Optimizing nutritional counseling for the disabled athlete

Along with the rapidly growing number of disabled people participating in
competitive sports, there is an increased need for (para)medical support in
disability sports. Disabled athletes experience differences in body
composition, metabolism, training load and habitual activity patterns compared
with non-disabled athletes. Moreover, it has been suggested that the
well-recognized athlete triad, and low energy availability and low bone mineral
density in particular, is even a greater challenge in disabled athletes.
Therefore, it is not surprising that sport nutritionists of disabled athletes
have expressed an urgency for increased knowledge and insights on the
nutritional demands of this group.

This project aims to assess whether the nutritional intake of Paralympic
athletes meets their physiological demands. Therefore, we will investigate
energy expenditure, dietary intake, body composition and bone health of
disabled athletes, ultimately leading to nutritional guidelines that promote
health and optimal sports performance for this unique population.

This is a cross-sectional study design with parallel measurements of energy
expenditure (doubly labelled water and indirect calorimetry), physical activity
patterns (accelerometry), dietary intake (24h recall), body composition (DXA
and anthropometry), blood analysis (5ml) and questionnaires (general health,
sports nutrition knowledge and risk on relative energy deficiency).

• During the baseline measurements, body composition will be assessed by DXA.
The measurement is painless, non-invasive and involves low radiation exposure
(<10 µSv).
• For venous blood collection, a small needle will be inserted into the
antecubital vein and blood is collected through a closed system attached to the
needle. The discomfort of this procedure is transient and is comparable to
having an injection by a needle, or donating blood.
• A wrist and hip-worn accelerometer will be worn during a 2-week period for
24h/day. This is measurement is comparable with wearing a watch and a small
belt.
• The 24-hour dietary recalls are aimed to be collected in person, if not
possible they will be collected via a phone call. A single 24-h recall takes
approximately 30 to 45 minutes to complete. The 24-h recall will be conducted
thrice over a 2-week period.
• Energy expenditure will be assessed by the doubly labelled water method. The
stable isotopes used in the doubly labelled water are non-radioactive, and also
non-toxic in the doses used. Therefore, the doubly labelled water method has
been used extensively in human volunteers, and even in infants and pregnant
women. The doubly labelled water requires the collection of 7 urine samples
over a period of 14 days.
Altogether, it can be concluded that the burden and risks associated with this
study are low. The study provides novel insight into the energy expenditure,
physical activity patterns, and dietary intake in disabled athletes. As such,
this study provides an important framework for dietary counselling in disabled
athletes.