Nutrition Risk Management: Is Your Department Prepared?

July 13th, 2018 | by Roberta Anding
Nutrition Risk Management: Is Your Department Prepared?

Nutrition Risk Management

Athletic departments invest time and resources creating policies and procedures consistent with their mission statement and NCAA rules and regulations. Team physicians and certified athletic trainers create policies for injury management, concussion and return to play criteria among others. In today’s multidimensional athletic models it’s not only logical but now necessary to have nutrition-related policies, procedures, and protocols in place. Nutrition risk management stands to support the overall risk and financial management efforts of the department. High-risk areas can include food allergies, nutritional supplements, post-surgical rehabilitation, weight and body composition data collection, concussion, disordered eating, and food costs for example.

Adoption and regular review of policies that outline the department’s nutritional supplement purchasing practices can reduce the risk of compliance violations; procedures that guide emergency action plans in food service areas can help reduce life-threatening events related to food allergies, and protocols that support the management of disordered eating cases serve to facilitate high-level care.

Protocol development for nutrition risk management should be consistent with the best evidence available in the scientific literature. Credentialed and well-practiced sports dietitians are uniquely qualified to provide leadership in this area. However, all members of the sports medicine or sports performance team will likely have defined roles in their development. Implementation requires not only buy-in from all members of the sports performance team but consistency in the application in order to track outcomes. Nutritional management of disordered eating, soft tissue, and concussion management are examples of protocols requiring the combined efforts of the sports medicine team and the sports nutrition staff.

An example of a more comprehensive protocol is the one designed to manage disordered eating, which is estimated to affect 6-45% of female collegiate athletes. The protocol should include various layers such as screening, identification of those athletes requiring additional support, key prevention, and educational strategies, criteria for removal from sport and the criteria to return. Sports medicine, certified athletic trainers, mental health clinicians and the sports dietitian must collaborate on this process. Screening can be initiated during the pre-participation physicals using various, existing validated tools or questionnaires. Low energy availability increases the risk of bone injury by almost 5 fold. Athletes with low energy availability can also be hypothermic, bradycardic and prone to syncopal or dizziness episodes. Below are some key screening and action areas to consider.

Key screening components:

  • Screening during physicals
  • Flag high-risk athletes
  • Refer to sports dietitian for further evaluation
  • Assess for markers of under-fueling or relative energy deficiency in sport via sports medicine or ATC*
    • Hypothermia < 97.5 degrees
    • Bradycardia < 50 bpm in females
    • Postural orthostatic tachycardic syndrome (POTS) or syncope- lying to standing heart rate change at 5 minutes of 30 beats per minute
    • Amenorrhea- missing three menstrual cycles in a row

Action plan considerations for athletes with positive markers:

  • DEXA scan for bone density and body composition
  • Reduction of training volume
  • Evaluation or referral to mental health

Return to sport considerations:

  • Adequate energy availability
  • Improvement in biological markers of hypothermia bradycardia and POTS
  • Return of menses
  • Increasing training volume
  • Return to competition

*criteria vary among sports medicine professionals

Developing policy, procedure, and protocol documents is an important step to comprehensive risk management for the health and safety of all student-athletes. Implementation in these high-risk areas, when properly integrated, can also provide a framework of risk reduction for the institution. Your student-athletes deserve the best care and opportunity for success and this includes the addition of a nutrition risk management plan. Are you prepared? Stay tuned for more on concussion and management of food costs.

Roberta Anding About Roberta Anding
Roberta Anding, MS, RD/LD,CDE,CSSD, is a board-certified sports dietitian, a certified diabetes educator and a founding principal of Performance 365, a sports nutrition consulting group serving the needs of athletes, organizations, universities and aligned industry partners with evidence and experience. Roberta and Performance 365 are proponents of the fuels of engagement, with a focus on guiding athletes, teams, and performance artists to peak performance in their sport and health.

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