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Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts
Open accessAbstract
Adolescent high-performance gymnasts are considered to be at risk for low energy intake. The aim of the present study was to determine the effects of implementing a nutritional education program during the sports season on the nutritional status and nutrition knowledge of the female artistic gymnasts from the Technification Center of the Balearic Islands (n = 24; age, 14.1 ± 2.3 years). A quasi-experimental intervention design was applied, which consisted of implementing a nutritional education program of seven sessions given during eight months. Measurements of nutritional intake, nutrition knowledge, and anthropometric parameters, as well as hematological and biochemical blood parameters, were performed. Gymnasts reported low energy and carbohydrate intakes, with significant increases during the study (energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg−1, p = 0.015, carbohydrate 3.2 ± 0.2 vs. 3.9 ± 0.2 g kg−1, p = 0.004). The average values for parameters such as hemoglobin, ferritin, lipoprotein, and vitamin C and E levels in the plasma were within normal ranges. Low intakes of most of the food groups were observed during the study, with similar initial and final values. Nutrition knowledge did not change as a result of the study (28.0 ± 1.7 vs. 31.1 ± 1.3, p = 0.185). In conclusion, gymnasts reported low energy intakes. However, blood markers and most of the anthropometrical parameters measured were within normal ranges. The nutrition education program implemented did not produce significant improvements in the dietary habits or nutritional knowledge of gymnasts.
Overview
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TL;DR
In a quasi-experimental study of 24 young female artistic gymnasts at a Spanish technification center, an eight-month nutrition education program did not significantly improve dietary habits or nutrition knowledge, despite modest increases in energy and carbohydrate intake. Gymnasts reported low energy intakes throughout, yet blood markers and most anthropometric parameters remained within normal ranges.
Key findings
- Energy intake was below recommended levels throughout but rose during the study (28.3 ± 1.4 vs. 32.8 ± 1.4 kcal·kg⁻¹, p = 0.015), as did carbohydrate intake (3.2 ± 0.2 vs. 3.9 ± 0.2 g·kg⁻¹, p = 0.004), still below the 5–6 g·kg⁻¹ suggested for athletes.
- Nutrition knowledge did not change significantly with the intervention (28.0 ± 1.7 vs. 31.1 ± 1.3, p = 0.185), nor did Mediterranean diet adherence (7.21 ± 0.35 vs. 7.56 ± 0.24, p = 0.119) or diet diversity score (2.26 ± 0.35 vs. 2.60 ± 0.17, p = 0.295).
- Blood markers (hemoglobin, ferritin, lipoproteins, vitamins C and E) were within normal ranges; two gymnasts had initial hemoglobin <12 g/dl and four had ferritin <15 ng/dl, but all values were adequate by the end. Mean EAT-26 score was 10.8 ± 8.7, with only one of 24 gymnasts scoring above the at-risk threshold of 20.
- Weight, height, BMI, fat mass, muscle mass and fat-free mass all increased significantly (p < 0.001 for most), while fat mass percentage decreased (p = 0.003).
Methods
- Quasi-experimental pre-post intervention design; 25 female gymnasts recruited from the Sports Technification Center of the Balearic Islands (one withdrew, n = 24; age 14.1 ± 2.3 years) across high-performance (n = 5), technification (n = 10) and follow-up (n = 9) levels.
- Intervention: seven formative nutrition education sessions (45–90 min, monthly) over eight months (October 2008–May 2009) for gymnasts, coaches and/or parents, plus leaflets and individualized advice.
- Measures at baseline, three and six months, and end: three 24-h recalls, semi-quantitative FFQ, nutrition knowledge questionnaire (61 items), EAT-26, hematological/biochemical blood parameters (HPLC for vitamins), anthropometry (ISAK, skinfolds, bioelectrical impedance), and heart-rate monitoring during training. Analysis used paired t-tests and repeated-measures ANOVA in SPSS (p < 0.05).
Limitations
- Stated by the authors: the quasi-experimental design lacked a control group (no comparable group available; withholding the program was considered ethically inappropriate and contamination was expected); small sample size limiting generalizability; three 24-h recalls inadequate for proper micronutrient measurement, with likely under- or mis-reporting bias.
- Evident in the text: the increase in carbohydrate/energy intake may reflect the start of the more demanding training season rather than the intervention (the authors themselves raise this); plasma vitamin D was not measured, so vitamin D status could not be assessed; the intervention's content, frequency, session number and duration are suggested by the authors as possibly inadequate.
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![Figure 1 Intake of food groups with respect to recommendations at the beginning and end of the study. The results were expressed as the percentage of food group intake with respect to the recommendations for each group [32]. The 100% value represented the recommended intake.](/paper-figures/ca0a3fc3252f4a7c990c8a4dad5c78c9/nutritional-status-and-implementation-of-a-nutritional-education-program-in-figure-1.jpg)
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Claims the paper makes
0 Valid · 0 Not valid · 42 Not checked · 73 Own results and interpretations
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Gymnasts reported low energy and carbohydrate intakes, with significant increases during the study (energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg−1, p = 0.015, carbohydrate 3.2 ± 0.2 vs. 3.9 ± 0.2 g kg−1, p = 0.004).”
- Also stated in: § 3.1. Dietary Intake, Quality of the Diet, and Nutrition Knowledge · plain
“However, energy intake was below the recommended level (Table S1) throughout the study.”
- Also stated in: § 4. Discussion · plain
“The main finding of the present study was the low energy intake of gymnasts.”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > Abstract
plainn = 24- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Rests on an assumption not shown here.
- Also stated in: § 3.1. Dietary Intake, Quality of the Diet, and Nutrition Knowledge · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The plasma vitamin E concentration decreased significantly (p = 0.012) during the study (Table 5).”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.3. Biochemistry Parameters and Vitamin Levels
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Regarding the lipid profile, significant decreases in the total cholesterol (p < 0.001), LDL-cholesterol (p = 0.006), and HDL-cholesterol concentrations were observed (p < 0.001).”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.3. Biochemistry Parameters and Vitamin Levels
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“While both vitamin A and vitamin C blood levels reflected adequate intakes, it is striking that vitamin E levels were within the normal range despite intake being below recommended values.”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 4. Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, lipid intake increased (p = 0.006), leading to a decrease in the percentage of energy from proteins (p = 0.015).”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.1. Dietary Intake, Quality of the Diet, and Nutrition Knowledge
plainstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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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
“Despite established nutritional guidelines for athletes (6), a substantial proportion of female athletes fail to meet these recommendations, commonly exhibiting inadequate carbohydrate intake, excessive fat consumption, and insufficient intake of key nutrients such as calcium, iron, and vitamin D (7–9).”
In the citing paper
“In response, nutrition education interventions, delivered through both face-to-face and digital formats, have demonstrated beneficial effects on SNK and, in some cases, on dietary intake among young female athletes (3, 7, 8, 18–28).”
In the citing paper
“Three previous studies in female athletes reported significant improvements in body composition following nutrition education interventions (7, 23, 56), with program durations ranging from 4 to 8 months.”
In the citing paper
“Four studies included in this review used this questionnaire(20,21,33,46).”
From Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review (2024) · cites this paper as [21]
In the citing paper
“Aguilo et al.(21) made major modifications to the questionnaire, resulting in only sixty-one questions being included.”
From Adolescent athletes have better general than sports nutrition knowledge and lack awareness of supplement recommendations: a systematic literature review (2024) · cites this paper as [21]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
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
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.4. Physical Activity Levels and Anthropometrical Parameters
“significant increases in weight (p < 0.001), height (p < 0.001), BMI (p < 0.001), fat mass (p = 0.002)”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 4. Discussion
“This weight increase could be attributed to the increases in height and fat-free mass without increases in fat mass.”
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
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.1. Dietary Intake, Quality of the Diet, and Nutrition Knowledge
“While initial vitamin A intakes were higher than recommended”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.1. Dietary Intake, Quality of the Diet, and Nutrition Knowledge
“Therefore, if hydrosoluble vitamins were not considered, only sodium intake at the end of the study and phosphorus intake throughout the study were above the recommended levels.”
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
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > Abstract
“energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg−1, p = 0.015”
§ Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts > 3. Results > 3.1. Dietary Intake, Quality of the Diet, and Nutrition Knowledge
“based on body weight (p = 0.0015)”
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Nutritional counseling in athletes: a systematic review
Fiorini, S., Neri, L. D. C. L., Guglielmetti, M., Pedrolini, E., Tagliabue, A., Quatromoni, P. A., & Ferraris, C. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1250567 · Cited by 45
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Villa, M., Villa, G., Seco‐Calvo, J., Mielgo‐Ayuso, J., & Collado, P. S. (2021) · Nutrients · doi:10.3390/nu13062083 · Cited by 33
Lower calcium and iron intake in adolescent gymnasts: A case of concern for youth sports nutrition
Vicente, F., Holanda, M., Ramalho, R., Mendes, J., Marques-Vidal, P. M., & Pereira, P. M. D. C. C. (2023) · Nutrition · doi:10.1016/j.nut.2023.112020 · Cited by 9
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Nevala, E. (2023) · UEF eRepo (University of Eastern Finland)
Nutritional Inadequacies and Body Composition in Czech Competitive Rhythmic Gymnasts: A Pilot Study
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Metadata
- Authors
- Aguilo, A., Lozano, L., Tauler, P., Nafría, M., Colom, M., & Martínez, S.
- Affiliations
- Research Group on Evidence, Lifestyles and Health, Department of Nursing and Physiotherapy, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain
- Research Institute of Health Sciences (ES)
- Health Research Institute of the Balearic Islands (ES)
- Corresponding author
- Tauler, Pedro
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2021-04-21
- Volume
- 13
- Issue
- 5
- Pages
- 1399
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC8143314
- OpenAlex
- W3154927307
- Cited by
- 23
- References
- 66
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 1 · 2023: 7 · 2021: 1
- FWCI
- 1.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Docusalut (Conselleria de Salut i Consum del Govern de les Illes Balears) (submittedVersion, cc-by)
- Hispana (submittedVersion, cc-by)
- Funders
- Consorci Escola Balear de l‘Esport. Conselleria de Presidència. Govern de les Illes Balears (Ref 1292)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- nutrition education, artistic gymnasts, youth athletes, energy intake, carbohydrate intake, nutrition knowledge, dietary habits, nutritional status, micronutrient status, female athletes, sports nutrition
- MeSH terms
- Adolescent, Blood Cell Count, Energy Intake, Diet, Drinking, Female, Food, Health Education, Health Plan Implementation, Humans, Iron, Health Knowledge, Attitudes, Practice, Nutritional Status, Vitamins, Exercise, Fitness Centers
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