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Nutritional counseling

Nutritional counseling

When diets are Nutritiojal too far eating disorders Nutritional counseling to form. Health Sciences North Ramsey Lake Health Centre 41 Ramsey Lake Road Sudbury, Ontario, P3E 5J1. Chesnokova V, Pechnick RN, Wawrowsky K.

Nutritional counseling -

A list of specific nutrition concerns, topics or goals for the dietitian to help with is also useful. The appointment may be virtual telephone or videoconference or in-person. For virtual appointments, children school-aged and older should attend with their caregiver.

For assistance, please call NEO Navigation, central intake team at Health Sciences North Ramsey Lake Health Centre 41 Ramsey Lake Road Sudbury, Ontario, P3E 5J1. Phone: ext or Email: neokidsinfo hsnsudbury.

Nutritional Counseling Clinic. Provider Referral : This clinic requires a healthcare provider referral. Please see "Referrals" menu for more information. NC typically occurs in the context of an ongoing professional relationship where the nutrition counselor works privately with the client through a series of individualized sessions.

The role of the sport nutrition counselor is to help athletes identify, adopt, and sustain a customized fueling strategy that maximizes training, performance, recovery, and holistic well-being while applying resources that facilitate nutritionally adequate, balanced eating patterns and address potential obstacles and barriers that predispose athletes to LEA and REDs.

There is a role for both NE and NC when working with athletes, but the most appropriate strategy is one that is individually selected by the nutrition professional informed by their appraisal of the nutritional assessment, nutrition-related diagnosis, client needs, abilities, and life circumstances The role of the sport nutrition counselor is to offer advice to people interested in solving various current problems that the client s may face, which comprehend, for example, the ones derived from the preparatory work for performance in sports i.

and to optimize sport performances To the best of our knowledge, no review articles evaluated the application of NC in athletes to date. This paper aims to systematically review the current evidence on the use of NC in athletes and to identify the specific outcomes investigated to characterize its impact.

This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA method The languages allowed were English and Italian according to the capability of comprehension of the authors.

No limits were considered according to the date of publication. Randomized controlled trials, uncontrolled observational studies, case study, case reports and case series, opinion articles, conference abstracts, theses, and dissertations were included.

The study protocol was previously submitted on the PROSPERO platform and has its registration number CRD The populations of interest were recreational and elite athletes. We did not specify comparison conditions in our search because this was not included in the aim of the study which was simply to evaluate the use of NC, not necessarily compared to other strategies.

The search strategy is illustrated in Table 1. Detailed criteria for study inclusion and exclusion are listed in Table 2. The research and study selection was carried out by two authors EP and LCLN independently using the Rayyan software 42 , following two steps.

First, authors read the titles and abstracts; next, they evaluated the full articles selected in the previous stage, and included other relevant studies found in the reference lists of the selected articles. When disagreement was found, a third author SF reviewed the full text articles to decide about inclusion.

Adherence, compliance rates, nutrition knowledge, eating disorders, REDs-S, athlete triad, injuries, performance, body image, body dissatisfaction, low energy availability, osteopenia, amenorrhea, anemia.

The risk of bias was also assessed by two authors, independently and blinded EP and LCLN using the RoB 2. When disagreement was found, a third author SF decided. This tool was applied only to the clinical trials because of the adequacy of the instrument in this specific study design and the lack of control groups in the other reports.

The quality of evidence checking was tested for all articles with the Mixed Methods Appraisal Tool system MMAT version 44 by two authors, independently and blinded EP and LCLN. A total of 2, records were identified through database searches.

After removal of duplicates, 2, articles remained. After first screening by title and abstract, 29 records were sought for retrieval. The indications for excluding 2, articles are shown in Figure 1. Eighteen articles were retrieved. Upon reading, eight articles were excluded because they did not use nutritional counseling strategies.

Ten studies were included in this review Figure 1. Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA flow chart. The selected studies are summarized in Table 3.

All were published between and Four studies were conducted in the United States 26 , 33 — 35 , two in Norway 27 , 28 , one in Poland 29 , one in Algeria 32 , one in Canada 31 , and one in Finland Table 3.

Details of included articles: population characteristics, type of intervention, results and quality of evidence Mixed Methods Appraisal Tool system [MMAT]. A variety of study designs are represented in this sample. There were four randomized cross-over studies 26 — 29 , one randomized controlled trial 30 , one cluster randomized controlled trial 31 , two longitudinal studies 32 , 33 , one case series 34 , and one dual case study No studies from grey literature were included.

The studies reported on a combined total of participants, mainly females Sample sizes ranged from two 35 to 80 participants Three studies 34 — 36 involved athletes with eating disorders.

Participants were adolescent athletes, college students, elite athletes qualified for national teams or members of a recruiting squad , and national or international level athletes.

Six studies 26 — 31 delivered group counseling, one study employed both group and individual counseling 33 , and three studies used only individual counseling 32 , 34 , The type of NC delivered was specified only in 6 articles, with three of them using multiple strategies 33 — The most commonly used was CBT 33 — 35 , combined with Dialectical Behavioral Therapy in two studies 33 , Abood et al.

delivered nutritional counseling based on social cognitive theory using self-efficacy educational sessions Laramée et al. focused on behavior change using the theory of planned behaviour targeting the specific determinant of intention to use restrictive dietary behaviors for losing weight Grabia et al.

dedicated one session of the program to motivation More specifically, 15 different strategies were applied across the interventions, described in Table 3. Quatromoni used a combination of ten different strategies across a sample of athletes Some topics were common in the different studies, so some themes are repeated in the count.

Only three studies reported the duration of each session. In the studies by Abood et al. In the reviewed studies, nutritional counseling was delivered by a RDN 31 , 34 , a multidisciplinary team in which an RDN was involved 33 , 35 , a nutritionist 30 , 32 , or two experienced nutritionists one clinical dietitian and one exercise physiologist specialized in sports nutrition 27 , Two studies did not report the qualifications or discipline of the facilitator 26 , The possible outcomes were categorized into Questionnaires results and Nutritional Counseling Efficacy, which is more specifically divided in 1 nutrition knowledge, 2 dietary intake and 3 remission from eating disorders.

Three studies 26 , 30 , 31 administered nutrition knowledge questionnaires to evaluate differences between pre- and post-intervention scores. Three studies 33 — 35 administered the Female Athlete Screening Tool FAST that screens for athlete-specific eating disorder risk Stranberg et al.

Anthropometric data were collected in all 10 studies. Body composition was assessed in three studies 27 , 28 , Seven studies assessed dietary intake and nutritional adequacy, using either a 3-day food record 26 , 30 , 31 , a 4-day weighed food record 27 , 28 , a h dietary recall 32 , a combination of tools for dietary assessment and monitoring 34 , 35 , or a questionnaire that informed the calculation of the ProHealthy-Diet-Index pHDI and the Non-Healthy-Diet-Index nHDI An individualized meal plan was part of the intervention in five studies 27 , 28 , 33 — Three studies 26 , 30 , 31 showed an improvement in nutrition knowledge in athletes to whom nutritional counseling was delivered.

Results of three studies 26 , 29 , 32 showed some measurable changes in dietary intake. In the study by Abood et al. Two studies 27 , 28 showed an increased energy intake and consequently, increased body weight, in the Nutritional Counseling Group NCG compared to baseline and compared to the Ad Libitum Group ALG that received no nutritional counseling intervention.

In both studies, athletes in the NCG increased fat mass and lean body mass to a greater extent than athletes in the ALG. From a longitudinal observational study of 15 college female athletes who underwent nutritional counseling in the setting of an intensive outpatient program for the treatment of eating disorders in sport, Stranberg et al.

Further evidence of remission from the eating disorder and achieving normalized eating patterns was provided by this study where a measurable decrease in EDE-Q scores and an increase in eating competence scores was shown as a consequence of the intervention.

The quality of evidence checking was tested using the Mixed Methods Appraisal Tool system MMAT version The results are reported in Table 3. Four studies reached three stars 29 , 32 , 34 , 36 , three studies 26 , 30 , 33 were evaluated with four stars, and three studies earned the maximum five stars 27 , 28 , Overall results showed one study at low risk of bias 31 , three studies with some concern 27 — 29 , and two studies at high risk of bias 26 , The randomization process was the domain at higher risk of bias.

Domains 2, 3, and 4 deviations from the intended intervention, missing outcome data, measurements of the outcome obtained a low-to-moderate risk of bias score for all studies except for Garthe et al. Figure 2. Results of risk of bias analysis.

A Percentage of risk of bias of each domain in all included studies. B Description of each domain of bias according to studies included To our knowledge, this is the first systematic review that evaluates the delivery of nutritional counseling to athletes and summarizes its potential effectiveness.

Each of the ten studies reviewed reported some beneficial changes in the diets or eating behaviors of athletes as a consequence of nutritional counseling interventions.

While more research is needed on this topic, these initial observations support the inclusion of nutrition professionals in sport environments to make NC interventions accessible and impactful.

Across the ten studies included in this review, there was a substantial amount of heterogeneity in key areas that affect the interpretation of this evidence. Authors used a variety of NC strategies grounded in different behavioral change theories.

The duration of the counseling interactions ranged from weeks to years, and in some instances was determined by individualized needs such as treatment for REDs or an eating disorder.

Most of the intervention plans delivered group counseling, some combined group and individual counseling strategies, and others only involved individual counseling. Finally, population characteristics varied widely.

Samples more often included females, but some studies did include males and they involved athletes of different ages and levels of competition, and the types of sports practiced were quite varied. While this gives some sense of comprehensive diversity and inclusion, it is somewhat challenging to draw definitive conclusions.

In spite of the heterogeneity in this literature, all of the studies reported outcomes that can be interpreted as desirable in terms of athlete nutritional status and well-being. In particular, the case report by Quatromoni et al.

During the NC sessions, the dietitian used strategies based on CBT, DBT, and MI. Both athletes achieved weight restoration and recovered from anorexia and ED reaching sport performance goals, and maintaining recovery years out from treatment. This latter paper 33 is the first one that documents the low level of eating competence in athletes treated for EDs, and shows how NC interventions that target personal feeding skills and eating behaviors are relevant, effective, and aligned with ED recovery.

Similarly, the study conducted by Laramée et al. Other studies documented important positive modifications in terms of nutrition knowledge and dietary intake among athletes provided NC from nutrition professionals It is well established that a balanced and adequate diet plays an important role in maintaining health, allowing athletes to perform at a high level, and recover from the stress of training and competition more efficiently 1 , To apply the principles of sports nutrition, basic knowledge and understanding of nutrition are necessary; however, knowledge does not necessarily translate to behavior and it may not be sufficient to allow athletes to thrive and reach their full potential.

The literature on NE is growing 49 — 51 , intending to support optimal eating patterns within the community or a specific target population such as athletes.

The addition of NC on top of NE appears essential. In fact, recent research has shown that NE programs may be less effective at inducing positive dietary changes Otherwise NC combines information with strategies to achieve a behavior change based on individual characteristics, beliefs, and goals, setting it apart as its own worthy intervention approach.

Some types of sport have been shown to be more related to the development of disordered eating and ED, specifically track, cross-country, cycling, swimming, gymnastics, dance, figure skating, and judo 18 , whereas other literature 54 , 55 suggests that ED in sport are more widespread, do not discriminate by sport, gender or body type, and after quite under-reported, under-diagnosed and under-treated.

Evidenced by the studies included in this review, nutritional counseling could represent a functional strategy in this pursuit. From our review it can be seen that CBT has been the most widely used NC theory. Furthermore, the most used strategies were motivational interviewing and self-monitoring, although the importance of a combination of different strategies has emerged.

There were some limitations in this systematic review. Aside from the heterogeneity of the athlete samples and study designs used, there was a lack of specification of the type of NC techniques used in some studies. These factors prevent us from addressing a more detailed hypothesis on whether and which specific NC theories or strategies could be more suitable or impactful, in general or for a specific group of athletes.

Moreover, nutritional counseling was not a keyword recognized in MESH terminology. This may contribute to a possible under-estimation of the actual number of studies to be evaluated if some were missed for this reason. Some reports constitute observations from clinical practice and, while more detailed in nature and certainly important to guide practice when research on a topic is limited, these reports lack the rigor of randomized controlled trials designed specifically to test hypotheses about treatment outcomes from interventions like NC.

The four studies that were not clinical trials were of moderate quality, and they are naturally subject to more potential risk of bias than the RCTs.

Although each of the six RCTs had a low risk of bias in the majority of the domains considered, only one trial had an overall low risk of bias. This review is also supported by some strengths.

First, scientific literature on the topic of NC in athletes is scarce, so this article provides the opportunity for critical thinking on this topic and a roadmap for future research.

Second, this line of research strictly differentiates nutritional counseling from food education interventions, demonstrating the added value and the unique role that nutrition professionals bring to the sports environment.

Actually, RDNs who specialize in sports and human performance nutrition i. Advanced training that allows the RDN to engage in screening, assessment, treatment, and prevention of REDs and eating disorders in sport is evidenced in this review. Considering the small yet emerging literature on this topic, almost half of the studies reviewed had a minimum quality rating of four stars using the MMAT method.

Nutritional counseling induces positive, measurable behavioral effects in athletes, improving nutrition knowledge, fostering the adoption of adequate eating patterns, and supporting recovery from REDs and ED in sport. There is, however, a lack of homogeneous research, in terms of design, population and methods, involving nutritional counseling provided to athletes which makes it difficult to make evidence-based conclusions about its efficacy to improve dietary intake, eating behavior, and nutritional risk in this specific population.

More studies are needed to better understand the importance of nutritional counseling in athletes given the unique risks and consequences associated with imbalanced nutrition and nutrition misinformation affecting eating behaviors.

Randomized controlled trials of sufficient size and heterogeneity, including all genders and a variety of sports are needed. As well, future NC interventions should investigate theory-based counseling methods tailored according to factors such as type of sport, level of competition, and age.

PQ and CF: conceptualization. SF, PQ, EP, LDCLN, CF, and MG: methodology. SF, EP, LDCLN, MG, and CF: investigation.

SF, EP, and LDCLN: data curation. SF, MG, and CF: writing — original draft preparation. SF, EP, LDCLN, PQ, MG, CF, and AT: writing — review and editing. CF: supervision. All authors contributed to the article and approved the submitted version. Project funded under the National Recovery and Resilience Plan NRRP , mission 4 component 2 investment 1.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Thomas, DT, Erdman, KA, and Burke, LM. Position of the academy of nutrition and dietetics, dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance.

J Acad Nutr Diet. doi: PubMed Abstract CrossRef Full Text Google Scholar. Kerksick, CM, Wilborn, CD, Roberts, MD, Smith-Ryan, A, Kleiner, SM, Jäger, R, et al. J Int Soc Sports Nutr. García-Rovés, PM, García-Zapico, P, Patterson, AM, and Iglesias-Gutiérrez, E. Nutrient intake and food habits of soccer players: analyzing the correlates of eating practice.

Baranauskas, M, Stukas, R, Tubelis, L, Žagminas, K, Šurkienė, G, Švedas, E, et al. Nutritional habits among high-performance endurance athletes. Medicina Kaunas. Jenner, SL, Trakman, G, Coutts, A, Kempton, T, Ryan, S, Forsyth, A, et al. Dietary intake of professional Australian football athletes surrounding body composition assessment.

CrossRef Full Text Google Scholar. Martin, L, Lambeth, A, and Scott, D. Nutritional practices of national female soccer players: analysis and recommendations. J Sports Sci Med. PubMed Abstract Google Scholar.

Clark, M, Reed, DB, Crouse, SF, and Armstrong, RB. Pre- and post-season dietary intake, body composition, and performance indices of NCAA division I female soccer players.

Int J Sport Nutr Exerc Metab. Abbey, EL, Wright, CJ, and Kirkpatrick, CM. Nutrition practices and knowledge among NCAA division III football players. Dietary status of trained female cyclists.

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