Improvements in competition performance of track and field athletes following a personalized nutrition intervention: A mixed methods approach

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However, limited research has explored the effectiveness of nutrition interventions in improving competition performance. This study used quantitative and qualitative methods to assess the impact of an evidence-based, culturally accepted, personalized sports nutrition intervention on the competition performance and general well-being of track and field athletes in Sri Lanka. Methods Fourteen national-level athletes who completed a 16-week nutrition intervention participated in the study. Both performance data and qualitative insights were gathered through in-depth interviews focusing on the athletes' experiences with the intervention. A directed content analysis was conducted on the qualitative data. Results The study population (mean age: 23.0 ± 3.9 years, 57.1% male) included 14 athletes specializing in sprinting, middle-distance running, long-distance running, jumping, and throwing. As a result of the intervention, participants reported reduced fatigue, enhanced performance, and improved well-being. Moreover, one athlete set a national record, six achieved personal bests, and four recorded seasonal bests during competition. They adhered to dietary recommendations and prescribed vitamins and supplements, acknowledging the importance of proper dietary habits including nutritional supplements in boosting performance. Almost all athletes reported performance gains with respective ergogenic supplements, including caffeine (13/14), bicarbonate (3/4), creatine (3/3), beta-alanine (5/6), and beetroot juice (3/3). Five athletes reported fewer injuries and illnesses following the intervention, and two athletes reported that hydration advice enhanced their performance. Despite the positive outcomes, adverse effects were reported from the prescribed vitamins and supplements, including constipation, sleeplessness, and abdominal discomfort. Almost all respondents expressed satisfaction with the consultation setting, sports nutrition intervention, tests and investigations conducted, and the research team's efforts, indicating a positive reception to the overall intervention process. Conclusions This study highlights the importance of personalized, culturally specific sports nutrition interventions in improving athletic performance and general well-being. Sports nutrition personalized nutrition sports performance track and field mixed methods Introduction Personalized nutrition interventions tailored to athletes' requirements have emerged as the best approach to enhancing athletic performance ( 1 ). These strategies include practising healthy dietary habits, maintaining balanced macronutrient ratios, ensuring adequate micronutrient intake, and carefully using sports supplements and ergogenic aids. Additionally, addressing misconceptions related to sports nutrition and applying sports nutrition knowledge (SNK) to develop practical dietary patterns is crucial for fuelling physical activities, supporting recovery and repair, optimizing performance, and promoting overall health and wellness ( 2 ). Monitoring effective nutrient timing, such as consuming carbohydrates and proteins to enhance glycogen replenishment and accelerate muscle protein synthesis, is also contingent upon maintaining proper nutrition ( 3 ). A study by Viribay and colleagues demonstrated that consuming a high amount of carbohydrates (120 g/h) during a mountain marathon can reduce exercise-induced muscle damage, compared to carbohydrate intakes of 60 and 90 g/h ( 4 ). Another trial reported that a whey protein supplement (25 g protein, 2.5 g fat, and 3 g carbohydrates) aids moderate improvements in acute anaerobic power and strength, indicating enhanced recovery after an intense full-body resistance training session, compared to a calorie-matched carbohydrate drink (32.5 g carbohydrates) ( 5 ). Similarly, another randomized crossover trial involving soccer players demonstrated that pre-sleep casein protein supplementation benefits countermovement jumps recovery and reactive strength index recovery at 12- and 36-hours post-match ( 6 ). Muscle soreness, measured using a visual analogue scale, was also significantly greater in the control group compared to the casein protein group at 12 hours post-match (72 ± 17 vs. 42 ± 20 mm) ( 6 ). In addition, vitamin supplementation has also been shown to improve sports performance. Rockwell and colleagues found that vitamin D supplementation (vitamin D3 5000 IU/day for 12 weeks) increased fat-free mass and enhanced performance in deadlift ( p < 0.01) and vertical jump ( p < 0 .01) tests compared to their control counterparts ( 7 ). A systematic review of 12 randomized controlled trials reported that iron supplementation in athletes improved performance in endurance sports ( 8 ). Furthermore, iron supplementation may be more beneficial for athletes with ferritin levels below 20 µg/L compared to those with higher baseline ferritin levels ( 8 ). Furthermore, supplements, ergogenic aids have been shown to enhance exercise performance and recovery in elite athletes ( 9 ). For instance, a trial conducted with cyclists showed that a 6 mg·kg⁻¹ dose of caffeine consumed one hour pre-exercise significantly improved performance in 4×10-km time trials compared to a placebo group (intervention group vs. placebo, p = 0.008) ( 10 ). Similarly, a double-blind randomized controlled study discovered that six-week creatine-electrolyte (CE) supplementation enhanced overall and repeated short-duration sprint cycling performance ( 11 ). The CE group showed a 4% increase in overall peak power (pre: 734 ± 75 W; post: 765 ± 71 W; p = 0.040) and a 5% increase in overall mean power (pre: 586 ± 72 W; post: 615 ± 74 W; p = 0.019;), while the placebo group exhibited no significant changes. Additionally, repeated sprint analysis revealed significant improvements in peak (pre: 737 ± 88 W; post: 767 ± 92 W; p = 0.002;) and mean power (pre: 650 ± 92 W; post: 694 ± 87 W; p < 0.001;) in the first sprint effort for the CE group ( 11 ). Although most interventions show a positive effect, they typically address only a specific component of sports nutrition practice, such as dietary modifications related to a single macronutrient or micronutrient, a sports supplement, or an ergogenic aid. However, sports performance depends on many nutritional aspects, including proper energy and macronutrient intake, addressing micronutrient deficiencies, maintaining proper hydration, and the appropriate and timely use of sports and ergogenic supplements. Furthermore, most research findings report improvements in parameters within controlled environments or focus solely on surrogate measures of athletic performance. ( 12 ). 'Real-life' performance depends on various internal and external factors. Internal factors include physical and mental conditions, whereas external factors encompass weather and competition during the event. Consequently, quantitative parameters alone may not fully capture the impact of an intervention on a particular athlete, especially in a competitive setting. To the best of our knowledge, there are only a limited number of studies investigating the effectiveness of an evidence-based, culturally accepted, personalized sports nutrition intervention on improving sports performance during competition. Hence, our study aims to both quantitatively and qualitatively assess performance changes and explore athletes’ experiences regarding the effectiveness of an evidence-based, culturally accepted, personalized sports nutrition intervention among Sri Lankan track and field athletes. Methods Design and study population Elite and highly trained male and female track and field athletes from the national-level athletes' pool, who had previously completed the randomized controlled trial (RCT) of a 16-week evidence-based, culturally tailored, personalized sports nutrition intervention, were recruited for this separate study. The protocol for the original RCT has been published elsewhere ( 13 ). None of the participants had received formal, individualized nutrition counselling prior to the original RCT. All participants in the intervention group (n = 15) from the original RCT were included. Informed written consent was obtained from each participant after an in-depth explanation of the study, giving them adequate time to ask questions and clarify doubts about the research. All methods were performed in accordance with the Declaration of Helsinki. Ethical clearance for this trial has been obtained from the Institutional Ethical Review Committee, Faculty of Medicine, University of Peradeniya, Sri Lanka (2024/EC/21). Intervention The principal investigator offered an evidence-based, culturally tailored, personalized sports nutrition intervention tailored to each athlete's sports background. Cultural tailoring referred to adapting the nutrition advice to the local dietary practices, traditional food preferences, availability of food items, and sociocultural eating patterns typical of Sri Lankan athletes. It also considered religious dietary restrictions (e.g., vegetarianism, avoidance of beef or pork), economic accessibility of food items, and preferred meal timing and composition. These one-on-one sessions were conducted at week zero or baseline, 4th, and 8th weeks after recruitment. The primary nutrition-related areas covered throughout the process included: Energy intake: Athletes were advised to consume sufficient energy based on their energy balance. Energy requirements were estimated by the principal investigator, considering the athletes' characteristics and training loads. However, no mathematical calculations were performed due to the current setting's various practical and theoretical constraints. When energy intake needed to be adjusted, culturally familiar foods were emphasized; for example, increasing rice portions, incorporating traditional snacks, or reducing high-fat curries—ensuring that guidance was practical and contextually appropriate. In cases where dietary modifications alone were insufficient to meet energy needs, energy-containing supplements were prescribed to bridge the gap. Conversely, athletes with high adiposity and excess energy intake received culturally specific advice to reduce calorie intake ( 14 ). Carbohydrate intake: Advice on carbohydrate intake was provided according to recent guidelines ( 15 ) and locally common carbohydrate sources (e.g., red rice, string hoppers, manioc, jackfruit) were recommended. Protein intake: Advice was provided according to established guidelines ( 16 ), recommending culturally familiar high-protein foods such as lentils, eggs, dried fish and chicken. The recommended total daily protein intake was calculated at 1.2–1.6 g/kg of body weight, with each meal containing 0.3–0.4 g/kg of body weight, thereby necessitating four protein-rich meals per day. When athletes could not meet the recommended protein intake, whey protein supplements were prescribed. Fat intake: Foods high in saturated fats, such as coconut oil, coconut milk, and coconut sambal, were discouraged, and coconut oil was substituted with healthier unsaturated oil such as extra virgin olive oil, gingelly oil, and sunflower oil. For participants consuming insufficient amounts of fish, especially those not eating oily fish at least twice per week, a daily supplementation of 1000 mg of omega-3 fish oil was prescribed. Participants were advised to limit or avoid consuming deep-fried foods, oily street foods, and high-fat sweets such as chocolate. Micronutrients: Dietary advice was provided to achieve adequate micronutrient intake, and micronutrient supplements were prescribed for athletes with a biochemically diagnosed deficiency. Vitamin D insufficiency or deficiency was treated by prescribing either 60,000 IU weekly, and/or 5,000 IU, 2,000 IU, or 1,000 IU daily (Alvin Andersen Distributors, INC., based in Hialeah, Florida), depending on the blood values ( 17 ). In cases of iron deficiency, as indicated by serum ferritin levels or anaemia according to haemoglobin levels, oral iron supplements were prescribed (Dumasules by DUMEX, based in Mandaluyong City, Philippines.; Ferrous Fumarate BP 300 mg, equivalent to 100 mg of elemental iron, and other vitamins). Additionally, multivitamin-multimineral supplements (Menuvit tablet; Finecure Pharmaceuticals Limited) and calcium supplements (Ascal tablet: Calcium Carbonate 450 mg, Vitamin C 40 mg, Vitamin D3 200 IU), were prescribed to all athletes. Intake of fibre: Participants were encouraged to consume grains, fruits, vegetables, nuts and legumes as part of their healthy meal habits. However, for fibre intake, foods with high amounts of fibre were discouraged during pre-training and before and during the competition period. Hydration: Personalized hydration advice was given according to individual hydration status measured by urine specific gravity (USG), urine colour and thirst. Ergogenic supplements: Different ergogenic supplements were prescribed in accordance with the International Olympic Committee (IOC) guidelines ( 9 ). Caffeine capsules were recommended for most athletes before training and during competition. Sprinters, jumpers, and throwers were advised to take 3 to 5 grams of creatine monohydrate, while beta-alanine (BA) was prescribed for 400 m and 800 m runners. Sodium bicarbonate was suggested before competitions for selected athletes, and beetroot juice was recommended for long-distance runners. No pre-workout supplements were recommended. Data collection Data were collected via face-to-face in-depth interviews at the 4th, 8th, and 16th weeks and finally, information from all three interviews at the given time points was compiled into one document for each participant. Each participant was separately interviewed following a pre-designed guide (Supplementary material 1). Trained research assistants conducted in-depth interviews using a set of open-ended, semi-structured questions to guide the participants and maintain consistency across all participants. The in-depth interview comprised five themes of questions regarding participants' opinions on 1) the dietary changes encountered, 2) the prescribed vitamins and supplements, 3) the consultation setting, 4) the changes observed in SNK and performance, and 5) the prescribed ergogenic supplements. The in-depth interviews were conducted in the participants' native language, either Sinhalese or Tamil, and their responses were recorded. The interviewer provided guidance, maintained focus, stimulated constructive discussion, and ensured adherence to time constraints, all while remaining neutral about the content of the discussion. The principal investigator was deliberately excluded from the interview process to minimize bias. Data analysis and rigour A directed content analysis of the collected qualitative data was conducted, involving a systematic approach that began with pre-selecting themes based on the study's objectives. Subsequently, the research team meticulously coded and organized each participant's responses under their respective themes. This coding process was iterative, carefully accounting for the nuances and depth of the participants' responses. Theme development was achieved through an in-depth examination of the coded segments, facilitating the identification of patterns and relationships within the dataset. The verbal responses of each participant, following their in-depth interviews, were analyzed using notes and saved audio recordings. This process occurred immediately after each interview, during which the research team documented all relevant information mentioned by the participants and cross-referenced their notes with the audio recordings. Each in-depth interview resulted in a comprehensive document, which was collectively assessed by the research team at the study's conclusion. Initially recorded in Sinhalese and Tamil, the native languages of the respondents, the interviews were later translated into English by independent translators. The research team, with the translators' assistance, compared each translation through an iterative consensus process to produce the final written piece. Results Participants Fourteen elite track and field athletes from across the nation, comprising both genders, successfully completed the nutrition intervention. The mean age of the athletes was 23.0 ± 3.9 years, with a mean sports experience of 7.2 ± 3.5 years. The gender distribution was 57.1% male and 42.9% female. The participants were involved in five different track and field categories: six sprinters, two middle-distance runners, three long-distance runners, two jumpers, and one thrower. The highest education levels achieved by the participants included: 35.7% had completed primary education (ten years of school education), 50.0% had completed secondary education (13 years of school education), and 14.3% had completed or were enrolled in a university degree or diploma program. Quantitative findings The quantitative data (Table 1 ) indicate that one athlete set a national record, six out of 14 athletes achieved personal bests (PBs) in competitions during the intervention period, and another four athletes recorded seasonal bests (SBs). Most of them reported achieving their personal best during training, although some were not able to convert these into competition performances. In addition to performance, all athletes, except for three long-distance runners, reported improvements in their resistance training and achieved personal bests in 1RM in most exercises during the intervention. Additionally, all athletes (14/14) reported "feeling better" overall as a result of the intervention. INSERT Table 1 ABOUT HERE Table 1 Outline of the performance of the participants Participant characteristics Competition PB achieved Competition SB achieved Training PB achieved PB during resistance training achieved Feeling better No change M, 23 y, 5000 m x NA x M, 25 y, 800 m x x x F, 23 y, high jump x x x M, 26 y, 5000 m, 10 000 m x NA x M, 26 y, 400 m x x x M, 20 y, 400 m hurdles x x x M, 25 y, 110 m hurdles x x M, 21 y, High jump x x x M, 22 y, 800m x x x F, 28 y, 100 m hurdles x x x F, 21 y, Hammer throw x x X F, 22 y, 5000 m, 10 000m x* NA X F, 21 y, 400 m hurdles x x X F, 19 y, 400 m x x X F: Female, M: Male, PB: Personal Best, SB: Seasonal Best, * Set a new national record Qualitative findings In-depth interviews, designed around five themes to qualitatively explore athletes’ experiences with the effectiveness of the personalized sports nutrition intervention, lasted approximately 10–15 minutes each and the total duration of each athlete was 30–45 minutes. The key findings for each theme are presented in Table 2 . INSERT Table 2 ABOUT HERE Table 2 Key qualitative findings on athletes’ experiences with the sports nutrition intervention Theme Key findings Illustrative quotes 1. Experience with the dietary advice Most athletes followed the recommendations and reported positive impacts on energy, well-being, and training performance; common dietary changes included pre/post-training meals, increased protein intake, and healthier fat sources; a few faced challenges (e.g., time, taste) -“I started eating a banana before training and drank milk after.” (M, 25) 2. Opinion on the prescribed vitamins and supplements Athletes viewed supplements as beneficial for energy, performance, recovery, and injury prevention; some experienced side effects (e.g., constipation, gastritis) which were managed with adjustments -“I didn’t take any vitamins earlier, but now I feel like I have more energy.” (M, 23) 3. Opinion on the consultation setting Athletes expressed high satisfaction with consultations, advice, and medical testing; some wanted longer consultations or more detail initially, which was addressed in follow-ups -“I haven’t followed sports-specific dietary advice like this before… my knowledge about nutrition has improved a lot.” (M, 25) 4. Opinion on changes in sports nutrition knowledge and performance All athletes reported improved energy, recovery, reduced fatigue and injuries, better hydration practices, and enhanced performance -“My timing has improved, I feel less tired, and I have more energy.” (M, 25) 5. Opinion on prescribed ergogenic supplements Most athletes reported performance benefits from supplements (e.g., caffeine, bicarbonate, creatine, BA, beetroot juice); some experienced side effects like nausea, loose stools, sleep disturbances; adverse effects were managed -“I have improved my throwing distance by 4 meters because of the caffeine.” (F, 21) Theme 1: Experience with the dietary advice Most athletes reported that they were able to follow nearly all the dietary recommendations provided by the principal investigator and expressed high appreciation for how these changes positively impacted their well-being. One athlete shared, "I didn’t eat anything before and immediately after training but after the doctor’s advice. I started eating a banana before my training and also drank a packet of milk after the training" (middle-distance runner, M, 25 years). Another participant noted, "I didn’t take dates or ORS (Jeewani) during training before. But now, since the doctor prescribed them, I do. Only after making these changes, I have been able to fully perform my workouts with much more energy " (long-distance runner, M, 23 years). Similarly, another athlete stated, "I followed all the dietary advice given by the doctor. I ate a sandwich and drank a glass of milk before training. After training, I have a banana and a protein bar" (sprinter, M, 26 years). In addition, many athletes reported that they had incorporated boiled eggs into their post-training meals as a convenient protein source along with their meals, especially in the morning when they can’t find any cooked fish or meat, finding it an easy way to increase their protein intake. As one sprinter mentioned, "The doctor asked me to take eggs, which I did " (sprinter, F, 19 years). Another added, "I have included eggs with rice and curry immediately after my training now " (long-distance runner, M, 23 years). All the athletes reported replacing coconut oil either with extra virgin olive oil or gingelly oil, as recommended by the principal investigator. Some athletes opted for gingelly oil instead of olive oil due to financial constraints. " I also added extra virgin olive oil to my diet." (jumper, M, 21 years). A notable benefit reported by the athletes was an improved sensation of hunger due to the proper pre-training meal advice. One athlete stated, "I feel much more comfortable training now. I don't feel hungry during training like I did before" (long-distance runner, F, 22 years). Another sprinter mentioned feeling more energetic and less lethargic during training due to the dietary changes, saying, " I don't feel laziness like before. I also feel so comfortable and fit while running. Earlier, I had body pain and tiredness after heavy work, but now that’s gone " (sprinter, F, 19 years). Additionally, one sprinter highlighted the improvement in her sleep quality, attributing it to the prescribed diet plan, which included taking a scoop of whey protein before bedtime. She commented, "I feel so much better in my body. Earlier, I used to get hungry late at night because of what I ate for dinner, but that’s not the case now " (sprinter, F, 28 years). Moreover, a hammer thrower, who had been advised to reduce her caloric intake due to being obese (body fat 37.8%), reported feeling much more comfortable during training after losing a few kilograms. She stated, " I feel so relaxed in my body because the doctor asked me to reduce my rice intake and increase green vegetables. This change has greatly improved my training, and I have been recording greater distances than before " (Hammer Thrower, F, 21 years). On the other hand, a few athletes noted challenges in fully complying with the dietary recommendations due to practical constraints such as time limitations. One long-distance runner mentioned, "The doctor also asked me to eat boiled chickpeas in the morning on some days, but I didn't have enough time to cook that " (long-distance runner, F, 22 years). Another long-distance runner experienced initial discomfort when consuming extra virgin olive oil, as it was unfamiliar to him. He shared, "It was initially hard to take it because of the bitter taste" (long-distance runner, M, 23 years). But subsequently, he could tolerate it. Theme 2: Opinion on the prescribed vitamins and supplements All participants (14/14) recognized the significant importance of the recommended multivitamin, multimineral, and sports supplements in enhancing their sports performance, recovery, reducing injury risk, and overall well-being. They also expressed positive feedback regarding the prescribed vitamins and supplements, detailing the beneficial effects they experienced from the supplementation. One participant noted, "I didn't take any vitamins earlier, but with these vitamins and supplements, I feel like I have more energy. I can run so well now" (long-distance runner, M, 23 years). Another participant commented, "I feel so fit. I no longer have the laziness I had earlier. I'm much quicker now, and my timing has also improved. I ran really well in the morning sessions" (sprinter, M, 26 years). Despite the positive feedback, some athletes experienced adverse effects from the prescribed vitamins and supplements, including constipation and abdominal discomfort. One athlete reported, "I got a bit of gastritis from the multivitamin and iron tablets " (thrower, F, 21 years). Another stated, "I had constipation because of the whey protein. I couldn't pass stools for three days straight, and because of that, I experienced bloating in my stomach" (sprinter, F, 28 years). Additionally, a jumper experienced vomiting after the first day of whey protein intake during training, stating, "I vomited on the very first day of taking the whey protein during training, but I don't feel nauseous when taking the protein now" (jumper, M, 21 years). The research team closely monitored athletes who reported adverse effects. They received guidance on mitigating these effects, such as consuming iron with a main meal, avoiding protein supplements early in the morning, or using medications for those with gastric discomfort. During follow-up consultations, all affected athletes (3/3) reported that they did not experience such side effects afterwards. Additionally, upon reviewing the medical history of the sprinter who experienced abdominal bloating and constipation due to whey protein supplementation, it was found that she had milk food intolerance. Consequently, she was advised to switch to a non-dairy protein, such as a beef-based protein supplement, and the problems were resolved. Theme 3: Opinion on the consultation setting Almost all respondents reported being satisfied with the sports nutrition intervention they experienced and expressed appreciation for the dietary advice provided by the principal investigator. “I haven't followed sports-specific dietary advice like this before. After this program, I feel my knowledge about nutrition has improved a lot .” (middle-distance runner, M, 25 years). “The explanations are enough. Since the doctor allowed me to record his advice, I got the chance to go home and listen to the missed points.” (middle-distance runner, M, 22 years). All the athletes also expressed great satisfaction with the tests and investigation they underwent as part of the sports nutrition intervention and highly appreciated the efforts made by the research team. “Those tests were essential. From those tests, I learned that the fat percentage of my body is higher than normal.” (middle-distance runner, M, 22 years). Another sprinter commented that, “Yes, those tests were really important. From them, I learned that my haemoglobin has been low .” (sprinter, F, 28 years). Another athlete acknowledged the importance of the SNK he acquired through participating in the intervention. “I got to know many important facts that I didn't know earlier. The doctor said that I'm drinking an excess amount of water looking at my urine specific gravity values, so I stopped that practice as well.” (sprinter, M, 20 years). In contrast, a few participants (3/14) reported that they would have appreciated extended consultation times and more detailed explanations of the dietary advice. “I feel it would be better if the doctor could explain more about how to take food throughout a given day.” (sprinter, M, 26 years). “I feel like it would be great if I could get more time for my consultation.” (sprinter, F, 28 years). However, this feedback was incorporated into the subsequent interviews, and consequently, they were satisfied with the duration of the following consultation. Theme 4: Opinion on the changes observed in sports nutrition knowledge and performance All athletes (14/14) reported feeling better and experiencing less fatigue after the sports nutrition knowledge intervention. "My timing has improved, I feel less tired, and I have more energy." (middle-distance runner, M, 25 years). "Yes, I have more energy now. I can perform better compared to before. " (jumper, F, 23 years). Another middle-distance runner noted that his recovery had significantly improved following the implementation of the sports nutrition strategies. " I felt a great advantage from the diet recommended by the doctor. I feel like my recovery has improved after a heavy workout." (middle-distance runner, M, 22 years). A marathoner commented that the hydration and dietary advice he followed after the sports nutrition intervention enhanced his performance. " Earlier, I didn’t drink enough water and didn’t eat properly. With this dietary advice, I see a significant improvement in energy levels." (marathoner, M, 23 years). Additionally, some athletes reported experiencing fewer injuries and illnesses after following the prescribed dietary advice and supplementation. "Earlier, I used to get sick frequently, but now that's not the case. I can do my training so well now. I feel very fit and experience less fatigue." (jumper, M, 21 years). Another middle-distance runner mentioned that, "Earlier, I had Achilles tendon pain frequently, but now it is very rare." (middle-distance runner, M, 22 years). Theme 5: Opinion on the prescribed ergogenic supplements Based on the specific ergogenic supplements prescribed for each athlete, depending on their main sports event, the athletes reported mixed opinions regarding the beneficial effects and adverse side effects they experienced. Regarding the use of caffeine, nearly all athletes (13/14) reported improvements in their sports performance, particularly in terms of timing and increased energy levels. "I have improved my throwing distance by 4 meters because of the caffeine. I also feel more energetic." (hammer thrower, F, 21 years). One sprinter achieved his personal best during an athletic tournament following caffeine supplementation. "My timing has improved because of caffeine. Earlier, my personal best was 1:53.00 for 800 m, but I achieved 1:51.20 at the Junior National meet, and I placed first ." (middle-distance runner, M, 22 years). Another athlete also recorded her best timing after using caffeine before the competition. "I got my best timing for the 400 m with 59.7 seconds; initially, it was over 60 seconds. In the 800m, I ran 2:27 seconds compared to my previous time of 2:44 seconds. I won first place in both events at the zonal meet." (sprinter, F, 19 years). However, some athletes reported adverse effects, such as eye irritation, following caffeine use. "I found no difference in my performance with caffeine, but instead, my eyes were irritated afterwards." (sprinter, M, 20 years). Another sprinter reported difficulty sleeping in the evening and late at night after consuming caffeine in the morning. “I couldn’t sleep on the days I took caffeine. Previously, I used to sleep around 8–9 PM, but now I'm awake until 12 − 1 AM” (Sprinter, F, 21 years). Regarding bicarbonate use, most athletes (3 out of 4) who were advised to take it reported positive effects on their sporting performance. “I think bicarbonate was very beneficial for me. After using it, I felt no tightness in my legs during running, and my timing improved ” (Middle-distance runner, M, 22 years). However, two athletes experienced side effects such as loose stools, bloating, and nausea following bicarbonate supplementation. “I felt nauseous when I took bicarbonate on the first day of training. My coach advised me to take a break and try it again after a couple of days” (Sprinter, M, 26 years). Athletes prescribed creatine (3/3) demonstrated notable improvements in explosive power compared to earlier performances. The hammer thrower reported significant performance gains following creatine supplementation, with the athlete now achieving a throw of 42 meters, up from her previous seasonal best of 40 meters. "I’m now recording greater distances than before; previously, my best throw was 38 meters in my last meet, but now I have reached 42 meters during training" (Hammer Thrower, F, 21 years). Similarly, a sprint hurdler noted improvements in energy levels and performance during morning workouts. "Earlier, I felt less energetic for morning workouts. It was really hard for me to perform plyometrics and explosive exercises " (Sprinter, M, 25 years). Regarding BA supplementation, most athletes (5/6) noted a positive impact. One sprinter reported feeling much fitter and more energetic during training, along with improved timing. "I think the BA has started to work because my timing is perfect now" (Sprinter, M, 20 years) " (Middle-distance runner, M, 22 years). Additionally, beetroot juice was recommended for some athletes (3/3). Those already using it were advised to enhance the preparation by adding spinach leaves and celery. "I used to drink beetroot juice, and sir asked me to mix in spinach leaves and celery. It's easy for me since they're readily available near my residence" (Long-distance runner, M, 23 years). Athletes who experienced side effects from ergogenic supplementation were prescribed medications to relieve their symptoms by the principal investigator and were closely monitored for improvements. Discussion This study aimed to assess the effectiveness of an evidence-based, culturally specific personalized sports nutrition intervention quantitatively and qualitatively in improving the performance and well-being of professional track and field athletes in Sri Lanka. To the best of our knowledge, this is the first study to present real-life performance improvements, particularly in competition situations, following a personalized sports nutrition intervention. Our findings highlight the effectiveness of personalized nutrition advice in improving performance both during and outside of competition, as one participant set a national record, six achieved PBs, four recorded SBs, and all the athletes reported improved well-being and reduced fatigue. The distinctiveness of this study lies in the fact that our sample consisted of elite and highly trained athletes who had not previously received proper nutritional guidance. Consequently, the mean age of this group is relatively low, as most mature and experienced athletes are typically on professional nutrition plans and/or dietary supplements. Such a participant group is uncommon in developed countries, where the majority of professional athletes receive structured nutritional care. However, our study can be replicated in resource-limited settings, such as in Asian and African countries. The current study demonstrated significant performance improvements in most participants, which can be attributed to the personalized dietary advice provided. This included consuming sufficient calories, macronutrients, and micronutrients, as well as practicing evidence-based use of ergogenic supplements. Low energy availability is very common among athletes and is correlated with decreased testosterone levels, reduced bone density, and a lower resting metabolic rate, which negatively impact performance and general well-being ( 18 ). Many Sri Lankan athletes come from low socioeconomic backgrounds and exhibit poor dietary practices ( 19 ). Optimizing calorie intake in this population may enhance both performance and overall well-being. Additionally, adequate protein intake, along with appropriate dietary planning, has been shown to improve performance ( 20 ). Sri Lankan diets are predominantly high in saturated fat, primarily derived from coconut ( 21 ). Saturated fats are known to affect negatively affect musculoskeletal tissues ( 22 ). All athletes were instructed to replace high-saturated coconut oil with high-unsaturated oil sources such as either EVOO or gingelly oil. Several studies suggest that EVOO, rich in phenolic compounds, exhibits beneficial biological effects due to its antimicrobial, antioxidant, and anti-inflammatory properties ( 23 ). Furthermore, supplementation with EVOO has been found to improve cardiorespiratory coordination during moderate-intensity exercise compared to palm oil ( 24 ). Participants were also advised to limit or avoid consuming deep-fried and oily street foods, as the literature indicates that trans fats increase inflammation ( 25 ). Micronutrients are not only essential for sporting performance and overall health but also play a crucial role in the energy production process. For example, many B-complex vitamins are involved in the metabolism of carbohydrates and fats, which is particularly important during exercise of varying intensities ( 26 ). Many micronutrients play a crucial role in the synthesis of proteins involved in oxygen transport, maintaining healthy bone tissue, supporting immune function, and regulating water and electrolyte balance in the body ( 27 ). Vitamin D deficiency is common in athletic populations. A double-blind, placebo-controlled randomized controlled trial examining the efficacy of 3-week vitamin D supplementation found a marked decrease in post-exercise biomarkers among endurance runners ( 28 ). In the present study, vitamin and mineral supplements were prescribed to athletes diagnosed with biochemically confirmed micronutrient deficiencies. Similarly, iron deficiency is highly prevalent among athletes and is independently associated with reduced athletic performance ( 29 ). Iron deficiencies, indicated by low serum ferritin levels and/or anaemia based on haemoglobin levels, were treated with oral iron supplements. Long-term multivitamin and mineral supplementation have shown no significant advantages in improving athletic performance in well-nourished populations ( 30 , 31 ). Consequently, empirical multivitamin supplementation is generally not recommended. However, the majority of these studies have been conducted in developed countries among well-nourished, active individuals. In contrast, Sri Lankan athletes often exhibit poor dietary practices due to economic and social challenges ( 32 ). In such low-resource settings with suboptimal diets, multivitamin supplementation may offer potential benefits by addressing micronutrient deficiencies and supporting athletes in achieving their maximum performance capacity. The positive impact of ergogenic supplementations on sporting performance has been widely discussed in the literature depending on the sports event. Caffeine, a well-known ergogenic aid, is widely used by athletes for its stimulant effects, including improved endurance, strength, and alertness ( 33 ). Our study also showed enhanced performance with caffeine intake both during training and competition. Creatine monohydrate is another widely recognized supplement that has been shown to enhance strength, power, and high-intensity exercise performance ( 34 ). Research suggests that creatine supplementation increases the availability of phosphocreatine in muscles, enabling athletes to sustain high-intensity efforts for longer periods, which is crucial for sprinters, jumpers, and throwers. The recommended dosage of 3–5 grams of creatine monohydrate in this study follows the standard practice established in the literature ( 35 ), with numerous studies demonstrating its efficacy in improving power output and athletic performance, particularly in explosive activities. BA, another key supplement recommended in the current study for middle-distance runners (400m and 800m), has been shown to enhance performance by buffering lactic acid accumulation, thereby delaying fatigue. An umbrella review found that BA supplementation, with daily doses ranging from 1.2 to 7.0 g and intervention periods of 4 days to 13 weeks, generally improved exercise performance ( 36 ). The greatest benefits were observed in exercise durations between 30 seconds and 10 minutes ( 36 ). Sodium bicarbonate, prescribed for selected athletes, is also known for its ability to enhance performance by neutralizing the acid build-up during high-intensity, short-duration efforts ( 37 ). This supplement has been shown to improve performance in sports requiring repeated bouts of intense activity, such as sprints, cycling, and swimming ( 38 ). This is consistent with the findings of McNaughton et al., who suggest its positive effects on anaerobic capacity ( 39 ). Finally, beetroot juice, recommended for long-distance runners in the current study, has gained attention for its potential to enhance endurance performance due to its high nitrate content ( 40 ). Previous research has demonstrated that certain physical performance indicators significantly improve among athletes following sports nutrition interventions, though not all parameters exhibit the same extent of improvement. For example, a trial conducted on elite athletes to evaluate the effects of nutritional guidance reported improvements in all one-repetition maximum tests in both groups (6–12%), but no significant changes in the 40 m sprint or countermovement jump ( 41 ). Compared to our findings, this study reported modest results, likely because their participants were better nourished than those in our sample, who had not previously received professional sports nutrition support and were also from a developing country. Similarly, another study reported improvements in jump and squat performance as well as 5-10-5 shuttle times among basketball players following a 90-minute sports nutrition education intervention, observed from pre- to post-intervention ( 42 ). However, no significant differences were noted between the IG and CG. To reinforce the intervention, additional 45-minute sessions were conducted every three weeks in small groups of five players at the university dining hall ( 42 ). Although this study also employed a mixed-methods approach similar to our research, the observed improvements were not as significant as those in our study. The dual approach used in our intervention, which combined individualized support with online guidance, likely played a critical role in the enhanced performance outcomes. Continuous individual support, regular monitoring through online platforms, and tailored advice on both general and sports nutrition allowed athletes to actively engage with the intervention. Furthermore, enabling them to record all guidance provided by the principal investigator through their smartphones may have significantly contributed to the superior performance improvements observed in our study compared to others. A key strength of the present study is its combination of culturally tailored, evidence-based, individualized dietary and supplement guidance, which aligns well with the needs of athletes and enhances their engagement. Additionally, the real-life assessment of this intervention allowed us to evaluate its impact on both competition performance and the general well-being of track and field athletes in Sri Lanka. Additionally, the use of both quantitative metrics (e.g., performance improvements, strength gains) and qualitative feedback provides a comprehensive view of the intervention's impact. The study also acknowledges challenges, such as time constraints for food preparation and taste aversion, which are common in dietary interventions, highlighting the study’s realism and applicability. A primary limitation of this study is the relatively short duration, which may limit the observation of long-term effects on athletes' performance and health. Additionally, the reliance on self-reported dietary compliance introduces potential biases, as athletes may overestimate adherence to the intervention. The sample size, while sufficient for initial insights, could limit the generalizability of findings across diverse athlete populations. Lastly, it is beyond the scope of this study to examine the factors such as individual variations in metabolism and external stressors, which may influence outcomes and highlight areas for further research to refine personalized nutrition approaches for athletes. Future studies should consider extending the duration of interventions and with a higher number of athletes from different sports disciplines to assess the long-term sustainability and impact of personalized nutrition on athletes' performance. Incorporating more objective measures of dietary adherence, such as biomarkers or wearable technology, could provide a more accurate assessment of compliance. Additionally, future research could explore the influence of external factors, such as training load and psychological stress, on the effectiveness of nutrition interventions. Conclusions The current study demonstrates that personalized, culturally specific evidence-based nutrition interventions can significantly enhance athletes' knowledge, performance, and well-being while addressing practical considerations. Abbreviations 1RM One Repetition Maximum CG Control Group EVOO Extra Virgin Olive Oil g/kg Grams per Kilogram IG Intervention Group IOC International Olympic Committee IU International Units ORS Oral:Rehydration Solution PB Personal Best RCT Randomized Controlled Trial SB Seasonal Best SNK Sports Nutrition Knowledge SNKQ Sports Nutrition Knowledge Questionnaire USG Urine Specific Gravity. Declarations Acknowledgements We express our gratitude to all the participants who took part in this study and to the other researchers who contributed to the improvement of the study. Funding No funding was received for conducting this study. Conflicts of interest The authors declare no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Consent for publication Not applicable. Availability of data and materials Not applicable. Ethical approval and consent to participate Ethical clearance for this study was granted by the Ethics Review Committee, Faculty of Medicine, University of Peradeniya, Sri Lanka (Ref No. 2024/EC/21). Authors' contribution RJ conceived and designed the study. RJ and KW contributed to drafting the manuscript. IN, NSK, TM, and APH, as supervisory team members participated in the revision of the paper. All authors provided valuable feedback on the manuscript. Additionally, all authors carefully reviewed and approved the final version of the manuscript. References Guest NS, Horne J, Vanderhout SM, El-Sohemy A. Sport Nutrigenomics: Personalized Nutrition for Athletic Performance. Front Nutr. 2019;6:8. Thomas DT, Erdman KA, Burke LM. 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German Journal of Sports Medicine. 2020;71(7-9):185-91. Jäger R, Kerksick CM, Campbell BI, Cribb PJ, Wells SD, Skwiat TM, et al. International Society of Sports Nutrition Position Stand: protein and exercise. Journal of the International Society of Sports Nutrition. 2017;14(1):20. Tuma C, Schick A, Pommerening N, Braun H, Thevis M. Effects of an Individualized vs. Standardized Vitamin D Supplementation on the 25(OH)D Level in Athletes. Nutrients. 2023;15(22):4747. Loucks AB. Energy balance and body composition in sports and exercise. J Sports Sci. 2004;22(1):1-14. Jayawardena R, Weerasinghe K, Madhujith T, Hills AP, Kalupahana N. Perceptions of the importance of sports nutrition knowledge and barriers in implementing them: a qualitative study among track and field stakeholders in Sri Lanka. BMC Nutrition. 2024;10(1):17. Kloby Nielsen LL, Tandrup Lambert MN, Jeppesen PB. The Effect of Ingesting Carbohydrate and Proteins on Athletic Performance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2020;12(5). Swarnamali H, Ranasinghe P, Jayawardena R. Changes in serum lipids following consumption of coconut oil and palm olein oil: A sequential feeding crossover clinical trial. Diabetes Metab Syndr. 2024;18(6):103070. Lin RT, Osipov B, Steffen D, Chamberlin M, Pathak SJ, Christiansen BA, et al. Saturated fatty acids negatively affect musculoskeletal tissues in vitro and in vivo. Matrix Biol Plus. 2024;23:100153. Cicerale S, Lucas LJ, Keast RS. Antimicrobial, antioxidant and anti-inflammatory phenolic activities in extra virgin olive oil. Curr Opin Biotechnol. 2012;23(2):129-35. Esquius L, Garcia-Retortillo S, Balagué N, Hristovski R, Javierre C. Physiological- and performance-related effects of acute olive oil supplementation at moderate exercise intensity. Journal of the International Society of Sports Nutrition. 2019;16(1):12. Iwata NG, Pham M, Rizzo NO, Cheng AM, Maloney E, Kim F. Trans fatty acids induce vascular inflammation and reduce vascular nitric oxide production in endothelial cells. PLoS One. 2011;6(12):e29600. Brancaccio M, Mennitti C, Cesaro A, Fimiani F, Vano M, Gargiulo B, et al. The Biological Role of Vitamins in Athletes' Muscle, Heart and Microbiota. Int J Environ Res Public Health. 2022;19(3). Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients. 2020;12(10). Żebrowska A, Sadowska-Krępa E, Stanula A, Waśkiewicz Z, Łakomy O, Bezuglov E, et al. The effect of vitamin D supplementation on serum total 25(OH) levels and biochemical markers of skeletal muscles in runners. J Int Soc Sports Nutr. 2020;17(1):18. Keller K, Friedrich O, Treiber J, Quermann A, Friedmann-Bette B. Iron deficiency in athletes: Prevalence and impact on VO(2) peak. Nutrition. 2024;126:112516. Telford RD, Catchpole EA, Deakin V, Hahn AG, Plank AW. The effect of 7 to 8 months of vitamin/mineral supplementation on athletic performance. Int J Sport Nutr. 1992;2(2):135-53. Singh A, Moses FM, Deuster PA. Chronic multivitamin-mineral supplementation does not enhance physical performance. Med Sci Sports Exerc. 1992;24(6):726-32. de Silva A, Samarasinghe Y, Senanayake D, Lanerolle P. Dietary supplement intake in national-level Sri Lankan athletes. Int J Sport Nutr Exerc Metab. 2010;20(1):15-20. Guest NS, VanDusseldorp TA, Nelson MT, Grgic J, Schoenfeld BJ, Jenkins NDM, et al. International society of sports nutrition position stand: caffeine and exercise performance. Journal of the International Society of Sports Nutrition. 2021;18(1):1. Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal of the International Society of Sports Nutrition. 2017;14(1):18. Larsen FW, Bladt J, Rahbek C. Improving the performance of indicator groups for the identification of important areas for species conservation. Conserv Biol. 2007;21(3):731-40. Jayawardena R, Weerasinghe K, Sooriyaarachchi P, HILLS A. Effect of the beta-alanine supplementation in sports: an umbrella review of systematic reviews and meta-analyses. Medicina dello Sport. 2023;76(2):260-71. Grgic J, Pedisic Z, Saunders B, Artioli GG, Schoenfeld BJ, McKenna MJ, et al. International Society of Sports Nutrition position stand: sodium bicarbonate and exercise performance. Journal of the International Society of Sports Nutrition. 2021;18(1):61. Keselman A, Browne AC, Kaufman DR. Consumer health information seeking as hypothesis testing. J Am Med Inform Assoc. 2008;15(4):484-95. McNaughton LR, Siegler J, Midgley A. Ergogenic effects of sodium bicarbonate. Curr Sports Med Rep. 2008;7(4):230-6. Domínguez R, Cuenca E, Maté-Muñoz JL, García-Fernández P, Serra-Paya N, Estevan MC, et al. Effects of Beetroot Juice Supplementation on Cardiorespiratory Endurance in Athletes. A Systematic Review. Nutrients. 2017;9(1). Garthe I, Raastad T, Refsnes PE, Sundgot-Borgen J. Effect of nutritional intervention on body composition and performance in elite athletes. European journal of sport science. 2013;13(3):295-303. Rossi FE, Landreth A, Beam S, Jones T, Norton L, Cholewa JM. The Effects of a Sports Nutrition Education Intervention on Nutritional Status, Sport Nutrition Knowledge, Body Composition, and Performance during Off Season Training in NCAA Division I Baseball Players. J Sports Sci Med. 2017;16(1):60-8. Additional Declarations No competing interests reported. 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These strategies include practising healthy dietary habits, maintaining balanced macronutrient ratios, ensuring adequate micronutrient intake, and carefully using sports supplements and ergogenic aids. Additionally, addressing misconceptions related to sports nutrition and applying sports nutrition knowledge (SNK) to develop practical dietary patterns is crucial for fuelling physical activities, supporting recovery and repair, optimizing performance, and promoting overall health and wellness (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Monitoring effective nutrient timing, such as consuming carbohydrates and proteins to enhance glycogen replenishment and accelerate muscle protein synthesis, is also contingent upon maintaining proper nutrition (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). A study by Viribay and colleagues demonstrated that consuming a high amount of carbohydrates (120 g/h) during a mountain marathon can reduce exercise-induced muscle damage, compared to carbohydrate intakes of 60 and 90 g/h (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Another trial reported that a whey protein supplement (25 g protein, 2.5 g fat, and 3 g carbohydrates) aids moderate improvements in acute anaerobic power and strength, indicating enhanced recovery after an intense full-body resistance training session, compared to a calorie-matched carbohydrate drink (32.5 g carbohydrates) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Similarly, another randomized crossover trial involving soccer players demonstrated that pre-sleep casein protein supplementation benefits countermovement jumps recovery and reactive strength index recovery at 12- and 36-hours post-match (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Muscle soreness, measured using a visual analogue scale, was also significantly greater in the control group compared to the casein protein group at 12 hours post-match (72\u0026thinsp;\u0026plusmn;\u0026thinsp;17 vs. 42\u0026thinsp;\u0026plusmn;\u0026thinsp;20 mm) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, vitamin supplementation has also been shown to improve sports performance. Rockwell and colleagues found that vitamin D supplementation (vitamin D3 5000 IU/day for 12 weeks) increased fat-free mass and enhanced performance in deadlift (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and vertical jump (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0 .01) tests compared to their control counterparts (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A systematic review of 12 randomized controlled trials reported that iron supplementation in athletes improved performance in endurance sports (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Furthermore, iron supplementation may be more beneficial for athletes with ferritin levels below 20 \u0026micro;g/L compared to those with higher baseline ferritin levels (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, supplements, ergogenic aids have been shown to enhance exercise performance and recovery in elite athletes (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). For instance, a trial conducted with cyclists showed that a 6 mg\u0026middot;kg⁻\u0026sup1; dose of caffeine consumed one hour pre-exercise significantly improved performance in 4\u0026times;10-km time trials compared to a placebo group (intervention group vs. placebo, p\u0026thinsp;=\u0026thinsp;0.008) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Similarly, a double-blind randomized controlled study discovered that six-week creatine-electrolyte (CE) supplementation enhanced overall and repeated short-duration sprint cycling performance (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The CE group showed a 4% increase in overall peak power (pre: 734\u0026thinsp;\u0026plusmn;\u0026thinsp;75 W; post: 765\u0026thinsp;\u0026plusmn;\u0026thinsp;71 W; p\u0026thinsp;=\u0026thinsp;0.040) and a 5% increase in overall mean power (pre: 586\u0026thinsp;\u0026plusmn;\u0026thinsp;72 W; post: 615\u0026thinsp;\u0026plusmn;\u0026thinsp;74 W; p\u0026thinsp;=\u0026thinsp;0.019;), while the placebo group exhibited no significant changes. Additionally, repeated sprint analysis revealed significant improvements in peak (pre: 737\u0026thinsp;\u0026plusmn;\u0026thinsp;88 W; post: 767\u0026thinsp;\u0026plusmn;\u0026thinsp;92 W; p\u0026thinsp;=\u0026thinsp;0.002;) and mean power (pre: 650\u0026thinsp;\u0026plusmn;\u0026thinsp;92 W; post: 694\u0026thinsp;\u0026plusmn;\u0026thinsp;87 W; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001;) in the first sprint effort for the CE group (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough most interventions show a positive effect, they typically address only a specific component of sports nutrition practice, such as dietary modifications related to a single macronutrient or micronutrient, a sports supplement, or an ergogenic aid. However, sports performance depends on many nutritional aspects, including proper energy and macronutrient intake, addressing micronutrient deficiencies, maintaining proper hydration, and the appropriate and timely use of sports and ergogenic supplements. Furthermore, most research findings report improvements in parameters within controlled environments or focus solely on surrogate measures of athletic performance. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e'Real-life' performance depends on various internal and external factors. Internal factors include physical and mental conditions, whereas external factors encompass weather and competition during the event. Consequently, quantitative parameters alone may not fully capture the impact of an intervention on a particular athlete, especially in a competitive setting. To the best of our knowledge, there are only a limited number of studies investigating the effectiveness of an evidence-based, culturally accepted, personalized sports nutrition intervention on improving sports performance during competition. Hence, our study aims to both quantitatively and qualitatively assess performance changes and explore athletes\u0026rsquo; experiences regarding the effectiveness of an evidence-based, culturally accepted, personalized sports nutrition intervention among Sri Lankan track and field athletes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and study population\u003c/h2\u003e \u003cp\u003eElite and highly trained male and female track and field athletes from the national-level athletes' pool, who had previously completed the randomized controlled trial (RCT) of a 16-week evidence-based, culturally tailored, personalized sports nutrition intervention, were recruited for this separate study. The protocol for the original RCT has been published elsewhere (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). None of the participants had received formal, individualized nutrition counselling prior to the original RCT. All participants in the intervention group (n\u0026thinsp;=\u0026thinsp;15) from the original RCT were included.\u003c/p\u003e \u003cp\u003e Informed written consent was obtained from each participant after an in-depth explanation of the study, giving them adequate time to ask questions and clarify doubts about the research. All methods were performed in accordance with the Declaration of Helsinki. Ethical clearance for this trial has been obtained from the Institutional Ethical Review Committee, Faculty of Medicine, University of Peradeniya, Sri Lanka (2024/EC/21).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eThe principal investigator offered an evidence-based, culturally tailored, personalized sports nutrition intervention tailored to each athlete's sports background. Cultural tailoring referred to adapting the nutrition advice to the local dietary practices, traditional food preferences, availability of food items, and sociocultural eating patterns typical of Sri Lankan athletes. It also considered religious dietary restrictions (e.g., vegetarianism, avoidance of beef or pork), economic accessibility of food items, and preferred meal timing and composition. These one-on-one sessions were conducted at week zero or baseline, 4th, and 8th weeks after recruitment. The primary nutrition-related areas covered throughout the process included:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eEnergy intake: Athletes were advised to consume sufficient energy based on their energy balance. Energy requirements were estimated by the principal investigator, considering the athletes' characteristics and training loads. However, no mathematical calculations were performed due to the current setting's various practical and theoretical constraints. When energy intake needed to be adjusted, culturally familiar foods were emphasized; for example, increasing rice portions, incorporating traditional snacks, or reducing high-fat curries\u0026mdash;ensuring that guidance was practical and contextually appropriate. In cases where dietary modifications alone were insufficient to meet energy needs, energy-containing supplements were prescribed to bridge the gap. Conversely, athletes with high adiposity and excess energy intake received culturally specific advice to reduce calorie intake (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eCarbohydrate intake: Advice on carbohydrate intake was provided according to recent guidelines (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and locally common carbohydrate sources (e.g., red rice, string hoppers, manioc, jackfruit) were recommended.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eProtein intake: Advice was provided according to established guidelines (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), recommending culturally familiar high-protein foods such as lentils, eggs, dried fish and chicken. The recommended total daily protein intake was calculated at 1.2\u0026ndash;1.6 g/kg of body weight, with each meal containing 0.3\u0026ndash;0.4 g/kg of body weight, thereby necessitating four protein-rich meals per day. When athletes could not meet the recommended protein intake, whey protein supplements were prescribed.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eFat intake: Foods high in saturated fats, such as coconut oil, coconut milk, and coconut sambal, were discouraged, and coconut oil was substituted with healthier unsaturated oil such as extra virgin olive oil, gingelly oil, and sunflower oil. For participants consuming insufficient amounts of fish, especially those not eating oily fish at least twice per week, a daily supplementation of 1000 mg of omega-3 fish oil was prescribed. Participants were advised to limit or avoid consuming deep-fried foods, oily street foods, and high-fat sweets such as chocolate.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMicronutrients: Dietary advice was provided to achieve adequate micronutrient intake, and micronutrient supplements were prescribed for athletes with a biochemically diagnosed deficiency. Vitamin D insufficiency or deficiency was treated by prescribing either 60,000 IU weekly, and/or 5,000 IU, 2,000 IU, or 1,000 IU daily (Alvin Andersen Distributors, INC., based in Hialeah, Florida), depending on the blood values (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In cases of iron deficiency, as indicated by serum ferritin levels or anaemia according to haemoglobin levels, oral iron supplements were prescribed (Dumasules by DUMEX, based in Mandaluyong City, Philippines.; Ferrous Fumarate BP 300 mg, equivalent to 100 mg of elemental iron, and other vitamins). Additionally, multivitamin-multimineral supplements (Menuvit tablet; Finecure Pharmaceuticals Limited) and calcium supplements (Ascal tablet: Calcium Carbonate 450 mg, Vitamin C 40 mg, Vitamin D3 200 IU), were prescribed to all athletes.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Intake of fibre: Participants were encouraged to consume grains, fruits, vegetables, nuts and legumes as part of their healthy meal habits. However, for fibre intake, foods with high amounts of fibre were discouraged during pre-training and before and during the competition period.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHydration: Personalized hydration advice was given according to individual hydration status measured by urine specific gravity (USG), urine colour and thirst.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eErgogenic supplements: Different ergogenic supplements were prescribed in accordance with the International Olympic Committee (IOC) guidelines (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Caffeine capsules were recommended for most athletes before training and during competition. Sprinters, jumpers, and throwers were advised to take 3 to 5 grams of creatine monohydrate, while beta-alanine (BA) was prescribed for 400 m and 800 m runners. Sodium bicarbonate was suggested before competitions for selected athletes, and beetroot juice was recommended for long-distance runners. No pre-workout supplements were recommended.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected via face-to-face in-depth interviews at the 4th, 8th, and 16th weeks and finally, information from all three interviews at the given time points was compiled into one document for each participant. Each participant was separately interviewed following a pre-designed guide (Supplementary material 1). Trained research assistants conducted in-depth interviews using a set of open-ended, semi-structured questions to guide the participants and maintain consistency across all participants. The in-depth interview comprised five themes of questions regarding participants' opinions on 1) the dietary changes encountered, 2) the prescribed vitamins and supplements, 3) the consultation setting, 4) the changes observed in SNK and performance, and 5) the prescribed ergogenic supplements.\u003c/p\u003e \u003cp\u003eThe in-depth interviews were conducted in the participants' native language, either Sinhalese or Tamil, and their responses were recorded. The interviewer provided guidance, maintained focus, stimulated constructive discussion, and ensured adherence to time constraints, all while remaining neutral about the content of the discussion. The principal investigator was deliberately excluded from the interview process to minimize bias.\u003c/p\u003e\n\u003ch3\u003eData analysis and rigour\u003c/h3\u003e\n\u003cp\u003eA directed content analysis of the collected qualitative data was conducted, involving a systematic approach that began with pre-selecting themes based on the study's objectives. Subsequently, the research team meticulously coded and organized each participant's responses under their respective themes. This coding process was iterative, carefully accounting for the nuances and depth of the participants' responses. Theme development was achieved through an in-depth examination of the coded segments, facilitating the identification of patterns and relationships within the dataset.\u003c/p\u003e \u003cp\u003e The verbal responses of each participant, following their in-depth interviews, were analyzed using notes and saved audio recordings. This process occurred immediately after each interview, during which the research team documented all relevant information mentioned by the participants and cross-referenced their notes with the audio recordings. Each in-depth interview resulted in a comprehensive document, which was collectively assessed by the research team at the study's conclusion. Initially recorded in Sinhalese and Tamil, the native languages of the respondents, the interviews were later translated into English by independent translators. The research team, with the translators' assistance, compared each translation through an iterative consensus process to produce the final written piece.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFourteen elite track and field athletes from across the nation, comprising both genders, successfully completed the nutrition intervention. The mean age of the athletes was 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 years, with a mean sports experience of 7.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5 years. The gender distribution was 57.1% male and 42.9% female. The participants were involved in five different track and field categories: six sprinters, two middle-distance runners, three long-distance runners, two jumpers, and one thrower. The highest education levels achieved by the participants included: 35.7% had completed primary education (ten years of school education), 50.0% had completed secondary education (13 years of school education), and 14.3% had completed or were enrolled in a university degree or diploma program.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuantitative findings\u003c/h3\u003e\n\u003cp\u003eThe quantitative data (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) indicate that one athlete set a national record, six out of 14 athletes achieved personal bests (PBs) in competitions during the intervention period, and another four athletes recorded seasonal bests (SBs). Most of them reported achieving their personal best during training, although some were not able to convert these into competition performances. In addition to performance, all athletes, except for three long-distance runners, reported improvements in their resistance training and achieved personal bests in 1RM in most exercises during the intervention. Additionally, all athletes (14/14) reported \"feeling better\" overall as a result of the intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINSERT Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e ABOUT HERE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutline of the performance of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompetition PB achieved\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompetition SB achieved\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTraining PB achieved\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePB during resistance training achieved\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFeeling better\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo change\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 23 y, 5000 m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 25 y, 800 m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF, 23 y, high jump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 26 y, 5000 m, 10 000 m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 26 y, 400 m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 20 y, 400 m hurdles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 25 y, 110 m hurdles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 21 y, High jump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM, 22 y, 800m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF, 28 y, 100 m hurdles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF, 21 y, Hammer throw\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF, 22 y, 5000 m, 10 000m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF, 21 y, 400 m hurdles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF, 19 y, 400 m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eF: Female, M: Male, PB: Personal Best, SB: Seasonal Best, \u003cb\u003e* Set a new national record\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eQualitative findings\u003c/h3\u003e\n\u003cp\u003eIn-depth interviews, designed around five themes to qualitatively explore athletes\u0026rsquo; experiences with the effectiveness of the personalized sports nutrition intervention, lasted approximately 10\u0026ndash;15 minutes each and the total duration of each athlete was 30\u0026ndash;45 minutes. The key findings for each theme are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eINSERT Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e ABOUT HERE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey qualitative findings on athletes\u0026rsquo; experiences with the sports nutrition intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKey findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIllustrative quotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Experience with the dietary advice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost athletes followed the recommendations and reported positive impacts on energy, well-being, and training performance; common dietary changes included pre/post-training meals, increased protein intake, and healthier fat sources; a few faced challenges (e.g., time, taste)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u0026ldquo;I started eating a banana before training and drank milk after.\u0026rdquo; (M, 25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Opinion on the prescribed vitamins and supplements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAthletes viewed supplements as beneficial for energy, performance, recovery, and injury prevention; some experienced side effects (e.g., constipation, gastritis) which were managed with adjustments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u0026ldquo;I didn\u0026rsquo;t take any vitamins earlier, but now I feel like I have more energy.\u0026rdquo; (M, 23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Opinion on the consultation setting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAthletes expressed high satisfaction with consultations, advice, and medical testing; some wanted longer consultations or more detail initially, which was addressed in follow-ups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u0026ldquo;I haven\u0026rsquo;t followed sports-specific dietary advice like this before\u0026hellip; my knowledge about nutrition has improved a lot.\u0026rdquo; (M, 25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Opinion on changes in sports nutrition knowledge and performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll athletes reported improved energy, recovery, reduced fatigue and injuries, better hydration practices, and enhanced performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u0026ldquo;My timing has improved, I feel less tired, and I have more energy.\u0026rdquo; (M, 25)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Opinion on prescribed ergogenic supplements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMost athletes reported performance benefits from supplements (e.g., caffeine, bicarbonate, creatine, BA, beetroot juice); some experienced side effects like nausea, loose stools, sleep disturbances; adverse effects were managed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u0026ldquo;I have improved my throwing distance by 4 meters because of the caffeine.\u0026rdquo; (F, 21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Experience with the dietary advice\u003c/h2\u003e \u003cp\u003eMost athletes reported that they were able to follow nearly all the dietary recommendations provided by the principal investigator and expressed high appreciation for how these changes positively impacted their well-being.\u003c/p\u003e \u003cp\u003eOne athlete shared, \u003cem\u003e\"I didn\u0026rsquo;t eat anything before and immediately after training but after the doctor\u0026rsquo;s advice. I started eating a banana before my training and also drank a packet of milk after the training\"\u003c/em\u003e (middle-distance runner, M, 25 years).\u003c/p\u003e \u003cp\u003eAnother participant noted,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I didn\u0026rsquo;t take dates or ORS (Jeewani) during training before. But now, since the doctor prescribed them, I do. Only after making these changes, I have been able to fully perform my workouts with much more energy\u003c/em\u003e\" (long-distance runner, M, 23 years).\u003c/p\u003e \u003cp\u003eSimilarly, another athlete stated,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I followed all the dietary advice given by the doctor. I ate a sandwich and drank a glass of milk before training. After training, I have a banana and a protein bar\"\u003c/em\u003e (sprinter, M, 26 years).\u003c/p\u003e \u003cp\u003eIn addition, many athletes reported that they had incorporated boiled eggs into their post-training meals as a convenient protein source along with their meals, especially in the morning when they can\u0026rsquo;t find any cooked fish or meat, finding it an easy way to increase their protein intake. As one sprinter mentioned,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The doctor asked me to take eggs, which I did\u003c/em\u003e\" (sprinter, F, 19 years).\u003c/p\u003e \u003cp\u003eAnother added,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I have included eggs with rice and curry immediately after my training now \"\u003c/em\u003e (long-distance runner, M, 23 years).\u003c/p\u003e \u003cp\u003eAll the athletes reported replacing coconut oil either with extra virgin olive oil or gingelly oil, as recommended by the principal investigator. Some athletes opted for gingelly oil instead of olive oil due to financial constraints.\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eI also added extra virgin olive oil to my diet.\"\u003c/em\u003e (jumper, M, 21 years).\u003c/p\u003e \u003cp\u003eA notable benefit reported by the athletes was an improved sensation of hunger due to the proper pre-training meal advice.\u003c/p\u003e \u003cp\u003eOne athlete stated, \u003cem\u003e\"I feel much more comfortable training now. I don't feel hungry during training like I did before\"\u003c/em\u003e (long-distance runner, F, 22 years).\u003c/p\u003e \u003cp\u003eAnother sprinter mentioned feeling more energetic and less lethargic during training due to the dietary changes, saying,\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eI don't feel laziness like before. I also feel so comfortable and fit while running. Earlier, I had body pain and tiredness after heavy work, but now that\u0026rsquo;s gone\u003c/em\u003e\" (sprinter, F, 19 years).\u003c/p\u003e \u003cp\u003eAdditionally, one sprinter highlighted the improvement in her sleep quality, attributing it to the prescribed diet plan, which included taking a scoop of whey protein before bedtime. She commented,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I feel so much better in my body. Earlier, I used to get hungry late at night because of what I ate for dinner, but that\u0026rsquo;s not the case now\u003c/em\u003e\" (sprinter, F, 28 years).\u003c/p\u003e \u003cp\u003eMoreover, a hammer thrower, who had been advised to reduce her caloric intake due to being obese (body fat 37.8%), reported feeling much more comfortable during training after losing a few kilograms. She stated,\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eI feel so relaxed in my body because the doctor asked me to reduce my rice intake and increase green vegetables. This change has greatly improved my training, and I have been recording greater distances than before\u003c/em\u003e\" (Hammer Thrower, F, 21 years).\u003c/p\u003e \u003cp\u003eOn the other hand, a few athletes noted challenges in fully complying with the dietary recommendations due to practical constraints such as time limitations.\u003c/p\u003e \u003cp\u003eOne long-distance runner mentioned, \u003cem\u003e\"The doctor also asked me to eat boiled chickpeas in the morning on some days, but I didn't have enough time to cook that\u003c/em\u003e\" (long-distance runner, F, 22 years).\u003c/p\u003e \u003cp\u003eAnother long-distance runner experienced initial discomfort when consuming extra virgin olive oil, as it was unfamiliar to him.\u003c/p\u003e \u003cp\u003eHe shared, \u003cem\u003e\"It was initially hard to take it because of the bitter taste\"\u003c/em\u003e (long-distance runner, M, 23 years). But subsequently, he could tolerate it.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Opinion on the prescribed vitamins and supplements\u003c/h2\u003e \u003cp\u003eAll participants (14/14) recognized the significant importance of the recommended multivitamin, multimineral, and sports supplements in enhancing their sports performance, recovery, reducing injury risk, and overall well-being. They also expressed positive feedback regarding the prescribed vitamins and supplements, detailing the beneficial effects they experienced from the supplementation.\u003c/p\u003e \u003cp\u003eOne participant noted, \u003cem\u003e\"I didn't take any vitamins earlier, but with these vitamins and supplements, I feel like I have more energy. I can run so well now\"\u003c/em\u003e (long-distance runner, M, 23 years).\u003c/p\u003e \u003cp\u003eAnother participant commented, \u003cem\u003e\"I feel so fit. I no longer have the laziness I had earlier. I'm much quicker now, and my timing has also improved. I ran really well in the morning sessions\"\u003c/em\u003e (sprinter, M, 26 years).\u003c/p\u003e \u003cp\u003eDespite the positive feedback, some athletes experienced adverse effects from the prescribed vitamins and supplements, including constipation and abdominal discomfort. One athlete reported, \u003cem\u003e\"I got a bit of gastritis from the multivitamin and iron tablets \"\u003c/em\u003e (thrower, F, 21 years).\u003c/p\u003e \u003cp\u003eAnother stated,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I had constipation because of the whey protein. I couldn't pass stools for three days straight, and because of that, I experienced bloating in my stomach\"\u003c/em\u003e (sprinter, F, 28 years).\u003c/p\u003e \u003cp\u003eAdditionally, a jumper experienced vomiting after the first day of whey protein intake during training, stating,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I vomited on the very first day of taking the whey protein during training, but I don't feel nauseous when taking the protein now\"\u003c/em\u003e (jumper, M, 21 years).\u003c/p\u003e \u003cp\u003eThe research team closely monitored athletes who reported adverse effects. They received guidance on mitigating these effects, such as consuming iron with a main meal, avoiding protein supplements early in the morning, or using medications for those with gastric discomfort. During follow-up consultations, all affected athletes (3/3) reported that they did not experience such side effects afterwards.\u003c/p\u003e \u003cp\u003eAdditionally, upon reviewing the medical history of the sprinter who experienced abdominal bloating and constipation due to whey protein supplementation, it was found that she had milk food intolerance. Consequently, she was advised to switch to a non-dairy protein, such as a beef-based protein supplement, and the problems were resolved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Opinion on the consultation setting\u003c/h2\u003e \u003cp\u003eAlmost all respondents reported being satisfied with the sports nutrition intervention they experienced and expressed appreciation for the dietary advice provided by the principal investigator.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I haven't followed sports-specific dietary advice like this before. After this program, I feel my knowledge about nutrition has improved a lot\u003c/em\u003e.\u0026rdquo; (middle-distance runner, M, 25 years).\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The explanations are enough. Since the doctor allowed me to record his advice, I got the chance to go home and listen to the missed points.\u0026rdquo;\u003c/em\u003e (middle-distance runner, M, 22 years).\u003c/p\u003e \u003cp\u003eAll the athletes also expressed great satisfaction with the tests and investigation they underwent as part of the sports nutrition intervention and highly appreciated the efforts made by the research team.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Those tests were essential. From those tests, I learned that the fat percentage of my body is higher than normal.\u0026rdquo;\u003c/em\u003e (middle-distance runner, M, 22 years).\u003c/p\u003e \u003cp\u003eAnother sprinter commented that,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, those tests were really important. From them, I learned that my haemoglobin has been low\u003c/em\u003e.\u0026rdquo; (sprinter, F, 28 years).\u003c/p\u003e \u003cp\u003eAnother athlete acknowledged the importance of the SNK he acquired through participating in the intervention.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I got to know many important facts that I didn't know earlier. The doctor said that I'm drinking an excess amount of water looking at my urine specific gravity values, so I stopped that practice as well.\u0026rdquo;\u003c/em\u003e (sprinter, M, 20 years).\u003c/p\u003e \u003cp\u003eIn contrast, a few participants (3/14) reported that they would have appreciated extended consultation times and more detailed explanations of the dietary advice.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I feel it would be better if the doctor could explain more about how to take food throughout a given day.\u0026rdquo;\u003c/em\u003e (sprinter, M, 26 years).\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I feel like it would be great if I could get more time for my consultation.\u0026rdquo;\u003c/em\u003e (sprinter, F, 28 years).\u003c/p\u003e \u003cp\u003eHowever, this feedback was incorporated into the subsequent interviews, and consequently, they were satisfied with the duration of the following consultation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Opinion on the changes observed in sports nutrition knowledge and performance\u003c/h2\u003e \u003cp\u003eAll athletes (14/14) reported feeling better and experiencing less fatigue after the sports nutrition knowledge intervention.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My timing has improved, I feel less tired, and I have more energy.\"\u003c/em\u003e (middle-distance runner, M, 25 years).\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Yes, I have more energy now. I can perform better compared to before.\u003c/em\u003e\" (jumper, F, 23 years).\u003c/p\u003e \u003cp\u003eAnother middle-distance runner noted that his recovery had significantly improved following the implementation of the sports nutrition strategies.\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eI felt a great advantage from the diet recommended by the doctor. I feel like my recovery has improved after a heavy workout.\"\u003c/em\u003e (middle-distance runner, M, 22 years).\u003c/p\u003e \u003cp\u003eA marathoner commented that the hydration and dietary advice he followed after the sports nutrition intervention enhanced his performance.\u003c/p\u003e \u003cp\u003e\"\u003cem\u003eEarlier, I didn\u0026rsquo;t drink enough water and didn\u0026rsquo;t eat properly. With this dietary advice, I see a significant improvement in energy levels.\"\u003c/em\u003e (marathoner, M, 23 years).\u003c/p\u003e \u003cp\u003eAdditionally, some athletes reported experiencing fewer injuries and illnesses after following the prescribed dietary advice and supplementation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Earlier, I used to get sick frequently, but now that's not the case. I can do my training so well now. I feel very fit and experience less fatigue.\"\u003c/em\u003e (jumper, M, 21 years).\u003c/p\u003e \u003cp\u003eAnother middle-distance runner mentioned that,\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Earlier, I had Achilles tendon pain frequently, but now it is very rare.\"\u003c/em\u003e (middle-distance runner, M, 22 years).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Opinion on the prescribed ergogenic supplements\u003c/h2\u003e \u003cp\u003eBased on the specific ergogenic supplements prescribed for each athlete, depending on their main sports event, the athletes reported mixed opinions regarding the beneficial effects and adverse side effects they experienced. Regarding the use of caffeine, nearly all athletes (13/14) reported improvements in their sports performance, particularly in terms of timing and increased energy levels.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I have improved my throwing distance by 4 meters because of the caffeine. I also feel more energetic.\"\u003c/em\u003e (hammer thrower, F, 21 years).\u003c/p\u003e \u003cp\u003eOne sprinter achieved his personal best during an athletic tournament following caffeine supplementation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My timing has improved because of caffeine. Earlier, my personal best was 1:53.00 for 800 m, but I achieved 1:51.20 at the Junior National meet, and I placed first\u003c/em\u003e.\" (middle-distance runner, M, 22 years).\u003c/p\u003e \u003cp\u003eAnother athlete also recorded her best timing after using caffeine before the competition.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I got my best timing for the 400 m with 59.7 seconds; initially, it was over 60 seconds. In the 800m, I ran 2:27 seconds compared to my previous time of 2:44 seconds. I won first place in both events at the zonal meet.\"\u003c/em\u003e (sprinter, F, 19 years).\u003c/p\u003e \u003cp\u003eHowever, some athletes reported adverse effects, such as eye irritation, following caffeine use.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I found no difference in my performance with caffeine, but instead, my eyes were irritated afterwards.\"\u003c/em\u003e (sprinter, M, 20 years).\u003c/p\u003e \u003cp\u003eAnother sprinter reported difficulty sleeping in the evening and late at night after consuming caffeine in the morning.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I couldn\u0026rsquo;t sleep on the days I took caffeine. Previously, I used to sleep around 8\u0026ndash;9 PM, but now I'm awake until 12\u0026thinsp;\u0026minus;\u0026thinsp;1 AM\u0026rdquo;\u003c/em\u003e (Sprinter, F, 21 years).\u003c/p\u003e \u003cp\u003eRegarding bicarbonate use, most athletes (3 out of 4) who were advised to take it reported positive effects on their sporting performance.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think bicarbonate was very beneficial for me. After using it, I felt no tightness in my legs during running, and my timing improved\u003c/em\u003e\u0026rdquo; (Middle-distance runner, M, 22 years).\u003c/p\u003e \u003cp\u003eHowever, two athletes experienced side effects such as loose stools, bloating, and nausea following bicarbonate supplementation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I felt nauseous when I took bicarbonate on the first day of training. My coach advised me to take a break and try it again after a couple of days\u0026rdquo;\u003c/em\u003e (Sprinter, M, 26 years).\u003c/p\u003e \u003cp\u003eAthletes prescribed creatine (3/3) demonstrated notable improvements in explosive power compared to earlier performances. The hammer thrower reported significant performance gains following creatine supplementation, with the athlete now achieving a throw of 42 meters, up from her previous seasonal best of 40 meters.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I\u0026rsquo;m now recording greater distances than before; previously, my best throw was 38 meters in my last meet, but now I have reached 42 meters during training\"\u003c/em\u003e (Hammer Thrower, F, 21 years).\u003c/p\u003e \u003cp\u003eSimilarly, a sprint hurdler noted improvements in energy levels and performance during morning workouts.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Earlier, I felt less energetic for morning workouts. It was really hard for me to perform plyometrics and explosive exercises\u003c/em\u003e\" (Sprinter, M, 25 years).\u003c/p\u003e \u003cp\u003eRegarding BA supplementation, most athletes (5/6) noted a positive impact. One sprinter reported feeling much fitter and more energetic during training, along with improved timing.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I think the BA has started to work because my timing is perfect now\"\u003c/em\u003e (Sprinter, M, 20 years)\u003cem\u003e\"\u003c/em\u003e (Middle-distance runner, M, 22 years).\u003c/p\u003e \u003cp\u003eAdditionally, beetroot juice was recommended for some athletes (3/3). Those already using it were advised to enhance the preparation by adding spinach leaves and celery.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I used to drink beetroot juice, and sir asked me to mix in spinach leaves and celery. It's easy for me since they're readily available near my residence\"\u003c/em\u003e (Long-distance runner, M, 23 years).\u003c/p\u003e \u003cp\u003eAthletes who experienced side effects from ergogenic supplementation were prescribed medications to relieve their symptoms by the principal investigator and were closely monitored for improvements.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to assess the effectiveness of an evidence-based, culturally specific personalized sports nutrition intervention quantitatively and qualitatively in improving the performance and well-being of professional track and field athletes in Sri Lanka. To the best of our knowledge, this is the first study to present real-life performance improvements, particularly in competition situations, following a personalized sports nutrition intervention. Our findings highlight the effectiveness of personalized nutrition advice in improving performance both during and outside of competition, as one participant set a national record, six achieved PBs, four recorded SBs, and all the athletes reported improved well-being and reduced fatigue. The distinctiveness of this study lies in the fact that our sample consisted of elite and highly trained athletes who had not previously received proper nutritional guidance. Consequently, the mean age of this group is relatively low, as most mature and experienced athletes are typically on professional nutrition plans and/or dietary supplements. Such a participant group is uncommon in developed countries, where the majority of professional athletes receive structured nutritional care. However, our study can be replicated in resource-limited settings, such as in Asian and African countries.\u003c/p\u003e \u003cp\u003eThe current study demonstrated significant performance improvements in most participants, which can be attributed to the personalized dietary advice provided. This included consuming sufficient calories, macronutrients, and micronutrients, as well as practicing evidence-based use of ergogenic supplements. Low energy availability is very common among athletes and is correlated with decreased testosterone levels, reduced bone density, and a lower resting metabolic rate, which negatively impact performance and general well-being (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Many Sri Lankan athletes come from low socioeconomic backgrounds and exhibit poor dietary practices (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Optimizing calorie intake in this population may enhance both performance and overall well-being. Additionally, adequate protein intake, along with appropriate dietary planning, has been shown to improve performance (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Sri Lankan diets are predominantly high in saturated fat, primarily derived from coconut (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Saturated fats are known to affect negatively affect musculoskeletal tissues (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). All athletes were instructed to replace high-saturated coconut oil with high-unsaturated oil sources such as either EVOO or gingelly oil. Several studies suggest that EVOO, rich in phenolic compounds, exhibits beneficial biological effects due to its antimicrobial, antioxidant, and anti-inflammatory properties (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Furthermore, supplementation with EVOO has been found to improve cardiorespiratory coordination during moderate-intensity exercise compared to palm oil (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Participants were also advised to limit or avoid consuming deep-fried and oily street foods, as the literature indicates that trans fats increase inflammation (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMicronutrients are not only essential for sporting performance and overall health but also play a crucial role in the energy production process. For example, many B-complex vitamins are involved in the metabolism of carbohydrates and fats, which is particularly important during exercise of varying intensities (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Many micronutrients play a crucial role in the synthesis of proteins involved in oxygen transport, maintaining healthy bone tissue, supporting immune function, and regulating water and electrolyte balance in the body (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Vitamin D deficiency is common in athletic populations. A double-blind, placebo-controlled randomized controlled trial examining the efficacy of 3-week vitamin D supplementation found a marked decrease in post-exercise biomarkers among endurance runners (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In the present study, vitamin and mineral supplements were prescribed to athletes diagnosed with biochemically confirmed micronutrient deficiencies. Similarly, iron deficiency is highly prevalent among athletes and is independently associated with reduced athletic performance (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Iron deficiencies, indicated by low serum ferritin levels and/or anaemia based on haemoglobin levels, were treated with oral iron supplements. Long-term multivitamin and mineral supplementation have shown no significant advantages in improving athletic performance in well-nourished populations (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Consequently, empirical multivitamin supplementation is generally not recommended. However, the majority of these studies have been conducted in developed countries among well-nourished, active individuals. In contrast, Sri Lankan athletes often exhibit poor dietary practices due to economic and social challenges (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). In such low-resource settings with suboptimal diets, multivitamin supplementation may offer potential benefits by addressing micronutrient deficiencies and supporting athletes in achieving their maximum performance capacity.\u003c/p\u003e \u003cp\u003eThe positive impact of ergogenic supplementations on sporting performance has been widely discussed in the literature depending on the sports event. Caffeine, a well-known ergogenic aid, is widely used by athletes for its stimulant effects, including improved endurance, strength, and alertness (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Our study also showed enhanced performance with caffeine intake both during training and competition. Creatine monohydrate is another widely recognized supplement that has been shown to enhance strength, power, and high-intensity exercise performance (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Research suggests that creatine supplementation increases the availability of phosphocreatine in muscles, enabling athletes to sustain high-intensity efforts for longer periods, which is crucial for sprinters, jumpers, and throwers. The recommended dosage of 3\u0026ndash;5 grams of creatine monohydrate in this study follows the standard practice established in the literature (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), with numerous studies demonstrating its efficacy in improving power output and athletic performance, particularly in explosive activities. BA, another key supplement recommended in the current study for middle-distance runners (400m and 800m), has been shown to enhance performance by buffering lactic acid accumulation, thereby delaying fatigue. An umbrella review found that BA supplementation, with daily doses ranging from 1.2 to 7.0 g and intervention periods of 4 days to 13 weeks, generally improved exercise performance (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The greatest benefits were observed in exercise durations between 30 seconds and 10 minutes (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Sodium bicarbonate, prescribed for selected athletes, is also known for its ability to enhance performance by neutralizing the acid build-up during high-intensity, short-duration efforts (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This supplement has been shown to improve performance in sports requiring repeated bouts of intense activity, such as sprints, cycling, and swimming (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This is consistent with the findings of McNaughton et al., who suggest its positive effects on anaerobic capacity (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Finally, beetroot juice, recommended for long-distance runners in the current study, has gained attention for its potential to enhance endurance performance due to its high nitrate content (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious research has demonstrated that certain physical performance indicators significantly improve among athletes following sports nutrition interventions, though not all parameters exhibit the same extent of improvement. For example, a trial conducted on elite athletes to evaluate the effects of nutritional guidance reported improvements in all one-repetition maximum tests in both groups (6\u0026ndash;12%), but no significant changes in the 40 m sprint or countermovement jump (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Compared to our findings, this study reported modest results, likely because their participants were better nourished than those in our sample, who had not previously received professional sports nutrition support and were also from a developing country.\u003c/p\u003e \u003cp\u003eSimilarly, another study reported improvements in jump and squat performance as well as 5-10-5 shuttle times among basketball players following a 90-minute sports nutrition education intervention, observed from pre- to post-intervention (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). However, no significant differences were noted between the IG and CG. To reinforce the intervention, additional 45-minute sessions were conducted every three weeks in small groups of five players at the university dining hall (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Although this study also employed a mixed-methods approach similar to our research, the observed improvements were not as significant as those in our study. The dual approach used in our intervention, which combined individualized support with online guidance, likely played a critical role in the enhanced performance outcomes. Continuous individual support, regular monitoring through online platforms, and tailored advice on both general and sports nutrition allowed athletes to actively engage with the intervention. Furthermore, enabling them to record all guidance provided by the principal investigator through their smartphones may have significantly contributed to the superior performance improvements observed in our study compared to others.\u003c/p\u003e \u003cp\u003eA key strength of the present study is its combination of culturally tailored, evidence-based, individualized dietary and supplement guidance, which aligns well with the needs of athletes and enhances their engagement. Additionally, the real-life assessment of this intervention allowed us to evaluate its impact on both competition performance and the general well-being of track and field athletes in Sri Lanka. Additionally, the use of both quantitative metrics (e.g., performance improvements, strength gains) and qualitative feedback provides a comprehensive view of the intervention's impact. The study also acknowledges challenges, such as time constraints for food preparation and taste aversion, which are common in dietary interventions, highlighting the study\u0026rsquo;s realism and applicability.\u003c/p\u003e \u003cp\u003eA primary limitation of this study is the relatively short duration, which may limit the observation of long-term effects on athletes' performance and health. Additionally, the reliance on self-reported dietary compliance introduces potential biases, as athletes may overestimate adherence to the intervention. The sample size, while sufficient for initial insights, could limit the generalizability of findings across diverse athlete populations. Lastly, it is beyond the scope of this study to examine the factors such as individual variations in metabolism and external stressors, which may influence outcomes and highlight areas for further research to refine personalized nutrition approaches for athletes.\u003c/p\u003e \u003cp\u003eFuture studies should consider extending the duration of interventions and with a higher number of athletes from different sports disciplines to assess the long-term sustainability and impact of personalized nutrition on athletes' performance. Incorporating more objective measures of dietary adherence, such as biomarkers or wearable technology, could provide a more accurate assessment of compliance. Additionally, future research could explore the influence of external factors, such as training load and psychological stress, on the effectiveness of nutrition interventions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe current study demonstrates that personalized, culturally specific evidence-based nutrition interventions can significantly enhance athletes' knowledge, performance, and well-being while addressing practical considerations.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e1RM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOne Repetition Maximum\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEVOO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtra Virgin Olive Oil\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eg/kg\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGrams per Kilogram\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntervention Group\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIOC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Olympic Committee\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Units\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eORS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOral:Rehydration Solution\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePersonal Best\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandomized Controlled Trial\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSeasonal Best\u003c/div\u003e \u003cdiv class=\"Description\"\u003e\u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSports Nutrition Knowledge\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNKQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSports Nutrition Knowledge Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUrine Specific Gravity.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our gratitude to all the participants who took part in this study and to the other researchers who contributed to the improvement of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance for this study was granted by the Ethics Review Committee, Faculty of Medicine, University of Peradeniya, Sri Lanka (Ref No. 2024/EC/21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRJ conceived and designed the study. RJ and KW contributed to drafting the manuscript. IN, NSK, TM, and APH, as supervisory team members participated in the revision of the paper. All authors provided valuable feedback on the manuscript. Additionally, all authors carefully reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGuest NS, Horne J, Vanderhout SM, El-Sohemy A. Sport Nutrigenomics: Personalized Nutrition for Athletic Performance. Front Nutr. 2019;6:8.\u003c/li\u003e\n\u003cli\u003eThomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Acad Nutr Diet. 2016;116(3):501-28.\u003c/li\u003e\n\u003cli\u003eMoore DR. Nutrition to Support Recovery from Endurance Exercise: Optimal Carbohydrate and Protein Replacement. 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The Effects of a Sports Nutrition Education Intervention on Nutritional Status, Sport Nutrition Knowledge, Body Composition, and Performance during Off Season Training in NCAA Division I Baseball Players. J Sports Sci Med. 2017;16(1):60-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sports nutrition, personalized nutrition, sports performance, track and field, mixed methods","lastPublishedDoi":"10.21203/rs.3.rs-6571056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6571056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePersonalized nutrition interventions tailored to athletes' needs are essential for enhanced performance and well-being. However, limited research has explored the effectiveness of nutrition interventions in improving competition performance. This study used quantitative and qualitative methods to assess the impact of an evidence-based, culturally accepted, personalized sports nutrition intervention on the competition performance and general well-being of track and field athletes in Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFourteen national-level athletes who completed a 16-week nutrition intervention participated in the study. Both performance data and qualitative insights were gathered through in-depth interviews focusing on the athletes' experiences with the intervention. A directed content analysis was conducted on the qualitative data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study population (mean age: 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 years, 57.1% male) included 14 athletes specializing in sprinting, middle-distance running, long-distance running, jumping, and throwing. As a result of the intervention, participants reported reduced fatigue, enhanced performance, and improved well-being. Moreover, one athlete set a national record, six achieved personal bests, and four recorded seasonal bests during competition. They adhered to dietary recommendations and prescribed vitamins and supplements, acknowledging the importance of proper dietary habits including nutritional supplements in boosting performance. Almost all athletes reported performance gains with respective ergogenic supplements, including caffeine (13/14), bicarbonate (3/4), creatine (3/3), beta-alanine (5/6), and beetroot juice (3/3). Five athletes reported fewer injuries and illnesses following the intervention, and two athletes reported that hydration advice enhanced their performance. Despite the positive outcomes, adverse effects were reported from the prescribed vitamins and supplements, including constipation, sleeplessness, and abdominal discomfort. Almost all respondents expressed satisfaction with the consultation setting, sports nutrition intervention, tests and investigations conducted, and the research team's efforts, indicating a positive reception to the overall intervention process.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study highlights the importance of personalized, culturally specific sports nutrition interventions in improving athletic performance and general well-being.\u003c/p\u003e","manuscriptTitle":"Improvements in competition performance of track and field athletes following a personalized nutrition intervention: A mixed methods approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-15 09:39:43","doi":"10.21203/rs.3.rs-6571056/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40f27518-f98f-4ac3-a58e-60cb7343a882","owner":[],"postedDate":"May 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T11:23:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-15 09:39:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6571056","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6571056","identity":"rs-6571056","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}