Funding and college-provided nutritional resources on diet quality among female athletes

Collegiate Student-Athletes' Use and Knowledge of Third-Party-Tested Nutritional Supplements: An Exploratory Study

CONTEXT

Nutritional supplement use in athletes is common, accompanied by potential doping risk.

OBJECTIVE

To determine athletes' nutritional supplement and third-party-tested (TPT) supplement use, supplement knowledge, and factors influencing their behavior.

DESIGN

Cross-sectional study.

SETTING

National Collegiate Athletic Association Division I athletic departments.

PATIENTS OR OTHER PARTICIPANTS

Student-athletes (n = 410, 53% female, age = 21.4 ± 1.6 years).

MAIN OUTCOME MEASURE(S)

Survey questions addressed topics including nutritional supplement knowledge and use, TPT supplement knowledge and use, and logo recognition, and data were stratified for sex differences.

RESULTS

Athletes (91%) reported the use of supplements, but the total number of supplements used was lower in female (median = 7; interquartile range, 4-11) than in male (median = 9; interquartile range, 4-12) athletes, with U = 17 960 and P = .01. A total of 48% (n = 191, out of 402 responses) reported purchasing supplements outside of their athletic department, with significantly fewer female (40%, n = 84) than male (56%, n = 107) athletes reporting this behavior (χ2 = 11.20, P < .001). No association between TPT logo recognition and TPT use was seen (χ2 = 0.238, P = .63). Of all athletes using supplements, 38% (n = 140) reported "consistent TPT use," whereas female athletes (36%, n = 70) reported this less often than male athletes (41%, n = 70, χ2 = 0.952, P < .32). No sex differences were seen for receiving nutritional counseling (89%, P = .37) or low nutritional supplement knowledge (<50%, P = .38); however, males had 2.5 times greater odds at recognizing a TPT organization logo than females (odds ratio = 2.45; 95% CI, 1.58-3.79).

CONCLUSIONS

Most athletes use nutritional supplements. Female athletes report slightly fewer supplements than male athletes, while also less frequently purchasing them outside their athletic department, potentially explaining the lower TPT logo recognition in female athletes.

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.

Explorative Characterization of GI Complaints, General Physical and Mental Wellbeing, and Gut Microbiota in Trained Recreative and Competitive Athletes with or without Self-Reported Gastrointestinal Symptoms

The current state of the literature lacks a clear characterization of gastrointestinal (GI) symptoms, gut microbiota composition, and general physical and mental wellbeing in well-trained athletes. Therefore, this study aimed to characterize differences in self-reported symptoms, gut microbiota composition, and wellbeing (i.e., sleep quality, mood, and physical (PHQ) and mental wellbeing) between athletes with and without GI symptoms. In addition, we assessed the potential impact of a 3-week multi-ingredient fermented whey supplement in the GI complaints group, without a control group, on the gut microbiota and self-reported GI symptoms and wellbeing. A total of 50 athletes (24.7 ± 4.5 years) with GI issues (GI group at baseline, GI-B) and 21 athletes (25.4 ± 5.3 years) without GI issues (non-GI group, NGI) were included. At baseline, there was a significant difference in the total gastrointestinal symptom rating scale (GSRS) score (24.1 ± 8.48 vs. 30.3 ± 8.82, p = 0.008) and a trend difference in PHQ (33.9 ± 10.7 vs. 30.3 ± 8.82, p = 0.081), but no differences (p > 0.05) were seen for other outcomes, including gut microbiota metrics, between groups. After 3-week supplementation, the GI group (GI-S) showed increased Bifidobacterium relative abundance (p < 0.05), reported a lower number of severe GI complaints (from 72% to 54%, p < 0.001), and PHQ declined (p = 0.010). In conclusion, well-trained athletes with GI complaints reported more severe GI symptoms than an athletic reference group, without showing clear differences in wellbeing or microbiota composition. Future controlled research should further investigate the impact of such multi-ingredient supplements on GI complaints and the associated changes in gut health-related markers.

Development of a screener to assess athlete risk behavior of not using third-party tested nutritional supplements

Introduction

The aim of this cross-sectional study was to develop an algorithm to predict athletes use of third-party tested (TPT) supplements. Therefore, a nutritional supplement questionnaire was used with a section about self-reported TPT supplement use.

Methods

Outcomes were randomly assigned to a training dataset to identify predictors using logistic regression models, or a cross-validation dataset. Training data were used to develop an algorithm with a score from 0 to 100 predicting use or non-use of TPT nutritional supplements.

Results

A total of n = 410 NCAA Division I student-athletes (age: 21.4 ± 1.6 years, 53% female, from >20 sports) were included. Then n = 320 were randomly selected, of which 34% (n = 109) of users consistently reported that all supplements they used were TPT. Analyses resulted in a 10-item algorithm associated with use or non-use of TPT. Risk quadrants provided the best fit for classifying low vs. high risk toward inconsistent TPT-use resulting in a cut-off ≥60% (χ2(4) = 61.26, P < 0.001), with reasonable AUC 0.78. There was a significant association for TPT use (yes/no) and risk behavior (low vs. high) defined from the algorithm (χ2(1)=58.6, P < 0.001). The algorithm had a high sensitivity, classifying 89% of non-TPT users correctly, while having a low specificity, classifying 49% of TPT-users correctly. This was confirmed by cross-validation (n = 34), reporting a high sensitivity (83%), despite a lower AUC (0.61).

Discussion

The algorithm classifies high-risk inconsistent TPT-users with reasonable accuracy, but lacks the specificity to classify consistent users at low risk. This approach should be useful in identifying athletes that would benefit from additional counseling.

High School Athletes' Use and Knowledge of (Safe) Nutritional Supplement Use: An Exploratory Study

The use of nutritional supplements can lead to doping risk and no data exist on high school athletes' use of certified third-party tested supplements. A cross-sectional cohort design was developed using an anonymous survey. Descriptive data for supplement use, use of third-party tested supplements, and knowledge in high school athletes were reported. A total of 225 high school athletes, ranging from 14-19 years of age, from a private high school in the western US, were included in the analysis of the results. A total of 94% (n=211) of athletes reported nutritional supplement use within the past year with an average of six (interquartile range: 3-9) individual supplements, ranging from 0-20 supplements per person. Most frequently reported were sports drinks (72%), vitamins (65%), sports bars (60%), protein powder (58%), caffeine (37%, as part of normal beverages, or 13% as a supplement), followed by creatine (23%). A total of 24% claimed to know for sure that all their supplements were third-party tested. In addition, the recognition of third-party testing organization icons was low (46% in supplement users vs. 14% in nonusers). Athletes also scored low in reporting how to find (22%) and how to order (25%) third-party tested supplements. In conclusion, almost all athletes in this study reported the use of multiple nutritional supplements annually. Only one-fourth of the athletes reported consistently using third-party tested supplements. Knowledge of where and how tested supplements could be purchased was limited in this high school athlete population.

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.

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.