Do nutrition education interventions really embed what we want our athletes to know?

Your weekly research review

James Morehen

By Dr. James Morehen
January 31st, 2020 | 5 min read

Contents of Research Review

  1. Background & Objective
  2. What They Did
  3. What They Found
  4. Practical Takeaways
  5. Reviewer’s Comments
  6. About the Reviewer

Background & Objective

Many nutrition practitioners attempt to educate their athletes on better nutritional behaviours with the aim of improving health and enhancing athletic performance. However, the number of studies that have critically evaluated these interventions to understand their effectiveness on actually improving behaviours, health, and performance is questionable.

If an education intervention has not been assessed for success, then it is difficult for practitioners working with athletes to accurately say that what they are currently delivering is the right approach. The aim of this review was to identify the correct methods, timings, and approaches successfully to embed a nutrition education in athletes.

What They Did

In this systematic review, the search terms were: (but not limited to), nutrition knowledge, education, competitive athlete, behaviour change, and intervention. The inclusion criteria included:
⇒ Original research conducted on humans.

⇒ Interventions aimed at improving sport/general nutrition knowledge in athletes.

⇒ Use of nutrition knowledge assessment instrument producing quantitative score before/after intervention.

⇒ Available in English.

Athletes where defined as those who regularly engaged in sports at any level (recreational through to elite), all ages, male and females, and included those with physical (not intellectual) disabilities.

Following the inclusion/exclusion process from a potential 69,226 papers, only 32 manuscripts were selected which included a total of 36 experiential conditions.

What They Found

Overall, 41% of the manuscripts used a randomised control trial design with only 1 study being completed on elitelevel athletes competing professionally.

⇒ The most frequent topics covered were carbohydrates, fats, and proteins,
⇒ Each macronutrient was discussed regarding the roles of each with. adaptation, fueling, and recovery from training and competition, particular requirements for athletes and which food sources are best.

⇒ Most of the interventions were delivered face-to-face.

⇒ All in all, this resulted in a nutrition knowledge increase of 19.2 ± 1.6% between before and after interventions.

⇒ A single-arm pre-post design was utilised by 59% (19/32 studies) with the curriculum including hydration, as well as, carbohydrates, fats, and proteins. Similarly, the education was delivered face-to-face and resulted in an average knowledge increase after the intervention of 12.7 ± 0.8%.

⇒ In total, 27/32 studies significantly improved nutrition knowledge in athletes.

Practical Takeaways

Unfortunately, the range of education methods used makes it difficult to compare studies and determine which delivery method, including modality and dose, were most effective. With this in mind, practitioners should consider the audience they are trying to educate and the amount of time you have each week or month, to try and help formulate the best strategy for your scenario.

The use of different nutrition knowledge assessment instruments, most with limited validation or reliability testing, makes it difficult to directly compare the changes reported, and therefore, it is difficult for practitioners working in the applied settings to make inferences on these changes.

Reviewer’s Comments

“Reflecting back on my early career, I tried to deliver nutrition-specific education to team-sports athletes but with minimal success. I wonder now, was this due to the wrong intervention being put in place, or was it due to a lack of contact time with the athlete, was it due to not enough content in a way that the athlete best learned? It was probably a combination of all of these, and I think it is very important for nutritionists the spend the time planning and preparing how best to execute the education with their particular team or athlete. Understanding how a school dietician went through this approach is a great way to learn a little outside the box and is included in the podcast below. To be honest, no two strategies can be the same. If you are a full-time practitioner, you will have more available contact time for education compared to a practitioner that is on a 1 -day per week set-up.

An important observation is that most studies did not adjust for confounding variables, such as previous nutrition education. Therefore, how confident can the authors be that the change in nutrition education can be directly attributed to the intervention that they delivered, rather than previous athletes’ knowledge of nutrition already?
When embarking on an education intervention, I would recommend spending some time to think about the best way to evaluate and assess it after one season. This is something we are focusing really hard on in my role. Ultimately to understand the effectiveness of what we have delivered and also how we can improve our curriculum moving forward. A good example of this in athletics is included in the article and infographic below.”

Want to learn more?
Then check these out…

Read this article
Listen to this podcast
Look at this infographic

The full study can be read here.

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    James Morehen

    Dr. James Morehen

    Dr. James Morehen is a Performance Nutritionist for Bristol Bears Rugby Union. He is a SENr registered performance nutritionist and works privately with both elite athletes and individuals through his business Morehen Performance Ltd.

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