Assessing the Influence of Sport Nutrition Education to Lower the Risk of Low Energy Availability in Elite Athletes
Study Details
Study Description
Brief Summary
Athletes in low energy availability (LEA) are at increased risk of developing the Relative Energy Deficiency in Sports (RED-S) syndrome (Mountjoy et al., 2018). LEA is a mismatch between dietary energy intake and exercise energy expenditure, leaving inadequate energy to support physiological functions, and the RED-S syndrome increases the risk of impaired health and performance (Drew et al., 2018, Sesbreno et al., 2022a, under review; Sesbreno et al., 2022b, in preparation; & VanHeest et al., 2014). Although athletes with eating disorders are at high risk, many more may be vulnerable due to uninformed practices for weight loss and/or failure to match energy intake to energy demands for exercise (Wells et al., 2020). Despite efforts to better detect athletes in LEA/RED-S;there is no research on the effectiveness of dietary interventions to influence energy intake in international elite/world-class athletes tomitigate risk of LEA (De Souza et al., 2021; Elliott-Sale et al., 2018; Heikura et al., 2021; Melin et al., 2014; Stellingwerf et al., 2021;Stenqvist et al., 2021 & Rogers et al., 2021). Therefore, it is important to investigate dietary interventions to influence eating habits to improve energy availability in elite athletes.
Energy deficit associated with LEA in elite athletes may be accompanied by insufficient carbohydrate intake for training demands (Burke et al., 2011; Heikura et al., 2017; Sesbreno et al., 2021). Unfortunately, there is a paucity of information on the influence of sport nutrition education interventions on dietary intake in elite international (tier 4) and world-class (tier 5) athletes (McKay et al., 2022). However, recent findings suggest an association between nutrition knowledge and energy/carbohydrate availability in young female endurance athletes (Kettunen et al., 2021). This finding may offer a cost effective approach to lower the risk of LEA since education programs have shown to improve nutrition knowledge in athletes (Tam et al., 2019). However, an increase in nutrition knowledge may not always lead to a parallel increase in energy/carbohydrate intake (Heikkila et al., 2019). Indeed, the influence of nutrition education programs on improving dietary intake in athletes is reportedly equivocal (Boidin et al., 2021). However, the differences in intervention design with lack of guidelines on standardized and/or validated methods to assess sport nutrition knowledge and eating habits in elite athletes have made comparisons difficult for generalized interpretation. Fortunately, the new arrival of the Platform to Evaluate Athlete Knowledge of Sports Nutrition Questionnaire (PEAK-NQ) and the Athlete Diet Index (ADI) offer validated methods for assessing sport nutrition knowledge and eating habits in elite athletes (Capling et al., 2021 and Tam et al., 2021). Nevertheless, it is also important to appreciate that nutrition knowledge is not the sole influencing factors to athletes' dietary habits; and recognizing additional factors affecting athletes' decisions around nutrition is critical.
A multitude of factors influence food choices in elite athletes (Thurecht et al., 2019). It ranges from sensory appeal, emotional influences, influence of others, weight control, performance among others (Thurecht et al, 2020). Interestingly, a moderate intercorrelation between nutritional attributes of the food and weight control, performance as well as food values and beliefs were reported (Thurecht et al., 2021). In fact, restraint eating behaviour have been associated with LEA, body weight and physique morphology (Jurov et al., 2021; Sesbreno et al., 2021; Sesbreno et al., 2022c in preparation; Sesbreno et al., 2022d, in preparation & Viner et al., 2015). Clearly, multiple factors influence dietary habits, and therefore, it is important to consider how education interventions are developed to influence dietary outcomes in elite athletes.
The Capability, Opportunity, Motivation - Behaviour (COM-B) model describes the importance of influencing 3-sources of behaviour to consistently alter habits (Michie et al., 2011). This was reiterated by sport nutritionists who characterized enablers and barriers to nutrition adherence in high performance sports (Bentley et al., 2019). In a case study, dietary interventions that targeted all 3-source behaviours was associated with improvements in dietary intake, including energy availability as an elite rugby player prepared for his 1st professional season (Costello et al., 2018). Therefore, a sport nutrition education program that accounts for all source behaviours may be necessary to improve eating habits intake to lower the risk of LEA/RED-S in elite international and world-class athletes during the competitive season.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Overall Aim: Investigate whether elite athletes' nutrition knowledge and dietary intake can improve through an education intervention to lower the risk of low energy availability.
Question: Could a short-term (3 weeks) group-based specific nutritional education intervention about LEA increase sport nutrition knowledge and dietary intake in elite athletes compared to a group-based generic nutritional education intervention?
Hypothesis: We hypothesize that a nutrition education program will increase nutrition knowledge and not dietary habits.
This is a randomized controlled study. Participants will be randomized in either specific nutritional education intervention or in generic nutritional education intervention (control).
We aim to recruit 30 elite national-level athletes through the Canadian Olympic and Paralympic Sport Institute Network and National Sport Organizations between June 2022 and May 2023. Participants will be eligible for inclusion if they compete internationally for Canada at a sport event hosted by an International Federation on the Olympic program between 2021 and the time they complete the study protocol.
Inclusion Criteria
To be eligible to participate, subjects must meet all the following criteria:
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Over 18 years of age to maintain an emphasis on adult participants
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Active to participate in training and competition to ensure typical in-season dietary habits
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Able-bodied sport program based on the validity of the assessment tools used in the investigation
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Having given informed consent
Exclusion Criteria
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Eating Disorder Examination Questionnaire 6.0 total score > 2.50 (women) and > 1.68 (male) (Kuikman et al., 2021) and a medical professional diagnosis of an eating disorder listed under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to ensure vulnerable subgroups are not subjected to mental health triggers that may encourage problems with eating (ie: food logging and skinfold testing)
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Unable to understand spoken and written English because the screening tools have not been validated in french
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Placebo Comparator: Control Group Education (General nutrition and sport nutrition) |
Other: Education - Motivational factor
Will emphasize educational elements associated with motivation
|
| Active Comparator: Treatment Group Education (General nutrition and sport nutrition with athlete testimonials on impacts of RED-S on health) |
Other: Education - Motivational factor
Will emphasize educational elements associated with motivation
|
Outcome Measures
Primary Outcome Measures
- Change in Knowledge [3 weeks]
PEAK-NQ questionnaire
- Change in carbohydrate intake [3 weeks]
Food intake record
Secondary Outcome Measures
- Change in food frequency [3 weeks]
Athlete Diet Index Questionnaire
Eligibility Criteria
Criteria
Inclusion Criteria:
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Over 18 years of age to maintain an emphasis on adult participants
-
Active to participate in training and competition to ensure typical in-season dietary habits
-
Able-bodied sport program based on the validity of the assessment tools used in the investigation
-
Having given informed consent
Exclusion Criteria:
- Eating Disorder Examination Questionnaire 6.0 total score > 2.50 (women) and > 1.68 (male) (Kuikman et al., 2021) and a medical professional diagnosis of an eating disorder listed under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to ensure vulnerable subgroups are not subjected to mental health triggers that may encourage problems with eating (ie: food logging and skinfold testing) • Unable to understand spoken and written English because the screening tools have not been validated in french
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | McGill University | Montréal | Quebec | Canada | H9X 3V9 |
Sponsors and Collaborators
- McGill University
- Institut National du Sport du Quebec
- Canadian Sport Institute Ontario
- University of Sydney
- Sunshine Coast University
- McMaster University
- Buffalo Sabres
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 22-05-051-02