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

Study Overview
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Brief Summary
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In this study, we investigated the effect of series of nutrition education sessions given by a registered dietitian on energy availability, some anthropometric measurements, eating attitude and sports nutrition knowledge in young female endurance athletes (football, basketball, volleyball) aged 15-18 y (n=83) who train more than 10 hours per week.

Detailed Description
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Participants were divided into two groups. Fifty participants took 6 physical nutrition education lectures and the other group (n=33) didn't have any nutrition education. All of them filled the LEAF-Q (Low energy availability in athletes questionnaire), EAT-26 (Eating Attitude Test) and SNKQ (Sports Nutrition Knowledge Questionnaire). Energy and nutrient intakes were assessed based on 3-day food records. 3 days activity logs were analysed to measure exercise energy expenditure. All of the tests have been repeated after 6 months

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

Conditions
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Relative Energy Deficiency in Sport

Intervention / Treatment
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* Behavioral: Nutrition education


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Single Group Assignment
Interventional Model Description: A total of 83 adolescent female elite athletes from 3 different sport clubs (football n=34, basketball n=16 and volleyball n=33) between 15 and 18 years(mean 17.2 ± 2.0) were included in the study.They were divided into either the intervention or the control group. Fifty participants took 6 physical nutrition education lectures and the other group (n=33) didn't have any nutrition education. All of them filled the LEAF-Q (Low energy availability in athletes questionnaire),EAT-26(Eating Attitude Test)and SNKQ (Sports Nutrition Knowledge Questionnaire).Energy and nutrient intakes were assessed based on 3-day food records. Activity logs were analysed to measure exercise energy expenditure. All of the tests have been repeated after 6 months. Nutrition education was comprised of 6 physical 60 minutes sessions given every week in a school class. Each session was consisted of a different subject. Participants got written information as a printed booklet.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nutrition education intervention group<br>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<br>* 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.<br>|
| No Intervention: Control group<br>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?
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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 |