The mean NK score of semi-professional players in this study was 53.4%. The observed score in the present study is significantly lower compared to other studies on elite rugby athletes ( 73% (Alaunyte et al. 2015) and 61.3% (Spendlove et al. 2012)). However, this study used an adapted NSKQ consisting of 39 questions (Trakman 2017), whereas the other two studies used 90-points and 72-points of the same GNKQ (Alaunyte et al. 2015; Spendlove et al. 2012). Disparity in results may be due to different assessment tools used. Semi-professional players may have limited opportunity to access nutritional resources and advice, therefore lower NK in comparison to elite athletes may be expected (Heaney et al. 2011).
The differences in the scores of the good NK and poor NK groups were significant for all sections excluding supplements and alcohol. Discrepancies between studies make it difficult to compare scores as different tools, nutrition subsections, cut-offs and sample characteristics have been used (Spendlove et al. 2012; Alaunyte et al. 2015; Trakman et al. 2016). However, a common theme between the current findings and other studies has emerged (Torres-Mcgehee et al. 2012; Trakman et al. 2016) and reveals that athletes’ knowledge of supplementation is poor. In a study with Australian football players, it was noted that most players were aware of the alcohol recommendations however only a few were able to identify a unit of alcohol (Devlin and Belski 2015). Given the drinking culture in the sports industry (Barnes 2014) it is surprising to have a gap in knowledge in this area (Martens et al. 2006; O’Brien and Kypri 2008). However, in contrast to previous findings, the average alcohol intake of the rugby players in this study was significantly lower than the maximum allowance of 14 units per week (median 6.3, p < 0.001). In addition to general health benefits, this is a noteworthy finding as most players were striving to maximise anabolism, and research has shown that muscle protein synthesis can be suppressed if alcohol is consumed, even in the presence of adequate protein intake (Parr et al. 2014).
Contrary to the hypothesis, neither increased age, years game experience, level of education obtained, nor employment status were associated with improved NK or DI. This study did not find significant differences in NK between all levels of education. This may be due to participants’ level of education (100% had GSCEs). Despite NK being shown to be influenced by education (Trakman et al. 2016), similarly to a study on Australian elite athletes (Spronk et al. 2014), this study did not find any significant correlations between NSKQ with either education or age. However, respondents that were familiar with the Eatwell Guide, scored significantly higher in the NSKQ overall and the micronutrients sections. Similarly to the findings of Andrews and Itsiopoulos (2015), participants with health-related qualifications scored higher overall in the NSKQ and the sports nutrition sections. Total NK% was not significantly correlated with dietary input however, subjects who had previously had a consultation with a dietitian or nutritionist scored significantly higher in the Macronutrients and Sports Nutrition subsections which may be related to the information received during the consultation. Participants in this study that have not had a prior consultation with a dietitian reported a range of reasons including problems accessing a sports dietitian (S-RD)/nutritionist, belief around the adequacy of their own NK and lack of trust. It is common for semi-professional athletes to have trouble accessing S-RDs due to limited resources and time (Hull et al. 2016). Athletes’ supplements usage is frequently directed by family, friends, teammates, coaches, athletic trainers and the media instead of S-RDs/nutritionists (Braun et al. 2009; ACSM 2016).
Results showed the players’ mean energy intakes from food sources were 26.3 ± 9.2kcal/kg body weight which may be insufficient to meet athletic demands. However, fluctuation of dietary intakes throughout seasons according to training demands were not accounted for in the dietary analysis. Average carbohydrate intake (3 g/kg/day) met ACSM sports nutrition guidelines for skill-based activities (3–10 g/kg/day). However, intakes for 89.5% of the group were below the specified recommendation of 5 g/kg BW per day for athletes performing moderate intensity daily exercise. Notably, carbohydrate intakes may have been underreported as supplement use was not accounted for in the calculation of average carbohydrate intakes. These results were consistent with findings from previous studies of rugby athletes where carbohydrate intakes have frequently been shown as inadequate (Potgieter et al. 2014; Alaunyte et al 2015; Mackenzie et al. 2015). Similarly, to the findings of Tooley et al. (2015), mean fibre intake (21.7 ± 10.1 g/d) was less than the recommended amount (30 g/day).
Total fat %TEI did not differ significantly from the guidelines and mean daily protein intake (1.4 ± 0.4 g/kg/day) was in line with ACSM (2016) sports nutrition guidelines, in contrast to past research where protein intakes of rugby players exceeded recommendations (Potegieter et al. 2014; Mackenzie et al. 2015). However, 31.6% of the study population did not meet the lower range of the recommended amounts (< 1.2g/kg/day) from food sources. Interestingly, 68% participants reported taking whey protein supplements, therefore, it is possible that players with intakes below the recommended amount were meeting their protein requirements through a combination of food sources and supplements. Although some results were inconsistent with previous findings (Potgeiter et al. 2014), overall macronutrient and energy intake results corresponded with the findings from a recent systematic review in which dietary intakes of semi-professional team sports athletes were found to meet or exceed sports nutrition recommendations for protein and/or fat and were inadequate for carbohydrate and energy (Jenner et al. 2019).
Overall, the good NK group had higher energy and macronutrient intakes than the poor NK group, suggesting the good NK group would be more likely to reach their energy and protein requirements from food sources. However, the present study reveals that the majority of participants had CHO intake below the lower range of ACSM guidelines, with higher prevalence observed in poor NK group (80% versus 56% for good NK group), this is consistent with other findings (Bradley et al. 2015a ; Bradley et al. 2015b; Devlin et al. 2017). Higher NK has been positively associated with consumption of fruit, vegetables and carbohydrate-rich foods (Alaunyte et al. 2015). However, there are controversial beliefs around CHO in sports nutrition as over the years there has been a downward trend in CHO intakes among athletes including rugby players which may be influenced by motives to reduce body fat and optimise training adaptations (Bradley et al. 2015a). This may be caused by how the media portrays nutritional information in relation to governmental dietary guidelines (Ellison et al. 2011). Interestingly, a recent study found that adherence to nutritional guidance was seasonal among high performance athletes and similarly to the present study, dietary behaviours were underpinned by emotional barriers/motivation with training schedules limiting opportunities for food planning (Bentley et al. 2021).
Results from a systematic review suggests weak but significant positive correlations between higher NK and DI, and particularly intake of fruits and vegetables (Spronk et al. 2014). Participants in the current study overwhelmingly reported that natural foods or a well-balanced diet should provide all requirements which is in line with the British Dietetic Association (BDA) recommendation for sports (BDA 2020). Stokes et al. (2018) also reported adolescent rugby players to perceive similar foods as healthy. Foods reported as unhealthy by the participants in this study included sugary foods, takeaways, and sugary drinks, which was consistent with other studies (Heaney et al. 2008; Smart and Bisogni 2001; Stokes et al. 2018). Common limitations in studies included varied quality with only a few studies using validated instruments to assess NK and DI (De Vriendt et al. 2009; Spronk et al. 2014; Wardle et al. 2000).
Perception of healthy eating of participants was in line with the messages from the Eatwell Guide in this study (PHE 2018). A study investigating dietary practices of elite athletes in Australia found similar results with participants describing healthy eating with achieving balance and having a variety of foods (Heaney et al. 2008). Players of the current study emphasized the need for moderation which agrees with findings on university students (House et al. 2006). A theme emerged from this study in which players described healthy eating as a perfect balance between reward (e.g. “cake”) and self-control (“unhealthy when in excess”). This cultural norm of associating food high in sugar and fat as a treat was also noted amongst male college hockey athletes who reported the need to balance between self-sacrifice and indulgence (Smart and Bisogni 2001). This is explained by Connors and colleagues (2001) as balancing strategies used by adults to make food choices where there are competing priorities of values such as health and taste.
The current study reported that 68% of players were taking supplements to enhance performance which is line with other studies, with prevalence of supplements use ranging between 37% and 89% (Braun et al. 2009; Maughan 2018). Attitudes towards PES use were variable; 23% of players felt PES gave them a competitive advantage, whereas 46% utilized them for convenience and 50% considered them non-essential. Similarly, to the findings of Potgieter et al. (2014) and Bradley et al. (2015), PES use was high and all players that used supplements took whey protein. Furthermore, 31% used caffeine prior to a game for enhanced-energy purposes and 25% utilised various other PES to aid with training and recovery. It is evident that participants may not be aware of the evidence to support the ergogenic effects of some of these ingredients. Participants used supplements to boost performance, to help achieve nutrient goals, optimize recovery, immune function, improve BC and compensate for a poor nutrition which is in accordance with other studies (Braun et al. 2009; Maughan 2018; Stokes et al. 2018). A systematic review has shown elite athletes are more likely to use PES than semi-professional athletes (Knapik et al. 2016) and a recent study of rugby players found prevalence of ergogenic supplements use was greater among professional rugby athletes than amateur players (Sanchez-Oliver et al. 2021). It could be argued that non-elite athletes are more susceptible to assist their current diet with supplements to gain a competitive edge (Sekulic et al. 2019).
In this study all participants had cooking skills which has been considered an enabler to healthy eating (Smart and Bisogni 2001). The majority of players (67%) reported being primarily responsible for the cooking and shopping in their household however, some players stated that preferences of other members of the household influenced their dietary patterns. Studies have shown that accommodating family or friends food preferences deterred their determination to maintain dietary goals (Stokes et al. 2018; Chang et al. 2008; Thornton et al. 2006). Cost, convenience and availability were also influencing factors however, contrary to previous findings (Heaney et al. 2008; Stokes et al. 2018) cost was not a primary determinant of food choice for most players in the current study. This is most often observed amongst those with limited finances such as low-income groups, students and adolescents (Boek et al. 2012; Glanz et al. 1998).
Players in this study also described decreased personal motivation/discipline as a challenge to maintain dietary goals. This is particularly evident during off-season amongst elite athletes with some drastically changing their eating practices (Smart and Bisogni 2001; Heaney et al. 2008). Similar to the findings of Heaney et al. (2008), many respondents considered lack of time and preparation to be the primary challenge towards healthy eating healthy and meeting dietary goals. Although the majority reported lack of time to prepare meals as a barrier, a few reported that COVID-19 lockdown has enabled them to have more time to prepare and cook meals. An Italian survey found similar results with participants having more aspiration to cook, which has led to higher consumption of homemade foods (Di Renzo et al. 2020). Moreover, a study of professional/semi-professional rugby union players in New Zealand found the majority of players to have a reduced intake of packaged/convenience foods and greater fruit and vegetable consumption during the COVID-19 pandemic. Findings were similar to the present study, and players reported lack of motivation and limited access to training equipment as challenges during lockdown (Roberts et al. 2020). Concerns over the impact of reduced training and its impact on BC was cited by a few players, which may have detrimental impact on future performance. Elite athletes may be provided with home-based exercise programs and in some cases live video training sessions led by fitness trainers however in this study, none of the participants reported access to such opportunity during skype interviews (Sarto et al. 2020).
Strengths and limitations of the study
To the researcher’s knowledge, this is the first study to address NK, APC around dietary goals and dietary practices of semi-professional rugby players in Scotland.
The researchers used both quantitative and qualitative methods, which enabled a more complete picture of the investigated research field (Kelle 2006). The tools used were validated, which enables this paper comparison with other studies in future research. However, the ‘Demographics & APC’ questionnaires was developed by the researchers therefore not standardised for use in the population and NSKQ was adapted therefore was not validated. The EPIC FFQ is a validated tool but not for athletic populations, and additionally, it may not provide an accurate measurement of fibre and alcohol, whereas FETA software does not account for supplement use in the calculation of macronutrient intakes. Intentional underreporting/overreporting as well as self-reported height and weights may have affected the accuracy of the results. Interviews were carried out individually and therefore the influence of peers, family and coach was significantly reduced. Additionally, all participants were asked the same interview questions ensuring responses were not led by researchers’ perspective. However, participants may have answered some of the questions to please the researchers and to meet perceived beliefs. Furthermore, researchers tried to minimise bias in retrieving themes during the analysis by triangulation of data. Additionally, the researcher was able to investigate the dietary impact of COVID-19 on participants, which is a unique time in the history since the second world war that athletes had to interrupt competition (Sarto et al. 2020). The recommendations from this research (supplementary material Table 2) could be potentially used by professionals working with athletes in the UK ensuring optimum nutrition despite limited resource availability (Heaney et al. 2011).
In conclusion, the current group of semi-professional rugby players appeared to have average NK, lacked awareness of current sports nutrition guidelines and subsequently had inadequate carbohydrate and fibre intakes from food sources. Players with good NK had significantly higher total energy, carbohydrate and protein intakes. Despite average dietary intakes of protein meeting the recommended amounts, most players took whey protein due to the perceived benefits for enhancing performance and body composition adaptation. The main challenge identified by players in achieving their dietary goals was lack of time for meal planning, preparation and cooking. Thus, some players found it easier to meet their dietary goals during the COIVD-19 pandemic with more free time however restricted access to equipment was a significant challenge in meeting body composition goals during the same period.