Impact of Culinary Medicine Course on Confidence and Competence in Diet and Lifestyle Counseling, Interprofessional Communication, and Health Behaviors and Advocacy.

Most physicians report inadequate training to provide diet and lifestyle counseling to patients despite its importance to chronic disease prevention and management. To fill the nutrition training gap, elective Culinary Medicine (CM) courses have emerged as an alternative to curriculum reform. We evaluated the impact of an interprofessional CM course for medical and health professional students who experienced the hands-on cooking component in person or a in mixed-mode format (in-person and via Zoom) at the University of Utah from 2019-2023 (n = 84). A factorial ANOVA assessed differences between educational environment and changes between pre- and post-course survey responses related to diet and lifestyle counseling, interprofessional communication, and health behaviors and advocacy. Qualitative comments from post-course surveys were analyzed on a thematic level. Students rated themselves as having greater confidence and competence in diet and lifestyle counseling (p < 0.05) and increased ability to prepare eight healthy meals (p < 0.05). Additionally, a Mann-Whitney two-sample rank-sum test was used to compare data from exit survey responses from medical students who took the CM course (n = 48) and did not take the CM course (n = 297). Medical students who took CM were significantly more likely to agree that they could counsel patients about nutrition (p < 0.05) and physical activity (p < 0.05). CM courses may improve students' confidence to provide diet and lifestyle counseling.

Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches.

STUDY OBJECTIVE: This study aimed to determine awareness/knowledge of the Triad and its health implications among female high school athletes and their coaches, and to evaluate coaches' Triad screening/intervention practices. DESIGN: Cross-sectional survey. SETTING: Two high schools in the western United States. PARTICIPANTS: Female athletes from a variety of sports (N = 240) ages 14-18 years and their coaches (N = 10). INTERVENTION: Participants completed surveys that assessed Triad knowledge and athlete Triad risk factors. MAIN OUTCOME MEASURES: Frequency of responses to Triad knowledge, Triad risk factor, and Triad education/screening procedures questions; athlete summative knowledge score. RESULTS: Half (N = 120) of participants reported menstrual irregularity, and 42% (N = 101) had 2 or more Triad risk factors: past amenorrhea (N = 39), past stress fracture (N = 41), self-reported not eating enough (N = 53), underweight (BMI-for-age < 5(th) percentile) (N = 10), pressure to be a certain weight (N = 143), and wanting to lose >10 pounds when self-reported weight was in a healthy range (N = 34). Average athlete Triad knowledge score was 2.97 ± 1.61 out of 8. Coach Triad knowledge was limited; however, most (9/10) were comfortable discussing menstruation with their athletes. Barriers to Triad screening/education were coaches' insufficient time, knowledge, and educational resources. CONCLUSION: Triad risk factors were prevalent among athletes and coach and athlete Triad knowledge was low. Providing coaches with Triad screening/education training may increase Triad knowledge and decrease Triad risk among high school athletes.

Female athlete triad update.

The passage of Title IX legislation in 1972 provided enormous opportunities for women to reap the benefits of sports participation. For most female athletes, sports participation is a positive experience, providing improved physical fitness, enhanced self-esteem, and better physical and mental health. Nonetheless, for a few female athletes, the desire for athletic success combined with the pressure to achieve a prescribed body weight may lead to the development of a triad of medical disorders including disordered eating, menstrual dysfunction, and low bone mineral density (BMD)--known collectively as the female athlete triad. Alone or in combination, the disorders of the triad can have a negative impact on health and impair athletic performance.

The prevalence of disordered eating, menstrual dysfunction, and low bone mineral density among US collegiate athletes.

The purpose of this study was to examine the prevalence of disordered eating (DE), menstrual dysfunction (MD), and low bone mineral density (BMD) among US collegiate athletes (n = 112) representing 7 different sports (diving, swimming, x-country, track, tennis, field hockey, and softball) and determine differences in prevalence existed between athletes participating in lean-build (LB) and non-lean build (NLB) sports. DE and MD were assessed by a health, weight, dieting, and menstrual history questionnaire. Spinal BMD was determined via dual energy x-ray absorptiometry. Twenty-eight athletes met the criteria for DE, twenty-nine for MD, and two athletes had low BMDs (using a Z score below -2.0). Ten athletes met the criteria for two disorders (one with disordered eating and low BMD and nine with disordered eating and menstrual dysfunction), while only one athlete met the criteria for all three disorders. Using a Z score below -1.0, two additional athletes met the criteria for all three disorders and three more athletes met the criteria for a combination of two disorders. With the exception of MD, which was significantly more prevalent among LB vs. NLB sports (P = 0.053), there were no differences between the groups in the prevalence of individual disorders or combinations of disorders. These data indicate that the combined prevalence of DE, MD, and low BMD among collegiate athletes is small; however, a significant number suffer from individual disorders of the Triad.

Eating disorder and menstrual dysfunction screening, education, and treatment programs.

UNLABELLED: To describe the nature, scope, and perceived effectiveness of selected National Collegiate Athletic Association (NCAA) Division 1 programs for the screening, education, and treatment of eating disorders (ED) and menstrual dysfunction (MD). METHODS: Surveys were mailed to the team physician or the head athletic trainer of all NCAA Division 1 schools currently supporting at least two of the following women's sports: cross-country/track, swimming, and gymnastics. The survey contained closed- and open-ended questions to ascertain the types of ED and MD screening, education, and treatment programs and their perceived effectiveness. RESULTS: A total of 170 surveys were sent, and 81% were returned. Although 79% of schools reported screening for MD, only 24% used a comprehensive menstrual history questionnaire. An MD treatment protocol was used by 33% of schools, and 7% reported withholding those with MD from athletic participation. Screening for ED was reported by 60% of schools, but less than 6% used a structured interview or a validated ED questionnaire. Athletes with confirmed ED were withheld from athletic participation by 21% of the schools; athletes with suspected ED were withheld by 9%. Education about ED and MD was made available to athletes by 73% of the schools, and 61% of the schools made this education available to coaches. However, less than 41% of schools made such education a requirement. Thirty-five percent of respondents perceived their MD screening programs to be successful or very successful, compared with 26% for ED screening programs. CONCLUSIONS: These results indicate a pressing need for more standardized ED and MD screening, prevention, and treatment programs among NCAA Division 1 schools. At the very least, all NCAA-member institutions should implement mandatory ED and MD education for all athletes and athletic personnel.

Disorders of the female athlete triad among collegiate athletes.

This study examined the prevalence of and relationship between the disorders of the female athlete triad in collegiate athletes participating in aesthetic, endurance, or team/anaerobic sports. Participants were 425 female collegiate athletes from 7 universities across the United States. Disordered eating, menstrual dysfunction, and musculoskeletal injuries were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), and the Eating Disorder Inventory Body Dissatisfaction Subscale (EDI-BD). The percentage of athletes reporting a clinical diagnosis of anorexia and bulimia nervosa was 3.3% and 2.3%, respectively; mean ( SD) EAT and EDI-BD scores were 10.6 9.6 and 9.8 7.6, respectively. The percentage of athletes with scores indicating "at-risk" behavior for an eating disorder were 15.2% using the EAT-26 and 32.4% using the EDI-BD. A similar percentage of athletes in aesthetic, endurance, and team/anaerobic sports reported a clinical diagnosis of anorexia or bulimia. However, athletes in aesthetic sports scored higher on the EAT-26 (13.5 10.9) than athletes in endurance (10.0 9.3) or team/anaerobic sports (9.9 9.0, p <.02); and more athletes in aesthetic versus endurance or team/anaerobic sports scored above the EAT-26 cut-off score of 20 (p <.01). Menstrual irregularity was reported by 31% of the athletes not using oral contraceptives, and there were no group differences in the prevalence of self-reported menstrual irregularity. Muscle and bone injuries sustained during the collegiate career were reported by 65.9% and 34.3% of athletes, respectively, and more athletes in aesthetic versus endurance and team/anaerobic sports reported muscle (p =.005) and/or bone injuries (p <.001). Athletes "at risk" for eating disorders more frequently reported menstrual irregularity (p =.004) and sustained more bone injuries (p =.003) during their collegiate career. These data indicate that while the prevalence of clinical eating disorders is low in female collegiate athletes, many are "at risk" for an eating disorder, which places them at increased risk for menstrual irregularity and bone injuries.

Eating behaviors, nutritional status, and menstrual function in elite female adolescent volleyball players.

Nutritional status, eating behaviors and menstrual function was examined in 23 nationally ranked female adolescent volleyball players using a health/weight/ dieting/menstrual history questionnaire, the Eating Disorder Inventory (EDI), and the Body Shape Questionnaire (BSQ). Nutrient and energy intakes (El) and energy expenditure (EE) were determined by 3-d weighed food records and activity logs. Iron (Fe), vitamins C, B12, and Folate status were assessed using serum and whole blood. Mean El (2248 +/- 414 kcal/d) was less than EE (2815 +/- 306 kcal/d). Mean carbohydrate (5.4 +/-1.0g/kg/d) and protein (1.1+/-0.3g/kg/d) intakes were below recommended levels for highly active women. Mean intakes for folate, Fe, Ca, Mg, and Zn were less than the respective RDAs/DRIs and almost 50% of the athletes were consuming less than the RDAs/DRIs for the B-complex vitamins and vitamin C. Three athletes presented with Fe deficiency anemia (Hb <12 mg/dL), while marginal vitamin B12 status (<200 pg/ml) and vitamin C status (<28 mmol/L) were found in 1 and 4 athletes, respectively. Approximately 1/2 of the athletes reported actively "dieting". Mean BSQ and EDI subscales scores were within the normal ranges; yet, elevated scores on these scales were reported by 26% and 35% of athletes, respectively. Past or present amenorrhea was reported by 17% of the athletes and 13% and 48%, reported past or present oligomenorrhea and "irregular" menstrual cycles, respectively. These results indicate that elite adolescent volleyball players are at risk for menstrual dysfunction and have energy and nutrient intakes that place them at risk for nutritional deficiencies and compromised performance.