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

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.

The relationship between nutrition knowledge and low energy availability risk in collegiate athletes

OBJECTIVES

This was a pilot study that examined the relationship between nutrition knowledge and risk for low energy availability (LEA) in NCAA athletes.

METHODS

Athletes (64.4 % female, 35.6 % male) completed the Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ) and either the Low Energy Availability in Females Questionnaire (LEAF-Q) or Male Athlete Triad (MAT) screening questions.

RESULTS

Females at risk for LEA had higher nutrition knowledge, demonstrated by higher A-NSKQ scores, than those classified as low risk (16.5 vs 14.5, p = 0.01). There was a very weak correlation between MAT and A-NSKQ scores (R2 = 0.012).

Carbohydrate beliefs and practices of ultra-endurance runners in Ireland for gastrointestinal symptom management

Purpose

This study aimed to investigate the carbohydrate beliefs and practices of ultra-endurance runners in Ireland to gain an understanding of their gastrointestinal symptom (GIS) management strategies.

Methodology

An adapted version of a previously developed and validated questionnaire was distributed online to ultra-endurance runners, recognized as those who completed a single bout of exercise lasting 4 or more hours. The questionnaire asked about carbohydrate awareness and sourcing, and dietary practices, particularly in relation to GIS management.

Results

A total of n = 68 individuals completed the adapted questionnaire. Of these, n = 1 was excluded due to their reporting of an ulcerative colitis diagnosis. The remaining participants included 46 men and 21 women. Personal previous experience was the main source directing participants' nutrition practices (n = 30), while only 3 participants quoted sourcing information from qualified professionals. Forty-two participants experienced GIS, usually equally around training and competition times. Many participants had not previously implemented any specific dietary or non-dietary strategies to alleviate exercise-induced GIS. Supplementing with nitrates (n = 9) and probiotics (n = 4) were the most common dietary practices to alleviate GIS, while other practices (n = 14) and portion control (n = 13) were the most reported non-dietary practices.

Discussion

Similar to previous studies, these findings suggest that GISs are prevalent in the ultra-endurance running community, occurring regardless of whether during training or an event. Similarly, this research highlights the vast range of GISs experienced by this population. However, the absence of both dietary and non-dietary-related practices used for GIS management alludes to a current deficit in the availability of nutrition information specific to this problem. Further research is required to understand the mechanisms behind ultra-endurance-associated GISs and its various management strategies as well as best practices for communicating these to the target audience to reduce individuals' risks of developing long-term, chronic health complications.

Risk of low energy availability and nutrition knowledge among female team sport athletes

BACKGROUND

Nutrition knowledge influences adequate dietary intake in athletes. Inadequate dietary intakes can result in low energy availability (LEA) which can lead to relative energy deficiency in sport (RED-S). To date, there is little information on the relationship between nutrition knowledge and the risk of LEA in female team sport athletes. This study investigates if general and sports nutrition knowledge are associated with the risk of LEA in female team athletes.

METHODS

A cross-sectional design was used. Female athletes (>16 years) who participate in team sports in New Zealand were asked to complete an online questionnaire. The LEA in Females Questionnaire and the Abridged Sport Nutrition Knowledge Questionnaire were included. LEA risk and general/sports nutrition knowledge were assessed. The relationship between LEA risk and knowledge was analyzed using the Kruskal-Wallis Test of independent variables and χ2 tests.

RESULTS

Among 100 female athletes, 53% were at-risk for LEA, and 70% (N.=67) had poor nutrition knowledge. Athletes who were "at-risk" for LEA and those who were "not at-risk" for LEA did not differ statistically in terms of age (P=0.350) or BMI (P=0.576). Of those "not at risk" 54% had an A-NSK score between 50 and 60% (i.e., average knowledge), whereas 54% of the athletes who were "at risk" for LEA had poor nutrition knowledge. There was no statistical difference between the groups (P=0.273).

CONCLUSIONS

The poor nutrition knowledge and the high rates of those "at risk" of LEA among team sports athletes indicates the need for more nutrition education in this population.

Nutrition knowledge, weight loss practices, and supplement use in senior competition climbers

Introduction

Sport climbing has gained increased scientific attention, including studies investigating the dietary habits and nutritional requirements of climbers; however, significant gaps in the literature remain. An assessment of nutritional knowledge, weight loss for competition, and supplement use has not been previously reported in senior competition climbing athletes.

Methods

Fifty climbers (26 male, 24 female; BMI 21.6 ± 1.9; 23.7 ± 5.2 years) participated in the study. Participants answered a 72-item questionnaire, comprised of demographic data and three main sections to assess general and sports nutrition knowledge, weight loss strategies, and supplement use.

Results

The mean nutrition knowledge score was 'average', with considerable individual variation (53.5 ± 11.1 %). There were no significant sex differences in the general (GNK) or sport (SNK) nutrition knowledge scores, or effect of age. Significantly higher knowledge was demonstrated by national vs. international athletes for the GNK scores (11.09 ± 1.58 vs. 9.58 ± 1.75; p = 0.028). Participants scored well in questions concerning protein, carbohydrates, alcohol, and supplements, and conversely, performed poorly in hydration and micronutrient related questions. Less than one-fifth of respondents had access to a dietitian. Forty-six percent of males and 38% of female climbers reported intentional weight loss for competition on at least one occasion. Of those, ~76% reported utilizing concerning practices, including methods that conform with disordered eating and/or eating disorders, dehydration, vomiting, and misuse of laxatives. Approximately 65% of athletes reported using at least one nutritional supplement in the previous 6 months, with 44% reporting multiple supplement use. There was no significant difference in supplement use between sexes or competition level.

Discussion

Due to the established importance of nutritional intake on athlete health and performance, educational support should be employed to improve knowledge in climbers and address shortcomings. Moreover, intentional weight loss for climbing competition is common, with most athletes achieving ~3-8% body weight loss over ≥2 weeks. It is crucial that professionals working with competitive climbers are vigilant in identifying athletes at risk of concerning weight management and establish referral pathways to the appropriate specialist services. High quality intervention trials to assess the efficacy of ergogenic aids in climbing remains inadequate.

Evaluation of Validity and Reliability of a German General and Sports Nutrition Knowledge Questionnaire for Athletes and Coaches (GSNKQ-AC)

Despite the availability of nutritional recommendations, studies have reported inadequate nutrition in athletes. The existing literature highlights the importance of the nutritional knowledge of both athletes and coaches in influencing athletes' food choices and behavior, as well as its direct and indirect impact on athletes' performance and health. To adequately assess nutritional knowledge, monitoring via valid and reliable questionnaires is required. As no questionnaire tailored to German-speaking athletes and coaches exists, this study aimed at developing a new General and Sports Nutritional Knowledge Questionnaire for Athletes and Coaches (GSNKQ-AC). The development followed a literature-based, ten-step validation approach. The initial questionnaire (63 items) was revised and reduced to 29 items in the final version after conducting construct verification in the target group (n = 84 athletes and coaches), evaluating content validity by a panel of nutrition experts (n = 8), verifying face validity by think-out-loud interviews in the target group (n = 7), and conducting classical test theory for item reduction analysis (n = 53). For the final GSNKQ-AC, internal consistency, calculated as Cronbach's alpha, was 0.87. Students with a focus on sports nutrition (n = 31) scored significantly higher than athletes and coaches (n = 53), revealing good construct validity (77% vs. 62%, p < 0.001). Test-retest reliability (n = 42, matched pairs) showed a Spearman's correlation coefficient of r = 0.61 (p < 0.01). The brief GSNKQ-AC can be used for status quo or longitudinal assessment of nutritional knowledge among athletes and coaches to reveal gaps and ensure purposeful planning of educational interventions.

Assessment of General and Sports Nutrition Knowledge, Dietary Habits, and Nutrient Intake of Physical Activity Practitioners and Athletes in Riyadh, Saudi Arabia

Physical performance and overall health are crucial in the athletic population, and their improvement relies on specific dietary guidelines and practices. Athletes and physical activity practitioners who participate in physical activity for specific health reasons need nutritional knowledge to improve physical performance. This study aimed to understand nutrient intake and nutritional knowledge among physical activity practitioners and athletes in Riyadh, Saudi Arabia. This cross-sectional study sampled 263 individuals divided into two groups: athletes (n = 121) and practitioners (n = 142). Their nutritional knowledge and dietary intake were measured with validated questionnaires: the Arabic Abridged Nutrition for Sport Knowledge Questionnaire and the Saudi Food Frequency Questionnaire. The majority of the sample (77.2%) had poor nutritional knowledge. Highest scoring domains for the dietary intake were protein from meat, fish, chicken (65.6%), vegetarian protein (62.4%), grains (51.0%), and the lowest were vegetables (41.1%), dairy (36.3%), and fruits (27.9%). In conclusion, athletes and practitioners in Riyadh, Saudi Arabia, have poor nutritional knowledge and dietary intake and may benefit from nutritional education and training to improve their knowledge, dietary intake, and performance.

Mind the gap: limited knowledge of carbohydrate guidelines for competition in an international cohort of endurance athletes

Despite the well-documented role of carbohydrate (CHO) in promoting endurance exercise performance, endurance athletes typically fail to meet current recommendations in competition. Adequate nutrition knowledge is key to drive athletes' behaviour, but the current level of knowledge in this population is not known. The present study assessed knowledge of CHO for competition in an international cohort of endurance athletes using the Carbohydrates for Endurance Athletes in Competition Questionnaire (CEAC-Q). The CEAC-Q was completed by 1016 individuals (45 % female), from the United Kingdom (40 %), Australia/New Zealand (22 %), the United States of America/Canada (18 %) and other countries (21 %). Total CEAC-Q scores were 50 ± 20 % (mean ± sd), with no differences in scores between the five subsections (10 ± 5 points, P < 0⋅001). Based on typical knowledge and frequency of correct answers, we defined questions with low (0-39 %), moderate (40-69 %) and high (70-100 %) knowledge at a population level. Knowledge deficiencies were identified in questions related to CHO metabolism (Low: 2 out of 5 questions (2/5), Moderate: 3/5), CHO-loading (Low: 2/5, Moderate: 1/5), pre-event CHO (Low: 2/5, Moderate: 2/5), CHO during exercise (Moderate: 4/5) and CHO for recovery (Low: 3/5, Moderate: 1/5). Current CHO amounts recommendations were identified correctly for CHO-loading, pre-competition meal, during competition >2⋅5 h) and post-competition recovery by 28% (Low), 45 % (Moderate), 48 % (Moderate), and 29 % (Low), respectively. Our findings indicate that endurance athletes typically have limited knowledge of carbohydrate guidelines for competition, and we identify specific knowledge gaps that can guide targeted nutrition education to improve knowledge as an initial step towards optimal dietary practice.

Body Composition, Energy Availability, Risk of Eating Disorder, and Sport Nutrition Knowledge in Young Athletes

Young athletes may be at risk for low energy availability (LEA) or dietary habits that are indicative of eating disorders. Thus, the purpose of the current study was to investigate the prevalence of LEA among high school athletes and examine those at risk for eating disorders. A secondary aim was to examine relationships between sport nutrition knowledge, body composition, and LEA.

METHODS

94 male (n = 42) and female (n = 52) mean ± SD age: 18.09 ± 2.44 y; height: 172.6 ± 9.8 cm; body mass: 68.7 ± 14.5 kg; BMI: 22.91 ± 3.3 kg·m^-2) athletes completed a body composition assessment and electronic versions of the abridged sports nutrition knowledge questionnaire (ASNK-Q), brief eating disorder in athletes questionnaire (BEDA-Q), and the low energy availability for females questionnaire (LEAF-Q; females only).

RESULTS

52.1% of female athletes were classified as being at risk for LEA. Moderate inverse relationships existed for computed LEAF-Q scores and BMI (r = -0.394; p < 0.01). A total of 42.9% of males (n = 18) and 68.6% of females (n = 35) were at risk for eating disorders, with females being at greater risk (p < 0.01). Body fat percentage was a predictor (β = -0.095; p = -0.01) for eating disorder risk status. For every 1 unit increase in body fat percentage, athletes were 0.909 (95% CI: 0.845-0.977) times less likely to be classified as at risk for an eating disorder. Male (46.5 ± 13.9) and female (46.9 ± 11.4) athletes scored poorly on the ASNK-Q, with no differences between sex (p = 0.895).

CONCLUSIONS

Female athletes were at a greater risk for eating disorders. No relationships existed between sport nutrition knowledge and %BF. Female athletes with a higher %BF had a lower risk for an eating disorder and risk for LEA.

Validation of the General and Sport Nutrition Knowledge Questionnaire (GeSNK) in Spanish Adolescents

The General and Sport Nutrition Knowledge Questionnaire (GeSNK) is an instrument that has been developed and validated to assess the level of nutrition knowledge in adolescents and young adults. The aim of the present study was to validate the GeSNK questionnaire in a group of Spanish adolescents in the framework of a Nutrition Education Programme in Secondary Schools in Andalusia, Spain. This cross-sectional questionnaire validation study was developed in two phases: translation-cultural adaptation and validation. A total of 305 adolescents aged 11 to 17 years, studying from the first to the third year of compulsory secondary education, participated on a voluntary basis. The GeSNK questionnaire consists of 62 items: 29 items for the General Nutrition section and 33 items for the Sports Nutrition section. Cronbach's alpha coefficient for the complete questionnaire (GeSNK Total) was: 0.934; for the GeSNK General Nutrition section it was 0.918; and for the GeSNK Sports Nutrition section it was 0.856. The stability measured by the correlation coefficient for the General Nutrition section was 0.406 (p = 0.000); for the Sports Nutrition section it was 0.198 (p = 0.017); and for GeSNK Total the stability was 0.545 (p = 0.000). The questionnaire also demonstrated adequate construct validity. We therefore conclude that the Spanish version of the GeSNK questionnaire is a valid instrument to measure the level of knowledge in general nutrition and sports nutrition in adolescents.

A Proposed Conceptual Sport Nutrition Approach for Athlete Development and Assessment: The Athlete Nutrition Development Approach

Appropriate dietary intake can improve athletes' health and sport performance and is a direct result of eating behaviours. Therefore, assessing and shaping athletes' eating behaviours and dietary intake is critical to the provision of sport nutrition services. As such, nutrition practitioners must also consider the determinants of eating behaviours. However, dietary intake, eating behaviours, and its determinants are inconsistently defined in the literature, requiring nutrition practitioners to navigate a complicated landscape of concepts and terminology. This is further complicated by limitations in practically measuring and influencing eating behaviours and dietary intake. The proposed Athlete Nutrition Development Approach was developed to aid practitioners in servicing decisions through the athlete development process, through a three-tiered approach to sport nutrition service delivery. Tier 1 addresses the determinants of eating behaviours, Tier 2 directly addresses eating behaviours and dietary intake, and Tier 3 addresses the consequences of dietary intake in relation to health and sport performance. Each tier includes tools for assessment and development.

A systematic review update of athletes' nutrition knowledge and association with dietary intake

Athletes' dietary intakes sometimes do not meet sports nutrition guidelines. Nutrition knowledge (NK) is one factor that may influence dietary intake, but NK measurement tools are often outdated or unvalidated, and results regarding athletes' NK are equivocal. The aims of this systematic review were to update previous systematic reviews by examining athletes' NK and to assess the relationship between athletes' general NK, sport NK and dietary intake. MEDLINE, CINAHL, Scopus, SPORTDiscus, Web of Science and Cochrane were searched for studies published between November 2015 and November 2020 that provided a quantitative measure of NK and described the NK tool used. Twenty-eight studies were included, study quality was assessed using JBI checklists and data on NK score and diet intake was extracted. Eight studies utilised validated, up-to-date NK measurement tools. Mean general and sport NK% scores varied between 40·2% ± 12·4 and 70 % ± 9. Mean protein and carbohydrate consumption was 1·1-3·4 g/kg.bw/d and 2·4-4·6 g/kg.bw/d, respectively. Weak-to-moderate, positive associations were found between NK and positive dietary behaviours. Due to a wide variety of NK measurement tools used, it is difficult to synthesise results to determine overall NK in athletes. Overall, there appears to be a low standard of knowledge. Quality of measurement tools for NK has improved but remains an issue. Future studies should use relevant, current validated NK tools or validate tools in their study population. More research is needed into the relationship between NK and other modifiable factors influencing dietary intake.

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.

Nutrition knowledge of elite and non-elite Gaelic footballers

Dietary intake plays a significant role in athletic performance and is influenced by several factors, including nutrition knowledge. Gaelic footballers are amateur athletes who conduct high-intensity, intermittent activity during training and competition, and have previously demonstrated insufficient dietary intake. This study aimed to examine nutrition knowledge in elite and non-elite Gaelic footballers. An online survey was distributed to competitive Gaelic footballers, examining nutrition knowledge using the Abridged Nutrition for Sport Knowledge Questionnaire. Total, general, and sport nutrition knowledge were compared between elite and non-elite athletes, and those who had and had not previously received nutrition education, using Mann-Whitney U-tests. A total of 190 participants (15.3% women) completed the survey. No differences between elite and non-elite athletes in nutrition knowledge were identified (p > 0.05). Athletes with previous nutrition education scored higher than those without previous nutrition education in total (54.0 ± 4.9% vs 46.8 ± 9.6%; p = 0.002) and sport (51.9 ± 12.5% vs 43.4 ± 11.8%; p = 0.005) nutrition knowledge. Findings suggest an importance of nutrition education at all levels of athletic competition to improve nutrition knowledge, which may empower athletes to make appropriate dietary decisions to support training and competition demands.

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.

General and sports nutrition knowledge among Jordanian adult coaches and athletes: A cross-sectional survey

BACKGROUND

Nutrition knowledge (NK) is a modifiable determinant of diet intake and can positively influence athletic performance. This study aimed to (1) adapt and translate a validated general and sports NK questionnaire into Arabic (2) assess the NK of Jordanian sportspeople, and (3) evaluate the relationship between NK and various sociodemographic factors.

METHODS

The Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ) was translated into Arabic using forward-backward translation and underwent pilot testing and psychometric validation (internal consistency, test-retest reliability, inter-rater agreement) using a convenience sample of 30 individuals. Following ANSKQ validation, athletes a from 50 sport institutes in Jordan were invited (via email) to complete the Arabic ANSKQ online. Differences in NK based on demographics were analysed using t-test or ANOVA for continuous variables and chi-square tests for categorical variables. The ability of demographic factors to predict NK score-category (poor/good/average/excellent) was assessed using multivariate logistic regression.

RESULTS

The Arabic ANSKQ had excellent internal consistency (Cronbach's alpha = 0.92), test-retest reliability (Pearson r = 0.926) and inter-rater agreement (Cohen's k statistic = 0.89). A total of 3636 eligible participants completed the Arabic ANSKQ. Participants were mostly athletes (91.4%), female (68.0%), had normal BMI (50.6%), and played high-intensity sports (59.6%). 88.3% of participants had poor NK (<50%). There were statistically significant differences in NK score based on participant role (athlete vs coach), age, gender, BMI, nationality, smoking, years playing sport, sport frequency, sport intensity, and nutrition training. Multivariate modelling showed participant role, BMI, education level, sport frequency and nutrition training were predictors of NK category.

CONCLUSIONS

In conclusion, Jordanian sportspeople have poor NK and may benefit from increased nutrition training.

Carbohydrate for endurance athletes in competition questionnaire (CEAC-Q): validation of a practical and time-efficient tool for knowledge assessment

Purpose

Despite unequivocal evidence demonstrating high carbohydrate (CHO) availability improves endurance performance, athletes often report under-eating CHO during competition. Such findings may be related to a lack of knowledge though currently there are no practical or time-efficient tools to assess CHO knowledge in athletes. Accordingly, we aimed to validate a novel questionnaire to rapidly assess endurance athletes’ knowledge of competition CHO guidelines.

Methods

The Carbohydrate for Endurance Athletes in Competition Questionnaire (CEAC-Q) was created by research-active practitioners, based on contemporary guidelines. The CEAC-Q comprised 25 questions divided into 5 subsections (assessing CHO metabolism, CHO loading, pre-event meal, during-competition CHO and recovery) each worth 20 points for a total possible score of 100.

Results

A between-group analysis of variance compared scores in three different population groups to assess construct validity: general population (GenP; n = 68), endurance athletes (EA; n = 145), and sports dietitians/nutritionists (SDN; n = 60). Total scores were different (mean ± SD) in all pairwise comparisons of GenP (17 ± 20%), EA (46 ± 19%) and SDN (76 ± 10%, p < 0.001). Subsection scores were also significantly different between the groups, with mean subsection scores of 3.4 ± 4.7% (GenP), 9.2 ± 5.2% (EA) and 15.2 ± 3.5% (SDN, p < 0.001). Test–retest reliability of the total CEAC-Q was determined in EA (r = 0.742, p < 0.001).

Conclusion

Taking ~ 10 min to complete, the CEAC-Q is a new psychometrically valid, practical and time-efficient tool for practitioners to assess athletes’ knowledge of CHO for competition and guide subsequent nutrition intervention.

The Influence of Sport Nutrition Knowledge on Body Composition and Perceptions of Dietary Requirements in Collegiate Athletes

Sport nutrition knowledge has been shown to influence dietary habits of athletes. The purpose of the current study was to examine relationships between sport nutrition knowledge and body composition and examine potential predictors of body weight goals in collegiate athletes. Participants included National Collegiate Athletic Association Division III women (n = 42, height: 169.9 ± 6.9 cm; body mass: 67.1 ± 8.6 kg; fat-free mass: 51.3 ± 6.6 kg; body fat percent: 24.2 ± 5.3%) and men (n = 25, height: 180.8 ± 7.2 cm; body mass: 89.2 ± 20.5 kg; fat-free mass: 75.9 ± 12.2 kg; body fat percent: 13.5 ± 8.9%) athletes. Body composition was assessed via air displacement plethysmography. Athletes completed a validated questionnaire designed to assess sport nutrition knowledge and were asked questions about their perceived dietary energy and macronutrient requirements, as well as their body weight goal (i.e., lose, maintain, gain weight). Athletes answered 47.98 ± 11.29% of questions correctly on the nutrition questionnaire with no differences observed between sexes (men: 49.52 ± 11.76% vs. women: 47.03 ± 11.04%; p = 0.40). An inverse relationship between sport nutrition knowledge scores and body fat percentage (BF%) (r = −0.330; p = 0.008), and fat mass (r = −0.268; p = 0.032) was observed for all athletes. Fat mass (β = 0.224), BF% (β = 0.217), and body mass index (BMI) (β = 0.421) were all significant (p < 0.05) predictors of body weight goal in women. All athletes significantly (p < 0.001) underestimated daily energy (−1360 ± 610.2 kcal/day), carbohydrate (−301.6 ± 149.2 grams/day [g/day]), and fat (−41.4 ± 34.5 g/day) requirements. Division III collegiate athletes have a low level of sport nutrition knowledge, which was associated with a higher BF%. Women athletes with a higher body weight, BF% and BMI were more likely to select weight loss as a body weight goal. Athletes also significantly underestimated their energy and carbohydrate requirements based upon the demands of their sport, independent of sex.

Development and validation of a questionnaire investigating endurance athletes practices to manage gastrointestinal symptoms around exercise

AIM

To develop and validate a questionnaire investigating endurance athletes' carbohydrate beliefs, knowledge, information sources, and other dietary and non-dietary practices related to exercise-associated gastrointestinal symptoms.

METHODS

A questionnaire was developed by a review of relevant literature and sports-related questionnaires, and input from five experienced sports dietitians. Item construct and format was adapted and modified from a previous questionnaire. The modified questionnaire sought information on demographics, nutrition knowledge, beliefs, intended practices, information sources and exercise-associated gastrointestinal symptoms. A five-phase validity process was conducted to determine content, face and construct validity, item difficulty and internal reliability of the questionnaire. The Delphi technique was applied with experts over three anonymous rounds. Items were reviewed to determine whether to keep, modify, or delete, rate the relevance of each item using a content validity index (CVI), and provide comments. A content analysis was conducted on all comments after each round. Online interviews were conducted with a pilot group of endurance athletes (n = 15) to assess item difficulty and feasibility. Nutrition knowledge was compared between pilot group of athletes and experts to determine construct validity and internal consistency. A test-retest process was applied to a second pilot group (n = 8) to verify questionnaire reliability.

RESULTS

High CVI (≥.83) and agreement scores were obtained through the Delphi technique. High reliability (r = .942) and acceptable internal consistency (α = .53-.78) of the questionnaire were obtained.

CONCLUSIONS

The questionnaire was shown to be a valid and reliable tool that will be of use for clinicians and research purposes.

The New Challenge of Sports Nutrition: Accepting Insect Food as Dietary Supplements in Professional Athletes

BACKGROUND

The dietary supplements market is growing, and their use is increasing among professional athletes. Recently, several new protein supplements have been placed in the marketplace, including energy bars enriched with insect flour. Edible insects, which are rich in protein content, have been promoted as the food of the future and athletes could be a reference sample for their continued emphasis on higher protein demand. The present study investigated the potential motivations to accept an energy protein bar with cricket flour, among a group of selected Italian professional athletes. A second aim was also to measure how an information treatment about the benefits of edible insects would have impact on acceptance.

METHODS

61 Italian professional athletes (27 females) completed a structured questionnaire regarding supplements and eating habits, food neophobia, nutrition knowledge, willingness to taste edible insects and the associated factors. A question about sports endorsement was also posed at the end of the survey.

RESULTS

all subjects consumed supplements, generally recommended by medical personnel, even though their general knowledge of nutrition was poor (47.8%). Our main results shown that on a seven-point Likert scale, the protein content (5.74 ± 1.01) and the curiosity about texture (5.24 ± 0.98) were the main drivers to taste the cricket energy bar; whereas the feeling of disgust (5.58 ± 1.08) justified the rejection of tasting insects. In addition, the level of food neophobia increases with age (p < 0.05) and reduces willingness to endorse the cricket bar (p < 0.05). Male athletes (4.47 ± 1.69) were more likely to endorse the product than females (3.3 ± 1.49). An increase in willingness to taste was observed after the information treatment (z = 4.16, p < 0.001). Even though the population under investigation is unique, it is important to mention that this study involves a relatively small and convenience sample, and therefore generalizability of the results should be done with caution.

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.

How Does the Dietary Intake of Female Field-Based Team Sport Athletes Compare to Dietary Recommendations for Health and Performance? A Systematic Literature Review

Field-based team sports present large energetic demands given their intermittent high-intensity nature. Current evidence suggests that the dietary intake of female athletes may be insufficient to meet such demands, resulting in negative consequences for athletic performance and health. The primary aim of this review was to therefore assess the adequacy of dietary intake of female field-based team sport athletes when compared to dietary recommendations. A systematic search of databases, including PubMed, Web of Science, SPORTDiscus, and OpenGrey, was performed from the earliest record available until July 2020, obtaining an initial total of 2588 articles. To be included within the final review, articles were required to provide a quantitative assessment of baseline dietary intake specific to the target population. A total of 20 studies (n = 462) met the full eligibility criteria. A majority reported that the dietary intake of female field-based team sport athletes was insufficient in overall energy (2064 ± 309 kcal·day^-1), carbohydrate (4.3 ± 1.2 g·kg·day^-1), and iron intake (13.6 ± 6.2 mg·day^-1) when compared to recommendations. Future research is required to establish why female team sport athletes consistently demonstrate deficient dietary practices, and to explore the potential negative consequences of this.

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.

Evaluation of Nutrition Knowledge in Female Gaelic Games Players

Improvements in nutrition knowledge have been associated with increased carbohydrate consumption and greater adherence to dietary recommendations among female athletes. In order to assess whether nutrition knowledge interventions in female Gaelic games players may be beneficial, it is necessary to first of all investigate current levels of nutrition knowledge in this population. Given that many demographic characteristics have been shown to influence nutrition knowledge, it is also important for these to be investigated. The aims of this study were to evaluate the nutrition knowledge of female Gaelic games players, compare knowledge by players’ characteristics and identify players’ preferences for information and support. A validated 35-item questionnaire was completed by 328 female Gaelic games players (Age: 23.7 ± 5.0 years). Players’ mean nutrition knowledge score was 46.0% ± 11.8% and classified as “poor”. Elite players scored greater (+4.5–5.9%, p < 0.05) than subelite players. Players with higher levels of general education, history of formal nutrition education and previous advice from a nutritionist also presented greater nutrition knowledge (+3.7–7.5%, p < 0.05). Future education interventions with female Gaelic games players may lead to beneficial changes in dietary behaviour and would likely benefit from stratifying content based on athletes’ demographic characteristics, given the differences observed.

Development and Validation of a Short Sport Nutrition Knowledge Questionnaire for Athletes

Weak evidence exists on the relationship between nutritional knowledge and diet quality. Many researchers claim that this could be in part because of inadequate validation of the questionnaires used. The aim of this study was to develop a compact reliable questionnaire on nutrition knowledge for young and adult athletes (NUKYA). Researchers and the sport clubs medical staff developed the questionnaire by taking into consideration the latest athlete dietary guidelines. The questionnaire content was validated by a panel of 12 nutrition experts, and finally tested by 445 participants including athletes (n = 264), nutrition students (n = 49) and non-athletes with no formal nutrition knowledge (n = 132). After consulting the experts, 59 of the 64 initial items remained in the questionnaire. To collect the evaluation of experts, we used the content validity index, obtaining high indices for relevance and ambiguity (0.99) as well as for clarity and simplicity (0.98). The final questionnaire included 24 questions with 59 items. We ensured construct validity and reliability through psychometric validation based on the Classical Test Theory and the Item–Response Theory (Rasch model). We found significant statistical differences comparing the groups of nutrition knowledgeable participants with the rest of the groups (ANOVA p < 0.001). We verified the questionnaire for test–retest reliability (R = 0.895, p < 0.001) and internal consistency (Cronbach’s α=0.849). We successfully fit the questionnaire data to a rating scale model (global separation reliability of 0.861) and examined discrimination and difficulty indices for items. Finally, we validated the NUKYA questionnaire as an effective tool to appraise nutrition knowledge in athletes. This questionnaire can be used for guiding in educational interventions, studying the influence of nutrition knowledge on nutrient intake and assessing/monitoring sport nutritional knowledge in large groups.

Validation of a General and Sports Nutrition Knowledge Questionnaire in Italian Early Adolescents

To the best of our knowledge, no specific questionnaires on sports nutrition knowledge (NK) have been validated so far in Italian early adolescents. The aim of the present study was to validate a short (26-item) general and sports NK questionnaire in a group of Italian early adolescents. To this aim, the questionnaire was administered to 264 subjects for analysis of internal consistency, and in a subgroup (n = 39) for evaluating the reliability over time. The questionnaire revealed good overall internal consistency and reliability (Cronbach’s α = 0.684) and a highly significant correlation over time (r = 0.977, p < 0.001). Comparison with other validated questionnaires is tricky, because the previous questionnaires were validated in different populations, such as middle or late adolescents or adults, with a higher number of items compared to our questionnaire. Furthermore, data on adolescent NK in Italy are very limited. This study provides a brief, feasible, and validated questionnaire that can be used for investigating sports NK in young subjects. It could be used for evaluating the efficacy of education on general and sports nutrition in both the general population and athletes, and for investigating the relationship between NK and different sports in early adolescence.

The Development of a Psychometrically Valid and Reliable Questionnaire to Assess Nutrition Knowledge Related to Pre-Schoolers

With rising childcare enrollments, caregivers have a unique opportunity to promote children’s nutrition education and healthy eating. Accurately identifying nutrition knowledge gaps amongst caregivers is necessary for professional development planning. Our aim was to design an early childhood education and care (ECEC) teacher nutrition knowledge questionnaire that satisfies psychometric criteria of validity and reliability. Items were based on the New Zealand Ministry of Health dietary guidelines, literature and expert advice. University students in their final year of a Bachelor of Science (BSc) in Human Nutrition (n = 40), and students with no nutrition background (n = 51) completed the questionnaire to assess construct validity; 35 BSc nutrition students completed the questionnaire two weeks later to assess reliability. The Mann-Whitney-U test and a median-split table assessed construct validity; Pearson’s product-moment correlation assessed test-retest reliability. Nutrition students achieved higher total and subcategory scores (p < 0.01). All nutrition students scored above the median of the combined group; 82% of non-nutrition students scored below the median. In testing reliability, first and second administration median scores for total and subcategories were significantly correlated (r = 0.43–0.78; p < 0.01). The questionnaire achieved construct validity and test-retest reliability and measured ECEC teachers’ nutrition knowledge for preschoolers.

Reliability and validity of a General Nutrition Knowledge Questionnaire for adults in a Romanian population

Background

Nutritional knowledge assessment is an important component in nutrition research, and a prerequisite for the implementation of many policies and programs aimed at improving eating behavior. In order to generate objective results, validated tools for a given population must be employed. The aim of this study was to determine the validity and reliability of a nutrition knowledge questionnaire for Romanian adults.

Methods

Kleimann’s version of a General Nutrition Knowledge Questionnaire, was translated and adapted to Romanian language, culture, and cuisine. The final format was developed in several steps and used four components: internal and external reliability were assessed in a general population sample (n1 = 412), respectively in a subgroup (n2 = 46) from Component 1; Component 3 assessed construct validity (n3 = 96) using the “known-groups” method; Component 4 (convergent validity, n4 = 508) tested the association between socio-demographic characteristics and nutrition knowledge.

Results

The overall internal reliability was 0.878 and the external reliability was >0.880 in all sections, and overall. Specialists had higher scores than nonspecialists, with a very large effect size. In the general population, females scored higher than males, and middle-aged and older adults scored higher than young adults. Higher scores were associated with higher levels of education. The characteristics of individuals prone to giving wrong answers were: males (beta = 0.170), high school or less (beta = 0.167), and no training in nutrition (beta = 0.154).

Conclusions

The Romanian version of the General Nutrition Knowledge Questionnaire is a reliable and valid tool for measuring nutrition knowledge in adults.

Australian team sports athletes prefer dietitians, the internet and nutritionists for sports nutrition information

AIM

To evaluate the information sources that are used and preferred by Australian athletes and to assess if preferences influence nutrition knowledge (NK).

METHODS

Elite and non-elite Australian team sport athletes, playing Australian football (AF), cricket, lawn bowls, soccer or hockey, were recruited via the sporting organisations' qualified sports dietitians or club presidents. Athletes completed one of two online, validated sports NK questionnaires. Frequency analysis on previous sources of advice, preferred sources of information and preferred type of support were assessed. Differences in NK scores (%) based on previous sources of dietary advice and preferences for obtaining information were assessed using t test or Mann-Whitney U test.

RESULTS

Demographic and information source questions were completed by 410 athletes; 331 also completed NK questions. Athletes were mostly non-elite (76%) and AF players (79%). Forty-four per cent of athletes reported having previously received advice from a dietitian. Twenty per cent, 19% and 16% of athletes chose "dietitian," "internet" and "nutritionist" as their preferred source of nutrition information, respectively. Athletes preferred information on sports nutrition (35%), individual consultations (33%), and information on general healthy eating (33%), over cooking classes (4%) and group presentations (3%). There were no significant associations between preferred and previous information sources and NK scores.

CONCLUSIONS

Australian athletes prefer dietitians, the internet and nutritionists for sports nutrition information. There is an interest in and need for access to a qualified sports dietitian and reputable internet-based nutrition information. Education programs and advice given to athletes need to be evaluated.

Modifications to the nutrition for sport knowledge questionnaire (NSQK) and abridged nutrition for sport knowledge questionnaire (ANSKQ)

New evidence and feedback from colleagues have led to modifications to the Nutrition for Sport Knowledge Questionnaire (NSKQ) and Abridged Nutrition for Sport Knowledge Questionnaire (ANSKQ). The changes predominately affect questions regarding the nutrient content of foods, protein recommendations and the legality of supplements. Some English language edits have also been made.

Changes in Sport Nutrition Knowledge, Attitudes/Beliefs and Behaviors Following a Two-Year Sport Nutrition Education and Life-Skills Intervention among High School Soccer Players

The purpose of this study was to examine the impact of a sport nutrition education and life-skills intervention on sport nutrition knowledge (SNK), attitudes/beliefs and dietary behaviors relevant to sport nutrition among high school (HS) soccer players. Three assessments were done over the 2-year intervention (baseline = time 1, end year 1 = time 2, end year 2 = time 3). Participants (n = 217; females = 64%; Latino = 47.5%; 14.9 ± 0.9-year; 46.5% National School Breakfast/Lunch Program) were assigned to an intervention group (IG, n = 153; 9 schools) or comparison group (CG, n = 64; 4 schools) based on geographical location. Differences over time were examined based on group, sex, socioeconomic status (SES) and race/ethnicity. The IG increased SNK scores by ~10% (time 1 = 51.6%; time 3 = 60.9%; p ≤ 0.001), with the greatest change in the female IG vs. CG and no differences in male IG vs. CG. Daily breakfast consumption was 53.7% in both groups. IG players were 3 times more likely (95%CI = 2.59, 7.77) to report trying to eat for performance (IG = 48.7% vs. CG = 30.2%). By time 3, IG players were less likely to report that 'diet met nutritional requirements' (31.6%) compared to CG (47.6%). For IG, the consumption of lunch (≥5-days/week) did not change (92.2⁻93.4%), but declined in the CG (90.6%) (p = 0.04). No other differences by sub-population (race/ethnicity, SES) were observed. Our findings indicate that HS athletes are motivated to learn and improve diet behaviors, and benefit from team-based nutrition interventions. Future interventions should consider delivery of curriculum/experiential learning during a defined training period, with messages reinforced with supports at home, school and athletic settings.