Assessment of nutritional knowledge in female athletes susceptible to the Female Athlete Triad syndrome

Eating Attitudes and Characteristics of Physical Activity Practitioners and Athletes in Riyadh, Saudi Arabia

Background: Disordered eating among athletes and physical activity practitioners is a growing concern that can negatively impact health and performance. Understanding the prevalence and predictors of disordered eating in these populations is essential for developing effective interventions. Objective: To investigate disordered eating tendencies among athletes and physical activity practitioners in Riyadh, Saudi Arabia. Methods: Participants from five athletic clubs and six fitness centers were surveyed. Data were collected using an interviewer-administered questionnaire that included the Eating Attitudes Test (EAT-26), the Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ), and the Global Physical Activity Questionnaire (GPAQ). Anthropometric data were also collected. The study comprised a sample of 263 individuals, who were divided into two groups: athletes (n = 121) and physical activity practitioners (n = 142). Results: The average age of the participants was 26.41 years with a standard deviation of 8.1 years. Females comprised nearly two thirds of the sample, representing 60.8% of the participants. Physical activity practitioners exhibited higher disordered eating scores compared to athletes. The total EAT-26 scores were significantly higher in practitioners (15.63 ± 4.12) than in athletes (13.21 ± 3.89; p < 0.001). Subscale scores for Dieting (8.95 ± 2.73 vs. 7.49 ± 2.58; p = 0.001) and Bulimia (3.32 ± 1.15 vs. 2.20 ± 1.03; p < 0.001) were also higher in practitioners. BMI was a significant predictor of higher total EAT-26 scores and its subsets, indicating a greater risk of disordered eating behaviors in individuals with higher BMI. Participants with lower levels of sports nutritional knowledge and those engaging in low-intensity physical activities were more likely to exhibit disordered eating tendencies. Conclusions: The findings highlight that physical activity practitioners are at a higher risk of disordered eating compared to athletes. Addressing BMI and improving nutritional knowledge are key strategies for preventing and managing disordered eating behaviors in physically active populations. Interventions targeting these areas may enhance health outcomes and performance among athletes and practitioners.

Nutrition Knowledge and Dietary Adequacy in Powerlifters

ABSTRACT

Leonhardt, TPM, Chilibeck, PD, Ko, J, and Zello, GA. Nutrition knowledge and dietary adequacy in powerlifters. J Strength Cond Res 38(11): 1924-1932, 2024-Athletes competing in weight categories (e.g., powerlifters) often restrict food intake approaching competition, which may be detrimental to health and performance. Our purpose was to assess the effect of nutrition knowledge, sex, and time (off-season versus precompetition, when athletes often cut weight) on dietary adequacy in powerlifters. Twenty-three powerlifters (10 females; 30.7 ± 11.2 years) completed questionnaires to assess nutrition knowledge and dietary adequacy. Athletes with higher nutrition knowledge consumed more fruits and nuts and less vitamin B2, B3 across all time points ( p < 0.05) and a greater number (73%) were above the recommended dietary allowance for vitamin D compared with athletes with lower nutrition knowledge (50%) ( p < 0.05). Male powerlifters with higher nutrition knowledge consumed less alcohol and vitamin A than male powerlifters with lower nutrition knowledge ( p < 0.05). Female powerlifters with higher nutrition knowledge consumed less sugar and beverage calories than female powerlifters with lower nutrition knowledge ( p < 0.05). Intake of alcohol and carbohydrate decreased, and meat calories increased from off-season to precompetition ( p < 0.05). Male powerlifters increased B-vitamins, whereas female powerlifters decreased B-vitamin and sugar consumption approaching competition ( p < 0.05). Male powerlifters increased water consumption versus female powerlifters approaching competition (sex × time, p < 0.05). There was no effect of nutrition knowledge on dietary changes approaching competition. Nutrition knowledge, sex, and competitive season affect dietary intake of powerlifters. A higher nutrition knowledge predicts a higher intake of some foods and nutrients important for health and performance. Female powerlifters should pay close attention to the intake of B-vitamins and water before competitions when many are trying to cut weight.

Test of Oral Health Literacy in Adults (TOHLA): development and psychometric evaluation of a new scale

This study aimed to develop and rigorously evaluate the Test of Oral Health Literacy in Adults (TOHLA) for the Iranian population, addressing the limitations of existing oral health literacy (OHL) measurement instruments and contributing to the literature on OHL assessment. The development of the TOHLA involved a qualitative approach, which included a comprehensive literature review and semi-structured interviews with a panel of 15 experts from diverse fields and 22 Iranian adults aged 18 to 64 years. The instrument was designed with 48 items categorized into four domains: cognitive skill, communication skill, media skill, and functional skill. Content validity was established through expert input and content validation indices. Construct validity was supported by factor analysis, and concurrent validity was assessed by comparing TOHLA scores with demographic variables. Internal consistency and test-retest reliability analyses were performed to assess the instrument's reliability. The psychometric evaluation of the TOHLA demonstrated strong content validity, construct validity, concurrent validity, internal consistency, and test-retest reliability. The instrument exhibited a high level of internal consistency, with a Cronbach's alpha coefficient of 0.81 for the entire scale. Test-retest reliability was satisfactory, with an intraclass correlation coefficient (ICC) of 0.83. Concurrent validity analysis showed statistically significant associations between OHL scores and demographic variables, supporting the instrument's overall performance. The TOHLA overcomes the weaknesses observed in existing instruments and offers a comprehensive tool with strong psychometric properties to assess the OHL of the Iranian adult population. Researchers, policymakers, and healthcare providers can utilize the TOHLA to address oral health challenges and enhance overall oral health outcomes among Iranian adults.

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

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.

Elite lean athletes at sports high schools face multiple risks for mental health concerns and are in need of psychosocial support

The combined demands on an adolescence in an elite sports high school can negatively affect mental health (eg, stress, burnout, depression, anxiety). Late adolescence is also when elite-striving athletes typically transition from junior-to-senior level programs. In addition, adolescent elite lean sports athletes have an increased risk of suffering from abnormal eating pathology. The purpose of this study was to investigate the perceived psychosocial needs that young, elite-striving lean sports athletes in sports high schools find essential for their sports careers and transition from junior-to-senior level sports. Eight Swedish elite-striving lean sports athletes (2 men and 6 women; median age 17.0 years, range: 16-18 years) participated in this study and sports represented were athletics (n = 1), gymnastics (n = 3), and wrestling (n = 4). Semi-structured interviews were performed, and data was analyzed by thematic analysis. Results showed integration, both in the present situation and for the future, as an overarching theme perceived as essential for a successful elite sports career over time. Three additional themes were also identified: (a) Psychosocial stress (combined performance demands, diminished social life, sports-related body weight demands, taboo talking about eating disorders, injuries), (b) Protective psychosocial factors (social support and psychological safety, communication and coordination school and sports, self-care/health behaviors), and (c) support needs junior-to-senior transition (career advice and mentorship, individualized support). As a result, elite-striving, lean sports athletes attending sports high schools need additional support to excel in their academic and athletic endeavors. Sports developmental programs continue to provide inadequate support before and during the junior-to-senior level transition. Similarly, despite the continued calls for reducing the stigma of mental health, athletes in sports schools still encounter barriers from coaches and peers, making the subject taboo, particularly surrounding eating pathologies.

The Prevalence of Menstrual Cycle Disorders in Female Athletes from Different Sports Disciplines: A Rapid Review

The aim of this study was to rapidly review the literature on the prevalence of menstrual disorders in female athletes from different sports modalities. Articles were searched in the Web of Science and PubMed database in May 2022. A total of 1309 records were identified, and 48 studies were included in the final stage. The menstrual disorders described in the included studies were primary (in 33% of included studies) and secondary amenorrhea (in 73% of included studies) and oligomenorrhea (in 69% of included studies). The prevalence of menstrual disorders among the studies ranged from 0 to 61%. When data were pooled according to discipline (mean calculation), the highest prevalence of primary amenorrhea was found in rhythmic gymnastics (25%), soccer (20%) and swimming (19%); for secondary amenorrhea in cycling (56%), triathlon (40%) and rhythmic gymnastics (31%); and oligomenorrhea in boxing (55%), rhythmic gymnastics (44%) and artistic gymnastics (32%). Based on the results of this review, the study supports the literature of the higher prevalence of menstrual disorders in gymnastics and endurance disciplines. However, team sports modalities such as volleyball and soccer also presented a considerable percentage of menstrual disorders compared to the general population. It reinforces the importance of coaches and physicians paying attention to athletes' menstrual cycle as the occurrence of menstrual disorders can be associated with impairment on some health components.

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.

A new comprehensive oral health literacy scale: development and psychometric evaluation

BACKGROUND

It has been widely accepted that oral health status is related to oral health literacy. The need to measure oral health literacy has led to the development of measurement instruments. This study aimed to develop a comprehensive instrument for adults and to examine its reliability and validity in China.

METHODS

A three-step design process was used. First, a literature review and expert panel discussion were used to draw up a 37-item pool covering oral health knowledge, belief, practice, skill, and functional oral health literacy. The Delphi method was used to delete and modify questions in the item pool. The draft instrument was evaluated by nine experts and the consensus among them was calculated using the content validity index. The scale was then used to conduct a psychometric study among 370 participants from community health centers in Beijing. Construct validity, discriminant validity and concurrent validity were examined. The Cronbach's alpha coefficient, and test-retest methods were used to assess reliability.

RESULTS

The final scale included 30 items across four dimensions. The item-level content validity index was 0.90. Exploratory factor analysis extracted four fixed factors, and the result of the Kaiser-Meyer-Olkin and Bartlett's tests was 0.752, with the model explaining 35.21% of the total variance. The four dimensions were associated with oral health knowledge, perceptions of oral health issues, oral health practice and skills, and functional oral health literacy. The mean score of the lowest 27% was significantly lower than the highest 27% (P < 0.01), suggesting adequate discriminant validity. The associations between comprehensive oral health literacy scores and educational level, income and self-reported literacy level were significant (P < 0.001), showing adequate overall concurrent validity. Internal consistency and test-retest reliability were acceptable, with a Cronbach's alpha of 0.72 and a total test-retest reliability coefficient of 0.979.

CONCLUSIONS

Initial testing of the comprehensive oral health literacy instrument suggested that it is a valid and reliable instrument to evaluate individuals' oral health literacy, with four dimensions for evaluating knowledge, belief, skills, and functional oral health literacy.

Nutritional Risks Among Female Athletes

Background: Limited research studies have been conducted on nutritional risks among female athletes. Therefore, this literature review focuses on rigorously designed studies that examined nutritional risks among female athletes with further recommendations for athletes, coaches, parents, and health professionals, which would help improve the health of female athletes. Methods: This review evaluates the most recent research on nutritional risk among female athletes. Inclusion criteria included peer-reviewed studies of original research on human subjects 13 years of age or older; sample size of N ≥ 19; and studies with a thorough description of their sample and methods. A systematic search of the databases PubMed and Cochrane for published studies (from year 2000 to year 2019) was conducted to identify articles that met inclusion criteria. Bibliographies of identified articles were also searched for relevant articles. Results: Of the 11 studies that met our inclusion criteria, most were mainly cross-sectional in design with few rigorous controls. Findings reveal that strategies to enhance nutrition patterns among female athletes may be important to avoid risks of disordered eating, eating disorders, low energy availability, and symptoms of relative energy deficiency in sports. In addition, general nutrition knowledge is lacking among athletes, sports teams, and coaches. Conclusions: This review highlights the scarcity of evidence-based, rigorous studies examining nutritional risks among female athletes. Findings suggest that interdisciplinary working groups, comprising physicians, sports dietitians, and other supportive health professionals, would be beneficial for female athletes in helping to improve their overall diet, performance, and health.

Prevalence and Predictors of Dysmenorrhea, Its Effect, and Coping Mechanisms among Adolescents in Shai Osudoku District, Ghana

Background

Dysmenorrhea has been the most common gynecological problem worldwide. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s and usually declining with age. It has also been reported that dysmenorrhea affects more than 80% of women in the reproductive age. The study objective was to examine the predictors of dysmenorrhea, its effect, and coping mechanisms among adolescents in Shai Osudoku District, Ghana.

Methods

We conducted a cross-sectional study in September and November 2017 in selected schools in Shai Osudoku District, Ghana. We employed self-administered questionnaire to obtain data from adolescents volunteered to participate in the study. We analyzed the data using the SPSS programme IBM version 20. We used the Pearson chi-square test and multiple logistic regression analysis to assess the association between exposure variables and the outcome variable. The odds ratio was reported to establish the risk of dysmenorrhea at a confidence interval of 95%, and statistical significance was assumed at p < 0.05.

Results

The prevalence of dysmenorrhea was 68.1% (95% CI, 65.0–72.0) with one-third recounting their pain as severe. The pain during menstruation negatively influences the daily physical activities (22.5%), school attendance (6.9%), concentration during classes' hours (27.9%), and academic performance (31.1%) of the respondents. Besides, adolescents who do not live with their parent experienced a 53.1% increase in odds of self-reporting dysmenorrhea (AOR, 1.53 (95% CI, 1.02–2.23)). Similarly, respondents who had irregular menstrual cycle experienced a 72.5% increase in odds of self-reporting dysmenorrhea (AOR, 1.73 (95% CI, 1.16–2.57)). Finally, a significant association between irregular menstrual cycle (p < 0.01), not lived with their parent (p < 0.04), and self-reported dysmenorrhea was found.

Conclusion

This study establishes that dysmenorrhea is high among adolescents in Shai Osudoku District which negatively affects the daily activity of majority of them.

Development and validation of a brief general and sports nutrition knowledge questionnaire and assessment of athletes' nutrition knowledge

Background

The Nutrition for Sport Knowledge Questionnaire (NSKQ) is an 89-item, valid and reliable measure of sports nutrition knowledge (SNK). It takes 25 min to complete and has been subject to low completion and response rates. The aim of this study was to develop an abridged version of the NSKQ (A-NSKQ) and compare response rates, completion rates and NK scores of the NSKQ and A-NSKQ.

Methods

Rasch analysis was used for the questionnaire validation. The sample (n = 181) was the same sample that was used in the validation of the full-length NSKQ. Construct validity was assessed using the known-group comparisons method. Temporal stability was assessed using the test-retest reliability method. NK assessment was cross-sectional; responses were collected electronically from members of one non-elite Australian football (AF) and netball club, using Qualtrics Software (Qualtrics, Provo, UT).

Results

Validation - The A-NSKQ has 37 items that assess general (n = 17) and sports (n = 20) nutrition knowledge (NK). Both sections are unidimensional (Perc5% = 2.84% [general] and 3.41% [sport]). Both sections fit the Rasch Model (overall-interaction statistic mean (SD) = − 0.15 ± 0.96 [general] and 0.22 ± 1.11 [sport]; overall-person interaction statistic mean (SD) = − 0.11 ± 0.61 [general] and 0.08 ± 0.73 [sport]; Chi-Square probability = 0.308 [general] and 0.283 [sport]). Test-retest reliability was confirmed (r = 0.8, P < 0.001 [general] and r = 0.7, P < 0.001 [sport]). Construct validity was demonstrated (nutrition students = 77% versus non-nutrition students = 60%, P < 0.001 [general] and nutrition students = 60% versus non-nutrition students = 40%, P < 0.001 [sport]. Assessment of NK - 177 usable survey responses from were returned. Response rates were low (7%) but completion rates were high (85%). NK scores on the A-NSKQ (46%) are comparable to results obtained in similar cohorts on the NSKQ (49%). The A-NSKQ took on average 12 min to complete, which is around half the time taken to complete the NSKQ (25 min).

Conclusions

The A-NSKQ is a valid and reliable, brief questionnaire designed to assess general NK (GNK) and SNK.

Electronic supplementary material

The online version of this article (10.1186/s12970-018-0223-1) contains supplementary material, which is available to authorized users.

Nutrition "fat facts" are not common knowledge

ISSUE ADDRESSED

Individuals who are knowledgeable about nutrition are more likely to eat healthily. Yet, few studies have investigated levels of nutrition knowledge using a validated tool. The present study measured nutrition knowledge using the Re-examined General Nutrition Knowledge Questionnaire (R-GNKQ) to confirm influencing demographic characteristics.

METHODS

Adults aged 18-60 years were recruited. Nutrition knowledge was assessed using the R-GNKQ, examining four domains (dietary guidelines, sources of nutrients, choosing everyday foods, and diet-disease relationships) with 96 questions.

RESULTS

Of 606 respondents (mean age 38.8 ± 11.8 years), 506 completed all questions. R-GNKQ score was positively associated with education (p<0.001) and age (p<0.001). Those with the highest education levels scored higher across 89% of the R-GNKQ and the oldest (≥50 years) respondents scored higher than younger respondents. Other characteristics that were associated with higher levels of knowledge were being female, and having a healthy BMI. Lowest knowledge pertained to questions about diet-disease relationships and fatty acids in foods.

CONCLUSIONS

The majority of individuals had a good understanding about the Australian Dietary Guidelines, however the health benefits of adhering to the dietary guidelines was less well understood. Gaps in knowledge pertained to the specific details of how to adhere to the guidelines, particularly knowledge about the types of beneficial fats and their everyday food sources. SO WHAT?: Those with lower educational attainment, younger, males and those with higher BMI's would benefit from nutrition communications that identify foods with beneficial fatty acids to assist with adherence to the Australian Dietary Guidelines.

Developing and validating a nutrition knowledge questionnaire: key methods and considerations

Objective

To outline key statistical considerations and detailed methodologies for the development and evaluation of a valid and reliable nutrition knowledge questionnaire.

Design

Literature on questionnaire development in a range of fields was reviewed and a set of evidence-based guidelines specific to the creation of a nutrition knowledge questionnaire have been developed. The recommendations describe key qualitative methods and statistical considerations, and include relevant examples from previous papers and existing nutrition knowledge questionnaires. Where details have been omitted for the sake of brevity, the reader has been directed to suitable references.

Results

We recommend an eight-step methodology for nutrition knowledge questionnaire development as follows: (i) definition of the construct and development of a test plan; (ii) generation of the item pool; (iii) choice of the scoring system and response format; (iv) assessment of content validity; (v) assessment of face validity; (vi) purification of the scale using item analysis, including item characteristics, difficulty and discrimination; (vii) evaluation of the scale including its factor structure and internal reliability, or Rasch analysis, including assessment of dimensionality and internal reliability; and (viii) gathering of data to re-examine the questionnaire’s properties, assess temporal stability and confirm construct validity. Several of these methods have previously been overlooked.

Conclusions

The measurement of nutrition knowledge is an important consideration for individuals working in the nutrition field. Improved methods in the development of nutrition knowledge questionnaires, such as the use of factor analysis or Rasch analysis, will enable more confidence in reported measures of nutrition knowledge.

A valid and reliable nutrition knowledge questionnaire for track and field athletes

Background

Establishing an understanding of an athlete’s nutrition knowledge can inform the coach/practitioner and support the development of the athlete. Thus the purpose of the study was to develop a psychometrically valid and reliable tool to assess general and sport nutrition knowledge.

Methods

An 85 question questionnaire was developed in consultation with a panel of experts. Ninety-eight participants from the UK completed the questionnaire, and again 3 weeks later. The participants were classified into two groups: those with nutrition (NUT, n = 53) training (sport nutritionists and dietitians who were either practicing or undertaking a postgraduate qualification in the field), and those without (NONUT, n = 48) training (professionals and postgraduate students with no exposure to any form of nutrition training). The questionnaire was then administered to a pilot cohort of UK based track and field athletes (n = 59) who were requested to time how long it took to complete the questionnaire.

Results

Psychometric statistical analysis of the results was completed, resulting in the removal of 23 questions for a total of 62 questions in the final questionnaire. The validated questionnaire was then administered to 58 track and field athletes. Internal consistency was assessed using Chronbach’s alpha (α > 0.7), Pearson’s correlation (p < 0.05) was used to assess reliability. Construct validity was evaluated using a t-test (p < 0.05). A total test retest correlation of 0.95 was achieved (sub-section range: 0.87–0.97). Internal consistency was accepted in each sub-section (α = 0.78–0.92) and the nutrition-trained group scored significantly higher on the overall questionnaire (80.4 vs 49.6%). The overall score for the athletic group was 61.0%.

Conclusion

The questionnaire satisfied all psychometric measures and provides a new valid and reliable tool to assess general and sport nutrition knowledge of track and field athlete.

Electronic supplementary material

The online version of this article (doi:10.1186/s40795-017-0156-0) contains supplementary material, which is available to authorized users.

Association between athletic participation and the risk of eating disorder and body dissatisfaction in college students

OBJECTIVE

Given that females exhibit a greater prevalence of eating disorders, there is of yet no conclusive evidence whether participation in college athletics exacerbates eating disorders or body shape dissatisfaction. This study assessed how gender and participation in collegiate athletics are associated with increased risk for disordered eating attitudes and body shape concerns in college students.

METHODS

This study used a cross-sectional research design. A total of 302 students at a Southern US university fully completed the eating attitudes test and the body shape questionnaire during class time or team meetings. Logistic regression was conducted to determine risk differentials for each group.

RESULTS

Of 302 students, 65.6% were females and 63.2% were non-athletes. Athletic status was significant as well but became slightly less so with adjustment (unadjusted at OR = 3.14, P < 0.001 vs. adjusted OR = 3.22, P < 0.001). Moreover, it was found that that non-athletic female students are slightly more at risk for disordered eating and significantly more dissatisfied with their body shape (OR = 5.95, P < 0.001).

CONCLUSIONS

Although there seems to still be many unresolved issues regarding eating disorders, one thing is clear females are at higher risk, and it remains a significant challenge to college health services. College health practitioners should be made aware of the significant effect stress has on freshman in particular.

A Systematic Review of Athletes' and Coaches' Nutrition Knowledge and Reflections on the Quality of Current Nutrition Knowledge Measures

Context: Nutrition knowledge can influence dietary choices and impact on athletic performance. Valid and reliable measures are needed to assess the nutrition knowledge of athletes and coaches. Objectives: (1) To systematically review the published literature on nutrition knowledge of adult athletes and coaches and (2) to assess the quality of measures used to assess nutrition knowledge. Data Sources: MEDLINE, CINAHL, SPORTDiscuss, Web of Science, and SCOPUS. Study Selection: 36 studies that provided a quantitative measure of nutrition knowledge and described the measurement tool that was used were included. Data extraction: Participant description, questionnaire description, results (mean correct and responses to individual items), study quality, and questionnaire quality. Data synthesis: All studies were of neutral quality. Tools used to measure knowledge did not consider health literacy, were outdated with regards to consensus recommendations, and lacked appropriate and adequate validation. The current status of nutrition knowledge in athletes and coaches is difficult to ascertain. Gaps in knowledge also remain unclear, but it is likely that energy density, the need for supplementation, and the role of protein are frequently misunderstood. Conclusions: Previous reports of nutrition knowledge need to be interpreted with caution. A new, universal, up-to-date, validated measure of general and sports nutrition knowledge is required to allow for assessment of nutrition knowledge.

Ultra-Marathon Athletes at Risk for the Female Athlete Triad

BACKGROUND

Worldwide female participation in ultra-endurance events may place them at risk for the female athlete triad (FAT). The study objectives were to establish triad knowledge, occurrence of disordered eating and triad risk amongst participants of the 2014 89-km Comrades Marathon event.

METHODS

A survey utilising the Low Energy Availability in Females questionnaire (LEAF-Q) and Female Athlete Screening Tool (FAST) questionnaire was conducted on female participants in order to determine the risk. In addition, seven questions pertaining to the triad were asked in order to determine the athlete's knowledge of the triad. Athletes were requested to complete the anonymous questionnaire after written informed consent was obtained while waiting in the event registration queues. Statistical analyses included Pearson product-moment correlations, chi-square tests and cross-tabulations to evaluate associations of interest.

RESULTS

Knowledge of the triad was poor with 92.5 % of participants having not heard of the triad before and most of those who had, gained their knowledge from school or university. Only three athletes were able to name all 3 components of the triad. Amenorrhoea was the most commonly recalled component while five participants were able to name the component of low bone mineral density. Of the 306 athletes included in the study, 44.1 % were found to be at risk for the female athlete triad. One-third of participants demonstrated disordered eating behaviours with nearly half reporting restrictive eating behaviours. There is a significant association between athletes at risk for the triad according to the LEAF-Q and those with disordered eating (χ²(1) = 8.411, p = 0.014) but no association (or interaction) between triad knowledge and category (at risk/not at risk) of LEAF-Q score (χ²(1) = 0.004, p = 0.949). More athletes in the groups with clinical and sub-clinical eating disorders are at risk for the triad than expected under the null hypothesis for no association.

CONCLUSIONS

Only 7.5 % of the female Comrades Marathon runners knew about the triad despite 44.1 % being at a high risk for the triad. Therefore, education and regular screening programmes targeting these athletes are overdue. Postmenopausal athletes are at particularly high risk for large losses in bone mass if they experience chronic energy deficiency and hence require special focus.

Nutritional knowledge and eating habits of professional rugby league players: does knowledge translate into practice?

Background

Adequate nutrient intake is important to support training and to optimise performance of elite athletes. Nutritional knowledge has been shown to play an important role in adopting optimal nutrition practices. The aim of the present study was to investigate the relationship between the level of nutritional knowledge and dietary habits in elite English rugby league players using the eatwell plate food categories.

Method

General nutritional knowledge questionnaires were collected during the Super League competitive season in the first team squad of 21 professional Rugby league players (mean age 25 ± 5 yrs, BMI 27 ± 2.4 kg/m2, experience in game 6 ± 4 yrs). According to their nutritional knowledge scores, the players were assigned to either good or poor nutritional knowledge group (n = 11, n = 10, respectively). Their dietary habits were assessment using a food frequency questionnaire.

Results

The findings revealed that nutritional knowledge was adequate (mean 72.82%) in this group of athletes with the highest scores in dietary advice section (85.71%), followed by food groups (71.24%) and food choice (69.52%). The majority of athletes were not aware of current carbohydrate recommendations. This translated into their dietary habits as many starchy and fibrous foods were consumed only occasionally by poor nutritional knowledge group. In terms of their eating habits, the good nutritional knowledge group consumed significantly more fruit and vegetables, and starchy foods (p <.05). Nutritional knowledge was positively correlated to fruit and vegetables consumption (rs = .52, p <.05) but not to any other eatwell plate categories.

Conclusions

The study identified adequate general nutritional knowledge in professional rugby league players with the exception of recommendation for starchy and fibrous foods. Players who scored higher in nutritional knowledge test were more likely to consume more fruits, vegetables and carbohydrate-rich foods.

Body mass index, nutritional knowledge, and eating behaviors in elite student and professional ballet dancers

OBJECTIVE

It is recognized that there is a high esthetic demand in ballet, and this has implications on dancers' body mass index (BMI) and eating behaviors. The objective of this study was to examine the association between BMI, eating attitudes, and nutritional knowledge of elite student and professional ballet dancers.

DESIGN

Observational design.

SETTING

Institutional.

PARTICIPANTS

One hundred eighty-nine participants from an elite full-time dance school (M = 53, F = 86) and from an elite ballet company (M = 16, F = 25) volunteered for the study. There were no exclusion criteria.

INTERVENTIONS

Anthropometric data (height and mass), General Nutrition Knowledge Questionnaire (GNKQ), and the Eating Attitude Test-26 (EAT-26) were collected from each participant.

MAIN OUTCOME MEASURES

Univariate analysis of variance was used to examine differences in gender and group for BMI, GNKQ, and EAT-26. Regression analyses were applied to examine interactions between BMI, GNKQ, and EAT-26.

RESULTS

Professional dancers had significantly greater BMI than student dancers (P < 0.001), and males had significantly higher BMI scores than females (P < 0.05). Food knowledge increased with age (P < 0.001) with no gender difference. Student dancers had a significant interaction between year group and gender because of significantly higher EAT-26 scores for females in years 10 and 12. Regression analysis of the subcategories (gender and group) reported a number of significant relationships between BMI, GNKQ, and EAT-26.

CONCLUSIONS

The findings suggest that dancers with disordered eating also display lower levels of nutritional knowledge, and this may have an impact on BMI. Female students' eating attitudes and BMI should especially be monitored during periods of adolescent development.

Prevalence of individual and combined components of the female athlete triad

PURPOSE

The female athlete triad (Triad) is a syndrome linking low energy availability (EA) with or without disordered eating (DE), menstrual disturbances (MD), and low bone mineral density (BMD) in exercising women. The prevalence of Triad conditions (both clinical and subclinical) has not been clearly established.The purpose of this review is to evaluate the studies that determined the prevalence of clinical or subclinical Triad conditions (low EA, DE, MD, and low BMD) in exercising women and in women participating in lean (LS) versus nonlean sports (NLS) using self-report and/or objective measures.

METHODS

A review of publications using MEDLINE and PubMed was completed. Randomized controlled trials and observational studies that evaluated the prevalence of clinical and subclinical Triad conditions (MD, low BMD, low EA, and DE) in exercising women were included.

RESULTS

Sixty-five studies were identified for inclusion in this review (n = 10,498, age = 21.8 ± 3.5 yr, body mass index = 20.8 ± 2.6 kg·m; mean ± SD). A relatively small percentage of athletes (0%-15.9%) exhibited all three Triad conditions (nine studies, n = 991). The prevalence of any two or any one of the Triad conditions in these studies ranged from 2.7% to 27.0% and from 16.0% to 60.0%, respectively. The prevalence of all three Triad conditions in LS athletes versus NLS athletes ranged from 1.5% to 6.7% and from 0% to 2.0%, respectively. LS athletes demonstrated higher prevalence rates of MD and low BMD (3.3% vs 1.0%), MD and DE (6.8%-57.8% vs 5.4%-13.5%), and low BMD and DE (5.6% vs 1.0%) than the NLS athletes.

CONCLUSIONS

Although the prevalence of individual/combined Triad conditions is concerning, our review demonstrates that additional research on the prevalence of the Triad using objective and/or self-report/field measures is necessary to more accurately describe the extent of the problem.

The female athlete triad: a case series and narrative overview

OBJECTIVE

To illustrate the varying presentations of the female athlete triad and to inform the practitioner of the potential sequelae of this common condition.

CLINICAL FEATURES

Four patients presented with a variety of signs and symptoms of the female athlete triad including low caloric intake, osteoporosis, amenorrhea and/or endothelial dysfunction.

INTERVENTION AND OUTCOME

A conservative treatment approach was utilized in each case including education on the female athlete triad, education on increased caloric intake and a referral to the family physician.

CONCLUSION

Health care practitioners should be aware of the different clinical presentations of the female athlete triad. A narrative review of the literature is provided to educate practitioners on the components of the female athlete triad, proper diagnosis and appropriate management.

Evaluation of general nutrition knowledge in elite Australian athletes

The aim of the present study was to investigate and benchmark the level of general nutrition knowledge in elite Australian athletes (EA) against a similar aged community (CM) and criterion sample with dietetic training (DT). EA (n175), CM (n116) and DT (n53) completed the General Nutrition Knowledge Questionnaire (GNKQ), which assesses four domains (sections A–D) of general nutrition knowledge (section A: dietary guidelines; section B: sources of nutrients; section C: choosing everyday foods; section D: diet–disease relationships). Age, sex and education level were collected in all groups, and athletic calibre and sport type (team or individual) in EA. Dietitians and nutrition scientists (n53) re-examined the GNKQ for content validity, resulting in instrument revision (R-GNKQ; ninety-six items). Psychometric assessment (internal consistency: Cronbach-α; test–retest: Spearman rank correlation) was performed in a sub-sample (n28). Independentttests, ANOVA and ANCOVA (χ2for categorical variables) were used to assess between-group differences. DT scored higher than EA and CM in all sub-sections and overall (P < 0·005). EA scored lower than CM in GNKQ for section B (P < 0·005) and overall (P < 0·005), and in R-GNKQ for section B (P < 0·005), section C (P < 0·005), section D (P = 0·006) and overall (P < 0·005). Overall score was influenced by age (P = 0·036 for GNKQ:P = 0·053 for R-GNKQ), sex (P = 0·016 for GNKQ:P = 0·003 for R-GNKQ) and athletic calibre (P = 0·029 for R-GNKQ only), but not level of education, living situation or ethnicity. EA and CM performed best on section A and worst on D. EA had lower overall general knowledge scores than CM. This was significantly influenced by age and sex.