From the findings, it is noted that male respondents constituted a bigger proportion than females. This is because generally, sports is strongly gendered in African settings and society tends to discourage females from participating in sports (23). Our findings relate to a previous study by Baranauskas et al, (24) where male athletes were more than female athletes. Additionally, we showed knowledge differences between the sexes, which differs from other studies such as Magee et al, (25). Our observed sports nutrition knowledge differences with sex could be because female adolescents are generally aware of their body image and tend to seek nutritional counselling more than their male counterparts(26). This also implies that there may be a need to provide sex-specific nutrition knowledge to athletes to accommodate this sex difference.
The majority of endurance athletes in this study were late adolescents and had participated for less than 2 years in athletics. This is similar to the cohort from Baranauskas et al., (24) whose respondents had a mean age of 17 years, but contrasts with a previous study conducted among Kenyan endurance athletes who were much older with the majority between 23–28 years of age with less than 3 years of participation, which is somewhat similar to our study findings (17).
The highest academic achievement of most athletes in our study was secondary school level, which is to be expected given their age and generally, such education levels are commonly reported in studies of Kenyan and Ugandan athletes (16, 17). Our report contrasts other studies whose respondents had certificates, tertiary/ university degrees as their highest level of education (27–29). Level of education has been associated with the level of SNK in other studies of physically active individuals (16, 17) and in our cohort may have implications for the development of future education materials, as these need to be tailored to the level of education of our cohort.
The study found that most athletes acknowledge that pre-event meals should be consumed at least three hours prior to the event, while a significant proportion of them did not know this. More than half of athletes were not knowledgeable about the six classes of nutrients. A big proportion of respondents had good knowledge that athletes’ food consumption should be higher than in non-athletes. Almost three-quarters of the athletes had the right knowledge that sports drinks are best to replace fluids lost in the field of play. In addition, the majority of the respondents in the current study had good dietary practices. This is similar to a study on undergraduate athletes from Nigeria where 63% of respondents reported adequate nutrition practices (22), as well as a study on Nepali athletes where 50% had good nutrition practice scores (30). Female athletes displayed better dietary practices compared to males in the current study just as was observed in Koch et al’s study of the Nemonit population (10).
Almost 75% of the athletes did not skip meals while almost every athlete always ate their breakfast, as shown in other cohorts (31). All respondents in this cohort take a lot of water during training and eat at least three meals a day. This is consistent with the findings of previous studies on in-training water consumption (22, 31) but contrasts with Oladunni & Sanusi., (32) who reported that 77% of athletes from Nigeria skip meals. The present findings also concur with the findings of Folasire et al., (22), which reported that 82.7% of athletes ate a pre-event meal at least three hours before the event; 57% agreed that athletes' food intake should be higher than non-athletes; 63.6% reported good knowledge of the six classes of nutrients.
Further, athletes in our study displayed a high level of sports nutrition knowledge when it came to the use of recovery strategies with 75% of endurance athletes having good knowledge of the consumption of vitamins to enhance recovery. This finding was corroborated by studies that show that vitamin intake enhances muscle recovery by negating the effects of exercise-induced muscle damage(33, 34). Such recovery strategies could be adopted by endurance athletes following this position statement(2). The present results are also corroborated by previous studies that report good sports nutrition knowledge in 56% of Kenyan endurance athletes and 69.42% of Ghanaian athletes (17, 29). However, the current study contrasts the findings of Klein et al., (31) that reported low sports nutrition among their athletes. This current study further disagrees with a more recent study of young athletes that reported poor average sports nutrition knowledge of its male and female respondents (25).
Our study found a statistically significant relationship between athletes’ sports nutrition knowledge and dietary practice which correlates with a review that established that nutrition knowledge had a weak positive relationship with positive dietary changes (13). Even though our results did not show a relationship between previously attending a nutrition course with sports nutrition knowledge, this phenomenon of ‘when we know better, we do better’ has also been demonstrated in other studies on sports nutrition knowledge (28, 31), and in other health domains, such as good menstrual hygiene and child caregiving where higher literacy is associated with better behaviours (35, 36). Hence, it is important to enhance athletes’ sports nutrition knowledge. It is noteworthy, however, that in Uganda, Nassanga et al., (35) reported that a combination of factors interplay when it comes to how knowledge is translated into proper dietary practices. Primarily, poverty, food security, the attitudes of the individuals, and the nature of jobs people are engaged in are key determinants of nutritional knowledge transfer. In our cohort, in particular, the median household income is Uganda Shillings (UGX) 100,000 which was not only associated with knowledge, but household income may not be enough to allow players to consume all the food groups in the requisite amounts. Hence, despite Ugandan athletes being knowledgeable about sports nutrition, they may not have the resources available to practice optimum sports nutrition due to low socioeconomic status (37).
Concerning the source of nutrition information, the majority of the respondents identified athletic trainers as a popular source of knowledge used in the camps, followed by parents/ family. Nutritionists/Dietitians, internet, TV/Radio, magazines, and others like doctors, peers, and schools were rarely consulted for sports nutrition information. These study findings are similar to other studies, which found that coaches/trainers are popular sources athletes rely on for nutrition knowledge. (22, 38, 16, 29, 39). However, this contrasts with Kathure et al., (17) who showed that 60% of their cohort relied on the Internet as the main source of nutrition information. Further, findings from UK runners show that 33–82% of them relied on internet/web sources for nutrition information (40). Interestingly, peer-reviewed literature was identified as the main source of information by Hispanic ultra-endurance athletes (42), while nutritionists and dietitians were popular sources amongst athletes from Australia (23).
In our cohort, less than a tenth consulted a nutritionist for nutrition information. This result was expected because of the lack of nutritionists/dietitians in athlete support staff in low and middle-income countries (LMICs) such as Uganda, due to inadequate budgets to cover the cost of such specialized staff (16). Generally, there exists a gap in the enrolment and training of nutritionists/dietitians within tertiary institutions in low and middle-income countries (LMICs) (44, 45). In Uganda, the majority of graduate nutritionists and dietitians from tertiary institutions enter the job market with incompetencies in some crucial domains of practice (46). In contrast, high-income countries (HICs) tend to have specialized and rigorously licensed and certified athlete nutrition staff (43, 47). Access to credible knowledge from nutritionists/dietitians could help inform dietary changes that in turn promote the healthy nutritional status of athletes (48, 49) and reduce the likelihood of misinformation (4, 50). Since African athletes rely primarily on their coaches/trainers for nutrition knowledge, it may be prudent to incorporate nutrition education in coach education (51, 52) as well as for athletes themselves (53). Moreover, the earlier this nutrition education is done, the sooner it will shape eating habits that are carried on into their careers and adulthood (54).
Cereals were the most frequently consumed. This is likely a reflection of the geographic location of the region, which is typically mountainous with no viable fishing grounds (lakes, swamps, and rivers). Fish is only obtained from markets distant from the region. Cereals like maize and millet are readily available in this region from cultivation as are legumes and nuts. This variation in the frequency is related to the accessibility of food by athletes (55). A previous report on dietary diversity supports a finding of the current study where high frequency of cereals consumption was observed by athletes as cereals (maize, wheat, and millet) make up a big part of the diet of inhabitants in Eastern, Northern and as well in the Southern African regions (56).
Our cohort showed a low frequency of meat/poultry, fish/make, and milk/eggs consumption by endurance athletes. This low consumption of animal protein may indirectly translate into inadequate protein intake in this population. Similarly reported by Moss et al, protein needs were not met by their endurance athletes, especially female athletes (57). Inadequate protein intake in endurance training compromises protein synthesis, promotes muscle atrophy, and prolongs recovery (58, 59). In contrast, Lin et al show evidence of enhanced endurance training with adequate protein intake (60). Endurance athletes require a recommended daily allowance (RDA) of protein in a range not greater than 1.6 g protein per kg ( PRO/kg) of body weight to maintain lean muscle mass (61, 62).
In the current study, root/tubers (e.g., sweet, potatoes, cassava, yams) were not consumed as highly as reported in other studies (32). Overall, the frequency of food group consumption is different from the profile observed among Nigerian athletes whose most frequently consumed food groups were, fish/meat, milk, and eggs (70.0% – 80.0%), and the least frequently consumed food groups were legumes-nuts (25%) and healthy root-tubers (15%) (22). Similar to a study on student athletes in Nigeria, knowledge positively related to the consumption of root/tubers like yams in Nigeria (32), SNK in our cohort was significantly and positively associated with root /tuber consumption. However, other studies have not observed the same (10). Kamande et al., (63) found a strong positive association between knowledge and legume and fruit consumption of Kenyan athletes unlike in the present study. This implies that Ugandan endurance athletes have a tendency to consume tuber/roots that are a key component in endurance carbohydrate fuelling techniques.
Recommendations
Since the athletes in this study most often consult athletic trainers for nutrition knowledge, the National Council of Sports Uganda should develop routine capacity-building programs to offer supplementary Sports nutrition training to trainers. This knowledge in turn will hopefully be disseminated to endurance athletes in training sessions in their camps. In the long term, it is important that nutritionists/dietitians be engaged as part of athlete support personnel to ensure good SNK as well as optimal consumption of nutrients in Ugandan endurance athletes.
Management of athletic camps to incorporate protein-rich diets in athletes’ daily and weekly meal plans for optimal protein intake.
Limitations and suggestions for future studies
This study is not without limitations. Firstly, the cohort only included 100 young endurance athletes from Sebei, with a few years of experience in athletics. Hence, the results should be generalized to other Ugandan regions and different age cohorts with caution.
Secondly, the study did not objectively assess athletes’ dietary intake but relied on self-reported practices and food consumption frequency from different food groups. This has the inherent weaknesses of recall bias, social desirability bias, as well as inaccuracy. Studies that prospectively assess the adequacy of nutrient intake by this population are suggested.
