Nutritional Adherence Research Articles

Adherence of Patients After Cholecystectomy for Diet

Background: Cholecystectomy often requires dietary and lifestyle adjustments, making adherence to educational programs crucial for optimal recovery. This study evaluated patients' compliance with a post-cholecystectomy educational program and examined how socio-demographic factors influenced adherence. This study aimed to evaluate patients' adherence to an educational program following cholecystectomy and to investigate the relationship between adherence and socio-demographic characteristics.Methods: A quasi-experimental design was employed at AL Imam Sadiq Teaching Hospital. Non-probability sampling was used to recruit 30 patients for the study group and 30 for the control group. A 9-item instrument was developed, and a panel of 11 experts established its validity. Descriptive and inferential statistical analyses were performed on the collected data.Results: The study found that socio-demographic factors play a significant role in patients' adherence to the educational program. The pretest adherence was (3.19) for the case group and (2.92) for the control group. Posttest adherence significantly improved to (5.78) for the case group and (3.13) for the control group. Notably, patients' employment status, educational level, and monthly income were found to significantly influence the effectiveness of the instructional program on nutritional adherence.Conclusion: The instructional program had a positive impact on patients who underwent cholecystectomy, effectively improving their nutritional adherence in both the case and control groups. This success underscores the potential of such programs in post-cholecystectomy patient care. The study recommends increasing patients' knowledge regarding nutritional adherence and explaining dietary recommendations through social media. Additionally, it suggests implementing the present program for all patients undergoing cholecystectomy.

Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement.

Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF. 37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence. 43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant. When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.

Specifically formulated ketogenic, low carbohydrate, and carnivore diets can prevent migraine: a perspective.

This article presents a hypothesis explaining the cause of migraines, suggesting that electrolyte imbalance, specifically a lack of sufficient sodium in the extracellular space of sensory neurons, leads to failed action potentials. The author argues that migraines are triggered when sodium channels fail to initiate action potentials, preventing communication between neurons. The article discusses the evolutionary perspective of the migraine brain, stating that migraineurs have a hypersensitive brain with more sensory neuronal connections, making them more reactive to environmental stimuli and in need of more minerals for the increased sensory neuronal communication. Since glucose is often used to reduce serum hypernatremia, it follows that a high carbohydrate diet reduces sodium availability for use in the brain, causing an electrolyte imbalance. Low carbohydrate diets, such as ketogenic, low carb-high fat (LCHF), and carnivore (all animal products), can be beneficial for migraineurs by reducing/eliminating carbohydrate intake, thereby increasing sodium availability. In support, many research papers and some anecdotal evidences are referred to. The article concludes by proposing lifestyle modifications, such as dietary changes and sodium intake management. These will provide migraineurs with a long-term healthy metabolic foundation helping them to maintain strong nutritional adherence and with that aiding continued proper neuronal functioning and migraine free life.

Narrowing inequity gap: ERAS home delivery kit

ObjectiveTo enhance adherence to Enhanced Recovery After Surgery (ERAS) protocols and address pre-operative preparation equity gaps, a system was developed to automatically mail chlorhexidine (CHG) and nutritional carbohydrate supplements (ERAS Kits) to surgical patients. BackgroundThis retrospective observational study focused on adult patients undergoing abdominal surgeries at a large academic hospital, using a pre-post design. MethodsThe study compared adherence to pre-operative ERAS pathways, involving nutritional supplements and chlorhexidine soap usage, before (September 2021-March 2022) and after (September 2022-March 2023) implementing automatic ERAS Kits mailing. A Chi square test analyzed adherence rates. ResultsPost-implementation, adherence to preoperative nutrition rose from 49.6 % to 57.7 % (P = 0.006), and surgical site preparation from 73.8 % to 78.7 % (P = 0.06). Notable improvements were seen among Black patients, Medicaid recipients, and those from lower-income neighborhoods in nutrition adherence, and among younger patients and Medicaid recipients in site preparation. ConclusionMailing ERAS Kits directly to patients significantly enhanced compliance with preoperative protocols, demonstrating an effective strategy to improve care accessibility and reduce disparities for vulnerable groups.

Dialysis and Nutrition: Optimizing Dietary Support for Patients Undergoing Blood Purification

This study evaluated the effectiveness of individualized dietary interventions in improving the nutritional status and general health of individuals undergoing dialysis. A total of 120 patients undergoing dialysis were equally allocated to the Standard Care Group and Intervention Group. The recipients of individualized dietary counseling had their plans modified monthly in accordance with their nutritional needs, personal preferences, and clinical circumstances. Nutritional adherence, biochemical parameters, clinical outcomes, and quality of life were evaluated and compared between groups. At baseline, both groups exhibited comparable demographic characteristics. Compared to baseline values, the Intervention Group showed substantial enhancements in albumin, hemoglobin, potassium, and phosphorus levels after six months (P < 0.05). The Intervention Group had a considerably higher rate of adherence to dietary recommendations than the Standard Care Group (92% vs. 75%, P < 0.01). Nutritional intake analyses revealed a noteworthy enhancement in energy and protein consumption, while sodium, potassium, and phosphorus intake decreased (P < 0.05). The results of the quality-of-life evaluation demonstrated notable improvements in physical, emotional, social, and overall health perception scores (P < 0.05). Thus, personalized dietary interventions substantially improve the nutritional status, biochemical profile, and overall quality of life of patients undergoing dialysis.

LESSONS LEARNED DEVELOPING A NUTRITIONAL ADHERENCE INTERVENTION FOR DEMENTIA PREVENTION: A QUALITATIVE ANALYSIS

Abstract Lifestyle interventions show considerable promise in delaying the onset and reducing risk for Alzheimer’s disease and related dementias (ADRD). Unfortunately, scalable interventions that address issues of long-term adherence have not been adequately developed or disseminated. Especially important for this effort is iterative evaluation and adaptation of interventions using participant feedback throughout the development process. Using the NIH ORBIT model for behavioral intervention development, our team has established the proof-of-concept (N=9) and pilot tested (N=58) a Mediterranean ketogenic nutrition (MKN) adherence program for older adults at risk for ADRD. This program incorporates motivational interviewing strategies and cognitive behavioral skills training to enhance uptake and long-term adherence to MKN. For each of these pilots, participants completed exit interviews at the conclusion of the 6-week, group intervention and 3-months post-intervention. Qualitative and quantitative data on the acceptability of the program, as well as detailed participant feedback about their experience and recommendations for improvements were collected. While quantitative data demonstrate high acceptability, thematic analysis of qualitative interviews demonstrate a range of recommendations for enhancing and refining important components of the intervention that will be necessary for future scaling and dissemination. We discuss important themes, future directions of this work, and implications for lifestyle intervention development more broadly.

Factors Influencing the Control of Diabetes Measured via Glycated Hemoglobin Concentrations in Adults with Type 1 Diabetes.

Numerous complications of type 1 diabetes (T1D) may be prevented through suitable glycemic control. Glycated hemoglobin (HbA1c) may be one of the markers for the early detection of the metabolic imbalance characteristic of the disease. However, optimal control of diabetes is not achieved in a large group of patients. It was demonstrated that numerous factors (sociodemographic, psychological, and clinical) contributed to this condition. The aim of the study was to identify factors influencing the control of diabetes measured via glycated hemoglobin concentrations in people with T1D. Independent factors influencing better diabetes control measured via HbA1c in the study group included higher disease acceptance, higher nutritional adherence, lower BMI, and a lower risk of eating disorders. Describing the determinants will allow for the improvement of the system of care provided to people with T1D and for it to comprise important psychological variables related to self-care and acceptance of the disease.

Brief intervention as strategy treatment that improves nutritional adherence in obesity: a pilot study

Brief intervention as strategy treatment that improves nutritional adherence in obesity: a pilot study

Prognostic Value of Regular Nutritional Treatment in Patients With Amyotrophic Lateral Sclerosis.

Malnutrition adversely affects the prognosis of amyotrophic lateral sclerosis (ALS). The aim of this study was to evaluate the effect of regular nutrition treatment and follow-up in clinical nutrition outpatient clinic (CNOC) on survival in ALS patients. The study included 55 ALS patients who were admitted and followed up in CNOC. Malnutrition was diagnosed using ESPEN criteria and nutrition treatment was planned according to needs of each patient. Nutritional status was followed up by body mass index (BMI), bioelectrical impedence analysis, and serum albumin. During the follow-up, survivors and nonsurvivors were compared according to their nutrition treatment success and changes in the anthropometric and laboratory measurements. Body weight, BMI, and fat free mass were decreased during the follow-up in both survivors and nonsurvivors (P<0.01). The decrease in the serum albumin and BMI were significantly higher in nonsurvivors (P<0.01). Mortality rate was lower in those with higher adherence to nutrition treatment (P<0.01) and patients with lower adherence to nutrition treatment showed more significant decrease in serum albumin levels (P<0.01). A personalized nutrition treatment combined with increased nutritional adherence in CNOC can decrease mortality in ALS patients.

Evaluation of the Effect of Self-Management Education in Teach Back Method on Medication and Nutritional Adherence of Elderly Patients with Type 2 Diabetes

Introduction: Medication and nutritional adherence include accurate consumption of medication and following the diet according to the recommendations provided by healthcare personnel, which leads to maintaining and promoting the health of the elderly. The present study aimed to evaluate the effect of teach-back self-management training on medication and nutritional adherence of the elderly with type 2 diabetes in the selected comprehensive health service centers in Mashhad, Iran. Method: This experimental study was conducted on 104 type 2 diabetic patients who were randomly divided into intervention and control groups. In the intervention group, self-management training was provided by return training method, and in the control group, routine training was provided. To collect data, the Moriski medication adherence questionnaire and the Midas dietry compliance questionnaire were completed before and after the intervention. Data analysis was performed using SPSS statistical software (version 20), and Chi-square, Fisher, independent t-test, and paired t-test. Results: Based on the findings of the present research, the mean scores of the medication and nutritional adherence in the two groups before the intervention were not significantly different (P&lt;0.05). However, after the intervention, medication and nutritional adherence of the intervention group was significantly increased compared to the control group (P&lt;0.05). Conclusion: The use of teach-back self-management training is suggested as an effective method in increasing medication and nutritional adherence of the elderly with type 2 diabetes

New Validated Short Questionnaire for the Evaluation of the Adherence of Mediterranean Diet and Nutritional Sustainability in All Adult Population Groups.

High adherence to a Mediterranean diet (MD) is favourable for its sustainability and beneficial effects on health. The available questionnaires, according to the MD dietary pattern, include the assessment of moderate alcohol consumption; but some groups, such as young adults and pre-conceptional and pregnant women, are not allowed to consume it. The aim of this study was to validate a new short questionnaire (MedQ-Sus) excluding alcohol consumption, to measure the adherence to the MD and to evaluate the nutritional adherence to a sustainable diet. The Harvard validated questionnaire was used for the validation study. A total of 316 subjects (20 to 70 YOA) completed both questionnaires. A high Spearman correlation coefficient (rho = 0.69; p < 0.01) was found between the MedQ-Sus and Harvard scores; a statistically significant positive correlation was found for all eight food groups. The MedQ-Sus had a significant discriminative capacity between adherence and non-adherence to the MD (optimal cut-off point = 9.5, sensitivity 0.86, specificity = 0.65). A very high nutritional adherence to a sustainable diet was found in the subjects for olive oil (97%), dairy food (90%), fresh vegetables (89%), fish and fish products (73), fresh fruit (56%), and cereals and cereals products (42%). A very low adherence was found for legumes (22%) and meat and meat products (9%). The results showed MedQ-Sus is a valid and quick assessment instrument for the evaluation of the adherence to the MD in all population groups, and could also be useful to evaluate the nutritional sustainability of the diet.

Perspectives of the barriers and enablers to nutritional adherence in professional male academy football players

ABSTRACT Background Nutritional intake is important for young football players; however, little is known about the factors that influence their nutritional adherence. Purpose The aim of this study was to investigate players’, sports nutritionists’,and coaches’ perspectives of the barriers and enablers to adhering to nutritional recommendations within a professional football club. Method Individual interviews, based on the Capability, Opportunity, Motivation – Behaviour (COM-B) model and Theoretical Domains Framework (TDF), were conducted with 13 players (18 ± 1.3 years), 12 sports nutritionists, and 10 coaches from 2, 12, and 10 professional football clubs, respectively. Thematic analysis was used to interpret the data. Results Seven key themes were generated relating to the players’ barriers and enablers to nutritional adherence: (1) Capability: (a) Nutritional Knowledge; (b) Cooking Skills; (2) Opportunity: (c) Training Venue Food Provision; (d) Nutritionist Accessibility and Approachability; (e) Living Status: (3) Motivation: (f) Performance Implications; and (g) Role Modelling. Conclusion Inadequate food provision within the training and home environment, and limited time with the sports nutritionist were key barriers to nutritional adherence in youth football players. Football clubs should allocate more time for sports nutritionists to deliver nutrition support and sports nutritionists should aim to control the players environment to support optimal nutritional intake.

Effect of the Nutraceutical Micodigest 2.0 on the Complication Rate of Colorectal Cancer Surgery With Curative Intent: Protocol for a Placebo-Controlled Double-blind Randomized Clinical Trial.

BackgroundMost colorectal cancer patients diagnosed are candidates for surgical resection with curative intent, although colorectal surgery is associated with some complications that could be life-threatening. Antibiotic prophylaxis is commonly used for the prevention of infectious postoperative complications. However, this intervention can change the composition of intestinal microbiota and promote adverse inflammatory outcomes in colorectal cancer patients. The combination of different fungal extracts could be beneficial because of their role in gut microbiota modulation and their anti-inflammatory activity.ObjectiveBased on this hypothesis, we have designed a double-bind, randomized clinical trial to evaluate the effect of the nutraceutical fungal extract Micodigest 2.0 on complications of surgery for colorectal cancer resection.MethodsColorectal cancer candidates for surgery will be considered for inclusion in the study. After evaluation by the multidisciplinary tumor board, patients who meet selection criteria will be screened, stratified according to tumor location, and randomly allocated to be treated with Micodigest 2.0 or placebo. Treatment will be continued until admission for surgery (4-6 weeks). Participants will undergo a medical and clinical evaluation including baseline and preadmission quality of life, microbiome composition, inflammatory and nutritional status, adverse events, and adherence assessments. The main end point of the study is the surgery complication rate. We will evaluate complications using the Clavien-Dindo classification. It will be necessary to recruit 144 patients to find a relevant clinical difference. We will also evaluate the effect of the nutraceutical on microbiome composition, inflammatory response, nutritional status, and quality of life, as well as the effect of these variables on surgical complications.ResultsThis study was funded in 2020 by the Center for Industrial Technology Development. Recruitment began in September 2021 and is expected to be completed in September 2022. Data will be analyzed and the results will be disseminated in 2023.ConclusionsThe results of this protocol study could help to reduce surgery complications in patients with colorectal cancer using the new treatment Micodigest. This study could also identify new features associated with colorectal surgery complications. In summary, this study trial could improve the management of colorectal cancer patients.Trial RegistrationClinical Trials.gov NCT04821258; https://clinicaltrials.gov/ct2/show/NCT04821258International Registered Report Identifier (IRRID)DERR1-10.2196/34292

HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast

BackgroundIn sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18–24 years from the Kenyan coast.MethodsData were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL.ResultsAmong these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH.ConclusionsIn this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.

MO560: Adherence to Nutritional Recommendations as Expressed by Patients on Hemodialysis, Their Informal Carers and Healthcare Professionals—the Goodrenal Project

Abstract BACKGROUND AND AIMS Low adherence to nutritional recommendations is common in patients on hemodialysis (HD), but the reasons are not well known. We explored the main needs, barriers and facilitators affecting nutritional adherence as experienced by patients on HD, their informal carers and their healthcare professionals (HCPs) at the dialysis centre. METHOD This study is part of the GoodRENal project—funded by the European Community, Erasmus + program that comprises four countries: Spain, Sweden, Belgium and Greece. As part of this project, exploratory questionnaires were constructed and answered by the patients, their carers and their HCPs. The questionnaire comprised three sections consisting of statements exploring the needs, barriers and facilitators affecting adherence to nutritional recommendations for patients on HD. Each statement could be rated from 1 (strongly disagree), 2 (disagree), 3 (neither agree or disagree), 4 (agree) to 5 (strongly agree). In addition, there was a section for free text. To avoid bias in patient selection, 10 patients were randomized from the first dialysis shift of the week in the four participating countries. RESULTS In total, 40 patients, 40 informal carers and 40 HCPs HealthCP accepted to participate, out of whom 38 patients (68% male, 62 ± 15 years), 33 informal carers (21% male, age 54 ± 12 years, of whom 68% were spouses) and 37 HCPs (22% male, age 42 ± 10 years, 60% were nurses) answered the questionnaires. Two of the four centres had a dedicated dietitian at the dialysis unit, who worked there on average 18 ± 8 hours per week. At the dialysis units without a dietitian, the nurses and doctors were responsible for nutritional care. To simplify the analysis, answers rated as 4 and 5 were grouped as agree. The main findings are presented below: CONCLUSION These descriptive findings show that patients, informal carers and HCPs identified different needs, barriers, and facilitators to increase adherence to nutritional recommendations. These results can be used to build and tailor strategies aimed at patients, informal carers and HCPs.

Feasibility of an MI-CBT ketogenic adherence program for older adults with mild cognitive impairment

BackgroundThe National Institutes of Health Obesity-Related Behavioral Intervention Trials model for intervention development was used to establish the feasibility and proof of concept of a motivational ketogenic nutrition adherence program for older adults with mild cognitive impairment.MethodsThis was a single-arm, single-center feasibility trial. A comprehensive assessment protocol, including a clinical interview, neuropsychological testing, and genetic sequencing was used as an initial screening. Nine participants (aged 64–75) with possible amnestic mild cognitive impairment were consented for the intervention. Participants completed pre- and post-intervention neuropsychological assessments using the updated Repeatable Battery for Assessment of Neuropsychological Status. Participants tracked their macronutrient consumption using food diaries and ketone levels using urinalysis test strips daily. Mood and other psychosocial variables were collected through surveys, and qualitative exit interviews were completed.Results100% of participants who began the trial completed the 6-week ketogenic nutrition adherence program, including completion of the pre- and post-assessments. Eight participants achieved measurable levels of ketones during the program. The average self-rated adherence across the program was 8.7 out of 10. A Wilcoxon Signed-Rank test demonstrated significant improvement in cognitive performance from baseline (median = 88) to follow up (median = 96, Z = − 2.26, p = .024). The average difference in cognitive performance from baseline to follow-up was − 7.33 (95% CI − 12.85, − 1.82).ConclusionsResults supported the feasibility for moving to the next phase and demonstrated proof of concept for the intervention. The next step is a randomized pilot trial to test clinical signals of effect compared to a control condition.Trial registrationThis trial was retrospectively registered with clinicaltrials.gov on July 13, 2021. The trial number is NCT04968041.

Abstract 12307: Differences in Outcomes Between Men and Women Enrolled in Chronic Disease Programs for Diabetes, Hypertension and Hyperlipidemia

Ischemic heart disease (IHD) affects over 48 million women in the US and is the leading cause of death. Hypertension, diabetes and dyslipidemia are risk factors for the genesis of IHD in women. Disease management programs (DM) have proven effective, overall, in facilitating lifestyle change and adherence to treatment plan but little is known about the effectiveness of these programs for men versus women. The purpose of this program evaluation was to identify differences in outcomes between men and women who participated in DM programs for hypertension, diabetes and dyslipidemia.Between 2015 and 2019, 616 unique individuals completed one of these DM programs. Measures of height, weight, exercise minutes, sedentary lifestyle, healthy nutrition, sleep, hydration and medication adherence were taken at the first and last visit. The sample was primarily female (70%), white (76%), Married (67%), educated (93% had bachelor’s or better), and were 49.3 years old, on average. Analysis revealed that males and females differ in response to the DM programs. While there was significant decrease in BMI for all participants (p&lt;.001), the decrease was significantly greater for males compared to females (-0.60 vs. -0.29, respectively, p&lt;.01). While exercise minutes did not differ between males and females from pre to post measurement, males who had zero exercise minutes at pre-test increased exercise minutes post program by a significantly greater amount than females who were not exercising at pretest (p=.02). Decreases in the number of missed medication days were significantly greater for women than men (0.50 days vs. 0.17 respectively; p=.02). Interestingly, while males did decrease significantly (p=.02), the decrease in medication days missed were far more substantial for females (p&lt;.001).Men and women differ in their response to DM programs focused on lifestyle modification. Interventions should be individualized based on sex and designed specifically for women in order to optimize outcomes.

269: Food security and nutritional adherence in adolescents with cystic fibrosis during the COVID-19 pandemic

269: Food security and nutritional adherence in adolescents with cystic fibrosis during the COVID-19 pandemic

287: Adolescent decision-making involvement, social support, and nutritional adherence in adolescents with CF

287: Adolescent decision-making involvement, social support, and nutritional adherence in adolescents with CF

Athlete perspectives on the enablers and barriers to nutritional adherence in high-performance sport

ObjectivesPoor adherence to nutritional guidance by athletes may compromise their health and performance. Enhancing adherence is therefore an important performance and welfare strategy. The aim of this study was to qualitatively explore the barriers and enablers of elite athletes' adherence to nutritional guidelines. DesignUnderpinned by our constructionist epistemological position and our relativist ontology, we conducted a qualitative study using focus groups. MethodsWe used the Capability, Opportunity, and Motivation Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to conduct focus group discussions with a purposive sample of 39 UK-based funded athletes (mean age = 23 ± 3.81), participating in either Olympic and Paralympic sport (n = 30) or professional sport (n = 9), who had access to a nutritionist. Data were analysed using reflexive thematic analysis. ResultsAthlete adherence to nutritional guidance was seasonal and included inadequate energy intakes and episodes of binge eating. Underpinning these behaviours, athletes' emotional barriers (motivation) are reinforced through their social interactions within the high-performance environment (opportunity) and athletes' training environment limits developmental opportunities for food planning (capability). However, a holistic-developmental approach by the sports nutritionists (opportunity) supports athlete wellbeing and nutritional adherence. ConclusionThese findings advance theoretical understanding of the barriers and enablers of nutritional adherence amongst elite-level athletes in high-performance sport and present a number of significant implications for athlete support personnel seeking to enhance performance in demanding sporting contexts. Drawing on the Behaviour Change Wheel (BCW), recommendations include the need to 1) train and educate sports nutritionists in human behaviour, 2) update regulations for sports nutrition profession practice to acknowledge the skills required to support athletes' emotional wellbeing, 3), educate coaches on the sensitivity of body weight and composition and develop guidelines for monitoring athletes' body weight and composition in sport, 4) persuade influential leaders to develop culture guidelines that shift the performance-narrative of high-performance (i.e., environmental restructuring).