Janelle Gifford

Evaluation of general nutrition knowledge in elite Australian athletes

The aim of the present study was to investigate and benchmark the level of general nutrition knowledge in elite Australian athletes (EA) against a similar aged community (CM) and criterion sample with dietetic training (DT). EA (n 175), CM (n 116) and DT (n 53) completed the General Nutrition Knowledge Questionnaire (GNKQ), which assesses four domains (sections A-D) of general nutrition knowledge (section A: dietary guidelines; section B: sources of nutrients; section C: choosing everyday foods; section D: diet-disease relationships). Age, sex and education level were collected in all groups, and athletic calibre and sport type (team or individual) in EA. Dietitians and nutrition scientists (n 53) re-examined the GNKQ for content validity, resulting in instrument revision (R-GNKQ; ninety-six items). Psychometric assessment (internal consistency: Cronbach-α; test-retest: Spearman rank correlation) was performed in a sub-sample (n 28). Independent t tests, ANOVA and ANCOVA (χ² for categorical variables) were used to assess between-group differences. DT scored higher than EA and CM in all sub-sections and overall (P < 0·005). EA scored lower than CM in GNKQ for section B (P < 0·005) and overall (P < 0·005), and in R-GNKQ for section B (P < 0·005), section C (P < 0·005), section D (P = 0·006) and overall (P < 0·005). Overall score was influenced by age (P = 0·036 for GNKQ: P = 0·053 for R-GNKQ), sex (P = 0·016 for GNKQ: P = 0·003 for R-GNKQ) and athletic calibre (P = 0·029 for R-GNKQ only), but not level of education, living situation or ethnicity. EA and CM performed best on section A and worst on D. EA had lower overall general knowledge scores than CM. This was significantly influenced by age and sex.

Effect of drink temperature on core temperature and endurance cycling performance in warm, humid conditions

Abstract The aims of this study were to determine the effect of cold (4°C) and thermoneutral (37°C) beverages on thermoregulation and performance in the heat and to explore sensory factors associated with ingesting a cold stimulus. Seven males (age 32.8 ± 6.1 years, [Vdot]O2peak 59.4 ± 6.6 ml · kg−1 · min−1) completed cold, thermoneutral, and thermoneutral + ice trials in randomized order. Participants cycled for 90 min at 65%[Vdot]O2peak followed by a 15-min performance test at 28°C and 70% relative humidity. They ingested 2.3 ml · kg−1 of a 7.4% carbohydrate-electrolyte solution every 10 min during the 90-min steady-state exercise including 30 ml ice puree every 5 min in the ice trial. Absolute changes in skin temperature (0.22 ± 1.1°C vs. 1.14 ± 0.9°C; P = 0.02), mean body temperature (1.2 ± 0.3 vs. 1.6 ± 0.3°C; P = 0.03), and heat storage were lower across the 90-min exercise bout for the cold compared with the thermoneutral trial. Significant improvements (4.9 ± 2.4%, P < 0.01) in performance were observed with cold but no significant differences were detected with ice. Consumption of cold beverages during prolonged exercise in the heat improves body temperature measures and performance. Consumption of ice did not reveal a sensory response, but requires further study. Beverages consumed by athletes exercising in the heat should perhaps be cold for performance and safety reasons.

Towards an Understanding of the Barriers to Good Nutrition for Elite Athletes

The objective of this study was to describe barriers influencing dietary practices of elite-level athletes using a focus-group design involving discussions with elite-level athletes, coaches and sports dietitians. The participants were sixteen male and thirty female elite athletes from an Australian State Institute of Sport, representing diving, netball, basketball and lawn bowls; twelve elite coaches representing swimming, diving, soccer, sailing, cycling and golf; and sixteen sports dietitians who consulted to state institutes/academies of sport with various sports. Focus groups were audio-taped and transcribed with in-depth notes also recorded during the groups. Thematic coding of transcripts and notes were undertaken by the primary coder and these themes were subsequently evaluated by the research team. A number of barriers to healthy eating were described. Lack of time for food preparation was a significant barrier raised by all groups. Financial limitations, inadequate cooking skills and difficulty with living arrangements also rated high among all three groups. Coaches were concerned with excess body weight and fat levels and perceived an impact on sports performance. Athletes reported concern about body shape due to societal pressures. Sports dietitians and coaches were concerned with issues relating to optimal dietary provision surrounding travel to and from training and competition. A range of barriers influence the diet of athletes, in particular time and financial constraints in addition to specific physique requirements. Health professionals working with elite athletes need to be aware of these barriers when assessing dietary intake, or designing nutrition interventions. Dietitians may need to advocate on behalf of athletes to facilitate increased financial or professional support to assist athletes to choose and then maintain healthy diet practices.

Challenges and lessons from systematic literature reviews for the Australian dietary guidelines

In 2009-10 the Dietitians Association of Australia conducted a series of systematic reviews for the National Health and Medical Research Council to generate evidence statements to inform the revision of the Dietary Guidelines for Australians. In total 202 body of evidence statements were constructed and assigned a grading detailing the certainty with which each could be used to inform policy. This paper describes some of the challenges and insights gained from the process, specifically related to: study type, study quality assessment, the lack of quantified data, diet exposure, definition of a healthy population, generalisability and applicability, and resource allocation. It is clear that there is still a need for further refinement of the methods for evaluating evidence for nutrition policy, but the current dietary guidelines are now much more robustly evidence informed than ever before.

Validity of Dietary Assessment in Athletes: A Systematic Review

Dietary assessment methods that are recognized as appropriate for the general population are usually applied in a similar manner to athletes, despite the knowledge that sport-specific factors can complicate assessment and impact accuracy in unique ways. As dietary assessment methods are used extensively within the field of sports nutrition, there is concern the validity of methodologies have not undergone more rigorous evaluation in this unique population sub-group. The purpose of this systematic review was to compare two or more methods of dietary assessment, including dietary intake measured against biomarkers or reference measures of energy expenditure, in athletes. Six electronic databases were searched for English-language, full-text articles published from January 1980 until June 2016. The search strategy combined the following keywords: diet, nutrition assessment, athlete, and validity; where the following outcomes are reported but not limited to: energy intake, macro and/or micronutrient intake, food intake, nutritional adequacy, diet quality, or nutritional status. Meta-analysis was performed on studies with sufficient methodological similarity, with between-group standardized mean differences (or effect size) and 95% confidence intervals (CI) being calculated. Of the 1624 studies identified, 18 were eligible for inclusion. Studies comparing self-reported energy intake (EI) to energy expenditure assessed via doubly labelled water were grouped for comparison (n = 11) and demonstrated mean EI was under-estimated by 19% (−2793 ± 1134 kJ/day). Meta-analysis revealed a large pooled effect size of −1.006 (95% CI: −1.3 to −0.7; p < 0.001). The remaining studies (n = 7) compared a new dietary tool or instrument to a reference method(s) (e.g., food record, 24-h dietary recall, biomarker) as part of a validation study. This systematic review revealed there are limited robust studies evaluating dietary assessment methods in athletes. Existing literature demonstrates the substantial variability between methods, with under- and misreporting of intake being frequently observed. There is a clear need for careful validation of dietary assessment methods, including emerging technical innovations, among athlete populations.

Do Bodybuilders Use Evidence-Based Nutrition Strategies to Manipulate Physique?

Competitive bodybuilders undergo strict dietary and training practices to achieve an extremely lean and muscular physique. The purpose of this study was to identify and describe different dietary strategies used by bodybuilders, their rationale, and the sources of information from which these strategies are gathered. In-depth interviews were conducted with seven experienced (10.4 ± 3.4 years bodybuilding experience), male, natural bodybuilders. Participants were asked about training, dietary and supplement practices, and information resources for bodybuilding strategies. Interviews were transcribed verbatim and analyzed using qualitative content analysis. During the off-season, energy intake was higher and less restricted than during the in-season to aid in muscle hypertrophy. There was a focus on high protein intake with adequate carbohydrate to permit high training loads. To create an energy deficit and loss of fat mass, energy intake was gradually and progressively reduced during the in-season via a reduction in carbohydrate and fat intake. The rationale for weekly higher carbohydrate refeed days was to offset declines in metabolic rate and fatigue, while in the final “peak week” before competition, the reasoning for fluid and sodium manipulation and carbohydrate loading was to enhance the appearance of leanness and vascularity. Other bodybuilders, coaches and the internet were significant sources of information. Despite the common perception of extreme, non-evidence-based regimens, these bodybuilders reported predominantly using strategies which are recognized as evidence-based, developed over many years of experience. Additionally, novel strategies such as weekly refeed days to enhance fat loss, and sodium and fluid manipulation, warrant further investigation to evaluate their efficacy and safety.

Evaluation of an electronic tool to assess food label literacy in adult Australians: A pilot study

Aim This pilot study aimed to evaluate the food label literacy component of an electronic-Nutrition Literacy Tool (e-NutLiT) designed to assess nutrition literacy in adult Australians, and explore the influence of demographic factors. Methods Obese participants (OP) from an Australian obesity clinic and a criterion group of dietetic students (DS) from two Australian dietetic programs were recruited to complete the e-NutLit; OP also completed the ‘Newest Vital Sign’ (NVS), a health literacy screening tool. Construct validity was assessed by comparing scores from the two groups. Associations between demographic factors and e-NutLit scores were also explored. Results Sixty-one participants (OP: n = 32; DS: n = 29) completed the study. The total e-NutLit scores for OP was significantly lower than that of DS (71.9 ± 17.9%; 94.5 ± 5.6%, respectively: P = 0.01). Items requiring calculation of nutrient intake from the nutrition information panel (NIP) and interpreting endorsement logos were the worst performing sections on the e-NutLit in both OP (35.9%; 71.9%) and DS (86.2%; 75.8%). Adequate health literacy, indicated by an NVS ≥ 4, was strongly associated with higher scores on the e-NutLit in OP (P = 0.01). Level of education (≤year 10) and lack of engagement in food shopping were significantly associated with poorer competency on the e-NutLit (P < 0.05). Conclusions Comparison of scores indicated that construct validity was established on most items for participants with lower literacy. The e-NutLit identified specific weaknesses, such as nutrient calculations and interpretation of endorsement logos. This pilot study will help inform further development of the e-NutLit.

A Qualitative Investigation to Underpin the Development of an Electronic Tool to Assess Nutrition Literacy in Australian Adults

Nutrition literacy is linked to health via its influence on dietary intake. There is a need for a tool to assess nutrition literacy in research and dietetic practice. We sought guidance from nutrition professionals on topic areas and features of an electronic nutrition literacy assessment tool for Australian adults. 28 experienced nutrition professionals engaged in a range of nutrition and dietetic work areas participated in six focus groups using a semi-structured interview schedule. Data were analysed using an inductive approach using NVivo 10 (QSR International, Pty Ltd., Doncaster, Australia, 2012). Key areas identified to assess nutrition literacy included specific nutrients versus foods, labels and packaging, construction of the diet, knowledge of the Australian Dietary Guidelines and Australian Guide to Healthy Eating, understanding of serve and portion sizes, ability to select healthier foods, and demographics such as belief systems and culture. Exploitation of electronic features to enhance visual and auditory displays, including interactive animations such as “drag and drop” and virtual reality situations, were discussed. This study provided insight into the most relevant topic areas and presentation format to assess the nutrition literacy of adult Australians. The visual, auditory, and interactive capacity of the available technology could enhance the assessment of nutrition literacy.

Review of Short-Form Questions for the Evaluation of a Diet, Physical Activity, and Sedentary Behaviour Intervention in a Community Program Targeting Vulnerable Australian Children

Childhood obesity is associated with low socioeconomic status in developed countries, and community programs can deliver cost-effective obesity interventions to vulnerable children and adolescents at scale. Evaluating these programs in a low-cost, time-efficient, and culturally appropriate way with valid and reliable measures is essential to determining their effectiveness. We aimed to identify existing valid and reliable short-form instruments (≤50 items for diet, ≤15 items for physical activity) suitable for the assessment of change in diet, physical activity, and sedentary behaviour in an Australian obesity intervention program for children and adolescents aged 7–13 years from low socioeconomic groups, with a focus on Aboriginal and Torres Strait Islander children. Relevant electronic databases were searched, with a focus on Australian literature. Validity and/or reliability studies using diet instruments (5), physical activity/sedentary behaviour instruments (12), and diet and physical activity/sedentary behaviour instruments used with Aboriginal and Torres Strait Islander (3) children were identified. Seven questions on diet, one question on physical activity, and no questions on sedentary behaviour were recommended. These questions can be used for evaluation in community-based obesity programs among Australian children and adolescents, including those from low socioeconomic groups and Aboriginal and Torres Strait Islander children.

Barriers and enablers to applying for the Dietitians Association of Australia Advanced Accredited Practising Dietitian credential: A qualitative analysis

Aim The present study aimed to identify barriers and enablers to applying for the Advanced Accredited Practising Dietitian (AdvAPD) credential as well as problems with the application process. Methods Eleven Accredited Practising Dietitians (APDs) and nine AdvAPDs were recruited to participate by telephone in focus groups or in one-on-one interviews via the weekly national Dietitians Association of Australia (DAA) e-alert and advertisement at the 2012 National Conference. Semistructured interview schedules were used to guide the groups and interviews which were recorded via the DAA conferencing facility and subsequently transcribed verbatim. Themes were identified using qualitative analysis software. Results Barriers to applying for the AdvAPD credential included the onerousness of the process, busy-ness/finding the time, and having competing priorities, while working with colleagues, receiving recognition and having an AdvAPD mentor were predominant enablers. Problems identified with the application process included the difficulty in completing specific parts of the application, particularly the research and management/supervision components, and the assessment/definition of advanced practice itself. Suggested improvements included the use of technology in submission, and provision of a range of examples for reference. Conclusions APDs wishing to apply for the AdvAPD credential are encouraged to apply key findings such as engaging a mentor, working with colleagues and seeking successful application examples as strategies within their plan. The broader results will inform the review of the performance criteria and evidence examples currently available to AdvAPD applicants and support development of additional tools to assist the application process.