Dietary Intake of Athletes Seeking Nutrition Advice at a Major International Competition

International travel and short-term residence overseas is now a common feature of an elite athlete's competition schedule, however, food choice away from home may be challenging and potentially impact on performance. Guidelines for dietary intake speci c to competition exist for athletes, however, there is little evidence available to ascertain if athletes meet these recommendations during competition periods, particularly when food is provided in-house. During the Delhi 2010 Commonwealth Games, dietitians based in the dining hall recorded 24 h dietary recalls with all athletes who visited the nutrition kiosk. Analysis of dietary intake was conducted with FoodWorks (Xyris Pty Ltd., Brisbane, Australia). Overall, athletes reported consuming a median total daily energy intake of 8674 kJ (range 2384–18,009 kJ), with carbohydrate within the range of 1.0–9.0 g per kg of bodyweight (g/kg) (median = 3.8) and contributing to 50% total energy (TE) (range 14%–79%). Protein and fat intake ranged from 0.3–4.0 g/kg (median = 1.7) to 10–138 g (median = 67 g), and contributed to 21% TE (range 8%–48%) and 24% TE (range 8%–44%), respectively. Athletes reported consuming between 4 and 29 different food items (median = 15) in the previous 24 h period, with predominately discretionary, grains/cereals, meats, poultry, sh, eggs, and meat alternative items. This suggests that dairy, fruit, and vegetable intake may be suboptimal and intake of the micronutrients iron, zinc, calcium, and vitamins A and C may be of concern for a number of athletes. Keywords:dietary intake; athlete; international competition 1. Introduction International travel and short-term residence overseas is now a common feature of an athlete's competition schedule, however, differing eating arrangements and food options when away from home may in uence an athlete's food choice, and potentially their performance. An athlete needs to consume suitable food and uid prior to,

a number of athletes. Keywords:dietary intake; athlete; international competition 1. Introduction International travel and short-term residence overseas is now a common feature of an athlete's competition schedule, however, differing eating arrangements and food options when away from home may in uence an athlete's food choice, and potentially their performance. An athlete needs to consume suitable food and uid prior to, during, and after competition in order to maximise performance [1,2]. While sport-speci c recommendations exist for athletes to ensure that they consume suf cient total energy (TE) to meet requirements, carbohydrate (CHO) to replenish glycogen stores, protein to aid in muscle repair and growth, as well as uid to stay adequately hydrated [1,3–9], very little evidence is available to ascertain if athletes meet these recommendations in residence during major international competitions. While appropriate nutrition is important for performance, investigation into the dietary intake of high performance athletes is limited. Although there appears to be considerable individual variability in dietary intake, the majority of studies to date show that athletes tend on average to meet current evidence-based recommendations for protein, but not CHO [10–14]. This is particularly evident in females [15]. A number of studies have reported that TE intake may also be below expected requirements [14,16,17]. However, these studies are limited by the dif culties experienced when attempting to accurately measure dietary intake. Discrepancies exist between methods of data collection (for example a 24 h recall vs. 7 days weighed food diaries), whether the athlete is in Nutrients2016,8, 638; doi:10.3390/nu8100638

Nutrients2016,8, 638 2 of 14 a competition or training phase (or a combination of both), if the athlete is living at home or in a training camp, differing physiological requirements (e.g., strength and power athletes vs. endurance athletes), level of competition, and specific behaviours that may be associated with a particular sport (e.g., methods to make weight in weight-category sports). Assessing dietary intake is further made difficult by the practice of underreporting, where individuals report consuming less food than actual intake [18]. Additionally, the majority of research on dietary intake in athletic populations primarily focuses on quantifying dietary intake in regards to energy and macronutrient content; however, this does not guarantee that the athlete is selecting foods that contribute to a high quality diet. Diet quality is a concept based on the variety and type of foods in an entire diet, the relationship between health status and food groups, and is usually assessed by comparison to national dietary guidelines or similar, and the diversity of choices apparent within the diet [19]. To date, very little research on diet quality within the athletic population exists, with the exception of a comparison of the diets of a select group of Polish athletes to the Swiss Food Pyramid. This study found that athletes did not meet the recommendations for a number of food groups within the food pyramid guide [20]. Suf cient variety of foods from all core food groups is not only important for sports performance; it is often indicative of micronutrient intake and thus linked to prevention of de ciency and decreased risk of chronic disease [21], and therefore warrants investigation. While literature to date provides some information on dietary intake of athletes during both training and competition phases, limited data is available regarding intake while in residence at international competition events. At major events such as the Olympic (OG) and Commonwealth Games (CG), the majority of athletes and their support team live in a village residence and dine in a large communal dining hall. An extensive range of food is provided free of charge, 24 h a day, for the

is available regarding intake while in residence at international competition events. At major events such as the Olympic (OG) and Commonwealth Games (CG), the majority of athletes and their support team live in a village residence and dine in a large communal dining hall. An extensive range of food is provided free of charge, 24 h a day, for the duration of the competition. While recent data shows that athletes attending these events are generally satis ed with the food provided [22,23], data on actual dietary intake is limited. Only one study has investigated the types of diets (regimens) that are followed by these athletes [24]. Apart from records collected in 1949 [25] and 1964 [26], the most recent and relevant data on dietary intake in this type of environment was collected at the Sydney 2000 OG [23]. This data on apparent consumption within the dining hall suggested that athletes were consuming on average 592 g of carbohydrate (46% TE and on average 7–10 g/kg BM), 202 g (16% TE) of protein and 197 g (35% TE) of fat daily [23], however, no data on individual consumption was collected. Additionally, no data is available on the variety of foods consumed. Therefore, the aim of this research was to describe the self-reported food and dietary intake of athletes who sought professional guidance in regards to their competition diet immediately prior to or during competition at a major international competition. 2. Materials and Methods 2.1. Data Collection Australian dietitians (n= 4) based at the main dining hall nutrition kiosk at the Delhi 2010 Commonwealth Games recorded consultations with athletes who requested assistance with their competition dietary intake from 23 September to 14 October 2010. Athletes were asked to provide demographic details including gender, sport (and event if appropriate), country representing, country of birth, and highest level of education (no schooling, primary/middle school, senior school, or University or other tertiary institution). Information about past experience at similar events, stage of competition (more than 2 days before event, day before event, day of event, between events, or event completed) and previous nutrition support was

gender, sport (and event if appropriate), country representing, country of birth, and highest level of education (no schooling, primary/middle school, senior school, or University or other tertiary institution). Information about past experience at similar events, stage of competition (more than 2 days before event, day before event, day of event, between events, or event completed) and previous nutrition support was also collected. Athletes were asked to report if they had a nutrition competition plan to follow speci cally for this event. Dietitians also recorded the purpose of the athletes visit to the kiosk (e.g., weight loss/making weight, weight gain, training or performance nutrition, and clinical issues such as food intolerance/allergy). The dietitian then collected a recall of quantity and timing of all food, uids and supplements consumed by the athlete over the previous 24 h period on a standard proforma, and veri ed intake

Nutrients2016,8, 638 3 of 14 of all food groups from a provided checklist as per the USDA ve-step multiple pass method [27]. General questions about usual intake as per standard diet history were collected. The 24 h recall template was piloted and reviewed by a panel of expert dietitians prior to use at this competition. This was based on a similar template used in other settings [28]. Upon completion of the interview, dietitians were asked to subjectively rate the athlete regarding their expert opinion of the athletes' dietary intake and nutrition knowledge on a Likert scale of 1 (very poor) to 5 (very good). 2.2. Data Analysis Participants were classi ed into a sport category (power/sprint, weight category, endurance, racquet, skill, and team) based on the physiological requirements of their sport, and a region/country (western: Including Australia and the British Isles, and non-western: Africa, Caribbean, India and Sri Lanka, and Southeast Asia and the Paci c Islands) based on location and cultural style of eating [22]. Athletes were also grouped based on the reason for requesting advice at the kiosk including: General weight loss and making weight, weight gain, performance/training nutrition, and clinical issues (for example, food allergy/intolerance, gastrointestinal issues). The 24 h recall data was coded and input into FoodWorks Premium Edition (Version 7, Xyris software, Brisbane, Australia 2013) (FoodWorks) by the primary researcher. Foods consumed within the dining hall were matched to the nutritional analysis for the speci c menu items that had previously been coded in FoodWorks. If not consumed from the menu, the item was coded against the most appropriate matching food. As FoodWorks is a database of Australian and New Zealand foods, items were coded into the 2013 Australian Dietary Guidelines (ADG) ve core food groups (1) Grains—grain and cereal based foods; (2) Vegetables—vegetables and legumes/beans; (3) Fruit; (4) Dairy—milk, yoghurt, cheese and/or alternatives; (5) Meat and alternatives—lean meats, poultry, sh, eggs, tofu, nuts and seeds) and discretionary foods [21] for the analysis of diet variety (number of choices from each group). Discretionary foods were de ned as per the ADG as containing high amounts

groups (1) Grains—grain and cereal based foods; (2) Vegetables—vegetables and legumes/beans; (3) Fruit; (4) Dairy—milk, yoghurt, cheese and/or alternatives; (5) Meat and alternatives—lean meats, poultry, sh, eggs, tofu, nuts and seeds) and discretionary foods [21] for the analysis of diet variety (number of choices from each group). Discretionary foods were de ned as per the ADG as containing high amounts of saturated fat, added sugars and/or salt, and alcohol (for example, potato chips, biscuits, pizza and fried foods) [21]. Some items were coded as both discretionary and a core food due to the contribution of macro- and micronutrients to the athlete's diet. For example, a number of discretionary foods were included in the calculation of the main food groups. Cakes/biscuits (n= 11), pizza (n= 6), Coco-pops™ (n= 2), and a muf n (n= 1) were included in the calculation of the grains group, as the predominant ingredient is a cereal grain and thus are a source of CHO. All data were cross-checked to ensure consistency and accuracy of coding. Data were further coded and input into IBM SPSS Statistics (Version 21, IBM Corp., Armonk, NY, USA, 2012) for analysis. Data associations were calculated with the Kruskal–Wallis test, Mann–Whitney Utest, independentttest or ANOVA, depending on normality of data. Statistical signi cance was considered to bep 0.05 a priori. Results on nutrient intake are presented as median and range of g per kg of bodyweight (g/kg) and as a percentage of total energy intake (% TE). Micronutrient results were compared to the estimated average requirement (EAR), which is the “daily nutrient level estimated to meet the requirements of half the healthy individuals in a particular life stage and gender group” [29] or adequate intake (AI) which is the average daily nutrient intake level based on observed or experimentally-determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate [29]. Each athlete's 24 h recall data was also compared to recommendations [3–7,9,30] for CHO, protein, and fat intake, speci c to type of sport and demographic information (for example, height, weight, age,

level based on observed or experimentally-determined approximations or estimates of nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate [29]. Each athlete's 24 h recall data was also compared to recommendations [3–7,9,30] for CHO, protein, and fat intake, speci c to type of sport and demographic information (for example, height, weight, age, and gender). Diet variety and dietitians' rating of dietary intake and nutrition knowledge is presented as a median score and range. 2.3. Ethical Approval Ethical approval was granted by the University of the Sunshine Coast Human Ethics Committee (A/10/253). Participation was voluntary and participants were considered to have given consent to participate by taking part in a consultation.

Nutrients2016,8, 638 4 of 14 3. Results 3.1. Participant Characteristics A total of 44 athletes completed a 24 h dietary recall at the nutrition kiosk, representing 1% of the total number of athletes who competed at this event (n= 4352). However, not all athletes reside in the village, eat within the dining hall, and thus have access to the nutrition kiosk. This cohort was the entire sample of athletes that sought dietary advice. Athletes were predominately from non-western regions and reported competing in 13 speci c sports (Table). Over half of the athletes reported being in a precompetition stage (n= 30, 68%), with the majority of these athletes greater than 2 days away from competition (n= 28, 82%). The mean self-reported body weight of the male and female athletes was 74 kg (range 56–113 kg) and 65 kg (range 49–101 kg), respectively. Six athletes (14%) reported that they had received nutrition education prior to attending this event. While four athletes (10%) reported having a competition plan to follow, only two of these reported nutrition education prior to this event. 3.2. Dietary Intake and Eating Behaviours Overall, athletes reported consuming a median total daily energy intake of 8674 kJ (range 2384–18,009 kJ), with CHO within the range of 1.0–9.0 g/kg (median = 3.8 g/kg) and contributing to 50% TE (range 14%–79%). Protein intake ranged from 0.3 to 4.0 g/kg (median = 1.7 g/kg) and contributed to 21% TE (range 8%–48%), while total fat intake ranged from 10 to 138 g (median = 67 g) and contributed to 24% TE (range 8%–44%). Dietary intake varied according to reason for requesting assistance at the kiosk and gender of athletes (Table). Those competing in racquet ( n= 6) and power/sprint sports (n= 9) reported consuming the greatest energy (median = 11,298 kJ, range 7032–13,485 kJ and 10,149 kJ, range 2472–18,009 kJ, respectively). Athletes competing in skill and power/sprint sports reported consuming the highest protein intake (median = 1.8 g/kg, range 1–3 g/kg, and median = 1.7 g/kg, range 0.5–4 g/kg, respectively), while athletes in team sports (n= 2) reported the lowest energy intake (median

consuming the greatest energy (median = 11,298 kJ, range 7032–13,485 kJ and 10,149 kJ, range 2472–18,009 kJ, respectively). Athletes competing in skill and power/sprint sports reported consuming the highest protein intake (median = 1.8 g/kg, range 1–3 g/kg, and median = 1.7 g/kg, range 0.5–4 g/kg, respectively), while athletes in team sports (n= 2) reported the lowest energy intake (median = 7274 kJ, range 5953–8596 kJ). Athletes in team (n= 2) and weight category sports (n= 13) reported the lowest contribution of energy from CHO (median = 2.5 g/kg, range 1.7–3.3 g/kg, 39% TE, and median = 3.0 g/kg, range 1.0–6.0 g/kg, 46% TE), while athletes competing in endurance sports (n= 4) reported consuming the lowest amount of fat (median = 51 g, range 35–72 g, 21% TE). There was no signi cant difference in nutrient intake between those in the pre-versus postcompetition phases. Three main meals were consumed by the majority of athletes (n= 23, 77%). Overall, the greatest median contribution to total energy intake was from breakfast (29%) to lunch (31%). Carbohydrate contributed a greater proportion to total energy at breakfast (56%) and to snacks (69%) than lunch and dinner. Protein contribution was predominately from meals consumed at lunch and dinner. Fourteen athletes reported consuming sports drinks as a snack, with these drinks contributing to over half of the TE consumed between meals. Five athletes reported not consuming any snacks in the precompetition period. The average contribution of macronutrients to the total daily intake was similar between genders (Table). Dietary analysis showed that 80% of all athletes did not meet the estimated average requirement (EAR) for at least one micronutrient in the previous 24 h, with 25% not meeting the EAR/AI for 5 or more nutrients. Greater than 80% of both genders did not meet the EAR for iron and phosphorus, and vitamin B1–B3 and vitamin C. A greater proportion of women and men did not meet the EAR for vitamin A and magnesium, and zinc respectively (Figure). Over two-thirds ( n= 39, 90.5%) did not meet the EAR for iron (female M = 13.66 mg, range 3.8–28;

80% of both genders did not meet the EAR for iron and phosphorus, and vitamin B1–B3 and vitamin C. A greater proportion of women and men did not meet the EAR for vitamin A and magnesium, and zinc respectively (Figure). Over two-thirds ( n= 39, 90.5%) did not meet the EAR for iron (female M = 13.66 mg, range 3.8–28; male M = 12.32 mg, range 4.2–25 mg). Overall,n= 22 (50%) reported using at least one type of supplement, with almost half (n= 19, 43%) of all athletes reporting the use of a vitamin or multivitamin supplement. Multivitamin supplements were not disclosed in the 24 h recall by any athletes, and therefore were not included in the calculation of dietary intake. Five athletes (11%) reported that they had been previously diagnosed with a nutrient de ciency (one from each of team, skill, power/sprint, weight, and endurance), of which 4 of these reported as iron de ciency anaemia (n= 1, unknown).

Nutrients2016,8, 638 5 of 14 Table 1.Demographic information of all athletes who took part in a 24 h recall. Demographic TOTAL n= 44 Gender Reason for Consultation @ Female n= 18 (41%) Male n= 26 (59%) Making Weight or Weight Lossn= 26 (59%) Weight Gain n= 4 (9%) Performance n= 9 (21%) Clinical # n= 5 (11%) Age (years) (M SD) 26.6 (8) 27.6 (10) 25.9 (7) 25.9 (7) 24 (9) 30.9 (9) 24 (9) Region * (n, %) Non-Western ˆ 36 (86) 14 (78) 24 (92) 26 4 9 2 Western $ 8 (14) 4 (22) 2 (8) - - - 3 Sport (n, %) ~ Endurance 4 (9) 2 (11) 2 (8) 2 - 1 1 Power/Sprint 9 (21) 7 (39) 2 (8) 6 - 1 2 Racquet 6 (14) 2 (11) 4 (15) 1 1 3 1 Skill 10 (23) 4 (22) 6 (23) 6 - 3 1 Team 2 (5) 2 (11) - 1 - 1 - Weight 13 (30) 1 (6) 12 (46) 10 3 - - Education (n, %) Middle/Senior School 7 (17) 2 (12) 5 (20) 4 1 - 2 Completed Senior School 17 (40) 6 (35) 11 (44) 12 1 4 - Attended University 18 (43) 9 (53) 9 (36) 9 1 5 3 Experience (n, %) First CG/OG 34 (79) 15 (83) 19 (73) 21 3 5 5 First athletes village 30 (70) 14 (78) 16 (62) 18 2 5 5 Previous nutrition assistance (n, %) 6 (14) 2 (12) 4 (16) 5 (20) 0 0 1 (20) * 2 responses unknown for region and level of education; # Clinical consultations included Coeliac disease, corn allergy, nut allergy and re ux; ˆ Bahamas, Bangladesh, Belize, Gambia, India, Kenya, Malawi, Sierra Leone, Sri Lanka, St Vincent, Tanzania, Tonga, Trinidad and Tobago; $ Australia, England, Falkland Islands, Guernsey; @ Proportions not calculated for region, sport, education or assistance as numbers in most categories are <10; ~ Endurance includes; athletic events 800 m and over, cycling and swimming distance events; Power/Sprint includes; athletic events under 400 m, athletic eld events and swimming sprint events;

This study analyzes dietary intake of athletes during the Delhi 2010 Commonwealth Games.