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Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review
Open accessAbstract
Nutrition knowledge (NK) impacts food choices and may be improved through educational programmes. Identifying knowledge gaps related to NK among adolescent athletes may guide future nutrition education programmes. This review aimed to systematically review the level of NK in adolescent athletes based on the currently available published literature. The protocol for this review was registered with PROSPERO (CRD42022321765). A literature search was conducted in April 2022 using MEDLINE, CINAHL, SPORTDiscus, Web of Science and SCOPUS databases. The study design was not restricted, provided that a quantitative NK score was reported for adolescent athletes. Studies were limited to the English language and published between 2010 and April 2022. Studies were assessed for quality and risk of bias using the Academy of Nutrition and Dietetics Quality Appraisal Checklist. Data extracted included demographics, questionnaire name, number of items, validation status and mean total and subsection NK scores. Meta-analyses were inappropriate due to the heterogeneity of NK assessment tools; therefore, results were presented narratively. Thirty-two studies that assessed NK of 4553 adolescent athletes and 574 comparison participants were included. Critical appraisal of studies resulted in neutral rating ‘moderate quality’ for most (n 30) studies. Studies lacked justification for sample size and often used inadequately validated questionnaires. NK scores ranged from poor (33·3 %) to excellent (90·6 %). The level of NK across studies is difficult to determine due to heterogenous questionnaires often lacking appropriate validation. NK should be assessed using tools validated in the relevant population or revalidated tools previously used for other populations.
Overview
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TL;DR
This systematic review of 32 studies (4553 adolescent athletes and 574 comparison participants) found nutrition knowledge scores ranged from poor (33·3 %) to excellent (90·6 %), but heterogeneous and often inadequately validated questionnaires made the overall level difficult to determine. Adolescent athletes scored higher in general nutrition knowledge than sports nutrition knowledge when directly compared and showed poor supplement knowledge.
Key findings
- Across 32 studies and 4553 adolescent athletes, total nutrition knowledge scores ranged from 33·3 % to 90·6 %; most studies (n 30) received a neutral “moderate quality” rating, and only two received a positive rating.
- When general nutrition knowledge (GNK) and sports nutrition knowledge (SNK) were directly compared within studies (n 4), GNK was the highest-scoring section in all cases; supplement knowledge was poor wherever reported, with Bird and Rushton reporting supplements as the greatest source of uncertainty (45 % “don’t know” responses).
- The review included 21 questionnaires across 32 studies; 16 studies used a questionnaire with 25 or fewer questions, 13 described using a “previously validated questionnaire,” and only two revalidated after modifying a questionnaire.
- Nine studies included 574 non-adolescent comparison participants; adult athletes scored numerically higher than adolescent athletes in all but one study comparing these groups, and in the one age-matched non-athlete comparison, adolescent athletes scored higher in all sections.
Methods
- Systematic literature review following PRISMA, registered with PROSPERO (CRD42022321765); searched MEDLINE, CINAHL, SPORTDiscus, Web of Science and SCOPUS in April 2022, limited to English-language studies published between 2010 and April 2022.
- Included original studies providing a quantitative nutrition knowledge score for adolescent athletes aged 10–19 years (WHO definition) in any organised sport; 816 records were identified, 555 screened after duplicate removal, 104 full texts screened, and 32 studies included.
- Data extraction covered demographics, questionnaire details, validation status, and mean total and subsection scores converted to percentages; quality/risk of bias was assessed with the Academy of Nutrition and Dietetics Quality Appraisal Checklist, and results were synthesised narratively because meta-analysis was inappropriate.
Limitations
- The paper states that meta-analysis was implausible because of heterogeneous nutrition knowledge questionnaires; possible publication bias arose from excluding studies published before 2010 (11 otherwise eligible studies), excluding non-English and grey literature, and being unable to source four studies for full-text screening.
- The paper also states study-level limitations: small sample sizes, lack of justification for sample size or description of the target population, use of unvalidated or insufficiently validated tools, few comparison groups (especially age-matched), and no author responses to requests for missing or inconsistent data.
- Evident from the text: only two studies received a positive quality rating; 19 studies had fewer than 100 participants; several studies modified previously validated questionnaires without revalidation; and geographic representation was limited (no African countries, Brazil the only South American country, Australia the only Oceanian country).
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“Thirty-two studies that assessed NK of 4553 adolescent athletes and 574 comparison participants were included.”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Abstract
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In the paper
“NK scores ranged from poor (33·3 %) to excellent (90·6 %).”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Abstract
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In the paper
“Adult athletes’ mean score correct was reported as 66·7 %(23) and 70 %(42).”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
What the sources say
- Not checked yetcites [23] Argôlo D, Borges J, Cavalcante A, et al. (2018) Poor dietary intake and low nutritional knowledge in adolescent and adult competitive athletes: a warning to table tennis players. Nutr Hosp 35, 1124– 1130. 30307296 source
- Not checked yetcites [42] Nascimento M, Silva D, Ribeiro S, et al. (2016) Effect of a nutritional intervention in athlete’s body composition, eating behaviour and nutritional knowledge: a comparison between adults and adolescents. Nutrients 8, 535. 27618088 PMC5037522 source
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In the paper
“Three studies(34,35,38) using the Heikkila et al.(58) questionnaire reported supplements to be the lowest scoring section.”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
What the sources say
- Not checked yetcites [34] Heikkilä M, Lehtovirta M, Autio O, et al. (2019) The impact of nutrition education intervention with and without a mobile phone application on nutrition knowledge among young endurance athletes. Nutrients 11, 2249. 31540535 PMC6770376 source
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- Not matchedcites [35] Heikkilä M, Valve R, Lehtovirta M, et al. (2018) Nutrition knowledge among young Finnish endurance athletes and their coaches. Int J Sport Nutr Exerc Metab 28, 522– 527. 29252046
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked yetcites [38] Kettunen O, Heikkilä M, Linnamo V, et al. (2021) Nutrition knowledge is associated with energy availability and carbohydrate intake in young female cross-country skiers. Nutrients 13, 1769. 34067303 PMC8224650 source
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- Not matchedcites [58] Heikkila M, Valve R, Lehtovirta M, et al. (2018) Development of a nutrition knowledge questionnaire for young endurance athletes and their coaches. Scand J Med Sci Sports 28, 873– 880. 28975667
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Similarly, two studies(26,30) that used questionnaires based on Zinn et al. (59) reported poor scores.”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
What the sources say
- Not checked yetcites [26] Bird SP & Rushton BD (2020) Nutritional knowledge of youth academy athletes. BMC Nutr 6, 35. 32821418 PMC7433089 source
- Not checked yetcites [30] Escribano-Ott I, Mielgo-Ayuso J & Calleja-González J (2021) A glimpse of the sports nutrition awareness in Spanish basketball players. Nutrients 14, 27. 35010902 PMC8746623 source
- Not checked yetcites [59] Zinn C, Schofield G & Wall C (2005) Development of a psychometrically valid and reliable sports nutrition knowledge questionnaire. J Sci Med Sport 8, 346– 351. 16248475 source
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Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“This distinction is important in adolescents because knowing what should be eaten does not necessarily mean that the athlete has the autonomy, money, time, cooking skills, family support, or club environment required to translate knowledge into behavior (4–6).”
In the citing paper
“Recent literature indicates that adolescent athletes may have better general than sport-specific nutrition knowledge, with persistent gaps around carbohydrate periodization, hydration, recovery nutrition, supplement use, and the relationship between diet, health, and performance (6).”
In the citing paper
“It is necessary because many young athletes have gaps in sport-specific nutrition knowledge (6, 15, 28, 32, 33).”
In the citing paper
“while Hulland et al. (6) found that adolescent-athlete studies often used inadequately validated questionnaires and lacked sample-size justification.”
In the citing paper
“Dietary behaviours are also shaped by broader individual and environmental influences, including cooking ability, the home food environment, time constraints and the influence of parents, peers and coaches”
From Dietary intake, nutrition knowledge, and behavior in youth team sport athletes: a scoping review and call to advance research and practice (2026) · cites this paper as [18]
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Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
“a total of 555 articles were included for the title and abstract screening. Two hundred and sixteen articles were excluded during the title and abstract screening, including eleven articles that were published before 2010. A total of 107 articles were considered eligible for full-text screening”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Study selection
Reported 107 · recomputed 339
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
“however, the adult athletes scored lower within the GNK subsection than the adolescents.”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Study characteristics
“Argolo et al.(23), (2018); Brazil | GNK(3) | 55 | 12 | GNK: 82·5 | 23* | 66·7 | 10 | GNK: 97 | 9·4* | Neutral”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
“The results across adolescent athletes were comparable, with total mean correct reported as 72·7 %(34), 76 %(38) and 77·7 %(35).”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Study characteristics
“Heikkilä et al. (34), (2019); Finland | Nutrition recommendations, supplements, hydration, recovery, food choice/body image | Total participants: 77·7 | 7·6”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
“while pre- and post-exercise hydration mean % correct scores were similar at 47·2 % and 47·7 %, respectively.”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
“post-exercise hydration received the lowest scores (mean % correct = 33·2 %)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Results of individual studies
“Subsection scores were reported in two studies(31,57), which both indicated the lowest scoring section to be ‘protein’ and the highest ‘energy/refuelling’.”
§ Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review > Results > Study characteristics
“Hydration: 76·4, supplements 69·3, energy/refuelling 57·1, protein 39·2”
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Citations
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Metadata
- Authors
- Hulland, S. C., Trakman, G. L., & Alcock, R. D.
- Affiliations
- La Trobe University (AU)
- Corresponding author
- Hulland, Susan C.
- Venue
- British Journal of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2023-12-06
- Volume
- 131
- Issue
- 8
- Pages
- 1362-1376
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- PMC
- PMC10950453
- OpenAlex
- W4389393403
- Semantic Scholar
- 5ff5b52810442fa0af961983dbd9422fb9dd11a4
- Cited by
- 34
- References
- 75
- Citations by year
- 2026: 17 · 2025: 12 · 2024: 5
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- La Trobe University (cc-by)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Dietetics, Nutrition, and Education
- Keywords
- youth athletes, nutrition knowledge, sports nutrition, supplement recommendations, nutrition education, questionnaire validation, food choice
- MeSH terms
- Adolescent, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Sports, Dietary Supplements, Athletes, Sports Nutritional Sciences, Sports Nutritional Physiological Phenomena
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Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
