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Nutritional Analysis Case Study

Abstract. Subject – the subject was a 21-year-old male student from the University of Teesside. The subject was 1.78m, weighed 65.3kg and had a BMI of 20.52. The subject has a moderate/vigorous lifestyle. Methodology – A case study investigation whereby the subject was required to complete a 7-day food diary, which was assessed using COMP-EAT software. Dietary modifications were put in place before reviewing the post-intervention food dairy. Results – the post-intervention results show that carbohydrate amounts improved by 121g, proteins by 20.1g and fats by 7.8g. Fluid (water) intake also increased as well as an 18% drop in alcohol energy levels. Conclusion – Although the client’s nutritional status increased, there is still a need for improvement to meet the demands of an active lifestyle.

Introduction. Nutrition is a science that examines the relationship between diet and health (Morris et al, 2004). Deficiencies, excesses and imbalances in diet can produce negative impacts on health, which may lead to disease (CV, metabolic or musculoskeletal). Physical inactivity is also an influential factor in many diseases in later life, just like poor nutrition; therefore improvements in both areas can have positive effects on lifestyle and health. There are seven main classes of nutrients that the body needs: carbohydrates, protein, fats, vitamins, minerals, fibre and water (Murphy & Poos, 2002). The food we eat is then digested and absorbed and then metabolized to release energy that the body can use. The human body needs energy in order to function properly and individual energy requirements depend on a number of factors, based mainly on energy expenditure. The four components of energy expenditure comprise Basel metabolic rate (BMR); thermic effect of food (TEF); adaptive thermogenesis (AT) and of course physical activity (Griffin, 2002).

Current nutritional recommendations. Due to the subject leading an active lifestyle, the energy requirements would therefore be greater than that of a sedentary person. Dietary Reference Intakes (DRI, 2002) demonstrated that estimated energy requirements (EER) for sedentary adults ranged between 1800 to 2.600 kcal/day compared to an EER of 2.500 to 3.720 kcal/day that is suggested for active individuals (Reilly & Thomas, 1979). However, subject-specific, based on the assumption that energy expenditures off the football field are only moderate, the daily energy requirement of male soccer players were estimated at 14.7MJ. day -1 (3500kcal/day) (Williams, 1994). With the client’s recommended energy levels coinciding with the literature (+3500kcal), the client’s percentage of energy should be derived from 60% carbohydrates, 25% from fats and 15% from protein (Mullinix et al, 2002). However, Burke et al (2003) suggest that in active individuals, carbohydrates contribute to 60 -70% of total energy intake.

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Although the client may find it difficult to meet these requirements due to high alcohol levels and poor nutritional knowledge associated with students (Webb et al, 1996). With carbohydrates being the main source of energy for the body, DRI (2002) recommend that 130g/day is sufficient for both males and females. However, griffin (2002) states that 6g of glucose per hour or 144g / day, equivalent to approximately 600kcal per day is needed in order to function the brain. Carbohydrates are classified according to their structure into ‘simple’ or ‘complex’. Simple carbohydrates are the man source of energy for the body and directly absorbed and metabolized in the liver where it is converted to glucose (Griffin, 2002). Complex carbohydrates however are broken down in digestion to maltose and then glucose.

A higher carbohydrate intake is recommended when you exercise to maximize glycogen stores (Sheppard, 1999). People who exercise regularly along with athletes increase their carbohydrate intake, this is known as Carbohydrate loading. Effective carbohydrate loading approximately doubles normal glycogen stores. Once this has been accomplished, reserves remain elevated for 3-6 days unless exhausting exercise is undertaken (Goforth et al, 1994). Therefore the daily intake of carbohydrates that is recommended to maintain muscle glycogen stores during multiple days of exercise is 500-600g or 8-10g.kg-1 (Costill, 1988) or 60 – 70% of total energy intake (Clark, 1994; Maughan, 1997). Protein is made up of amino acids linked together in long chains.

It is found primarily in the muscles and comprises about 15% of the bodyweight for a human (Williams & Devlin, 1999). Protein is needed to build up and maintain all the cells in the body. It is essential in the actual structures of the body for the formation of muscles, bones, skin and hair (Griffin, 2002) as well as being used to meet energy demands if insufficient amounts of carbohydrates and fats available. The recommended dietary allowance (RDA) for protein is 52-56 g/day for adult males or 46 g/day for adult females or 0.80g. kg-1. day-1 for adult males (DRI, 2002). According to Burke & Deakin (2006) active athletes playing power sports (such as football), those engaged in muscle-development training, and elite endurance athletes, all require approximately 2 grams of protein per day per kilogram of body weight, roughly double that of a sedentary person.

It has also been established that more protein is needed in people who exercise to replace the amino acids metabolized in gluconeogenesis and to cover the demands of muscle repair and hypertrophy (Millward et al, 1994). However conficting literature (Butterfield & Calloway, 1994; Todd et al, 1984; Gontzea, 1975) suggests protein requirements should decrease in individuals who are regularly active as protein metabolism becomes more efficient. Dietary fat is a vital nutrient that should be included in the diet. Not only is fat an important source of energy and energy storage (adipose tissue), it also provides insulation for the body and support and cushioning for the vital organs (Griffin, 2002). Fat is also needed for the carrier of fat-soluble vitamins A, D, E and K and help their absorption. The essential fatty acids that the diet must supply are the omega-6 family (linolenic acid) and the omega-3 family (alpha-linolenic acid).

They are vital for the development of cell membranes and are also involved in the regulation of immune responses and blood clotting (Griffin, 2002) The acceptable macronutrient distribution range (AMDR) for fat is 25 – 35% for 14 – 18-year-old males/females and 20 – 35% for adult males/females (DRI, 2002). Soccer players however have been recommended to consume less than 30% of their total energy needs from fat (Clark, 1994). Just like carbohydrates, body fat stores provide a major source of energy fuel; whereas fat sources (Plasma free fatty acids derived from adipose tissue and intramuscular triglycerides) are relatively plentiful, carbohydrate sources (plasma glucose derived from the liver or dietary carbohydrate intake, and muscle glycogen stores) are limited (Burke et al, 2003).

Vitamins and minerals are found naturally in food and are fundamental in the maintenance of all body functions as well as helping to preserve health and preventing disease. Vitamins do not provide energy, although some are involved in the release of energy from food (Griffin, 2002). The recommended vitamin and mineral intake according to the US DRI (2002) can be seen in appendix 3. For the body to function properly it requires water; the precise amount depends on the level of activity (intensity), temperature, humidity as well as other factors. The recommended intake of water according to DRI (2002) is 3.7 L/day for adult males and 2.3 to 2.7 for adult females. However, Hicks (2005) proposed that 2-2.5 L/day is the minimum to maintain proper hydration. Although this amount doesn’t take into account the environmental temperature or those who perform physical activity.

The sweat loss that accompanies prolonged exercise leads to a loss of electrolytes and water from the body. The importance of fluid intake for hydration offers benefits to performance in a number of sports and exercise activities. Consequently, dehydration not only demonstrates decrement in performance but can also lead to severe health risks associated with substantial fluid loss (Coyle & Hamilton, 1990). Therefore it is detrimental that fluid intake is high for those who regularly participate in physical activity as a loss of 10 -20% total body water could result in serious disability or even death (Adolph et al, 1947).

Potential constraints to the subject meeting the requirements. Due to the subject being a university student, there are many possible constraints to the subject meeting the recommended requirements. Ruiz et al, (2005) established that when people go to university (mainly athletes) or start work, the quality of their diet deteriorates. This could be due not only to a lack of time to eat healthily but finding the unhealthy options readily available and easy to consume. Financial issues play a big part within a student’s life and can be a key constraint to the subject not meeting the requirements. Other potential constraints for students include peers, lack of knowledge on the appropriate foods and the inability to cook healthy meals (Haberman & Luffey, 1998).

Religion and food allergies can also provide limitations although this doesn’t apply to the subject. The student lifestyle generally includes a higher intake of alcohol due to social events and pressure from peers (Webb et al, 1996). The aim of this investigation was to assess the subject’s nutritional intake and provide them with the appropriate information to help improve their diet. The subject’s lifestyle and interests were important elements when interpreting the data and providing the correct interventions and dietary strategies to meet the client’s specific needs.

Method. Subjects. The subject for the case study investigation was a 21-year-old male student from the University of Teesside. The subject’s height was measured using a SECA, UK stadiometer (1.78m) and weighed using the SECA, UK scales (65kg), consequently, the subject had a BMI of 20.52 (kg . m-2). The subject was a member of the university men’s football team, which require participation in multiple training sessions and competitive games. The subject was considered to have a moderately / very active lifestyle (Appendix 8) due to participating in daily gym sessions as well as university and semi-professional football. The University of Teesside ethics board approved the investigation prior to the data collection and dietary analysis.

Procedure. Written informed consent and a medical questionnaire were obtained after the purpose, nature and requirements of the project were explained to the subject. All information gathered during the investigation was kept confidential and filed away only to be accessible to the researcher. Anthropometric data in terms of mass (kg) and height (m) of the participant was recorded and the associated body mass index (BMI) (kg . m-2) was calculated. Skinfold measurements were deemed insignificant for the study, as the subject’s set goal was to improve soccer performance and not weight loss/gain.

Analysis. The subject completed a seven-day food diary, recording the amount and type of food/drink ingested. The completed food diary was then analyzed using the COMP-EAT software (Appendix 4 COMP-EAT Guidelines), this helped identify the client’s nutrient excesses and deficiencies. From the first COMP-EAT analysis (Appendix 5), the subject’s total energy expenditure and so requirement (Appendix 8) were calculated, along with the client-specific macronutrient requirements (carbohydrates, protein and fats). The software used calculates the absolute measure of the quantity of each nutrient (in grams etc) and the corresponding percentages. The reference dietary intakes adopted in the study are the recommended values for the general population by age and sex, without taking into account physical activity.

From this data, the researcher was able to assess the client’s nutrient intake (deficiencies and excesses) and provide dietary strategies specific to the client’s current lifestyle. The subject was given dietary interventions to help improve their nutrition and set specific goals to help rectify current problems and also meet the demands of their current lifestyle. The process was then repeated following the implementation of the chosen nutritional strategy aimed at helping the case study to rectify the problems identified during the first analysis. The strategy was then evaluated based on the data provided from the second seven-day food dairy analyzed using the COMP-EAT software (Appendix 6).

This second COMP-EAT analysis was compared to the pre-intervention results to see if improvements had been made by the dietary modifications. The subject and researcher both discussed the nutritional strategies and agreed that the goal was to help improve performance in soccer. Increasing the client’s macronutrient consumption as well as fluid intake along with a decrease in alcohol levels was agreed. The client however specified that no supplements would be implemented into the diet in order to help performance due to a personal choice.

Results. The COMP-EAT data showed the clients contributing foods, nutrient content and a summary of intake. From this data, the client’s nutrient content could be targeted and compared to the recommended nutrient intake (NRI), the client-specific requirements (see appendix 7) and finally the results from the second COMP-EAT assessment after dietary strategies were put in place. Figure 1. The total energy requirements/expenditure of the client. The graph shows the total energy requirements/expenditure amounts that the client ingested pre and post-intervention compared to the RNI and the client-specific energy requirements. The graph shows an increase in kcal from 1969 kcal in pre-intervention to 2277.45 kcal post-intervention. These results show the subject fails to meet the RNI (2860 kcal) and the client-specific requirements (3681 kcal/ day) for energy requirements.

Figure 2. The subject’s carbohydrate, protein and total fat intake compared to the RNI and client-specific requirements. The client consumed 158.4g of carbohydrates at pre-intervention and increased to 280g after the nutritional strategies were put in place. However, the subject still failed to meet the RNI amount of 285g and the client-specific amount of 589g that takes into account the subject’s physical activity and sport completed. At pre-intervention, the client consumed 49.61g of protein, 89% of the recommended nutrient intake at 55g. However, after the interventions had been set the subject’s protein intake increased to 89.71g, consuming more than the RNI but still not meeting the client-specific requirements of 138g. At pre-intervention, the subject’s total fat intake was 77.69g, close to the recommended intake (RNI) of 72.2g. The subject showed an increase in total fat intake to 80g in post-intervention, however, the client-specific requirements suggest that the client should have a total fat intake of 102.27g.

Figure 3. The total percentage of energy derived from carbohydrates, protein, fats and alcohol. The recommended energy intake should be provided from 60% carbohydrates, 15% protein and 25% fats. The subject’s energy prior to the interventions came from only 30.17% carbohydrates, 10.08 protein, 35.51 fats and 24.49 from alcohol. The subject showed an improvement subsequent to receiving the interventions with 46.18% of energy coming from carbohydrates, 15.76% from protein, 32% from fats and only 6.27 from alcohol.

Figure 4. The subject’s element intake compared to the recommended requirements. Figure 4 shows the elements that the subject was showing a deficiency in the recommended intake for selenium is 75mg, however, the subject only consumed 7.86mg. Although after the nutritional strategies were set the subject showed a significant improvement by increasing the selenium amount to 43.49mg, yet still falling short of the recommended daily intake. The subject showed similar trends in iron, copper and zinc intake, presenting a low amount during the initial testing (7.87mg, 0.64mg & 4.9mg respectively) that didn’t meet the recommended requirements. In fact, all three elements increased to go above the recommended requirements, with iron reaching amounts of 14.23mg, copper 1.52mg and zinc amounts of 10.5mg.

Discussion. It is clear from the data gathered in Figure 1 that the client was unable to consume the required amount of kcal’s to meet the demands of energy expenditure on a daily basis. As the case study has an active lifestyle, it was calculated that 3681 kcal was sufficient to meet the demands of the subject’s active lifestyle. However, the client was unable to meet the client-specific target of 3681 kcal and only managed 2277 kcal after the interventions were implanted, showing much room for improvement.

Figure 2 shows that the subject recorded low levels of carbohydrates on the first test and was unable to RNI and client-specific requirements for carbohydrates and protein. However the subject was able to meet the RNI for total fat intake, therefore concentration on the other macronutrients was advised. With the dietary interventions in place the subject was able to increase the carbohydrates and protein amounts to meet the recommended nutrient intake and client-specific requirements. Figure 3 shows the percentage of energy accrued from each macronutrient at pre-post dietary intervention as well as the recommended percentages for the general population. The data shows that the subject’s percentage does improve due to the decrease in alcohol consumption although there is an issue in that there is still too much energy provided by fats that should be provided from carbohydrates.

Methodological limitations. The methodological limitations for the investigation came from a variety of sources. Firstly the food dairy given to the subject could show an incorrect representation of their diet due to either forgetting to record meals or making meals up. Human error also could be a limitation within this case study, whether it be when recording the height and weight measurements or using the COMP-EAT software. Also, the equipment used could have been inaccurate, for example, the scales may have not been calibrated to 0 or the subject not taking their shoes off for the height measurement.

The COMP-EAT software however was the main source when considering methodological limitations as the software regularly failed to search the required food type, but also the quantity of the food provided would have made the results inaccurate due to the options being small, average or large. Therefore the COMP-EAT assessment would not be a true representation of the subject’s weekly diet. In terms of ethical content, written informed consent and a medical questionnaire were obtained after the purpose, nature and requirements of the project were explained to the subject. All information gathered during the investigation was kept confidential and filed away in a safe or password-protected document only to be accessible to the researcher.

Dietary modifications. Consequently from the information gathered during initial testing (food dairy & COMP-EAT), it was apparent that dietary modifications needed to be implemented to improve the subject’s nutritional status. The subject and the researcher identified the aspect of implementing nutritional modifications to enhance performance in the subject’s sport (soccer) during the initial testing. Therefore the dietary modifications were implemented specifically to aid performance in soccer through the improvements in carbohydrate, protein, and fluid intake rather than additional supplements.

Soccer is a strength and power contact sport, involving high-intensity activity, training and competition. Competitive matches involve intermittent high-intensity sprints between periods of jogging and walking and repeated physical contact (Tumilty, 1993). Other than limits imposed by hereditary and training, diet is the single most important factor influencing athletic performance (Costill, 1986). Similarly, Kirkendall (1993) demonstrated that good nutrition helps optimize energy production, control and efficiency for sport. Moreover, inappropriate nutrition may contribute to sports injuries (Eichner, 1995).

Soccer players train at moderate to high intensity, the estimated mean daily energy demand for senior male players had been estimated at ~4000 on training days and ~3800 on match days (Rico-Sanz, 1998). However, Williams (1994) demonstrated that based on the assumption that energy expenditure off the football field is only moderate; the daily energy requirement of a male player can be estimated at 3500 kcal. day -1. Therefore the 1969 kcal consumed at pre-intervention and the 2277.45 kcal consumed at post-intervention would be classed as an insufficient amount of energy needed to participate in soccer training and competition. Although the subject only plays at the semi-professional level of football, the 3800 kcal plus recommendations for professional’s athletes would be excessive for the subject.

The dietary strategies and interventions that were implemented involved an increase in energy expenditure, carbohydrates, protein and fats to meet the demands required from participation in football, as well as a decrease in alcohol and unhealthy snacks. Another dietary strategy that was high in priority was to increase the intake of fluids (water), as the subject was consuming insufficient levels of fluids, which can be an issue, especially during exercise. The energy sources exploited over the course of a soccer match are similar to those found in other types of intermittent exercise (Shephard, 1982). Depletion of glycogen in the most frequently recruited muscle fibres becomes a significant cause of fatigue as the game progresses, and performance can be enhanced by an initial boosting of muscle glycogen reserves (Bangsbo et al, 1992).

A high carbohydrate intake is recommended to maximize glycogen stores (Shephard, 1999). The dietary recommendation for soccer players, best expressed per kilogram of body mass, is 8 g. kg -1. day-1 (Devlin & Williams, 1993) or even as high as 10 g. kg -1. day-1 for endurance athletes (Graham, 2000). These amounts coincide with the client-specific calculations with the requirement for carbohydrates being 589g a day or 9.02 g. kg -1. day-1. However, the results illustrate that the subject was unable to consume the recommended carbohydrate amounts, even though showing an increase from pre to post intervention. Therefore for the subject to improve performance and nutritional status, an increase in carbohydrates s needed still, which could be in the form of pasta, rice potatoes, beans or sports drinks. McArdle et al (2005) suggest that a physically active person should get their carbohydrates from milk (16%), fruits and vegetables (47%) and bread and cereals (37%).

As effective carbohydrate loading approximately doubles muscle glycogen stores, a recommendation for the subject would be to consume a high carbohydrate meal on the evening before a game to maximize glycogen stores. Glycogen loading results in a 5-6% increase in the ability of adult players to make multiple sprints after 45 min of simulated soccer (Bangsbo et al, 1992). Also, the literature suggests that a small dose of carbohydrate given shortly before a game may help spare muscle glycogen and maintain blood glucose (Tsintzus et al, 1993). Evidence also suggests that carbohydrate supplementation in male soccer players to decreases net muscle glycogen usage and enhances performance at the end of the match (Kirkendell, 1993).

Proteins are important molecules that serve structural and regulatory functions in the body (Tarnopolsky, 2004). The nutritional requirement for protein is the minimum amount ingested that will balance all nitrogen losses and thus maintain nitrogen equilibrium (Millward, 2001). Recommendations for protein intake usually amount to 0.8-1 g.kg-1 body mass. day-1 in adults without any reference to the undertaking of acute exercise or to the training status. However, it is widely accepted that the World Health Organization’s recommended daily protein intake of 1 g.kg-1 body mass. day-1 is too low for athletes who undertake training (Lemon, 1994). Studies based on metabolic tracers and nitrogen balance techniques suggest that 1.2 – 1.8 g.kg-1 is more appropriate (Meredith et al, 1989), which coincide with the client-specific protein requirements of 1.4 – 2.0 g.kg-1. Similarly, Shephard (1999) states that 1.5 g.kg-1 is a sufficient protein intake for male soccer players.

Aside from obligatory uses, protein would be necessary for increased energy demands, protein synthesis of enzymes that are stimulated by intermittent exercise and, perhaps, repair of muscle proteins damaged by intense workout (Tipton &Wolfe, 2003). However, client-specific, team sports athletes, would consider protein requirements necessary to increase muscle mass and strength and power. Increased amino acid oxidation during exercise is thought to be due to increased utilization of amino acids as fuels; therefore regular repeated exercise would then lead to increased protein requirements (Tipton & Wolfe, 2003). However conflicting literature suggests that the opposite occurs, with exercise training increases the efficiency of protein utilization, thus making increased intake unnecessary (Butterfield & Calloway, 1994; Todd et al, 1984). Similarly, Gontzea (1975) demonstrated that it is not necessary for physically active individuals to increase protein intake to maintain nitrogen equilibrium; in fact, exercise may decrease protein needs due to the increased efficiency of protein utilization.

The results show that the subject was unable to meet the protein requirements; therefore an intervention was put into place to increase the amount of protein ingested. An increase of protein in the body would help cover the demands of muscle repair and hypertrophy (Millward et al, 1994) that occur during physical activity and sport. With the subject’s goal in mind, mixed evidence has suggested that protein and amino acid ingestion is considered essential to performance (Tipton & Wolfe, 2003) and also inconclusive (Butterfield & Calloway, 1994; Todd et al, 1984; Gontzea, 1975) After the initial testing, the subject’s fat intake was slightly above the recommended requirements but just below the client specific target. Therefore no dietary modification was needed, as other nutrients took priority. However, the subject should continue monitoring food intake to ensure that the other interventions implemented do not interfere with fat intake.

Another dietary strategy that was implemented was that the subject was encouraged to take on more fluids and electrolytes daily. This was an important factor during the initial testing as the subject was consuming failing to meet the recommended intake of 3.7L/day (DRI, 2002). However conflicting evidence demonstrates that an intake of 2-2.5 L/day is sufficient fluid intake for the general population (Hicks, 2005), although this figure doesn’t take into account physical activity and the water lost through sweat. The metabolic heat generated by exercise must be dissipated to maintain body temperature within narrow physiological limits. When the ambient temperature exceeds skin temperature, heat loss can occur only by the evaporation of sweat from the skin surface (Shirreffs et al, 2003).

Dehydration symptoms generally become noticeable after 2 % of one’s water volume has been lost and within the athlete population a loss of performance of up to 30% can be seen (Bean, 2006). Similarly, it has also been well documented that even small body water deficits, incurred before (Sawka, 1992) or during (Cheuvront et al, 2003) exercise can significantly impair aerobic exercise performance, especially in the heat (Sawky, 1992; Cheavront et al, 2003). On the other hand, Shephard (1999) states that if glycogen stores were to be fully depleted over a game, a player might lose 1.5-2.0kg of body mass without significant dehydration.

However more client-specific, during soccer matches and training sessions, some players will lose considerable amounts of electrolytes – particularly sodium -and may need to replace these during the match or training session (Shirreff et al, 2003). From reviewing the literature the subject was advised to prepare a drink containing sodium, potassium and 5-6% of glucose or sucrose as it has a minor advantage over tap water in restoring balance after exercise (Lambert, 1997). Therefore if the subject was to continue participating in regular high intermittent exercise, severe dehydration may occur, which not only decreases aerobic power but muscular strength and endurance (Fogelholm, 1994) which makes everyday activities more difficult to perform.

The subject met the 100% requirement for most of the vitamins and minerals with the main deficiencies coming in iodine, selenium, copper, zinc and vitamin D. However it is important to note that the DRIs were not determined using athletes or regularly exercising individuals. In order for the client to reach the DRI for the previously stated elements, certain foods were identified. Dietary selenium functions as an antioxidant with glutathione peroxidase; complements vitamin E functions (McArdle et al, 2005) and can be found in nuts, cereals, meat fish and eggs (Barclay et al, 1995). However zinc is a component of several enzymes involved in energy metabolism; cofactor to carbonic anhydrase (McArdle et al, 2005) and is found in oysters, and to a far lesser degree in most animal proteins, beans, nuts and almonds but issues with finance would exclude the expensive options.

Natural sources of iodine include sea life, such as kelp and certain seafood, as well as plants are grown on iodine-rich soil. Vitamin D on the other hand can be found in milk, soy milk and cereal grains as well as exposure to sunlight. Research suggests that no enhancement of physiological characteristics or performance after the administration of either vitamin (Van der Beek, 1991; Fogelholm, 1994) or mineral (Clarkson, 1991; Similarly Shepherd (1999) demonstrated no benefit in male soccer player’s performance from vitamin or trace element ingestion. However, vitamins have been proven to improve recovery after the performance (Fogelholm, 1994). Potential constraints to not meeting requirements for carbohydrates, protein and other nutrients could be due to the following factors. A significant majority of students reported eating the same foods day after day. Also, student’s perceptions of diet or low-calorie foods may limit their choices; a lack of cooking experience and time constraints may also have a negative effect on student’s intakes (Haberman & Luffey, 1998).

Alcohol. Alcohol is an energy-supplying nutrient that forms a small but important part of the normal dietary intake of a large part of the world’s population (Maughan, 2005). Due to the fact that the case study is a student, it is inevitable that high consumption of alcohol is involved due to the social lifestyle and pressure from peers. However, the most prominent reason for drinking within the university population was pleasure, which was more important than social pressure or stress/anxiety (Webb et al, 1996). This is confirmed by the first COMP-EAT assessment with alcohol providing 24.49% of the subject’s energy. Consequently, the subject was given advice on the health risks of alcohol and recommended to reduce alcohol consumption as it would be impossible for the subject to completely stop due to the nature of the student lifestyle. A reason for the significant decline in alcohol consumption was the subject’s inability to afford alcohol.

If the client were to continue to lead an active lifestyle it would be advisable to further increase energy intake to the recommended requirements. It would also be suitable to increase carbohydrate intake, especially during exercise as it has been noted before to enhance performance (Bangsbo et al, 1992; Tsintzus et al, Kirkendell, 1993). With the literature on protein requirement and soccer performance varying in opinion, future recommendations would be down to the client’s personal choice. However, it would be imperative for the client to improve fluid intake, especially during exercise, as it can lead to serious health risks. It would also be advisable that the client should decrease alcohol intake in the future due to the health risks involved however the student lifestyle can be a huge constraint to the client meeting these requirements.

Summary. The investigation shows that the subject increased the macronutrient intake for carbohydrates, protein and fats, although more still needs to be done in order for the client to meet the demands of an active lifestyle. The post-intervention results show that carbohydrate amounts improved by 121g, proteins by 20.1g and fats by 7.8g. The subject showed improvements in fluid intake that have been known to be detrimental in performance enhancement (Sawky, 1992; Cheavront et al, 2003) as well as decreasing alcohol intake. The dietary modifications were imperative in terms of improving nutritional status and enhance performance although limitations due to student lifestyle will always play a negative part on nutritional status. Conversely, the subject would still be advised to increase macronutrient intake in the future to meet the demands that soccer imposes. Potential future research could focus on the dietary advice for the student population, including simple and cost-effective strategies to improve nutritional status.

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