Effect of Nutrition Education on Energy Availability, Body Composition, Eating Attitude and Sports Nutrition Knowledge

The Effect of Nutrition Education Sessions on Energy Availability, Body Composition, Eating Attitude and Sports Nutrition Knowledge in Young Female Endurance Athletes

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 hours per week (n=83).

Study Overview

• Status: Completed
• Conditions: Relative Energy Deficiency in Sport
• Intervention / Treatment: Behavioral: Nutrition education

Detailed Description

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 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 thorough 3-day food records, while exercise energy expenditure was assessed using 3-day activity logs. All of the questionnaires were repeated after a 6-months period.

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 has 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.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Sarıyer
    • Istanbul, Sarıyer, Turkey
      • Baltalimanı Research and Training Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Non-contraceptive using Competitive female endurance athletes 14-18 years of age training minimum 6 hours a week not taking a break from sports for more than 3 months due to injury

Exclusion Criteria:

Pregnancy or planned pregnancy chronic diseases (e.g. diabetes, crohn's disease, thyroid dysfunction) Use of any medication that may disturb hormonal balance

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Nutrition education intervention group; Nutrition education was comprimised of 6 physical face to face 60 minutes sessions which was given every week in a school class. Each session was consisted of a different subject including energy metabolism in sport, energy balance, nutrition before and after training, low energy availability, macro and micronutrients, hydration and supplements. Participants also got written information as a printed booklet in order to be able to take notes under sessions and review after the sessions.	Behavioral: Nutrition education; Fifty participants took 6 physical nutrition education lectures and the other group (n=33) didn't have any nutrition education. Nutrition education was comprimised of 6 physical face to face 60 minutes sessions which was given every week in a school class. Each session was consisted of a different subject including energy metabolism in sport, energy balance, nutrition before and after training, low energy availability, macro and micronutrients, hydration and supplements. Participants also got written information as a printed booklet in order to be able to take notes under sessions and review after the sessions.
No Intervention: Control group; Control group has not taken any nutrition education but has been filled all of the questionnaires, acitivity logs and food diaries.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Energy Availability	Energy availability (EA) is described as the amount of energy left over and available for proper organism functions after the energy used for exercise is subtracted from the calories taken in the diet, by American College of Sports Medicine. It is shown that the young athletes often fail to follow the recommended dietary guidelines for their sport and activity level. Therefore that poses risk for low energy availability (LEA) EA below 30 kcal/kg FFM was considered to be low EA, EA between 30-45 kcal/kg was considered to be reduced and EA>45 kcal/kg was considered to be optimal.	6 months
Low Energy Availability Questionnaire (LEAF-Q)	The 25-item LEAF-Q was used to assess the risk of LEA. The LEAF-Q has been validated in female athletes aged 18-39 training ≥5 times/week, with findings producing an acceptable sensitivity (78%) and specificity (90%) to classify current energy availability[28]. Consistent with the original validation study players completed a paper version of the LEAF-Q to ensure validity and reliability were maintained. Scoring was based on the original validation study, with those who scored ≤7 being classified as 'not at risk' of LEA, and those who scored ≥8 being classified as 'at risk' of LEA[28].	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sports nutrition knowledge questionnaire (SNKQ)	Players completed the 88-item Sports Nutrition Knowledge Questionnaire (SNKQ) at pre and post intervention.The SNKQ has been assessed for validity (content and construct) and reliability (test-retest), with findings indicating a high construct validity and good test-retest concordance and therefore suitability to be used to determine sports nutrition knowledge. The SNKQ consists of five sub-sections (general nutrition concepts, fluid, recovery, weight control and supplements). One point was awarded for each correct answer, and an 'unsure' or incorrect response received zero points. The scores for each subsection and total score were calculated based on the number of questions answered correctly with a maximum total score of 83.	6 months
Eating Atittude Test (EAT-26)	EAT-26 has been used to assess eating disorder risks in many populations, including athletes. As recommended by the developers of the EAT-26 tool, scores of 20 or above on the EAT-26 assessment indicated eating disorder behaviors. Scores falling below 20 were assessed as low risk for eating disorder behaviors	6 months
Dietary intake	The mean daily intake of energy, macronutrients and some of the micronutrients over the three days (two weekdays, one weekend) was calculated. Participants used household measures to estimate intake. Dietary intake data was entered into BEBIS 6.1 nutrition analysis program. (Beslenme Bilgi sistemi, Turkey) Daily energy, protein, carbohydrate, fat and fiber intake was compared with the values reported in the current nutrition guidelines.	6 months
Exercise Energy Expenditure	Exercise energy expenditure (EEE) has been calculated according to the 3-day activity logs in the beginning of the season. Activity logs (including activity, exercise duration and rest periods) for resistance and any non-club based activities under 3 days were completed and assigned a Metabolic Equivalent (MET) value from the compendium of physical activities	6 months
Fat-free mass	at-free mass (FFM) is the primary determinant of TEE in all age groups.	6 months
Body Mass Index (BMI)	Body mass index (BMI) is a person's weight in kilograms divided by the square of height in meters.Low BMI was defined as BMI <18.5 kg/m2 as recommended when screening athletes for risk of LEA.	6 months
Basal metabolic rate (BMR)	he amount of energy expended while at rest in a neutrally temperate environment, and in a post-absorptive state (meaning that the digestive system is inactive, which requires about 12 hours of fasting)	6 months
Fat mass	Body fat can be predictor for eating disorder risk status.	6 months

Collaborators and Investigators

• Sponsor: Medipol University
• Investigators: Principal Investigator: Cansu T Akman, MS, Medipol University

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2019
• Primary Completion (Actual): September 1, 2019
• Study Completion (Actual): March 28, 2020

Study Registration Dates

• First Submitted: October 30, 2023
• First Submitted That Met QC Criteria: November 2, 2023
• First Posted (Actual): November 3, 2023

Study Record Updates

• Last Update Posted (Actual): March 15, 2024
• Last Update Submitted That Met QC Criteria: March 12, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Feeding and Eating Disorders; Relative Energy Deficiency in Sport
• Other Study ID Numbers: E.8234/196

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No