J Phys Fitness Sports Med, 8 (1): 29-35 (2019)DOI: 10.7600/jpfsm.8.29

JPFSM: Regular Article

Use of “Nutriatlet” smartphone application-based personalized nutritionprogram to improve energy consumption, body mass index,

and body fat percentage among martial arts athletesIrwan Budiono*, Tandiyo Rahayu, Soegiyanto and Arif Rahmat Kurnia

Received: August 4, 2018 / Accepted: October 3, 2018

Abstract There was a nutritional issue in the training camp of Central Java BPPLOP (Balai Pemusatan Pendidikan Latihan Olahraga Pelajar/Student Sport Education and Training Cen-ter). The year 2017 data showed that 8% of athletes experienced nutritional deficiency and 10% of athletes experienced nutritional excess. This research aimed to evaluate the effectiveness of a personalized nutrition program toward percentage of energy consumption level (%ECL), body mass index (BMI), and body fat percentage (%BF). This research utilized one-group pretest-posttest design. The subjects were 59 martial arts athletes in Central Java BPPLOP. The per-sonalized nutrition program intervention lasted a month and was encouraged by a smartphone application called Nutriatlet. The statistical test was a paired sample t test. The research con-cluded that mean %ECL improved significantly after intervention, from 63.37 ± 8.57 to 82.91 ± 6.31 (p < 0.001). The BF percentage also improved from 14.36 ± 6.19 to 13.40 ± 5.88 (p < 0.001). Mean BMI was not significantly different after intervention, from 21.95 ± 2.51 to 22.02 ± 2.25 (p = 0.524). We concluded that Nutriatlet usage to evaluate a personalized nutrition pro-gram could improve the energy consumption level and body fat percentage while maintaining body mass index.Keywords : personalized nutrition program, energy consumption, BMI, body fat percentage

Introduction

Nutrition is one of the essential factors supporting achievement in sports1). Adequate nutrition intake is needed for athletes during preparation or tournament period. Unbalanced nutrition intake would either result in malnutrition deficiency or excessive nutrition, which might interfere with athlete performance during a training program and/or competition1). An athletes’ role in a given game would determine their body composition, thus nutritional intake should be individualized2). Therefore, a nutrition program becomes a crucial part of a training camp1,3). In Indonesia, a sports training program is usually started from the regional level and progresses to the national level. At the national level, selected athletes would stay in a national training camp. Besides national training camps, regulators also encourage the establishment of flagship sports training camps in each province. Central Java, in an effort to support sports achievement improvement training, established a student sports center called Student Sport Education and Training Center (Balai Pemusatan Pendidikan Latihan Olahraga Pelajar/BP-

PLOP). The establishment of BPPLOP was a strategy to develop potential/talented athletes who could reach the national level. One of the flagship sports in Central Java BPPLOP is martial arts. There are 7 branches of martial arts in Central Java BPPLOP, namely Taekwondo, Wrestling, Wushu, Ka-rate, Boxing, Silat, and Judo. Martial arts use competitor weight categories to determine the class competition. To strive for a certain medallion, sometimes an athlete is forced to lose weight to qualify for a certain desired weight class in competition. Such measures often result in nutritional deficiency among athletes. Data from our internal 2017 study showed that 8% of athletes in Central Java BPPLOP experienced mal or insufficient nutrition4). Ideally, an athlete’s nutrition program should be indi-vidualized, because energy and nutritional needs for each athlete is different5). At the time of this study, nutritional care for athletes in Central Java BPPLOP was still gener-alized for all athletes. The food was provided by a food catering service. The absence of a personalized nutrition program caused an under-detected nutritional problem (deficiency) among athletes. In addition, 10% of martial arts athletes in Central Java BPPLOP experienced excess or over nutrition. Therefore, we initiated a plan for improving nutritional *Correspondence: irwan_budiono@mail.unnes.ac.id

Faculty of Sport Science, Semarang State University, Gunungpati, Semarang 50229, Indonesia

30 JPFSM : Budiono I, et al.

balance by arranging a personalized nutrition program for each athlete; and thus improve each athlete’s nutritional profile through their own individualized nutrition pro-gram. Another objective was to prevent any weight loss program, that an athlete might undergo in order to qualify for a certain weight class, from resulting in a sacrifice of the athlete’s nutritional status. Therefore, the nutrition and energy intake should be maintained in order to support an improvement in the nutritional status, including body fat percentage. One of the methods to control energy and intake needs was the use of a computerized program6,7). This research aimed to evaluate the effectiveness of a personalized nutrition program, using the smartphone app Nutriatlet, in maintaining a balanced nutritional profile including energy consumption level, body mass index, and body fat percentage.

Materials and Methods

Research design. This study was a large-scale trial from research that developed the smartphone model app Nutriatlet. In this phase, we conducted a test on model effectiveness to improve athlete nutritional status. We applied a pre-experiment design with one group pretest-posttest design. The intervention was a month-long per-sonalized nutritional program for athletes. Before and after the intervention, we obtained the data for percentage of energy consumption level, body mass index, and body fat percentage. We conducted this research in March 2018 mainly to reduce any potential bias. In this month, all martial arts athletes were on their pre-season schedule, and had similar training regiments. Study participants. The researchers tested 59 martial arts athletes in BPPLOP of Central Java, Indonesia. The martial arts branches included in the research were Tae-kwondo (9 athletes), Wrestling (8 athletes), Wushu (6 ath-letes), Karate (6 athletes), Boxing (12 athletes), Silat (12 athletes), and Judo (6 athletes). Personalized nutrition program. The intervention for the athletes was a personalized nutrition program called Nu-triatlet, an android smartphone app. This app has 8 menus, namely 1) personal data, 2) calorie needs calculation, 3) intake plan, 4) daily evaluation, 5) consumption recall, 6) anthropometry, 7) data report, and 8) data export. During the research period, food was still provided by Central Java BPPLOP, supported by a selected food ca-terer. In other words, the food service remained the same as before the study. In implementing the personalized nutrition program, athletes were guided by the Nutriatlet app in order to consume food and drinks in appropriate amounts based on individual needs. The energy needs of the BPPLOP athletes were calculated from adding basal metabolic rate (BMR) to specific dynamic action (SDA), physical activity level, energy expenditure (from specific

training or activities), and growth factor8). In this research, the energy needs and training phase were determined to design a controlled situation for all athletes. The provi-sion of food and drinks was by Central Java BPPLOP. Through the Nutriatlet app, participating athletes could easily obtain guidance on calculating their energy and daily nutrient needs. The athletes needed to input their ba-sic data, such as name, age, gender, physical activity, and type of martial art beforehand. Then, using the intake plan menu, they could find guidance in arranging their nutrient intake based on an energy needs calculation. Fig. 1 shows the calculation of daily energy needs in the Nutriatlet app. Next, to simplify the implementation of the personalized nutrition program, Nutriatlet helped athletes in selecting the type and amount of food to meet their energy require-ments as displayed in Fig. 1. Intake planning in Nutriatlet applied the concept of serving sizes. Through this, we expected that athletes could manage their daily intake pattern, so the calorie needs would be appropriate. Fig. 1 shows an example of intake planning for an energy need of 3,672 kcal/day. Fig. 1 gives an example of meeting the energy needs when total energy is set at 3,672 kcal/day. In such a case, an athlete should consume 8 servings of carbohydrate, 5 servings of animal protein, 6 servings of vegetable pro-tein, 5 servings of vegetable, 6 servings of fruit, 4 serv-ings of milk, 4 servings of oil, and 4 servings of sugar. To meet their energy needs, athletes were recommended to consume the food group according to the number of each servings. Fig. 1 shows an example of athletes selecting a vegetable protein according to availability in the camp. For example, 1 serving of vegetable protein could be ful-filled from 2 pieces of tempeh (fermented soybeans) (50 gr) or green beans (25 gr), soybeans (25 gr), red beans (25 gr), peanuts (20 gr), tolo beans (25 gr), oncom (fermented soy pulp) (50 gr), or tofu (100 gr).

Data collection and research. Before and after the in-tervention, we obtained data for the percentage of energy consumption level, body mass index, and body fat per-centage. The energy consumption level percentage data was obtained via the Nutriatlet app and cross-checked by five random 24-hour dietary recalls (a structured inter-view to capture information about all foods and bever-ages ingested in the last 24 hours). The Nutriatlet app measured the energy consumption level by these steps: 1) Determining the energy requirements of the athlete; 2) Counting energy intake from the consumed food; 3) Di-viding energy intake by energy needs and multiplying by 100%. The athletes input the food they consumed for 30 days under supervision of their coaches. Registered nutri-tionists were hired to clarify their dietary intake using five random 24-hour dietary recalls. The first recall was done before interventions, the second to fourth recall were done weekly during interventions on random days each week, and the fifth recall was done after the intervention ended.

31JPFSM : Nutriatlet to improve energy consumption, BMI, & body fat %

Holding a 24-hour dietary recall at least three times is considered enough to estimate energy intake in a popula-tion9,10). Body mass index and body fat percentage data were measured by a registered nutritionist twice (before and after intervention). Body fat percentage data was obtained by using the three-site (abdomen, suprailiac, triceps skin-fold) formula as follows11): Male: % body fat = (0.39287 x sum of three skinfolds) – (0.00105 x [sum of three skinfolds]2) + (0.15772 x age) – 5.18845 Female: % body fat = (0.41563 x sum of three skin-folds) – (0.00112 x [sum of three skinfolds]2) + (0.03661 x age) + 4.03653 Skinfold measurements were carried out by using skin-fold calipers on three sites (abdomen, suprailiac, and tri-ceps). The measurement procedure was done as follows: 1) Pinch the skin at approximately 1 cm from the skinfold site using thumb and forefinger, 2) Place the calipers on the site, then read the result in 4 seconds, 3) Continue to the next site until each is measured, 4) Repeat the proce-dure every 15 seconds 3 times. None of the participants were informed of the purpose of these measurements.

Statistical analysis. We conducted a paired t test and Wilcoxon test to evaluate the effectiveness of a person-alized nutrition program in improving the energy con-sumption level percentage, BMI, and body fat percentage among athletes.

Ethical Consideration. Protocol and procedures for this research were approved by the Ethical Clearance Commit-

tee in Universitas Negeri Semarang number: 018/KEPK/EC/2018. This study was conducted in accordance with Standard and Operational Guidance for Ethics Review of Health-Related Research with Human Participants from WHO 2011 and International Ethical Guidelines for Health-Related Research Involving Humans from CIOMS and WHO 2016. All subjects read and approved informed consent explaining all procedures and or measurements prior to the study.

Results

Results of the research showed that the number of male subjects was greater than the number of female subjects. All subjects were teenagers. The following Table 1 pre-sented the basic characteristics of subjects. Among the 59 athletes, the mean of energy consumption was under 70% before an intervention was conducted. This implied that the mean of the energy consumption level was categorized as deficient. However, after a month of personalized nutrition using the Nutriatlet app, the mean of the energy consumption level improved. An-other essential finding was a decreased body fat percent-age without significant BMI changes. The mean of the percentage of energy consumption level, BMI, and body fat percentage according to gender is presented in Table 2. The result showed that even though there was no statis-tically significant difference in body mass index before and after intervention, subjectively there was an improve-ment in the category of nutrition status. Fig. 2 showed that 46 athletes had under 70% energy consumption level. After intervention, this percentage improved above 70%

Fig. 1 The display of energy need calculation, intake planning, unit of vegetable protein-sourced food changers list using Nutriatlet app

32 JPFSM : Budiono I, et al.

Fig. 2 Category of percentage of energy consumption level, body mass index, and body fat percentage before and after intervention

Table 1. Characteristics of the research subjects according to age, gender, and sport branches

Table 2. Comparison of the mean of percentage of energy consumption level, BMI, and body fat percentage according to gender

Before intervention

After intervention

< 70% 70 - 80% 80 - 90% 90 - 110%

06

2

33

11

19

1

4650

40

30

20

10

0

A. Percentage of Energy Consumption Level

Num

ber o

f Ath

lete

s

< 18,5Kg/m2 Kg/m2 Kg/m2 Kg/m2

18,5 - 25,0 25,0 - 27,0 > 27,0

45

34

60

504030

2010

0

B. Body Mass Index

Num

ber o

f Ath

lete

s 49

9 61 1

Lean Optimal Slighty over fat

3 34 4

60

50

40

30

20

10

0

C. Percentage of Body Fat

Num

ber o

f Ath

lete

s 52 52

Characteristic Branches Total n(%) or M ± SD

Wrestling n(%) or M ± SD

Judo n(%) or M ± SD

Karate n(%) or M ± SD

Silat n(%) or M ± SD

Taekwondo n(%) or M ± SD

Boxing n(%) or M ± SD

Wushu n(%) or M ± SD

Gender Male 7

(87.5%) 2

(33.3%) 4

(66.7%) 8

(66.7%) 4

(44.4%) 5

(41.7%) 3

(50.0%) 33

(55.9%) Female 1

(12.5%) 4

(66.7%) 2

(33.3%) 4

(33.3%) 5

(55.6%) 7

(58.3%) 3

(50.0%) 26

44.1%) Age 17.12 ±

1.126 16.33 ± 1.506

15.17 ± 1.602

16.67 ± 0.985

16.33 ± 1.225

16.50 ± 1.382

16.83 ± 1.602

16.47 ± 1.340

Athletes’ nutritional profile

Gender Mean ± SD p Before After

Percentage of energy consumption level

Male 61.57 ± 6.70 80.95 ± 4.89 <0.001 Female 65.65 ± 1.01 85.40 ± 7.08 <0.001 Total 63.37 ± 8.57 82.91 ± 6.31 <0.001

Body mass index (BMI)

Male 22.26 ± 2.68 22.28 ± 2.41 0.848 Female 21.57 ± 2.26 21.69 ± 2.01 0.737 Total 21.95 ± 2.51 22.02 ± 2.25 0.524

Body fat percentage Male 9.51 ± 1.37 8.73 ± 1.42 <0.001 Female 20.51 ± 4.01 19.33 ± 3.53 <0.001 Total 14.36 ± 6.19 13.40 ± 5.88 <0.001

33JPFSM : Nutriatlet to improve energy consumption, BMI, & body fat %

for almost all athletes. A nutritional profile improvement was also achieved in body mass index and body fat per-centage.

Discussion

A personalized nutrition program using the Nutriatlet application in this research was proven effective for im-proving the energy consumption level of participants. A personalized nutrition program has been shown on several occasions to improve anemia among marathon athletes12). Research in Malaysia showed that a web-based applica-tion could improve the knowledge, attitude, and behavior of athletes related to their diet and nutritional status7). The Malaysian research recommended an effective and sus-tainable nutritional instrument for improving compliance towards diet among athletes7). Such a supporting nutri-tional instrument might even be considered as important as a physical training program by coaches. Therefore, coach and nutritionist support is essential for optimal results. Previous research has proven the importance of the commitment of a coach in supporting a nutritional program for athletes13). Other research even stated that commitment toward a nutrition program is an essential management function for all coaches14). The BPPLOP martial arts athletes were carefully se-lected from all regions in Central Java. As elite athletes, their food was fully funded by the government. Actually, Central Java BPPLOP had a nutritionist on staff that peri-odically counseled the athletes. However, due to the small number of nutritionists compared to athletes, personal-ized nutrition service could not be provided. Generally, all athletes had been previously exposed to some basic knowledge of nutrition management for athletes. How-ever, such knowledge did not translate into good nutrition practice for most of them. As previously presented in Fig. 1, most of the athletes had a deficient energy consumption level. This finding was consistent with a study in Mauri-tius15). In the Mauritius study, they concluded that there was a correlation between nutritional knowledge and eat-ing habits among teenagers. However, good nutritional knowledge does not always lead to good eating habits. Therefore, other methods are needed to bring about good eating habits15). The Nutriatlet app, a personalized nutrition program in-strument, is one of the newer technologies in engineering to help athletes to maintain energy balance. A month-long trial period proved that this program is effective in im-proving energy balance. One of the factors affecting this success rate was the presence of a daily nutrition evalu-ation for each athlete. It motivated the athletes to follow the application’s recommendations. This finding was consistent with a previous study that found that the use of a self-monitoring instrument could improve the energy balance among teenagers16). Another study also stated that the use of a self-evaluation instrument might reinforce a

training program’s achievements17). The body mass index category in martial arts athletes did not differ from the normal population. Research on years 2000, 2004, 2008, and 2010 Taekwondo Olym-pians showed that their BMI was ranging from 18.5 to 25, similar to the normal category in the general popula-tion18,19). In this study, the body mass index before and after intervention was not statistically different. However, Fig. 2 showed a decrease in the number of athletes with a low body mass index (BMI < 18.0) or with high body mass index (BMI > 25.0). The data also showed that there was an increase of athletes in the normal category (BMI 18.5–25.0). In addition, the data showed that meal modification for a month could improve an athlete’s body composi-tion. One month was originally considered too short to be able to see any change in body composition; but several studies showed similar changes in such a short time. A study on thirty-three obese individuals without chronic illnesses, showed that a daily dietary and exercise inter-vention could reduce body fat percentage and BMI whilst increasing lean body mass. Results were seen as early as the first month in a four-month intervention20). A study on gastrectomy patients showed a change in body weight loss and increasing lean body mass one month after sur-gery21). An observational study on Indonesian football athletes showed a change in body composition after four months of observation, but there was no time series analysis1). This finding was consistent with the previous study, which stated that a balanced intake of macronutri-ents could transform the body composition more ideally1). Zanchini and Malaguti (2014) also stated that to maintain an ideal body mass index, athletes should follow an indi-vidualized nutrition program3). The improvement in athletes’ nutritional profiles strongly indicates that Nutriatlet can be recommended as a personal nutrition program instrument for athletes. Usage of such an app could improve nutritional literacy among athletes. It was consistent with previous research that supported ongoing nutrition counseling to prevent un-healthy nutritional practice22,23). Food service for BPPLOP athletes of Central Java was categorized as generalized nutrition service. To ensure the consumption of appropri-ate foods, athletes should be able to select foods accord-ing to their needs. The Nutriatlet app consists of menus that help athletes choose the types and amounts of foods best suited to meet their needs. Research results were consistent with a previous study which stated that food selection is dynamic, complex, and changeable. There-fore, teenage athletes in the training camp must be able to select good food23,24). Such skills require a proficient level of health literacy among athletes. That nutritional literacy, according to Cotugna, must also entail specific nutrition education based on individual sports25). In addition, this study also proved that a personalized nutrition program was effective in lowering the body fat

34 JPFSM : Budiono I, et al.

percentage among athletes. There was a significant differ-ence between the body fat percentage before and after the intervention. The reduced body fat percentage and stag-nant BMI brought us to the conclusion that the lean body mass was increased because the BMI was not changed and the body fat percentage was improved. A promising finding in this study is the improvement in the energy consumption level. An increased energy consumption lev-el as well as decreased body fat percentage are difficult to achieve unless optimal protein consumption is combined with high-intensity resistance and aerobic exercise26). It is consistent with a previous study which showed a sig-nificant correlation between adequate energy intake and change in body composition1,27). It was important to note that this study had several weaknesses. First, there was no control group, which made it impossible to compare the effectiveness of Nu-triatlet with the usual practices. Second, the intervention duration was short, eliminating the opportunity to observe any possible changes over longer periods of time. Third, since the lean body mass data was not collected, any changes in muscle mass could only be predicted.

Conclusion

There was a significant difference in percentage of en-ergy consumption level and body fat percentage before and after the intervention. There was no statistically sig-nificant difference in body mass index before and after the intervention. A personalized nutrition program using the Nutriatlet app could improve the energy consumption level and body fat percentage while maintaining body mass index.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this article.

Acknowledgments

The researchers would like to thank all martial arts athletes in BPPLOP of Central Java for their great contribution as research subjects.

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