Fiona Pelly

Background and objective: The objective of this meta-narrative review was to identify, organise and map the literature on food provision and nutrition support at the summer and winter Olympic and Paralympic Games (OPG) and similar major competition events over the past 21 years. This builds on a comprehensive update of a previous historical review of the evolution of food provision at the summer Olympic Games up until 2000 and considers contemporary issues such as the global pandemic and sustainability goals.

Methods: A range of sources included primary research and review articles, edited book chapters, theses, conference papers or abstracts, International Olympic Committee reports, Organising Committees' food vision and post-Games reports, independent professional reports, and media and periodicals including magazines and trade journals. The search strategy included four steps: a database search that complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews criteria, a search of the Olympic Studies Centre, a review of reference lists for unpublished sources, and a Google search for additional media reports. The researchers followed an iterative process where emerging narratives were discussed, recorded and refined as data were extracted.

Results: The data from 229 records were extracted into a spreadsheet and grouped according to the type of evidence and specific event, then presented chronologically to give a perspective on the development of food provision and nutrition support. Eleven narratives emerged from the data extraction: 'description of meals, menus and food', 'vision of the food provision', 'food safety', 'catering company involvement', 'sponsorship or contracts with food companies', 'athlete perspective', 'stakeholder perspective', 'athlete food intake,' 'nutrition input in food provision', 'food environment' and 'sustainability'.

Conclusion: Results suggest that athletes' dining expectations, organising committee budgets, expert input and current global trends have led to food delivery changes. The OPG food environment has the capacity to positively influence the dietary choices of athletes and teams, while evolving to meet contemporary global challenges such as COVID-19 and sustainability targets.

Aim:
We aimed to explore the future roles of nutrition and dietetics professionals, and what capabilities the workforce would need to fulfil these roles.

Method:
A qualitative interpretive approach was employed. We conducted individual interviews with nutrition and non-nutrition thought leaders external to the profession. In addition, we conducted focus groups with experts within the nutrition and dietetics profession, academic dietetics educators and students/recent nutrition and dietetics graduates (total sample n = 68). Key nutrition-related issues and challenges, drivers for change and potential future roles of the profession were explored. Data were analysed using a team-based thematic analysis approach.

Results:
Future roles of nutrition and dietetics professionals were described as food aficionados, diet optimisers, knowledge translators, equity champions, systems navigators and food systems activists, change makers, activists and disruptors. In addition, science was identified as a uniting framework underpinning the professions. An additional 16 critical capabilities were considered to underpin practice.

Conclusion:
The results demonstrated that the current and future needs for workforce education and development need to address the impact of climate change, growing inequities, the democratisation of knowledge and the disruption of health and food systems. Education providers, regulators, professional associations and citizens need to work together to realise roles that will deliver on better health for all.

The individual determinants of food choice have been extensively investigated in the general population, but there have been limited studies in athletes. A better understanding of the food making decisions can help to target interventions that lead to optimal intake for athletes’ health and performance. A scoping review will provide an understanding of the sports and settings that have been investigated, the methods and approaches to assessing food choice, as well as the factors influencing food choice.

Concept-based approaches to curriculum design have been proposed in nursing and health sciences education to address the issue of content overload in curricula but have not been described in dietetics. This study aimed to identify core concepts for the dietetics discipline in Australia and investigate the commonality and differences in these concepts across different dietetic organizations across the world. This study used document analysis of a purposive sample of international dietetics competency or proficiency standards identified from English speaking dietetic organizations worldwide. Content analysis was applied to the performance criteria or equivalent from ten documents (nine organizations) to identify the most common elements. A total of 1,007 statements were analyzed. Fifty-six concepts were developed. The four most frequent concepts coded across all statements were "critical thinking," "communication," "nutrition and dietetic service" and "quality assurance and improvement." There were 55 concepts common to all standards. The concept of "food security" was not present in one of the standards from the United States. The concepts that emerged from this study were common across different English-speaking dietetic organizations across the world. Small differences on the emphasis of concepts, between different competency standards may reflect the health needs; health, political, economic, and social systems; and the cultural context of a country. Identifying core concepts in dietetics is the first step to help to inform curriculum design, which may address overcrowded curricular and promote conceptual learning.

This study aimed to identify the factors influencing the food choices of athletes at the Universiade and Commonwealth Games and explore di erences in the cohort across sport, competition history and demographic characteristics. A sample of 385 athletes (n = 153, 2017 Universiade, Taiwan; n = 232, 2018 Commonwealth Games, Australia), from 69 countries and 29 sports participated in this cross-sectional observational study. Participants rated 36 items from the Athlete Food Choice Questionnaire and 11 additional items (gut comfort, doping risk, availability, location, money, convenience, time of day, hunger, medical conditions, and food allergies) on how frequently (1 never to 5 always) each influences their food choices. "Performance", "sensory appeal", "food and health awareness" and "weight control" were reported as most frequently, while the least were "emotional influence", "influence of others" and "food values and beliefs". Commonwealth Games athletes were older, more experienced and more likely to report "performance" (median = 4.33 versus 4.00, U = 20250.0, p = 0.012) and less likely to report "emotional influences" (median = 2.80 versus 3.20, U = 14273.0, p = 0.001) than Universiade athletes. Greater numbers of younger athletes were often or always influenced by available money. Athletes across all sports reported frequently considering gut comfort in their food choices. These results can inform nutrition education strategies of high-performance athletes.

The selection of foods made by athletes during competition can impact performance, yet to date, the quality of their food choices has not been investigated. The aim of this study was to describe the food selection of athletes in a buffet-style dining hall setting in terms of diet quality, food variety, and volume of food and compare to their self-rating of their meal, reasons for the choosing the food items, access to previous nutrition advice, and use of nutrition labelling. A total of 81 athletes (42 females, 39 males) from 24 sports across 58 countries at the 2018 Commonwealth Games (Qld, Australia) participated in this study. A digital photograph was taken of the athletes' meal after selection from the buffet and prior to consumption. Each participant was asked a series of questions in relation to their food selection. The photographs were coded into recommended serves of food groups based on the Australian Guide to Healthy Eating. The nutritional analysis and photograph of a standard serve size were used to quantify the energy and nutrients for the meal. Most athletes chose adequate quantities of macronutrients, which agreed with their reasons for the food choice, but the majority did not include fruit (80.2%) or dairy (65.4%) in their food selection, while 54% of males included discretionary foods (0.25-7.0 serves). The median self-rating for food choice was 8/10. Most reasons for food choices were nutritional attributes, sensory factors, performance, usual eating practices and physiological factors (e.g., satiety, gut comfort). This suggests that athletes may need more education on the quality of food selected from buffet settings.

Aim: To examine whether the nutritional quality of children's packaged food products available in Australian supermarkets improved between 2013 and 2016, and whether any change could be detected in product reformulation since the introduction of the Health Star Rating (HSR) labelling scheme. Methods: Packaged food products marketed towards children were purchased from three Australian supermarkets in July 2013 (for a previous study) and July 2016. Nutritional quality was assessed using the Food Standards Australian New Zealand Nutrient Profiling Scoring Criterion. Comparisons were made between the nutrient composition and formulation of products (a) available in 2013 and 2016; and (b) with and without HSR graphics. Results: Of the 252 children's packaged products analysed, 53.6% were classified as 'less healthy'. HSR-labelled products had a significantly higher proportion classified as 'healthy' than those without the HSR (χ2 = 26.5; P < 0.0001; 73.8% and 59.0%, respectively). Overall, 28.5% displayed the HSR; the majority (81.5%) having a rating of ≥3.0 stars. Cereal-based products had the greatest uptake of the scheme, with HSR-labelled products having significantly lower mean energy and saturated fat content (P < 0.01) and higher mean protein and fibre content (P < 0.001) than non-HSR products. Reformulation of products that were available in 2013 had occurred in 100% of HSR-labelled products in comparison to 61.3% of non-HSR labelled products. Conclusions: Despite the introduction of the HSR, more than half of children's packaged foods sampled are 'less healthy'. However, early indications suggest that the HSR may stimulate healthier product reformulation.

This study aimed to develop and refine an Athlete Food Choice Questionnaire (AFCQ) to determine the key factors influencing food choice in an international cohort of athletes. A questionnaire that contained 84 items on a 5-point frequency scale was developed for this study. Athletes at the 2017 Universiade in Taiwan were invited to participate. Principal component analysis (PCA) was utilised to identify key factors and refine the questionnaire. Completed questionnaires were received from 156 athletes from 31 countries and 17 sports. The PCA extracted 36 items organised into nine factors explaining 68.0% of variation. The nine factors were: 'nutritional attributes of the food', 'emotional influences', 'food and health awareness', 'influence of others', 'usual eating practices', 'weight control', 'food values and beliefs', 'sensory appeal' and 'performance'. The overall Kaiser-Meyer-Olkin was 0.75, Bartlett test of sphericity was statistically significant (X2 (666) =2536.50, p< 0.001) and all communalities remained >0.5. Intercorrelations were detected between 'performance' and both 'nutritional attributes of the food' and 'weight control'. Price of food, convenience and situational influences did not form part of the factorial structure. This research resulted in an AFCQ that includes factors specific to athletic performance and the sporting environment. The AFCQ will enable researchers and sports dietitians to better tailor nutrition education and dietary interventions to suit the individual or team. The next phase will test the accuracy and reliability of the AFCQ both during and outside of competition. The AFCQ is a useful tool to assist with management of performance nutrition for athletes

Food provision at the Olympic Games has evolved since the advent of a unified menu, but there are challenges in catering for the expanding cultural and sporting diversity. Continuity between events is difficult due to the changes in location, organising committees, caterers, athletes, support staff and volunteers. Independent review of the food provision by sports nutrition experts has been implemented to help establish some consistency between Olympic Games. The aim of this study was to compare an expert desk top and onsite review of the food provided at the Rio 2016 Olympic Games, and compare this to a similar review at the London 2012 Olympic Games. A previously developed survey was completed by sports nutrition experts six months prior to the opening of the Rio 2016 Olympic village and during the Olympic Games in September 2016. Questions about the food provision included both scaled and open-ended responses. There was a significantly lower rating for menu variety onsite (p=0.025) versus the desk top review. All aspects of the menu as well as the ability to cater for specific situations rated as 'average' or less. A significantly (p=0.007) lower overall median rating was obtained for Rio (5out of 10) compared to London (8 out of 10), with hot gluten-free items rated as 'poor' at both events. Comments from experts related to lack of variety, sports and recovery foods, absence of signage and inaccurate nutrition labelling. An improved process for expert nutrition review at these events is warranted.