Module 8 - Sport Nutrition Assessment and Nutrition Care Plan for Athletes Flashcards
What are the parts of the nutrition care process model?
- Nutrition assessment and reassessment
- Nutrition diagnosis
- Nutrition intervention
- Nutrition monitoring and evaluation
All influenced by social systems, economics, practice setting, and health care system as well as the skills of the practitioner
What is the purpose of a nutrition assessment and what should be identified?
Purpose is to collect and interpret relevant client information to identify:
- If the athlete is at risk for malnutrition and if so, why
- The potential to positively influence sport performance through dietary changes
- Nutrition assessment gives you the evidence you need to know how to care for the athlete you are working with
- Assessment data, not the athlete’s preferences or wishes, determine the nutrition care plan
Define malnutrition
The condition that occurs when the body’s requirements for one or more essential nutrients is not met
What are some of the causes of malnutrition?
- Inadequate or unbalanced diet
- Problems with digestion or absorption
- Certain medical conditions
Explain how starvation and malnutrition are related
- Starvation = just one form of malnutrition! A subset of malnutrition
- A person can appear healthy and still be malnourished
What should you never assume when working with athletes?
Don’t assume all athletes are healthy
- There is a tendency to assume that all athletes are healthy by virtue of their participation in sport
- This is inaccurate and potentially dangerous
- There are many cases where athletes appear healthy but are subsequently diagnosed with very significant health issues, including malnutrition
- If we assume people are healthy, there is a risk that preventable or treatable illness will be missed or discounted
What occurred in the Capati versus crunch fitness case?
- Given a herbal supplement with epheddrine that cause capati to have a stroke, excessive and uncontrollable bleeding in the brain
- lack of health assessment skills (assumed she was healthy with no medications)
- Lack of understanding of health history: hypertension (high blood pressure)
- Lack of awareness of risk: assumption that the herbal supplements were “natural” and “safe”. Ephedrine increases blood pressure
- Focus on appearance versus health
What happened with Sergei Grinkov?
- Figure skater with olympic, worlds gold medals. Won majority of the competitions he was in
- Not obese, obviously active, appeared to be very healthy
- Died on the ice while training from a heart attack at age 28
- Clogged coronary arteries and genetic risk factors linked with premature heart attack that had gone undetected (family history)
Nutrition Assessment involves _________________
Critical thinking
What critical thinking/steps need to be done during a nutrition assessment?
- determine appropriate data to collect and selecting valid and reliable tools
- Distinguish relevant from irrelevant data
- Select appropriate norms and standards for comparing data
- Organizing and categorizing the data in a meaningful way that relates to the nutrition concerns of the client
- Identifying the absolute base nutrition issue (versus issues that are symptoms more than the base issue)
→ Low body weight in an adult with anorexia nervosa. Weight is a symptom; mental health issues are the base case
By the end of the nutrition assessment process what should you be able to say with confidence?
- What the athlete’s specific nutrition-related concerns are
- Why you know these are the concerns (e.g. you can cite your evidence) AKA back your diagnosis
- What you need to do to correct or optimize the athlete’s nutritional health
→ If you can’t say with confidence why you are offering the care or advice you’re offering you should not give care
What are the four main elements of the nutrition care process?
- Nutrition Assessment
- Nutrition Diagnosis
- Nutrition Intervention
- Monitoring an evaluation
What are the 5 key elements of a nutrition assessment?
- Personal health, sport, and social history
- Dietary assessment
- Body weight and composition assessment (anthropometric assessment)
- Assessment of energy expenditure
- Fitness assessment
What is the purpose of taking the personal health, sport, and social history of an athlete?
- Determine any current or potential health problems so you can determine their health risk level
- Provide contextual info about the athlete’s life, their training habits (type, frequency, duration, and intensity)
What are the key elements of personal health, sport, and social history?
- Demographic info: name, age, height, weight, gender
- Family and personal history of disease or health concerns (including allergies, menstruation)
- History of illness and injuries
- Surgical history
- Menstrual history (for females)
- Medication and supplement use
- Detailed info on their level of sport participation: type, frequency, duration, intensity, goals of sport participation
What is an example of how you could take an athlete’s history?
- Health History Questionnaire
What is the purpose of a dietary assessment?
- Used to assess energy (Kcal) and nutrient intakes
- Quantity supplement use
- Assess eating pattern (e.g. timing of meals and snacks, consistency of eating pattern)
What does the fitness assessment do? Who does it?
- Flexibility
- Muscular strength
- Muscular endurance
- Aerobic/cardiorespiratory fitness
- Anaerobic fitness
- Generally completed by the athlete’s trainer, coach or other qualified fitness appraiser and shared with the sport dietitian
When taking a social and personal history what should you find out?
- Socioeconomic status, social and medical support, cultural and religious beliefs, housing situation, and social isolation/connection
- Others involved in their Circle of Care: may include obtaining formal consent to communicate with others in the Circle
- Age, occupation, role in family, and education level
- ## Who is responsible for shopping for food, cooking, etc.
What is the purpose of finding out social/personal history?
Helps you understand how the athlete lives and the support they have. If parents are doing the cooking, may want to talk to them for example.
What are potential lab values of interest for athletes?
The following are good to check, if good then can move on:
- Blood lipid levels: Tchol, LDL, HDL, VLDL, LDL/HDL ratio, TG
- HbAic% (higher in diabetes)
- Blood glucose
- Urine protein
- Urine glucose
- BUN
- Serum creatinine
- Albumin
What should be done when doing a body weight and composition assessment?
- Current (Usual) Weight - is this weight normal for them? If rapid weight loss and unintended = red flag
- Ideal/optimal weight for sport - room for variation
- Weight history - has it changed? What direction and over how long? The larger the magnitude of weight change over the shorter duration of time = increased risk for malnutrition
- Body composition measures - if accessible
How do you calculate percent usual body weight?
% usual body weight = (Actual Body Weight/Usual Body Weight) x 100%
What are the percent usual body weights that indicate degree of malnourishment?
- Weight indicator of malnourishment
- Does not tell you how long it took to change
How do you calculate percent weight change? What is needed to show if this is a concern or not?
(Usual weight - Actual Weight)/Usual weight
E.g. Mary Jane was 150lb last time you saw her 3 weeks ago, today is is 135 lbs. = (150-135)/150 = 10%
- The importance of this change will depend on the time over which it occurred. 10% weight loss over 1 year is less of a concern, 10% weight loss over 1 month is a greater concern
What percent weight changes are considered significant versus severe?
Significant weight loss:
- 5% loss over 1 month
- 7.5% loss over 3 months
- 10% loss over 6 months
Severe weight loss:
- >5% loss over 1 month
- >7.5% over 3 months
- >10% loss over 6 months
These standards are widely used to assess significant weight changes in
Look into why these changes have occurred!!
What are the ideal weights for sport performance?
- Dependent on the sport and sometimes the gender
- In some sports it is advantageous to be heavy: heavy wresters can be harder to topple because of the low centre of gravity
- In some sports it is advantagoues to be light: being ligher makes it easier for female gymnasts to keep their balance and control their momentum
What is an NFPE?
- Nutrition focused physical findings - clinical exam. Not used on its own
- Includes a review of key physical areas related to nutrition
- At minimum all athlete’s should have a visual examination but looking at an athlete’s physical condition!
What will you look at when doing an NFPE?
- Hair
- Skin (colour, texture, integrity)
- Nails
- Muscle and fat mass
- Dentition/mouth teeth
- Eyes
- Emaciated
What are common diet assessment methods and their advantages and disadvantages?
What is meant by “respondent burden”?
- Get them to do all the work
- 24 hour recalls or food frequency questionnaires have lower burden (AKA less work)
What are the components of a 24 hour recall/dietary history/food record review?
- Includes all foods and quantities eaten, eating habits, accessibility of food, and cultural and socioeconomic factors that effect selection of food
- Details matter: portion sizes, brand names, eating times (pattern)
- Use the 3 pass method: Pass 1 - when and what (general), Pass 2 - portion sizes, Pass 3 - things often forgotten (condiments, items in or on things)
What process is followed to make a nutrition diagnosis?
- Sport dietitians develop a nutrition diagnosis for each athlete they work with
- A nutrition care process is followed!
- A diagnostic/PES statement is created for each problem
What is the best way to perform a PES statement
- Work the PES State,emt process backwards before writing it forwards: S/s then etiology then problem.
You are given the following situation, what is your initial assessment and what more info do you need? who would you like to talk to?
The same client has told you the following information, what else do you want to know and is anything you learned a concern?
Want to know about her menstrual cycle, iron status, family history, and diet history of what she is eating
You did further assessments and found the followin information, what can you tell from this?
- Likely has RED-S and potentially bulimia
- Low fat deposition impacting her endocrine system and body temperature
- Concern for iron deficiency
What does an “Easy” day plate look like?
- An easy day may contain just an easy workout or tapering without the need to load up for competition with energy and nutrients
- Weight management, post injury
What does a “moderate” day look like?
- May be one where you train twice but focus on technical skill in one workout and on endurance or strength in the other.
- ## The moderate day should be your baseline from where you adjust your plate down (easy) or up (hard/race)
What does a “hard” day look like for the athlete’s plate?
- A hard day contains at least 2 workouts that are relatively hard or involve competition
- If your competition requires extra fuel from CHO, use this plate to load up in the days before, throughout, and after the event or tournament day
What glycemic index should foods be for pre-event eating?
- In lead up phase want levels to gradually rise and avoid risk of rebound hyperglycemia.
- Choose low glycemic index foods!
Give examples of larger meals an athlete can have for 2 to 4 hours pre-event
Give examples of lighter meals an athlete could have 1 to 2 hours pre-event
During sport > 1 hour what can occur?
- Glycogen stores will start to decrease
- If they are inadequate at the start won’t make it through
When putting it all together, what should a day of training/game day foods look like?
- Before: hydration (fluid and sodium) and carb energy
- During: hydration and carbohydrate when training or competing greater or equal to 60 minutes
- After: hydration, carbohydrate when recovery time is short, and protein
Give examples of glycemic index foods that are high, moderate, and low
- Remember: glycemic indexes are not a measure of nutrient quality just how fast they are absorbed
How does glycemic index work? How does this apply to exercise?
- without exercise when you eat foods they can raise your blood sugar with high glycemic index foods doing it faster leading to high blood sugar
- This leads to insulin release which will lower blood sugar. Low blood sugar will trigger glucagon to breakdown glycogen
- When having high glycemic index foods they can cause a sharp increase then drop leading to low exercise performance and hypoglycemia
- Want to gradually increase blood glucose levels and prevent a steep drop
What glycemic index do you want for in-game eating for sport >1 hour?
- High glycemic index
- 30-60grams every hour (e.g. 250mL sport drink contains 14-24 grams)
- Not enough will not make a difference, too much can cause stomach upset and rebound hypoglycemia
- Need to have the proper dosage to maintain levels and have good performance
Why do athletes need to eat immediately after competing?
- To maximize recovery
- Muscle glycogen will stay low unless you have carbohydrate top ups. Need to do it as soon as possible.
- Glycogen synthase and glycogen will work opposite of each other
If one group of athletes immediately eats after exerise and another group has delayed eating, what will happen?
- the Group immediately fed will have glycogen higher than the delayed group
- The delayed group will then have a slight increase in glycogen afterwards when they eat
What should be paired with carbohydrate for recovery?
- Protein
- CHO and protein together will have optimal muscle glycogen synthesis than if just done alone
