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Are athletes adequately fuelled and informed? Dietary intake, energy availability and nutrition knowledge across athletes and their coaches

Despite moderate nutrition knowledge among participants, the study reveals a high prevalence of low energy availability and inadequate dietary intake in athletes, highlighting the critical role of coaches as mediators and the urgent need for specialized nutrition education programs led by registered dietitians.

Original authors: Xavier Puchalt-Urbano, María J Esteve, Raúl López-Grueso, Jesús Blesa

Published 2026-09-18

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CC BY 4.0

Original authors: Xavier Puchalt-Urbano, María J Esteve, Raúl López-Grueso, Jesús Blesa

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

For an athlete, the body is a high-performance engine that demands more than just rest and training; it requires precise fuel. Just as a car cannot run on the wrong grade of gasoline, a human body cannot perform at its peak without the right balance of energy and nutrients. This balance is not merely about eating enough food to avoid hunger; it is about having enough energy left over after exercise to power essential bodily functions like healing, hormone regulation, and immune defense. Scientists call this remaining energy "energy availability." When an athlete does not consume enough calories to cover both their daily life and their intense training, this availability drops, leading to a state where the body begins to shut down non-essential systems to survive. This condition, known as low energy availability, can silently erode health and performance, yet it often goes unnoticed because the athlete may still feel strong in the short term. Understanding how athletes fuel themselves, and what they actually know about food, is critical to preventing these hidden dangers.

A recent study set out to investigate exactly how well athletes and their coaches understand these nutritional needs and whether that knowledge translates into what is actually on the plate. Researchers gathered a group of 184 competitive athletes and 13 of their coaches from various sports and skill levels, ranging from regional competitors to international elites. The team asked the athletes to keep a detailed diary of everything they ate and drank for seven days, while also recording their training intensity and duration. To measure what the athletes knew, they used a specialized questionnaire covering topics like macronutrients, vitamins, hydration, and how to time meals around training. The goal was to see if there was a gap between what athletes thought they knew, what they actually ate, and how their coaches influenced these choices.

The results revealed a striking disconnect between knowledge and action. While the athletes and coaches possessed a moderate level of general nutrition knowledge, this understanding did not seem to guide the athletes' eating habits. In fact, the study found that an athlete's own knowledge score had no connection to whether they were eating enough food or the right types of food. The situation was quite different for the coaches. The research showed that when a coach had a stronger grasp of nutrition, their athletes tended to consume more total energy and more carbohydrates. This suggests that the coach acts as a powerful gatekeeper for an athlete's diet, often more so than the athlete's own education. Despite the moderate knowledge levels, the dietary intake of the group was far from ideal. The average athlete was not meeting the recommended amounts of carbohydrates, which are the primary fuel for high-intensity exercise. Instead, many were eating diets that were higher in protein and fat than necessary, a pattern often seen in modern sports culture but one that leaves the body short on its most critical fuel source.

Perhaps the most alarming finding was the prevalence of low energy availability. The researchers calculated that nearly 69% of the athletes in the study were in a state where their energy intake was insufficient to support their training and basic health needs. This number was high across the board, affecting both men and women, though the specific risks and hormonal impacts can differ between sexes. Even among the elite international athletes, who might be expected to have the best support systems, a significant portion was still struggling to fuel themselves adequately. The study also highlighted a widespread lack of knowledge regarding specific vitamins and minerals. Large majorities of the participants were not getting enough vitamin D, vitamin E, calcium, or folate, nutrients that are essential for bone health, muscle function, and recovery. These deficiencies were not just minor gaps; they were common enough to be a serious concern for long-term health.

The study also looked at how athletes perceived their own knowledge. A significant portion of the athletes believed they knew more about nutrition than they actually did, overestimating their understanding of the subject. This overconfidence, combined with the fact that their own knowledge did not correlate with better eating habits, points to a complex problem where knowing the theory does not automatically lead to the right practice. The coaches, while generally more knowledgeable than the athletes, still had room for improvement, particularly in specific areas like hydration and periodization, which involves adjusting nutrition based on the training cycle. The researchers noted that while the coaches were a positive influence, many still relied on outdated advice or information from non-expert sources rather than evidence-based guidelines.

Ultimately, the study paints a picture of a sports environment where the potential for better performance and health is being held back by a lack of practical application. The athletes are not necessarily ignorant, but their knowledge is not translating into the right fuel. The coaches are a key lever in this system; when they understand nutrition better, the athletes eat better. However, the high rates of low energy availability and inadequate carbohydrate intake suggest that current methods of education and guidance are not working well enough. The researchers conclude that to fix this, sports organizations need to implement specialized nutrition programs led by registered dietitians who can provide tailored advice to both the athletes and the coaches. Without this targeted intervention, the risk of health issues and stalled performance remains high, regardless of how hard the athletes train or how much they think they know about food.

Technical Summary: Dietary Intake, Energy Availability, and Nutrition Knowledge Across Athletes and Their Coaches

Problem Statement
Adequate nutrition is fundamental to athletic performance, recovery, and long-term health, yet athletes often face significant gaps in meeting specific dietary requirements compared to the general population. A critical concern is Low Energy Availability (LEA), defined as insufficient dietary energy intake to support physiological function after accounting for exercise energy expenditure, which is associated with Relative Energy Deficiency in Sport (REDs) and adverse health outcomes. While nutrition knowledge is theoretically a determinant of dietary behavior, evidence suggests that athletes frequently possess only moderate to inadequate knowledge regarding sport-specific guidelines, periodization, and nutrient timing. Furthermore, the relationship between knowledge and actual dietary practice is often non-linear. Coaches, who frequently serve as primary sources of nutritional guidance for athletes, often lack sufficient evidence-based nutrition training themselves, potentially relying on anecdotal or outdated information. This study addresses the disconnect between knowledge and practice by simultaneously evaluating the nutrition knowledge of athletes and their coaches, assessing actual dietary intake, and determining the prevalence of LEA.

Methodology
This cross-sectional observational study involved 184 competitive athletes (84 females, 100 males) and 13 coaches recruited from local and national sports clubs and federations in Spain. Participants were aged 16–35, had competed for at least two years, and trained at least three times weekly during the competition period. Competitive levels ranged from regional (Tier 2) to international (Tiers 4–5).

Data collection utilized three primary instruments:

Nutrition Knowledge: Assessed using the Nutrition Knowledge Questionnaire for Young and Adult Athletes (NUKYA), a 20-item questionnaire (59 total items) covering macronutrients, micronutrients, hydration, and periodization. Scores were categorized from "very low" to "very high."
Dietary Intake: Evaluated via a 7-day food diary processed using DietoPro software. Intake was compared against guidelines from the American College of Sports Medicine (ACSM), Academy of Nutrition and Dietetics (AND), and Dietitians of Canada (DC) for macronutrients, and the Spanish Agency for Food Safety and Nutrition (AESAN) for micronutrients and fat.
Energy Availability (EA): Calculated using the formula $EA = (EI - EEE) / FFM$ , where EI is energy intake, EEE is exercise energy expenditure (estimated via 7-day training logs and metabolic equivalents), and FFM is fat-free mass (measured via bioelectrical impedance analysis under strict pre-test conditions). LEA was defined as EA < 30 kcal/kg FFM/day.

Statistical analysis included descriptive statistics, t-tests/Mann-Whitney U tests for group comparisons, ANOVA/Kruskal-Wallis for competitive levels, and Pearson correlation coefficients to assess relationships between knowledge and intake variables.

Key Results

Nutrition Knowledge: Overall knowledge was moderate (mean score: 46.5/100). Coaches scored significantly higher than athletes ( $p < 0.05$ ), particularly in micronutrients and hydration. While international athletes scored higher than regional athletes, no significant sex differences were found in total scores. A notable finding was the inverse correlation between coaches' and athletes' knowledge scores ( $r = -0.237, p = 0.001$ ).
Energy Availability: The mean energy availability was 24.8 kcal/kg FFM/day. Alarmingly, 68.5% of athletes were classified as having Low Energy Availability (LEA). Prevalence was high across all levels, with 74.0% of males and 61.9% of females in the LEA category.
Dietary Intake Compliance:
- Carbohydrates: Compliance was critically low, with only 9.8% of athletes meeting recommendations (6–10 g/kg BW/day).
- Protein and Fat: Compliance was moderate, with 48.9% meeting protein recommendations (1.2–2.0 g/kg BW/day) and 59.2% meeting fat recommendations (20–35% of total energy).
- Micronutrients: High rates of inadequacy were observed, particularly for Vitamin D (77.2%), Vitamin E (73.4%), Calcium (60.9%), and Folate (56.0%).
Knowledge-Behavior Relationships: Crucially, athletes' own nutrition knowledge scores showed no significant association with their dietary intake or energy availability. In contrast, coaches' nutrition knowledge was positively associated with athletes' daily energy intake ( $r = 0.168, p = 0.022$ ) and carbohydrate intake ( $r = 0.199, p = 0.007$ ).

Significance and Claims
The study concludes that despite possessing moderate nutrition knowledge, athletes exhibit a high prevalence of LEA and chronically inadequate carbohydrate intake. The research highlights a critical disconnect: an athlete's own knowledge does not translate into optimal dietary behavior. Instead, the findings underscore the role of coaches as primary mediators of nutritional behavior, as their knowledge levels positively correlate with athletes' energy and macronutrient intake.

The authors assert that current educational efforts are insufficient, noting that athletes often overestimate their knowledge and hold misconceptions (e.g., regarding protein as a primary energy source). The paper argues that optimizing athlete health and performance requires specialized nutrition education programs led by registered dietitians. These programs must target both athletes and coaches to address the identified gaps, mitigate LEA risks, and align dietary practices with evidence-based sports nutrition guidelines. The study emphasizes that nutritional outcomes are not solely determined by the athlete's knowledge but are heavily influenced by the technical staff's expertise.

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