Improving sports nutrition knowledge and dietary intake in adolescent female athletes: a scoping review of nutrition education targeting low energy availability

Low energy availability (LEA), an inadequate energy intake relative to exercise energy expenditure and fat-free mass, has been increasingly documented among female adolescent athletes. Problematic LEA underpins Relative Energy Deficiency in Sport (REDs) and poses a serious threat to an athlete’s health, growth, and performance (1). Improving dietary intake through enhanced nutrition knowledge has been proposed as the key strategy to prevent problematic LEA (2). While various nutrition education approaches have attempted to address this issue, their effectiveness remains unclear. This scoping review synthesised the current evidence on nutrition education related to LEA in improving knowledge and dietary intake among female adolescent athletes. A systematic search of PubMed, Web of Science, Scopus, and EBSCOhost initially identified 1,517 records. Eligible studies involved female-only or female and male adolescent athletes (mean age: 10-19 years old), investigated at least one intervention group receiving nutrition education covering LEA, REDs, or Female Athlete Triad (Triad), and measured knowledge and/or dietary intakes. After screening, seven studies were eligible for inclusion. Of these studies (n= 695, 94.2% female), three were randomised controlled trials, three were single-arm intervention studies, and one was a two-arm study comparing two different interventions. Topics included the Triad (n=5) and energy availability (n=2). Nutritionists/dietitians were frequently involved in delivering or developing educational materials (n=5). Programme duration ranged from one session to three months (mean=67 days), with sessions delivered mostly weekly or more often (n=4). Delivery methods included face-to-face (n=3), independent learning (n=3), and remote education (n=1). Videos (n=4), printed materials such as booklets and workbooks (n=4), or a combination of both (n=2) were used to facilitate learning. Knowledge was assessed as Triad knowledge (n=4) and sports nutrition knowledge (SNK) across multiple subdomains (n=3) using self-developed (n=3), modified (n=3), or previously validated questionnaires (n=1). Post-intervention improvements in both Triad knowledge and SNK were reported in 6 studies. Dietary intake was assessed in two studies using food records or food diaries. Increases in energy and all macronutrient intakes were observed only in the face-to-face intervention that incorporated practical activities, whereas the remote approach showed no such changes. In conclusion, nutrition education involving nutrition professionals appears effective in improving knowledge among adolescent female athletes, but improving dietary intake may require face-to-face, activity-based programmes. However, variations in study design and outcome measurements are important limitations, highlighting the need for more rigorous research to inform effective strategies for LEA prevention.