5% vs. 35.9%), whereas amateur during pre-exercise (30.8% vs. 5.5%). The DS most consumed included whey protein (44%), caffeine (42%), sports drinks (38%), energy bars (34%) and creatine monohydrate (31%), with a higher prevalence in male and professional players of whey protein and creatine monohydrate. Conclusions: The main reason for DS consumption is for enhancing sports performance). Professional players more frequently purchase them on the Internet and consume DS during training and competition period and in the post-exercise, whereas amateur players consume during competition and pre-exercise. Related to the main form of DS consumption, it is observed that a moderate consumption of DS could be considered ergogenic, such as whey protein, sport bar and creatine, while an absence of other DS could be considered ergogenic.

Prevalence of Low Energy Availability in Collegiate Women Soccer Athletes

(1) Background: Limited information exists on the prevalence of low energy availability (LEA) in collegiate team sports. The purpose of this study was to examine the prevalence of LEA in collegiate women soccer players. (2) Methods: Collegiate women soccer athletes (n = 18, height: 1.67 ± 0.05 m; body mass: 65.3 ± 7.9 kg; body fat %: 24.9 ± 5.6%) had their body composition and sport nutrition knowledge assessed in the pre-season. Energy availability was assessed mid-season using a 4-day dietary log and activity energy expenditure values from a team-based monitoring system. A validated screening tool was used to screen for LEA. (3) Results: The screening tool classified 56.3% of athletes as at risk of LEA (<30 kcal/kg of FFM); however, the actual dietary intake identified 67% as LEA. Athletes identified as non-LEA consumed significantly more absolute (p = 0.040) and relative (p = 0.004) energy than LEA athletes. (4) Conclusions: There was a high prevalence of LEA among collegiate women soccer athletes. Although previously validated in women endurance athletes, the LEA screening tool was not effective in identifying those at risk of LEA in this sample of athletes.

The health-related determinants of eating pattern of high school athletes in Goiás, Brazil

Background

Athletes put their health at short- and long-term risk and a detailed investigation of health outcomes is important because it should allow the development of more specific interventions. This study aimed to evaluate the health-related determinants of eating pattern of high school athletes.

Methods

The study enrolled 248 Brazilian athletes aged 14–20 years. Eating pattern outcomes included skipping breakfast, vegetable and fruit consumption, and sweets consumption. The following factors were considered as independent variables: sociodemographic, economic, anthropometry, body weight control, psychosocial, sedentary behavior, sleeping time, meals, alcohol and smoking, and strength variables. Data were analyzed using Poisson regression model and the effect measure was the prevalence ratio (PR).

Results

The results showed that 45.6% of the athletes skipped breakfast, 29.8% ate sweets regularly, and only 8.9% consumed vegetables and fruit regularly. Multiple analysis revealed the following positive associations: breakfast skipping and vomiting or using laxatives to lose weight (PR, 1.12; 95% CI, 1.01–1.26); low fruit and vegetable consumption and using pills to lose weight (PR, 1.05; 95% CI, 1.02–1.07); high sweets consumption and female athletes (PR, 1.32; 95% CI, 1.12–1.55); high sweets consumption and more than 2 h spent watching TV (PR, 1.19; 95% CI, 1.02–1.39).

Conclusions

Our findings indicated that sociodemographic, body weight control and sedentary factors are determinants on eating patterns of high school athletes.

Diet Quality, Carotenoid Status, and Body Composition in NCAA Division I Athletes

Objectives: In this paper, we examined diet quality and associations between changes in skin carotenoids and body composition among selected NCAA Division I athletes. Methods: Athletes from women's (rowing, swimming, gymnastics) and men's (swimming, wrestling) teams at a large Midwest university (N = 129) completed one online food frequency questionnaire and 2 in-person visits, once in-season and once out-of-season, to assess skin carotenoids and body composition. Diet quality was assessed via Healthy Eating Index-2015 (HEI). Carotenoids were measured via resonance Raman spectroscopy and body composition via dual-energy x-ray absorptiometry. ANOVA and Pearson correlations were used to test differences between teams and determine association between changes from in-season to out-of-season. Results: Mean HEI score for all athletes was 71.0. Women's rowing reported the highest diet quality (73.5), men's wrestling lowest (56.5). Skin carotenoids decreased for all teams, except men's wrestling, from in-season to out-of-season. Body fat percentage increased for women and decreased for men. There was a moderate inverse association between changes in skin carotenoids and body fat percentage (r = -.334, p = .001). Conclusions: Suboptimal diet quality coupled with decreases in skin carotenoids and increases in body fat percentage from in-season to out-of-season may justify dietitian-led interventions year-round to improve dietary patterns in collegiate athletes.

Effectiveness of Education Interventions Designed to Improve Nutrition Knowledge in Athletes: A Systematic Review

BACKGROUND

A range of nutrition education strategies are used to assist athletes to improve nutrition knowledge. Evaluation of nutrition education interventions guides the delivery of efficacious nutrition education for athletes.

AIM

Our aim was to systematically review sport/general nutrition education interventions delivered to athletes, and to evaluate their effectiveness.

METHODS

A search was conducted using terms related to nutrition knowledge, athletes, education, and intervention. Included studies had to be conducted in athletes (all calibres), use a scored nutrition knowledge assessment tool, and measure knowledge before and after a nutrition education intervention. Peer-reviewed and unpublished theses were included.

RESULTS

Thirty-two manuscripts (randomised controlled trial, n = 13; single-arm pre/post design, n = 19) met the inclusion criteria. Participants (n = 2180; mean age 17.4 ± 1.7 years) were mostly female (66.1%), university-level (56.3%) athletes based in the US (75%). Comparison of different education methods was limited since the majority of interventions (n = 28/36, 77.8%) used face-to-face education. Most intervention conditions (n = 19) had a total contact time of < 300 min (5 h). The majority of interventions (n = 30, 85.7%) reported significant knowledge improvement, with a mean increase of 16.1 ± 0.7% (mean effect size 1.72; range 0.4-17.1). Only 15.6% of studies used well-validated knowledge assessment tools (more than three types of validity or reliability testing).

CONCLUSIONS

Most interventions reported a significant improvement in nutrition knowledge. Unfortunately, the wide range of knowledge assessment tools with limited validation, and the predominant use of face-to-face interventions, prohibits identification of the most effective modality and dose for nutrition education in athletes.

Individualized Breakfast Programs or Glycogen Super-Compensation: Which Is the Better Performing Strategy? Insights from an Italian Soccer Referees Cohort

The role of soccer referees has grown in importance in the last decades, as has attention to their performance, which may be influenced and improved with specific and evolved training programs. Today, multiple specialists are working as a team in order to develop effective training programs. Moreover, for athletes, it is becoming more and more important to be attentive to nutrition. By considering such items, in this study, we aimed to investigate the nutritional habits of a group of referees belonging to the Italian Soccer Referees' Association (on behalf of AIA-FIGC). Our main aim was to spread a "culture of nutrition" in refereeing, starting with a survey on referees' breakfast attitudes and in order to disseminate such a "culture", we chose top-level elite referees who were younger subjects (despite the average 4 years' experience). Therefore, we enrolled 31 subjects (aged 22.74 ± 1.79, BMI 22.30 ± 1.53) and asked them about their breakfast habits. Then, for measuring their performance, we used the conventional fitness test named Yo-Yo (YYiR1), performed in three different sessions (test 1, test 2, test 3). Test 1 was carried out without any nutritional indications, test 2 was given after individualized breakfast suggestions by a designed dietician, and test 3 after an individualized glycogen super-compensation strategy. The Wilcoxon statistical analysis indicates that following an individualized breakfast strategy may enhance referees' performance (p < 0.0001), whereas no significant effects were observed with the glycogen super-compensation option. However, further studies will be necessary to better address this topic and clarify whether high-carbohydrates (high-CHO) intake may be useful in other sports.

Nutrient Status and perceptions of energy and macronutrient intake in a Group of Collegiate Female Lacrosse Athletes

Background

The purpose of this study was to compare nutritional intakes against recommended values as well as between the perceived intake and needs of female lacrosse players.

Methods

Twenty female NCAA Division II lacrosse players (20.0 ± 1.7 yrs., 169.7 ± 6.4 cm; 69.9 ± 10.7 kg; 27.5 ± 3.3% fat) completed a four-day monitoring period during in-season. Athletes were outfitted with an activity monitor over four consecutive days and completed four-day food records to assess total daily energy expenditure (TDEE) and dietary intake. Body composition was assessed and used to calculate recommended dietary intakes. Actual intake was self-reported using a commercially available food tracking program (MyFitnessPal©, USA). Daily average values were calculated for total and relative energy, protein, carbohydrate, and fat intake. These values were then compared to published nutritional recommendations established by the International Society of Sports Nutrition. Appropriate pairwise comparisons were made depending on the normality of the distribution.

Results

Athletes ate significantly less than recommended values for energy, carbohydrates and protein. (p < 0.001). Significant discrepancies (p < 0.001) were also observed between perceptions of intake versus actual intake.

Conclusions

Athletes significantly underestimated perceived intake of dietary fat and carbohydrate when compared to perceived needs. Massive standard deviations and ranges were observed, suggesting that some athletes lack a basic understanding of their daily needs. Results from this data suggest that collegiate athletes lack appropriate understanding of basic nutrition needs and could benefit from basic nutrition education as it pertains to their health and performance.

Social Media as a Nutrition Resource for Athletes: A Cross-Sectional Survey

Social media contains a wealth of nutrition information and proposes a cost-effective, highly engaging platform to deliver nutrition information to athletes. This study used an online questionnaire to determine whether New Zealand athletes are using social media as a source of nutrition information and to understand perceptions of social media as a nutrition resource. Quantitative data were analyzed using t tests, chi-squared tests, and logistic regression analysis. Inductive thematic analysis was adopted for the qualitative data. From the 306 athletes who completed the questionnaire, 65% reported social media use for nutrition purposes in the past 12 months. Social media use was predicted by both athlete status and gender. Female athletes were more likely to have used social media for nutrition purposes (odds ratio = 2.7, 95% confidence interval [1.52, 4.62], p = .001) than males. Elite athletes were less likely to have used social media for nutrition (odds ratio = 0.44, 95% confidence interval [0.24, 0.83], p = .011) than recreational athletes. Athletes commonly used social media for practical nutrition purposes, including recipes and information about restaurants/cafes. Perceived advantages of social media as a nutrition resource included ease of access, well-presented information, personal connectedness, and information richness. Athletes' primary concern for obtaining nutrition information from social media was information unreliability.

Knowledge Concerning Dietary Supplements among General Public

Introduction. Diet and physical activity are widely recognized in maintaining health and preventing diseases. Currently, dietary supplements are also commonly believed to play a role in health promotion. However, a dietary supplement lacks single uniform definition within the scope of legal or nutritional sciences. Data on the usage of dietary supplements in Europe are still limited. The aim of this study was to assess subjective and objective knowledge of the inhabitants of south-eastern Poland about diet and supplementation in sport. Materials and Methods. The research was conducted in the south-east of Poland between October 2017 and July 2018 during three events organized by the University of Rzeszów. Initially, the study covered 500 people. During the preliminary analysis, 90 people were excluded from the study because they did not meet the previously well-explained rules of conduct during the study or did not meet the eligibility criteria for the tests. Finally, 410 people were qualified for the study. The survey method was a questionnaire with single-answer option. Results. Our study revealed statistically significant subjective and objective level of knowledge about diet and supplementation in terms of sex. Also, a correlation was found between sex and the fact of being involved in physical activity, as well as the subjects' knowledge of diet and supplementation in sport. Conclusion. High prevalence of dietary supplement use was found in our study population, but still significant percentage of the study group demonstrate inaccurate information about these products. Hence, there is an urgent need to provide the community with education and access to scientific and unbiased information.

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.

Differences in Mediterranean Diet Adherence between Cyclists and Triathletes in a Sample of Spanish Athletes

Adherence to the Mediterranean diet (MD) has rapidly declined in Mediterranean countries due to the increasing introduction of the Western diet. The aim of this study was to describe adherence to the MD within a sample of athletes from Spain. A second aim was to predict adherence to various components of the MD according to region, sex, and sport discipline. A cross-sectional study was conducted with a sample of 4037 (34.14 ± 9.28 years old) cyclists and triathletes (men: 90.1%). Participants self-reported their sex, date of birth, the number of years they had been practicing their sport, height, weight, sport discipline (cyclist, triathlon), and region. Mediterranean Diet Adherence Screener (MEDAS) was used to determine level of adherence to the MD. Women reported a higher MEDAS score and body mass index (BMI) (p ˂ 0.000) than men. Cyclists reported a lower MEDAS score (7.44, SD 2.12 vs. 7.85, SD 2.08), and older age (37.72, SD 9.67 vs. 34.54, SD 8.58) and BMI (23.74, SD 2.69) vs. 22.85, SD 2.28) than triathletes. The study showed that a large proportion of the surveyed athletic population were not meeting the MD guidelines, with particularly low consumption amongst men and cyclists. There were no regional effects. Nutritional guidelines for athletes should be individual rather than general and follow specifications identified by the present research.

Analysis of Nutritional Supplements Consumption by Squash Players

The aim of the present study is to analyse nutritional supplements (NS) consumption by squash players of different levels (international vs. national). A total of 14 international players and 28 national ones answered a NS consumption frequency questionnaire that had been previously validated. A T-Student test was used for independent samples and a χ² test was used in the comparative analysis among athletes of different levels. International level players consume NS in greater proportion vs. national level players (100% vs. 67.9% p = 0.017), with differences in the consumption of bicarbonate of soda, glutamine, branched-chain amino acids, and flaxseed oil (p < 0.05). Even though international level athletes show a greater total number of NS, as well as of the total of NS of each of the categories based on scientific evidence level (sports food, medical supplements, and ergogenic aids of groups A, B, C, and D) in relation to the national level athletes, no statistically significant differences were detected (p > 0.05). With regard to nutritional advice, there are also differences among performance levels (p = 0.003), being personal trainers (28.6%) and dietitians-nutritionists (21.4%) the greatest prescribers when it comes to international-level players, whereas 55.6% of the national-level players do not receive nutritional advice. The pattern of NS consumption, based on evidence level, is unbalanced and its performance could be favored if the dietitian-nutritionist were included as a nutritional advisor for these athletes.