الفهرس 
INTRODUCTION AND AIM OF THE STUDYOnly 14 pages are availabe for public view
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Abstract
Adolescence, a period of accelerated growth and development accompanied by increased nutrient requirements, is frequently a stage in the life cycle in which the dietary habits are unhealthy. Adequatenutrition is important to compensate for the physical changes occurring during puberty, and the social maturation in which teenagers struggle to establish their identity. Though the physical factor may increase nutrient requirements, the social influences may decrease the nutrient intake. Sound information of basic nutrition principles does not ensure desirable dietary practices. Having nutritional knowledge may affect an individual’s attitudes in a positive or negative way. Attitudes, acquired through socialization and habituation, pattern an individual’s response in certain occasions. Adolescents usually want their food choices to meet the approval of their peer group. In general, the peer group may have a negative influence on the eating habits of adolescents. Thus, the nutritive value of food maybe the least factor that concerns the adolescents when it comes to food selection.
Adolescent athletes need knowledge about how to optimize energy and nutrient intake, and combine this with optimal training. Because lifestyle practices formed early in life are usually carried into adulthood, there is an substantial need to increase adequate nutrition awareness, and change subsequent beliefs built on faulty information delivered via media. Though simply providing nutrition knowledge does not guarantee that correct practice is performed, yet education is necessary so athletes could understand the consequences of their poor eating habits. The aim of this study is to evaluate the nutritional knowledge, verify the attitudes towards nutrition, and detect the established dietary practices among adolescent athletes in Alexandria.
In the present study, a total of 202 adolescent athletes aged 16-19 years gathered from two sport clubs in Alexandria, 111 from ASC and 91 from AAC, volunteered to answer a structural designed questionnaire. This cross-sectional study was performed during the year from August 2017 to September 2018. The 130 and 72 male and female athletes, respectively, were recruited from different sport categories; ball sports (football, handball, volleyball and basketball), weight-sensitive sports (gymnastics, taekwondo, karate and judo), and endurance sports (swimming and strength training). The questionnaire first gathered socio-demographic data, menstrual history (of female athletes), and lifestyle pattern (physical activity and smoking habits) information. This was followed by 30 questions on nutritional knowledge concerning different topics (energy and macronutrients, micronutrients, dietary habits, meal pattern and performance, supplements, weight management, and hydration), in addition to their sources of nutritional information. Then proceeding were 15 statements on attitudes towards adequate nutrition, fluid replacement and supplements. Subsequently were questions to identify nutritional practices as regards main meals, snacks, event-related meals, and supplement consumption; to end with a FFQ to determine the daily consumption from different food groups. The data collected was then analyzed using appropriate statistical tests.
The socio-demographic data collected in this study reveals that the 16 -year old adolescent athletes were predominant in ASC (43.3%) in contrast to 17-year old athletes in AAC (40.6%). The mean ±SD age of athletes was 17.1± 1.1 years (p= 0.019). Male athletes contributed to 64.4% of the studied sample, while female athletes constituted 35.6%. More than three-fourths (77.7%) of the adolescent athletes attended secondary school, whereas 22.3% of them attended college. As for the athletes’ mothers’ educational level, 7.2% compared to 25.3% of the mothers in ASC and AAC, respectively, had school education (p= 0.007). A similar percentage was noticed regarding the athletes’ fathers’ educational level, 6.3% of fathers in ASC versus 25.3% of them in AAC received school education (p= 0.001). The parental educational level maybe considered as an indicator to the difference in socio-economic levels between athletes in the two clubs.
The menstrual history of female adolescent athletes indicated that about 32% of them suffered from irregular menstruation. Ball sports were the dominant type of sports in both clubs, in which the participating athletes accounted for 68.5% of ASC and 45% of AAC (p= 0.000). Adolescent athletes trained more than 2 hours per training session (p= 0.000) for more than 5 days weekly (p= 0.023). A total of only 3 athletes from the studied sample smoked cigarettes. Adolescent athletes in the studied sample mainly relied upon their parents (58.9%), coaches and fitness trainers (50.5%), and the internet (48.5%) as influential sources for nutritional information. Only a few (17.8%) sought nutritional advice from a nutritionist or a physician.
The current study demonstrated that only 4.0% of the studied sample showed good knowledge, more than half (56.4%) had fair knowledge, 39.6% had poor knowledge, and their mean NK score was 54.8%. Knowledge scores were similar to their practices scores, where 5.4%, 55%, and 39.6% had good, fair, and poor dietary practices, respectively. As for their attitudes, 30.7% had positive attitudes, two-thirds (66.8%) had neutral attitudes, and 2.5% had negative attitudes. No significant differences were detected in the knowledge and attitudes between adolescent athletes from both clubs. However, the dietary practices as regards main meals, of athletes from AAC (42.8%) was significantly better than those of athletes from ASC (34.1%) (p= 0.008). The club was one of the main predictors of healthy nutritional practices in this study (p= 0.041).
Female athletes (mean NK of 57.1%) were noticed to have significantly better nutritional knowledge (p= 0.030) than their male counterparts (mean NK score of 53.0%), especially concerning micronutrients and weight management categories (p= 0.049 and p= 0.000, respectively). It was also observed that they had significantly more positive attitudes towards adequate nutrition (p= 0.002) and more negative attitudes towards supplements (p= 0.027) than male athletes. However, they maintained less favorable dietary habits regarding their main meals, yet insignificant.
The mean NK scores of collegiate adolescent athletes (58.1%) were higher than scores of secondary school athletic students (54.8%), and significantly in energy and macronutrients (p= 0.043). Furthermore, the collegiate athletes had more positive attitudes towards adequate nutrition and fluid replacement, and more negative attitudes towards supplements, than secondary school athletes, though insignificant. Moreover, athletes in college had preferable dietary practices, still insignificant.
Acknowledging the role of education, the educational level of mothers showed a rather notable effect (p= 0.011) on the mean NK scores of the adolescent athletes (56.0%, 55.3% and 48.6% corresponding to higher, university, and school education of mothers, respectively); particularly in the energy and macronutrients (p= 0.002) and weight management (p= 0.037) categories. In addition, adolescent athletes whose mothers had university or higher education, adopted significantly healthier dietary habits than athletes whose mothers had school education, with special regards to main meals (p= 0.04) and event-related meals (p= 0.016). The mothers’ educational level was one of the main predictors of healthy dietary practices among adolescent athletes (p= 0.018). Nevertheless, the attitudes of all adolescent athletes did not vary significantly according to their mothers’ educational level.
According to the different sport types, adolescent athletes engaged in endurance sports demonstrated the highest NK scores (57.9% as compared to 53.5% and 53.1% of athletes playing ball and weight-sensitive sports, respectively), with specific regards to energy and macronutrients (p= 0.001), supplements (p= 0.026), and weight management (p= 0.036) categories. Their attitudes as well presented to be the most positive towards adequate nutrition (p= 0.008) and fluid replacement, and most negative as regards supplements. Since the nutritional requirements change with different types of sports, so does the dietary practices. Athletes participating in endurance sports followed the most favorable eating habits as regards main meals and supplement consumption (p= 0.002). Meanwhile, athletes playing weight-sensitive sports had healthier snacking and event- related eating habits, however insignificant.
More than two-thirds of the adolescent athletes in the current study possessed inadequate dietary habits; 70.3% skipped main meals, 67.8% ate from fast food restaurants (p= 0.003), and 38.1% consumed supplements. Thus concerning main meals, the results have indicated that 73.9% and 60.4% of athletes in ASC and AAC, respectively, followed poor eating practices (p= 0.008). Meanwhile, the most popularly consumed supplements were multivitamins and minerals (90.9%), protein supplements (57.1%), and sport drinks and bars (51.9%). Athletes using supplements depended on advice taken from coaches and fitness trainers (59.7%), the nutritionist (20.8%), and the internet (14.3%).
from data of the current study, the following conclusions have been reached:
• Even with positive or neutral attitudes, adolescent athletes had inadequate nutritional knowledge, and subsequently followed undesirable dietary practices.
• Female athletes, athletes in college, athletes whose mothers had university or higher education, and athletes participating in endurance sports; had better knowledge, adopted healthier dietary habits, and had more positive attitudes towards nutrition than male athletes, those in secondary school, those whose mothers had school education, and those engaged in ball or weight-sensitive sports.
• The dietitian/ nutritionist was not the first choice for dietary advice or supplement intake consultation.
from results of the present study, the following recommendations are proposed:
1. To Sport Clubs:
Importance of assigning sport dietitians: their duties would include the following:
• In terms of intervention, if optimizing performance is the dominant factor in motivating the athlete, implementation of suitable nutritional practices must be put in place. This requires a holistic approach, whereby the athlete’s eating and lifestyle patterns and psychosocial influences are addressed. Furthermore, defining the optimum body composition and promoting self-acceptance, healthy eating and reasonable training and recovery in athletes are expected to be effective in changing their nutritional knowledge, attitudes and practices.
• Tailored, sport-specific, age and gender-specific programs shall be made for all athletes; as well as easy access to sport dietitians to advise on supplements.
• While prioritization of weight-loss interventions during the off-season is recommended, this is not always practical. It is the responsibility of the dietitian to discuss the timing of weight loss with the coach, to prevent athletes from striving towards unrealistic weight goals to perform well. Moreover, a carefully timed, and conservative approach to weight management may be necessary should it coincide with a period of intense training, considering that consequences related to extreme dieting can cause disastrous performance setbacks. While there are several effective approaches to support an athlete’s weight loss, a ‘one size fits all’ approach is not supported.
2. To the Ministry of Education and the Ministry of Youth and Sports:
• School, sport coaches and family -based interventions are timely needed to promote healthy food choices and good eating habits of adolescents. Sports administrators and school policy makers should conduct a nutrition seminar workshop once every semester to keep the athletes and other students aware of the importance of proper nutrition on their daily lifestyles.
• An in-depth sport-based nutrition education is required to address topics related to macro- and micro-nutrients, which were seen to represent an area of confusion for young athletes.
• There is also a need for implementing national coach education programs on a regular basis. Athletic trainers and coaches require knowledge about the principles of physical growth, biological maturation and behavioural development occurring at this critical stage in the life cycle (due to hormonal changes in men and women), and how psychological factors relate to health and athletic performance.