Assessing Nutritional Adequacy, Essay Example

Critique of “Comparison of Strategies for Assessing Nutritional Adequacy in Elite Female Athletes’ Dietary Intake” by Susan Heaney, Helen O’Connor, Janelle Gifford and Geraldine Naughton (2010).

Nutritional adequacy is essential for good health of all living beings, and more in athletes, whose bodies are subject to stresses and strains in the pursuit to excel in their particular disciplines. Although every person, including athletes are by nature conscious of the merits of a properly balanced diet, whether the food they take is well balanced and appropriate according to nutritional demand of the body can only be accessed by an expert. Heaney et al, 2010 have attempted to identify the best methodologies and strategies essential to assess nutritional adequacy in elite, female, Australian athletes. In this study, they have chosen 72 athletes from various disciplines from within Australia who were subjected, with prior consent; to a questionnaire based collection of information which the authors’ decided was an optimal method for the assessment of their nutritional status.

The authors’ have built up the basis for their study citing the well researched and reported inadequacy of dietary intake by athletes as determined by dietary reference recommendations standardized by various authorities in different parts of the globe. Nutrient Reference Values (NRV), prevalent in New Zealand & Australia, and Dietary Reference Intakes (DRI) of US & Canada have been cited as the recommending authorities for determining nutrition standards, and EAR (Estimated Average Requirement); RDI/A (Recommended Dietary Intake/Allowance) for various nutrients are the units earmarked for determining standardized intake for a healthy population. The authors’ have however been tentative in blindly accepting these standards on the ground that nutrition is a matter which is highly influenced by multivariate factors and individual variations. For persons subject to additional stresses and strains, for example those serving in the military as well as athletes undergoing strenuous training, the EAR and RDI figures for various classes of nutrients are well above the recommended figures for normal people and appropriate overages/adjustments have been recommended for them.

Before undertaking the study proper, the authors have discussed the confounding factors which might interfere with their intended results in great detail. Enumerating the challenges in estimating nutrient intake in individuals, and particularly in athletes, the authors have identified difficulties such as variability in the nutrient content of foodstuffs, portions of particular types of foods actually taken, obsession of some athletes about body image/physique and the correctness of the data collection and evaluation methods.The authors have also discussed the difficulties in selecting the most appropriate method for dietary assessment. Citing ‘Seven-Day weighed-food Diaries’ as the gold standard for such an evaluation, the authors’ have decided against using this protocol due to the variation in intake across weeks of rigorous training in athletes, which might lead to misleading data. After an elaborate explanation about the various nuances of numerous dietary assessment methodologies’, the authors’ finally decided that the ‘Food-frequency questionnaire’ (FFQ) was the most appropriate method to be used for this study due to its past use and acceptance as an ideal mode of dietary analysis for athletes. Accordingly, a modified version of the original FFQ, prepared by the Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, was used for this study.

The major flaw in the FFQ based study design is that researchers have relied totally upon the integrity and honesty of the participants. The long period of the study may in fact interfere with the input of proper responses due to seasonal variations in foodstuffs. Moreover, at young ages food fads and likeability for certain type of food are dictated by personal preferences. At the young age to which most of the participant women athletes belonged, the responses to the administered questionnaire might be affected by personal comprehension limitations. Ideally, the proper food intake history is revealed better by getting information from those responsible for sourcing and preparing the meals for the athletes. Moreover, athletes from different games were selected and the number in each group is not large enough to detect variations in the level of stress they might have been exposed to. By their own admittance, the authors have informed that the gold standard for such a study is the food diaries analysis, which should have ideally been used. Randomization was not considered and blinding of the participants was not done which might have resulted in biased inputs by athletes, as they were aware of the study in advance.Moreover, it has been observed that such young athletes and particularly women athletes are subject to eating disorders and exhibit wide variations in terms of attitude towards eating, usually needing interventions from the coaches and mentors responsible for their training (Heffner etal, 2003).Women athletes at such young ages are usually not aware of their nutritional requirements and usually need educational interventions to put them on the right path (Abood et al, 2004). The awareness about the participants’ nutritional awareness was not determined prior to the study, which might have affected their input.

The title of the paper is also incongruent with the actual content. Instead of comparing strategies for assessing nutritional adequacy, the authors’ have gone into depth of elaborating the results of the FFQ study they conducted. They have stressed more on justifying the methodology they employed while relegating other well established methods for such an evaluation to a secondaryposition. They have delved deep into the statistical analysis of data to find out nutritional inadequacies in the participants instead of comparing the methodologies. They have therefore strayed from what their tagline suggests in the title.

The FFQs were self administered and aimed at collecting comprehensive details of the eating patterns of the participating athletes which included serving sizes of each type/category of the pre-identified popular foods, method of cooking/preparation as well as data for any supplements/additives consumed by the athletes. From the collected questionnaires’, information was gleaned, categorized and subjected to analysis employing an established dietary analysis program. Age and gender based sports nutrition recommendations were considered while analyzing the data. Appropriate statistical allowances were made for the analysis of specific micronutrients like Iron, etc. which might have escaped analysis if considered with general nutrients. As the participating athletes were all female, allowances were made keeping in view their propensity to need more iron and folate during menstruation. The data was analyzed using SPSS software, characterizing each category of information collected for analysis by the appropriate statistical tool. Average probabilities for inadequacy for specific classes and types of nutrients were determined for the final analysis.

The results revealed that the mean daily energy intake for the group was 10,551±3,836 kJ (kilojoules), with the protein, fat and carbohydrate, the major macronutrients’ distribution well within the prescribed standards of Australia public health guidelines. Athletes requiring higher energy intakes derived the excess primarily through fat intake, which exceeded the recommended standard by 8-10% in terms of the total energy intake. Alcohol intake was well below the prescribed minimal level of 20g per day for the eligible athletes (according to age). The authors’ have presented the analyzed data in easily comprehensible tabulated form. Participant characteristics have been tabulated according to game category and macronutrient intake has been shown for the different categories of athletes by calculating the percentage energy value of each macronutrient against the total energy intake. The tables have been well prepared and comparisons can be made at a mere glance. Variations existed in macronutrient intake levels in athletes from different disciplines with 30% of the athletes not meeting the recommended adequate protein intake level of 1.2 g/Kg/day, and 65% not meeting the recommended adequate carbohydrate intake of 5 g/Kg/day. Micronutrient intake was appropriate as per the RDI specifications except for folate, iron, vitamin D, Magnesium and Calcium. Probability estimate of inadequacy when calculated revealed the startling fact that folate reigned as the number one micronutrient which was inadequate in majority of the athletes. This may have repercussions on their normal health as well performance as women athletes need overages of this micronutrient due to their vulnerability. Other micronutrients found inadequate were iron, Calcium, Magnesium and Phosphorus. Intake of some essential vitamins was also found to be low.

The authors’ have expressed confidence in their research design and the derived results on the basis of elimination of numerous confounding factors which might have interfered if the traditional food diaries method had been used. The authors’ have been successful in discerning the inadequacies of macro as well as micronutrients as their data has been collected directly from a well designed FFQ which yielded elaborate information. They have been able to pinpoint the variations in athletes according to their specific games and energy requirements. Thereupon, this study has been suitable in pinpointing specific lacunae in the athletes’ dietary intakes according to games which can lead to appropriate recommendations for them to change their food habits.  However, by their own admittance, authors believe that certain biomarkers need to be assessed simultaneously in such a study to get more accurate results. Moreover individual variations between responses to the FFQs might have affected the results. Prior evaluation of athletes’ health before selection for such a study needs to be done. Existence of food allergies or history of disease in athletes needs to be considered before selection of the participants.

Take Home Message

The authors’ have provided an inroad into evaluation of nutritional inadequacy in athletes which needs to be strengthened by more comprehensive study design, involving healthcare professionals as well to yield better data for accurate analysis. Results from such analysis can be used for building nutritional plans for budding athletes.

Reference

Abood, D. A., Black, D. R., & Birnbaum, R. D. (2004). Nutrition Education Intervention for College Female Athletes,Journal of Nutrition Education & Behavior, 36(3), 135-139.

Heaney, S., O’Connor, H., Gifford, J. & Naughton, G (2010), Comparison of Strategies for Assessing Nutritional Adequacy in Elite Female Athletes’ Dietary Intake, International Journal of Sport Nutrition and Exercise Metabolism, Vol. 20, pp. 245-256

Heffner, J. L., Ogles, B. M., Gold, E., Marsden, K., & Johnson, M. (2003). Nutrition and Eating in Female College Athletes: A Survey of Coaches. Eating Disorders, 11(3), 209.