Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs)

Fahrenholtz, Ida Lysdahl; Melin, Anna; Garthe, Ina; Hollekim-Strand, Siri Marte; Ivarsson, Andréas; Koehler, Karsten; Logue, Danielle M.; Lundström, Petra; Madigan, Sharon M.; Wasserfurth, Paulina; Torstveit, Monica Klungland

doi:10.3390/nu15051082

Cited by 11 publications

(14 citation statements)

References 74 publications

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“…Despite a tailored curriculum, one-on-one sessions partnered with group lectures did not consistently improve dietary habits in adult athletes [43]. More recently, a 16-week intervention of weekly online lectures and nutrition counselling every second week improved sports nutrition knowledge and suggested weak evidence for improved sports nutrition behaviour in female endurance athletes with symptoms of Relative Energy Deficiency Syndrome [44]. Athletes in the current study ranked their preference for solely online delivery of NE as low.…”

Section: Format and Facilitator Preferencescontrasting

confidence: 61%

Athlete Preferences for Nutrition Education: Development of and Findings from a Quantitative Survey

et al. 2023

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Nutrition education (NE) is one of several strategies aimed at enhancing the dietary intake of athletes. This study investigated NE preferences of New Zealand and Australian athletes competing nationally and internationally. Athletes (n = 124, 22 (18, 27) years, female 54.8%) from 22 sports completed an online survey, with responses analysed using descriptive statistics. Teaching techniques considered ‘extremely effective’ were life examples (47.6% of athletes), hands-on activities (30.6%), and discussions with a facilitator (30.6%). Setting personal nutrition goals was important to most athletes (83.9%), along with two-way feedback with a facilitator (75.0%). General nutrition topics considered ‘essential’ were energy requirements (52.9%), hydration (52.9%), and nutrient deficiencies (43.3%). Performance topics considered ‘essential’ were recovery (58.1%), pre-exercise nutrition (51.6%), nutrition during exercise (50.0%), and energy requirements for training (49.2%). Athletes preferred a ‘combination of in-person group and one-on-one sessions’ (25% of athletes), ‘one-on one sessions’ (19.2%) and ‘in-person group sessions’ (18.3%), with only 13.3% interested in ‘exclusively online delivery’. Sessions of 31–60 min (61.3% of athletes) held monthly (37.5%) and undertaken with athletes of the same sporting calibre (61.3%) were favoured by the participants. The preferred facilitator was a performance dietitian or nutritionist (82.1% of athletes), who had knowledge of the sport (85.5%), experience in sports nutrition (76.6%), and credibility (73.4%). This research provides novel insights into the factors that need to be considered when designing and implementing nutrition education for athletes.

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Section: Format and Facilitator Preferencescontrasting

confidence: 61%

Athlete Preferences for Nutrition Education: Development of and Findings from a Quantitative Survey

et al. 2023

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“…For example, less than half of coaches and physicians surveyed were able to identify the three components of the female athlete triad147 148 150 151; other studies reported similar knowledge gaps among physiotherapists and athletic trainers 142 145. Short-term education programmes, using various delivery methods and focusing on factors associated with EDs, DE behaviours, and REDs have been shown to improve nutritional knowledge and reduce signs of dieting and body image concerns in female and male athletes 70 152–158. Furthermore, early identification of symptoms using screening instruments, individual health interviews and objective assessment of REDs biomarkers may be useful as secondary prevention 25.…”

Section: Introductionmentioning

confidence: 99%

2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Mountjoy,

Ackerman,

Bailey

et al. 2023

Br J Sports Med

110

113

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Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee’s expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

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“…Indeed, habits may take more than sixteen weeks to change ( 61 ) and we have previously emphasized the complexity of improving eating habits in this group of athletes ( 36 ). Since the increase in energy intake was modest among FUEL athletes (138 ± 453 kcal/day, corresponding to an increase of only 5%) ( 36 ), it may have been insufficient for improving REDs related symptoms in some of the athletes.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the FUEL intervention group completed a 6- and 12-months follow-up answering the LEAF-Q, the EDE-Q, and the EAI. Other assessments included in the study, including diet and training log, has previously been described and analyzed ( 36 ).…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, motivation, enabling, and supporting athletes have been identified as additional components necessary for changes in nutritional behavior ( 33 ). We have previously reported strong evidence for improved sports nutrition knowledge along with weaker evidence for increased energy intake in female endurance athletes with risk of REDs after a 16-week sports nutrition intervention, consisting of online sports nutrition lectures combined with individual athlete-centered nutrition counseling (the FUEL study) ( 36 ).…”

Section: Introductionmentioning

confidence: 99%

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Short-term effects and long-term changes of FUEL—a digital sports nutrition intervention on REDs related symptoms in female athletes

Fahrenholtz,

Melin,

Garthe

et al. 2023

Front. Sports Act. Living

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Female endurance athletes are at high risk for developing Relative Energy Deficiency in Sport (REDs), resulting in symptoms such as menstrual dysfunction and gastrointestinal (GI) problems. The primary aim of this study was to investigate effects of the FUEL (Food and nUtrition for Endurance athletes—a Learning program) intervention consisting of weekly online lectures combined with individual athlete-centered nutrition counseling every other week for sixteen weeks on REDs related symptoms in female endurance athletes at risk of low energy availability [Low Energy Availability in Females Questionnaire (LEAF-Q) score ≥8]. Female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47) were recruited. Fifty athletes with risk of REDs (LEAF-Q score ≥8) and with low risk of eating disorders [Eating Disorder Examination Questionnaire (EDE-Q) global score <2.5], with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a sixteen-week control period (n = 18) (CON). All but one completed FUEL and n = 15 completed CON. While no evidence for difference in change in LEAF-Q total or subscale scores between groups was detected post-intervention (BFincl < 1), the 6- and 12-months follow-up revealed strong evidence for improved LEAF-Q total (BFincl = 123) and menstrual score (BFincl = 840) and weak evidence for improved GI-score (BFincl = 2.3) among FUEL athletes. In addition, differences in change between groups was found for EDE-Q global score post-intervention (BFincl = 1.9). The reduction in EDE-Q score remained at 6- and 12- months follow-up among FUEL athletes. Therefore, the FUEL intervention may improve REDs related symptoms in female endurance athletes.Clinical Trial Registrationwww.clinicaltrials.gov (NCT04959565).

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Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs)

Cited by 11 publications

References 74 publications

Athlete Preferences for Nutrition Education: Development of and Findings from a Quantitative Survey

Athlete Preferences for Nutrition Education: Development of and Findings from a Quantitative Survey

2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Short-term effects and long-term changes of FUEL—a digital sports nutrition intervention on REDs related symptoms in female athletes

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