Review of Diet Quality Indices that can be Applied to the Environmental Assessment of Foods and Diets.

PURPOSE OF REVIEW: The aim was to identify indices of diet quality and health that could be applied to the environmental assessment of foods in order to provide metrics that collectively assess nutritional, health and environmental dimensions. RECENT FINDINGS: The review identified five major groups of indices: nutrient-food quantity-based; guideline-based; diversity-based; nutrient quality-based; health-based. Nutrient-food quantity-based and guideline type indices were the most frequently used to evaluate diet quality. Scaled assessment using a nutritional functional unit is the most common integration of diet quality with the environmental analysis of foods. There are fewer indices that measure the heath impacts of foods, but epidemiological dietary risk factors seem a promising approach to integrate diet and health impacts into the environmental assessment of foods. Five groups of nutritional and health indices were identified that can be applied when performing an environmental assessment of foods. This review proposes different methodological insights when doing such assessments to ensure transparency and comparability of the results.

The Environmental Impact of the Athlete's Plate Nutrition Education Tool.

Periodized nutrition is necessary to optimize training and enhance performance through the season. The Athlete's Plate (AP) is a nutrition education tool developed to teach athletes how to design their plates depending on training load (e.g., volume × intensity), from easy (E), moderate (M) to hard (H). The AP was validated, confirming its recommendations according to international sports nutrition guidelines. However, the AP had significantly higher protein content than recommended (up to 2.9 ± 0.5 g·kg-1·d-1; p < 0.001 for H male). The aim of this study was to quantify the environmental impact (EnvI) of the AP and to evaluate the influence of meal type, training load, sex and registered dietitian (RD). The nutritional contents of 216 APs created by 12 sport RDs were evaluated using Computrition Software (Hospitality Suite, v. 18.1, Chatsworth, CA, USA). The EnvI of the AP was analyzed by life cycle assessment (LCA) expressed by the total amount of food on the AP, kg, and kcal, according to the Swiss Agricultural Life Cycle Assessment (SALCA) methodology. Higher EnvI is directly associated with higher training load when the total amount of food on the plate is considered for E (5.7 ± 2.9 kg CO2 eq/day); M (6.4 ± 1.5 kg CO2 eq/day); and H (8.0 ± 2.1 kg CO2 eq/day). Global warming potential, exergy and eutrophication are driven by animal protein and mainly beef, while ecotoxicity is influenced by vegetable content on the AP. The EnvI is influenced by the amount of food, training load and sex. This study is the first to report the degree of EnvI in sports nutrition. These results not only raise the need for sustainability education in sports nutrition in general, but also the urgency to modify the AP nutrition education tool to ensure sports nutrition recommendations are met, while not compromising the environment.

Sustainable Diets for Athletes.

PURPOSE OF REVIEW: Sustainable production and healthy consumption have been the topic of recent publications. Due to the high environmental impact of the current food system, significant changes in how food is produced, distributed, and consumed are needed in all sectors and groups. While most research in sustainable diets has focused on the general population, limited work has involved athletes. The purpose of this review is to summarize the current knowledge on food and sustainability in athletes. RECENT FINDINGS: Meeting but not exceeding protein requirements through flexitarian and plant-based approaches, reducing packaged foods and food waste, and prioritizing seasonal produce were identified as possible mitigation options in athletes. There is urgency for more research on plant-centric, whole food-based strategies for post-exercise skeletal muscle and training adaptation, the effect of sustainable diets on health and performance, and behaviors to reduce packaging and food waste in athletes.

Relative Body Weight and Standardised Brightness-Mode Ultrasound Measurement of Subcutaneous Fat in Athletes: An International Multicentre Reliability Study, Under the Auspices of the IOC Medical Commission.

INTRODUCTION: Fat is a metabolic fuel, but excess body fat is ballast mass, and therefore, many elite athletes reduce body fat to dangerously low levels. Uncompressed subcutaneous adipose tissue (SAT) thickness measured by brightness-mode ultrasound (US) provides an estimate of body fat content. METHODS: The accuracy for determining tissue borders is about 0.1-0.2 mm and reliability (experienced measurers) was within ± 1.4 mm (95% limit of agreement, LOA). We present here inter- and intra-measurer scores of three experienced US measurers from each of the centres C1 and C2, and of three novice measurers from each of the centres C3-C5. Each of the five centres measured 16 competitive adult athletes of national or international level, except for one centre where the number was 12. The following sports were included: artistic gymnastics, judo, pentathlon, power lifting, rowing, kayak, soccer, tennis, rugby, basketball, field hockey, water polo, volleyball, American football, triathlon, swimming, cycling, long-distance running, mid-distance running, hurdles, cross-country skiing, snowboarding, and ice hockey. SAT contour was detected semi-automatically: typically, 100 thicknesses of SAT at a given site (i.e., in a given image), with and without fibrous structures, were measured. RESULTS: At SAT thickness sums DI (of eight standardised sites) between 6.0 and 70.0 mm, the LOA of experienced measurers was 1.2 mm, and the intra-class correlation coefficient ICC was 0.998; novice measurers: 3.1 mm and 0.988. Intra-measurer differences were similar. The median DI value of all 39 female participants was 51 mm (11% fibrous structures) compared to 17 mm (18%) in the 37 male participants. DISCUSSION: DI measurement accuracy and precision enables detection of fat mass changes of approximately 0.2 kg. Such reliability has not been reached with any other method. Although females' median body mass index and mass index were lower than those of males, females' median DI was three times higher, and their percentage of fibrous structures was lower. The standardised US method provides a highly accurate and reliable tool for measuring SAT and thus changes in body fat, but training of measurers is important.

Validation of the Athlete's Plate Nutrition Educational Tool: Phase I.

Nutrition education visual tools are designed to help the general population translate science into practice. The purpose of this study was to validate the Athlete's Plate (AP) to ensure that it meets the current sport nutrition recommendations for athletes. Twelve registered dietitians (RDs; 10 female and 2 male) volunteered for the study. Each registered dietitian was asked to create three real and virtual plates at three different times corresponding to breakfast, lunch, and dinner, and the three different AP training loads, easy (E), moderate (M), and hard (H), divided into two weight categories (male 75 kg and female 60 kg). Data of the real and virtual plates were evaluated using Computrition software (v. 18.1; Computrition, Chatsworth, CA). Statistical analyses were conducted by SPSS (version 23.0; IBM, Armonk, NY) to compare the difference between each training load category (E, M, and H) and the recommendations. No statistically significant differences were found among the created plates and the recommendations for energy, carbohydrates, fat, and fiber for E, M, and H. Protein relative to body mass (BM) was higher than recommended for E (1.9 ± 0.3 g·kg-1 BM·day-1, p = .003), M (2.3 ± 0.3 g·kg-1 BM·day-1, p < .001), and H (2.9+0.5 g·kg-1 BM·day-1, p < .001). No differences were found for the macronutrient distribution by gender when correcting for kilograms of body mass. The authors conclude that the AP meets the nutrition recommendations for athletes at different training intensities for energy, carbohydrates, fat, and fiber, but exceeds the recommendations for protein. Further research should consider this protein discrepancy and develop an AP model that meets, besides health and performance goals, contemporary guidelines for sustainability.

"Eat as If You Could Save the Planet and Win!" Sustainability Integration into Nutrition for Exercise and Sport.

Today's industrial food production contributes significantly to environmental degradation. Meat production accounts for the largest impact, including greenhouse gas emissions, land and water use. While food production and consumption are important aspects when addressing climate change, this article focuses predominantly on dietary change that promotes both health for planet and people with focus on athletes. Healthy, sustainable eating recommendations begin to appear in various governmental guidelines. However, there remains resistance to the suggested reductions in meat consumption. While food citizens are likely to choose what is good for them and the planet, others may not, unless healthy eating initiatives integrate creative food literacy approaches with experiential learning as a potential vehicle for change. This concept paper is organized in three sections: (1) Environmental impact of food; (2) health and sustainability connections; and (3) application in sports and exercise. For active individuals, this article focuses on the quantity of protein, highlighting meat and dairy, and quality of food, with topics such as organic production and biodiversity. Finally, the timing of when to integrate sustainability principles in sport nutrition is discussed, followed by practical applications for education and inclusion in team, institutional, and event operations.

Subcutaneous fat patterning in athletes: selection of appropriate sites and standardisation of a novel ultrasound measurement technique: ad hoc working group on body composition, health and performance, under the auspices of the IOC Medical Commission.

BACKGROUND: Precise and accurate field methods for body composition analyses in athletes are needed urgently. AIM: Standardisation of a novel ultrasound (US) technique for accurate and reliable measurement of subcutaneous adipose tissue (SAT). METHODS: Three observers captured US images of uncompressed SAT in 12 athletes and applied a semiautomatic evaluation algorithm for multiple SAT measurements. RESULTS: Eight new sites are recommended: upper abdomen, lower abdomen, erector spinae, distal triceps, brachioradialis, lateral thigh, front thigh, medial calf. Obtainable accuracy was 0.2 mm (18 MHz probe; speed of sound: 1450 m/s). Reliability of SAT thickness sums (N=36): R(2)=0.998, SEE=0.55 mm, ICC (95% CI) 0.998 (0.994 to 0.999); observer differences from their mean: 95% of the SAT thickness sums were within ± 1 mm (sums of SAT thicknesses ranged from 10 to 50 mm). Embedded fibrous tissues were also measured. CONCLUSIONS: A minimum of eight sites is suggested to accommodate inter-individual differences in SAT patterning. All sites overlie muscle with a clearly visible fascia, which eases the acquisition of clear images and the marking of these sites takes only a few minutes. This US method reaches the fundamental accuracy and precision limits for SAT measurements given by tissue plasticity and furrowed borders, provided the measurers are trained appropriately.