The effect of nutrition education sessions on energy availability, body composition, eating attitude and sports nutrition knowledge in young female endurance athletes.

Frontiers in public health. 2024;12:1289448
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Plain language summary

For young athletes, the role of healthy and balanced nutrition is particularly important because of its impact on growth and development. Several studies have shown that young female athletes often fail to adhere to the recommended dietary guidelines for their sport and activity level, posing a risk for low energy availability. The aim of this study was to assess the impact of nutrition education sessions conducted by a registered dietitian with athletes aged 15–18 years who train for more than 10 hours per week. This study was a randomised controlled trial which enrolled one hundred participants. The participants were divided into two groups, with one receiving six nutrition education lectures and the other none. Results showed significant improvements in the intervention group in relation to energy availability and sports nutrition knowledge, and a decrease in low energy availability scores. Additionally, there were significant increases in energy intake, weight, fat-free mass, and resting metabolic rate. Authors concluded that nutrition education is beneficial in enhancing dietary intake, positively influencing body composition, and improving nutrition knowledge, which contributes to increased energy availability in female athletes over the short term.

Expert Review


Conflicts of interest: None

Take Home Message:
  • Targeted nutrition education can significantly improve both energy balance and sports nutrition knowledge
  • Attitudes towards eating may require additional or different interventions to see significant improvements.

Evidence Category:
  • X A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
  • B: Systematic reviews including RCTs of limited number
  • C: Non-randomized trials, observational studies, narrative reviews
  • D: Case-reports, evidence-based clinical findings
  • E: Opinion piece, other

Summary Review:
Introduction

  • The primary aim of this study was to assess the impact of nutrition education on energy availability, body composition, eating attitudes, and sports nutrition knowledge among young female endurance athletes.
  • Given the risk of inadequate energy intake among these athletes, this study uniquely investigated whether targeted educational interventions could improve these parameters and, ultimately, promote overall health in this population.

Methods

  • 45 participants were allocated to an intervention group and 38 to the control group.
  • The intervention group had six- weekly face-to-face 1-hour nutrition education sessions and a booklet from a dietitian. Control group received no education.
  • Both groups completed measures at baseline and 6 months later, including the Low Energy Availability in Athletes Questionnaire (LEAF-Q), Eating Attitude Test (EAT-26) and Sports Nutrition Knowledge Questionnaire (SNKQ). Nutrient intake and energy expenditure were assessed from 3-day food and exercise logs. An electrical bioimpedance analyser measured body composition.

Results

  • The LEAF-Q scores for the experimental group significantly decreased from 8.57 ± 4.36 before the intervention to 6.82 ± 3.72 after the intervention (p=0.01). This suggests that the nutrition intervention was effective in improving factors related to low energy availability in female athletes.
  • A similar effect was seen in the SNKQ with scores increasing from baseline to post-intervention, 29.18± 8.60 and 35.29 ± 7.17,(p=0.01). This suggests knowledge of sports nutrition was successfully increased by the intervention.
  • No differences were seen in the EAT-26 scores post-intervention (F 1,81) =0.21, p=0.65 highlighting that attitude towards eating remained the same in both groups.

Conclusion

  • Female athletes often lack nutritional knowledge, increasing the risk of insufficient energy intake and nutrient deficiencies.
  • This educational intervention improved nutrition knowledge and energy availability, emphasising the importance of educating young athletes for better health and performance.
  • However, psychological factors related to eating attitudes remained unaddressed. Collaborating with families and coaches to reduce body shape pressures could further support athletes in maintaining appropriate diets for their sport.

Clinical practice applications:
  • Nutrition education can effectively improve energy availability and sports nutrition knowledge in young female endurance athletes. This is crucial for enhancing their performance and long-term health. However, as attitudes towards eating may not shift as easily, addressing disordered eating or unhealthy eating behaviours requires additional, specialised strategies.

To effectively improve eating attitudes in this population a different approach may be required. For example, psychological counselling, self-regulation techniques, or mindful eating practices.

This group would benefit from regular monitoring to ensure that nutrition education is not just improving knowledge, but also encouraging healthy, sustainable eating habits.

Considerations for future research:
  • Due to self-reporting for LEA there is a potential bias for overestimating its prevalence. Future studies could look at ways in which this bias is reduced through using for example wearable technology to assess energy expenditure, as well as food measurement apps that accurately measure portion size.
  • Given the similarity in the EAT-26 score between groups, psychological methods that can be employed to shift eating attitudes should be considered to improve results in future research.

Abstract

Nutrition knowledge plays a pivotal role in shaping dietary habits and food choices, particularly in the realm of sports nutrition. This study investigates the effects of a series of nutrition education sessions conducted by a registered dietitian on energy availability, various anthropometric measurements, eating attitudes, and sports nutrition knowledge in young female endurance athletes aged 15-18 years (football, basketball, volleyball) who engage in training for more than 10 h per week (n = 83). Participants were randomly divided into two groups with 45 individuals receiving six physical nutrition education lectures, and the remaining 38 participants receiving no nutrition education. Participants completed the low energy availability in females questionnaire (LEAF-Q), Eating Attitude Test (EAT-26), and Sports Nutrition Knowledge Questionnaire (SNKQ). Energy and nutrient intakes were evaluated through 3-day food records, while exercise energy expenditure was assessed using 3-day activity logs. All of the questionnaires were repeated after 6 months. At baseline, the prevalence of LEA among athletes was determined to be 63.8%. In the intervention group, energy availability (EA) and SNKQ scores increased, and LEAF-Q scores decreased significantly (p < 0.05). However, there was no significant change in EAT-26 scores between the two groups. Energy intake, weight, fat-free mass, and resting metabolic rate have been increased significantly in the intervention group (p < 0,05). These findings suggest that nutrition education proves beneficial in enhancing dietary intake, positively influencing body composition, and improving nutrition knowledge, ultimately contributing to increased energy availability in female athletes over the short term.

Lifestyle medicine

Fundamental Clinical Imbalances : Structural
Patient Centred Factors : Triggers/Nutrition education
Environmental Inputs : Diet ; Nutrients ; Physical exercise
Personal Lifestyle Factors : Nutrition ; Exercise and movement
Functional Laboratory Testing : Not applicable

Methodological quality

Jadad score : 3
Allocation concealment : Yes

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