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Nutrición Hospitalaria
ISSN: 0212-1611
info@nutriciónhospitalaria.com
Grupo Aula Médica
España
Martínez Rodríguez, Alejandro; Salar, Néstor Vicente; Montero Carretero, Carlos; Cervelló
Gimeno, Eduardo; Roche Collado, Enrique
Eating disorders and diet management in contact sports; EAT-26 questionnaire does not
seem appropriate to evaluate eating disorders in sports
Nutrición Hospitalaria, vol. 32, núm. 4, 2015, pp. 1708-1714
Grupo Aula Médica
Madrid, España
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Nutr Hosp. 2015;32(4):1708-1714
ISSN 0212-1611 • CODEN NUHOEQ
S.V.R. 318
Original / Deporte y ejercicio
Eating disorders and diet management in contact sports;
EAT-26 questionnaire does not seem appropriate to evaluate eating
disorders in sports
1 1 2
Alejandro Martínez Rodríguez , Néstor Vicente Salar , Carlos Montero Carretero ,
2 1,3
Eduardo Cervelló Gimeno and Enrique Roche Collado
1 2
Instituto de Bioingeniería, Universidad Miguel Hernández, Elche. Centro de Investigación del Deporte, Universidad Miguel
3
Hernández, Elche. CIBEROBN (CB12/03/30038) Instituto de Salud Carlos III, Spain.
Abstract DESÓRDENES ALIMENTARIOS Y
Introduction: there is a growing concern in the appea- SUPERVISIÓN DIETÉTICA EN DEPORTES
rance of eating disorders in athletes, especially those DE CONTACTO; EL CUESTIONARIO
that practice sports grouped into weight categories. This EAT-26 NO PARECE APROPIADO PARA
affects the way athletes eat, using frequently unheal- EVALUAR DESÓRDENES ALIMENTARIOS EN
thy strategies to control weight, especially during the DEPORTISTAS
pre-competition period. Resumen
Aim: this study analyses the prevalence of contact
sports athletes in developing eating disorders, and how Introducción: existe una preocupación creciente por
a controlled diet plan can reduce this risk. At the same los desórdenes alimentarios en deportistas, especialmen-
time, it evaluates the use of the EAT-26 questionnaire to te en aquellos que practican deportes agrupados en ca-
detect such disorders. tegorías de peso. Esto afecta a la manera de comer de
Methods: a randomized frequency study was perfor- los deportistas, usando con frecuencia estrategias no
med on 244 athletes (158 men, 86 women), who were se- saludables para control del peso, en especial en periodo
parated into two groups: those that followed a diet plan precompetitivo.
given by a nutritionist, and a control group on a free diet. Objetivo: este estudio analiza la prevalencia de desór-
The athletes completed an EAT-26 questionnaire while denes alimentarios en deportistas de deportes de contac-
participating in the University-level National Cham- to, y cómo una planificación dietética controlada puede
pionships. reducir el riesgo. También valora el uso del cuestionario
Results: the free diet group scored significantly higher EAT-26 para detectar dichos desórdenes.
on the questionnaire. Also, the female athletes controlled Métodos: ha sido realizado un estudio aleatorizado de
diet group scored significantly higher than their male frecuencias en 244 deportistas (158 varones, 86 mujeres),
counterparts. que fueron separados en dos grupos: los que seguían un
Discussion: the results of the questionnaire indica- plan dietético proporcionado por un nutricionista y un
te that an adequate nutritional program circumvents grupo control con una dieta libre. Los participantes relle-
the use of unhealthy habits to control body weight and naron el cuestionario EAT-26 mientras participaban en
therefore avoids developing particular eating disorders. los Campeonatos Universitarios Nacionales.
EAT-26 questionnaire does not seem the most appropria- Resultados: el grupo con dieta libre puntuó con valores
te tool to detect these disorders. más altos en el cuestionario. Al mismo tiempo, las depor-
(Nutr Hosp. 2015;32:1708-1714) tistas que seguían una dieta controlada puntuaron de for-
DOI:10.3305/nh.2015.32.4.9214 ma significativa en el cuestionario respecto a los varones
del mismo grupo.
Key words: Body weight. Contact sports. Combat sports. Discusión: los resultados del cuestionario indican que
Healthy habits. Sport nutrition. una adecuada planificación nutricional evita el uso de
hábitos poco saludables para controlar el peso corporal,
evitando desarrollar desórdenes alimentarios particu-
lares. El cuestionario EAT-26 no parece la herramienta
más apropiada para detectar estos desórdenes.
Correspondence: Enrique Roche Collado. (Nutr Hosp. 2015;32:1708-1714)
Instituto de Bioingeniería, Servicio de Nutrición Deportiva.
Universidad Miguel Hernández, Avda de la Universidad sn. DOI:10.3305/nh.2015.32.4.9214
03202 Elche (Alicante), España.
E-mail: eroche@umh.es Palabras clave: Peso corporal. Deportes de contacto. De-
Recibido: 7-V-2015. portes de lucha. Hábitos no saludables. Nutrición deportiva.
Aceptado: 26-VI-2015.
1708
042_9214 desordenes alimentarios y supervision dietetica.indd 1708 09/09/15 23:21
Abbreviations even recommended by their trainers. Therefore, it is
crucial to educate the athlete and their trainers as to
AMDQ: Athletic Milieu Direct Questionnaire. what are adequate methods of weight control, inclu-
BEDA-Q: Brief Eating Disorders in Athletes Ques- ding adopting proper eating habits.
tionnaire.
BULIT-R: Bulimia Test-Revised.
C: Control group following free diet. Objectives
CHRIS-73: College Health-Related Information
Survey. The objective of this study is to verify if an ade-
D: Group following a diet plan. quate diet plan can decrease behaviours related with
EAT-26: Eating Attitudes Test-26. eating disorders in contact sports athletes. To this
EDE-Q: Eating Disorder Examination Questionnaire. end, a group of male and female athletes following a
EDI: Eating Disorder Inventory. controlled diet plan were analyzed using the EAT-26
FAST: Female Athlete Screening Tool. questionnaire and compared with a control group on
J: Judo competitors. a free diet.
K: Karate competitors.
K-S test: Kolmogorov-Smirnov test.
M: Men. Method
PST: Physiologic Screening Test.
SEDA: Survey of Eating Disorders among Athletes. Participants
T: Taekwondo competitors.
W: Women. This study was performed with 244 volunteers
participating in the University-level National Cham-
pionships of judo, karate-kumite, and taekwondo. To
Introduction facilitate comprehension, the study groups were re-
ferred combining the abbreviations: J for judo com-
Eating disorders generally appear when a person´s petitors, K for karate competitors, T for taekwondo
body image is distorted, mainly due to social and cul- competitors, M for men, W for women, C for the con-
1
tural factors . Eating disorders are subdivided into trol group following free diet, and D for the group fo-
anorexia nervosa, bulimia nervosa, and atypical ea- llowing a diet plan. Weight and age of each group are
ting disorders. Anorexia nervosa is characterized by indicated in figure 1. Competitors participating in the
severe food restrictions supported by purgative beha- categories with no upper weight limit (heavy weights)
1
viours . Bulimia nervosa combines food restrictions were not considered for this study.
with episodes of compulsive binge-eating followed
by induced vomiting. Finally, atypical eating disor-
ders might take account of those profiles that do not Procedure and measurements
match the previous two cases, such as eating disorders
2
associated to weight control in sports . A modified version of the EAT-26 questionnaire
8
There is a growing concern in the appearance of (Eating Attitudes Test-26) was used in the study . The
eating disorders in athletes, especially those that prac- questionnaire indicates the risk or presence of eating
tice sports where they are divided into weight cate- disorders. It is comprised of 23 items divided into 3
gories. This method of categorization affects the way scales: dieting scale, bulimia and food preoccupation
athletes train and eat, who aspire to possess very low scale, and the oral control scale. The dieting scale eva-
fat content and high muscle mass. Recent studies have luates food restriction and obsession for losing wei-
indicated that many athletes use unhealthy strategies ght. The bulimia and food preoccupation scale evalua-
to control their weight, especially when a competition tes the use of binge-eating/induced vomiting conducts
is near3. The strategies include vomiting, severe water and thoughts about food. Finally, the oral control sca-
4
and food restrictions, and induced sweating . There- le evaluates food intake self-control and the pressure
fore, it is of vital importance to identify and prevent of the environment to lose weight. Items 1, 6, 7, 10,
the appearance of these eating disorders. This is espe- 11, 12, 14, 16, 17, 22, 23, 24, and 25 pertain to the
cially true in female athletes, due to the higher preva- diet scale, while the values obtained in items 3, 4, 9,
5
lence of eating disorders in women . However, there 18, 21, and 26 account for the bulimia scale. The re-
is very little information regarding unhealthy weight maining items correspond to the oral control scale (2,
6
control habits in male athletes . Unlike other popula- 5, 8, 13, 15, 19, and 20). The answers and value for
tions where eating disorders appear due to negative each item (except for items 1 and 25) include: never
social and cultural influences, athletes adopt these (0 points), rarely (0 points), sometimes (0 points), of-
unhealthy strategies in order to compete in a desired ten (1 point), usually (2 points), and always (3 points).
7
weight category . In many cases, these strategies are The answers and score for items 1 and 25 were in-
not seen as potentially harmful by the athlete, and are verted. A score of 20 or more (out of a total of 78)
Eating disorders and diet management in Nutr Hosp. 2015;32(4):1708-1714 1709
contact sports; EAT-26 questionnaire does
not seem appropriate...
042_9214 desordenes alimentarios y supervision dietetica.indd 1709 09/09/15 23:21
Sampling of participants
Study group
N = 244
M group W group
n = 158 n = 86
74.2 ± 12.3 kg 62.6 ± 9.9 kg
21.2 ± 2.8 years 20.8 ± 2.4 years
MC group MD group WC group WD group
n = 138 n = 20 n = 76 n = 10
74.3 ± 12.4 kg 75.8 ± 8.5 kg 62.2 ± 10.1 kg 69.8 ± 12.4 kg
21.3 ± 2.9 years 21.8 ± 3.1 years 20.9 ± 2.5 years 21.3 ± 2.4 years
JMC group JMD group JWC group
n = 52 n = 10 n = 31 JWD group
79.0 ± 14.4 kg 75.7 ± 15.3 kg 65.0 ± 14.6 kg n = 10
21.8 ± 3.3 years 21.9 ± 1.6 years 22.7 ± 4.3 years
KMC group KMD group KWC group
n = 39 n= 10 n = 25
73.9 ± 11.3 kg 75.9 ± 10.6 kg 62.5 ± 7.1 kg
23.2 ± 4.2 years 21.7 ± 4.6 years 21.1 ± 1.9 years
TMC group TWC group
n = 47 n = 20
70.2 ± 11.3 kg 59.0 ± 8.8 kg
19.0 ± 1.1 years 19.0 ± 1.4 years
Fig. 1.—
indicates a risk of developing or presenting an eating calculated according to the Harris-Benedict equation
disorder8. The analysis of internal validity and consis- taking in account in each case gender, the weight in
tency of the questionnaire (Cronbach’s alpha) for the kg, height in cm, and the age in years. Corrected body
3 factors was: dieting (= 0.78), bulimia (= 0.82), and weight was taken into account for the calculations,
9
oral control (= 0.84) . considering as ideal weight the upper limit of each
This study was conducted according to the guide- weight category in the corresponding disciplines. The
lines written in the Declaration of Helsinki and APA thermal effect of food was estimated as the 8.50% of
Ethics Code. All procedures were approved by the the sum of the resting metabolic rate plus physical ac-
10
Ethical Committee of the University. A written in- tivity expenditure . Physical activity expenditure was
11
formed consent was obtained from all participants. estimated from previously published tables .
Anonymity was preserved for all participants. Daily food intakes were adapted according to ac-
tivity and frequency taking into account training and
resting days. For weight reduction, a 10-15% calorie
Research Design restriction was applied in meals far from the training
sessions. The diets were adjusted to 1.60-2.00 g of
The study consisted in comparing the EAT-26 sco- protein/day/kg of body weight, 1 g of fat/day/kg of
res of the athletes following a diet plan (JMD, KMD, body weight, and 5-6 g of carbohydrates/day/kg of
and JWD) with the values obtained in the control body weight. The software used to design the diet plan
®
group. The last group was randomly recruited during was DietSource 3.0 (Novartis, Barcelona, Spain).
the University-level National Championships of judo,
karate-kumite, and taekwondo where the groups on a
controlled diet plan also participated. Data Analysis
JMD, KMD, and JWD groups initiated the diet plan
2-7 months before the tournament. The athletes that Software SPSS® version 20.0 was used for data
required more weight loss commenced the diet plan analysis. Different descriptive analyses were perfor-
earlier than the rest of the athletes. Caloric expenditu- med: ANOVA, post-hoc tests, one-sample K-S test
re was estimated and divided into 3 components: res- (Kolmogorov-Smirnov test), and T-test for indepen-
ting metabolic rate, thermal effect of feeding and phy- dent samples to compare means between different
sical activity expenditure. Resting metabolism was groups. The results in table I were expressed as mean
1710 Nutr Hosp. 2015;32(4):1708-1714 Alejandro Martínez Rodríguez et al.
042_9214 desordenes alimentarios y supervision dietetica.indd 1710 09/09/15 23:21
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