Comparison of Strategies for Assessing Nutritional Adequacy in Elite Female Athletes' Dietary Intake

Purpose: This study aimed to compare strategies for assessing nutritional adequacy in the dietary intake of elite female athletes. Methods: Dietary intake was assessed using an adapted food-frequency questionnaire in 72 elite female athletes from a variety of sports. Nutritional adequacy was evaluated and compared using mean intake; the proportion of participants with intakes below Australian nutrient reference values (NRV), U.S. military dietary reference intakes (MDRI), and current sports nutrition recommendations; and probability estimates of nutrient inadequacy. Results: Mean energy intake was 10,551 +/- 3,836 kJ/day with macronutrient distribution 18% protein, 31% fat, and 46% carbohydrate, consistent with Australian acceptable macronutrient distribution ranges. Mean protein intake (1.6 g . kg(-1) . d(-1)) was consistent with (>1.2 g . kg(-1) . d(-1)), and carbohydrate intake (4.5 g . kg(-1) . d(-1)), below, current sports nutrition recommendations (>5 g . kg(-1) . d(-1)), with 30% and 65% of individuals not meeting these levels, respectively. Mean micronutrient intake met the relevant NRV and MDRI except for vitamin D and folate. A proportion of participants failed to meet the estimated average requirement for folate (48%), calcium (24%), magnesium (19%), and iron (4%). Probability estimates of inadequacy identified intake of folate (44%), calcium (22%), iron (19%), and magnesium (15%) as inadequate. Conclusion: Interpretation of dietary adequacy is complex and varies depending on whether the mean, proportion of participants below the relevant NRV, or statistical probability estimate of inadequacy is used. Further research on methods to determine dietary adequacy in athlete populations is required.