Effect of a nutrition education intervention on sports nutrition knowledge, dietary intake, and body composition in female athletes: a randomized controlled trial

ERCT Criteria Breakdown

• Level 1 Criteria

  • C

    Class-level RCT

    • Randomisation was conducted at the club (cluster) level rather than on individual athletes, satisfying the class-level-or-stronger requirement.
    • "Randomization was performed at the club level to prevent potential contamination between groups and ensure the internal validity of the study." (p. 2)
    • Relevant Quotes: 1) "A community-based randomized controlled trial was conducted. Four handball clubs were randomly assigned to either an intervention group (IG) or a control group (CG)." (p. 1, Abstract) 2) "Randomization was performed at the club level to prevent potential contamination between groups and ensure the internal validity of the study." (p. 2, Section 2.2) 3) "Club-level allocation was necessary because the intervention was delivered in group sessions and individual randomization within clubs was not feasible due to the substantial risk of contamination arising from regular interaction and information sharing between players." (p. 2, Section 2.1) 4) "The four clubs were randomized to the study groups in a 1:1 ratio, allocating two clubs to the IG and two clubs to the CG. Random allocation was performed using a two-stage random selection and allocation procedure using Microsoft Excel." (p. 2, Section 2.2) Detailed Analysis: Criterion C requires that randomisation be carried out at the level of an intact group (class) or higher, rather than at the level of individual students within a single class, so that contamination between conditions is avoided. The paper is explicit that the unit of randomisation was the club, not the individual athlete. Two clubs were allocated to the intervention arm and two to the control arm in a 1:1 ratio, and the authors state directly that club-level allocation was chosen precisely to avoid contamination through information sharing between players. Each club team functions as the intact instructional group equivalent to a class, and the allocation procedure (two-stage random selection using Excel) is described. The allocation is therefore at a level at least as strong as class-level, so the weaker class-level requirement is satisfied. The small number of clusters (n = 4) is a statistical weakness the authors themselves acknowledge ("Given the small number of clubs (n = 4), club-level variance estimates were interpreted cautiously"), but the criterion concerns the unit of randomisation rather than cluster count. Criterion C is met because randomisation was performed at the club (cluster) level rather than on individual participants within a single group.
  • E

    Exam-based Assessment

    • Outcomes were assessed with an author-developed research questionnaire, a diet-adherence index, and self-reported food records rather than any standardised exam.
    • "SNK was evaluated using the Nutrition Knowledge Questionnaire for Young and Adult Athletes (NUKYA) (34) at baseline, post-intervention, and follow-up." (p. 4)
    • Relevant Quotes: 1) "SNK was evaluated using the Nutrition Knowledge Questionnaire for Young and Adult Athletes (NUKYA) (34) at baseline, post-intervention, and follow-up. Adherence to the Mediterranean diet (MD) was assessed with the KIDMED index (35), at baseline and follow-up." (p. 4, Section 2.6.1) 2) "The primary outcome was SNK. Secondary outcomes included adherence to the MD (KIDMED index), dietary intake variables, and anthropometric and body composition parameters." (p. 4, Section 2.7) 3) "Dietary intake was assessed using a three-day photographic food record, including two nonconsecutive weekdays and one weekend day corresponding to a match day." (p. 4, Section 2.6.2) 4) "Validated tools in a Spanish population were also used to assess nutrition knowledge and adherence to the MD, ensuring the reliability and accuracy of the measurements." (p. 11, Section 4.5) 5) Reference 34: "Vazquez-Espino K, Fernandez-Tena C, Lizarraga-Dallo MA, Farran-Codina A. Development and validation of a short sport nutrition knowledge questionnaire for athletes. Nutrients. (2020) 12:1-14." (p. 13, References) Detailed Analysis: Criterion E requires outcomes to be measured with standardised, widely recognised exam-based assessments that were not created for the purposes of the study or by the research team itself. The primary outcome instrument here is the NUKYA questionnaire, a short sport nutrition knowledge questionnaire. Although it is a published and validated instrument, it is a research questionnaire rather than a standardised exam of the kind ERCT requires (a national curriculum exam, a state-wide achievement test, or an equivalent widely recognised assessment). Critically, NUKYA was developed and validated by a team that includes the corresponding author of the present paper (Farran-Codina), so the outcome measure is not independent of the research team. The remaining outcome measures are further removed from exam-based assessment: KIDMED is a dietary-adherence index, dietary intake was captured through self-reported three-day photographic food records, and body composition was measured by bioelectrical impedance. None of these is a standardised academic examination. No national, regional, or otherwise externally administered standardised exam was used at any point in the study. Criterion E is not met because outcomes were measured with research questionnaires, self-reported food records, and body-composition devices rather than with a widely recognised standardised exam.
  • T

    Term Duration

    • Outcomes were re-measured at a follow-up roughly four to five months after the intervention started, exceeding the one-term minimum.
    • "The study design included four phases (Figure 1): pre-intervention, intervention, post-intervention, and a follow-up conducted 3 months after the completion of the intervention." (p. 3)
    • Relevant Quotes: 1) "A parallel-group cluster randomized controlled trial (RCT) in sports club settings was implemented to evaluate a three-week nutrition education intervention targeting adolescent female handball players in Catalonia, Spain." (p. 2, Section 2.1) 2) "The study design included four phases (Figure 1): pre-intervention, intervention, post-intervention, and a follow-up conducted 3 months after the completion of the intervention." (p. 3, Section 2.4) 3) "Week 0-4 Pre-intervention ... Intervention group: Focus group + Educational sessions ... Week 9 Post-intervention ... Week 22-25 Follow-up" (Figure 1, p. 3) 4) "The nutrition education intervention consisted of three in-person group sessions delivered by a licensed dietitian-nutritionist, each lasting 30 min and delivered once per week." (p. 3, Section 2.5) 5) "The follow-up evaluation, conducted 3 months after the intervention, coincided with the beginning of the subsequent competitive season." (p. 3, Section 2.4) Detailed Analysis: Criterion T requires that primary outcomes be measured at least one full academic term (roughly 3-4 months) after the intervention begins. The standard explicitly permits short interventions provided that tracking extends at least a term from the start. The intervention itself was brief: three weekly 30-min sessions, i.e. approximately three weeks, beginning after the pre-intervention window (weeks 0-4 in Figure 1). Outcome measurement, however, did not stop at the end of the sessions. A post-intervention assessment took place at week 9 and a full follow-up assessment (NUKYA, KIDMED, food records, anthropometry and body composition) took place at weeks 22-25. Measuring from the start of the educational sessions (around week 4-5) to the follow-up assessment (weeks 22-25) gives an interval of roughly 18 to 21 weeks, or approximately 4.5 to 5 months. This interval comfortably exceeds one academic term of three to four months, and the follow-up window is described as coinciding with the beginning of the next competitive season, confirming that a substantial period elapsed. Criterion T is met because the primary outcome was re-measured at a follow-up roughly four to five months after the intervention began, exceeding one full term.
  • D

    Documented Control Group

    • The control group's size, demographics, baseline values on all outcomes, and study conditions are documented in detail across Table 2 and Tables 3-6.
    • "The CG did not participate in any educational activities during the intervention phase. These participants were instructed to maintain their usual dietary habits and to avoid seeking additional nutritional information or counseling for the duration of the study." (p. 3)
    • Relevant Quotes: 1) "The CG did not receive any nutrition education intervention during the study period." (p. 1, Abstract) 2) "The CG did not participate in any educational activities during the intervention phase. These participants were instructed to maintain their usual dietary habits and to avoid seeking additional nutritional information or counseling for the duration of the study. This group received the same nutrition education intervention upon completion of the study." (p. 3, Section 2.5) 3) "Overall, 97 participants were included in the study, with 60 assigned to the IG and 37 to the CG. Participants' ages ranged from 12 to 19 years, with a mean of 15.9 +/- 1.2 years (Table 2)." (p. 5, Section 3) 4) "TABLE 2 Demographic characteristics of participants at baseline (N = 97). ... Age (years; mean and s.d.) 16.0 (1.0) [IG] 15.6 (1.5) [CG] ... Competition category ... Training period ... Level of education ... Mother's highest educational level ... Father's highest educational level ... Sources of nutritional information used" (p. 6, Table 2) 5) "At baseline (pre-intervention), no significant differences were observed between the IG and the CG in total questionnaire scores." (p. 7, Section 3.1) 6) "At baseline, 57 participants in the IG and 35 in the CG completed the 3-day dietary record. No statistically significant differences were observed between groups for any dietary variable at this initial phase." (p. 7, Section 3.3) 7) "Lost to follow-up (n=6) -Left the club (n = 2) - Unknown cause (n=4)" (Figure 2, CONSORT diagram, p. 5) Detailed Analysis: Criterion D requires detailed documentation of the control group: size, demographics, baseline performance, and what conditions or treatments it received. The paper documents all of these. Control group size is given (n = 37, two clubs), and Table 2 provides an extensive baseline breakdown for the CG separately from the IG: age, competition category, team role, training experience, own and parental education level, employment status, and sources of nutritional information. Baseline performance is reported for the CG on every outcome: NUKYA total and domain scores (Table 3), KIDMED (Section 3.2), full energy, macronutrient and micronutrient intake (Tables 4 and 5), and anthropometric and body composition parameters (Table 6). Baseline equivalence between arms is explicitly tested and reported as non-significant. The conditions placed on the control group are also clearly stated: no educational activities, instruction to maintain usual dietary habits and avoid seeking outside nutritional counselling, and receipt of the programme only after the study ended. Attrition in the CG is reported in the CONSORT diagram. Criterion D is met because the control group's size, demographics, baseline scores on every outcome, and conditions during the trial are all fully documented.

• Level 2 Criteria

  • S

    School-level RCT

    • Four whole handball clubs, the units implementing the intervention, were randomly allocated 1:1 to intervention and control, satisfying institution-level randomisation.
    • "Using the official registry of women's handball clubs in Catalonia, each club was assigned a unique sequential numerical code, and selection was carried out randomly. ... The four clubs were randomized to the study groups in a 1:1 ratio." (p. 2)
    • Relevant Quotes: 1) "Four handball clubs were randomly assigned to either an intervention group (IG) or a control group (CG)." (p. 1, Abstract) 2) "Randomization was performed at the club level to prevent potential contamination between groups and ensure the internal validity of the study. Using the official registry of women's handball clubs in Catalonia, each club was assigned a unique sequential numerical code, and selection was carried out randomly." (p. 2, Section 2.2) 3) "If a club declined the invitation, the next club on the sequential list was contacted until a total of four clubs agreed to participate. The four clubs were randomized to the study groups in a 1:1 ratio, allocating two clubs to the IG and two clubs to the CG." (p. 2, Section 2.2) 4) "Allocated to intervention (Teams n=2; Participants n=60) ... Allocated to control (Teams n=2; Participants n=37)" (Figure 2, CONSORT diagram, p. 5) 5) "Changes over time ... were analyzed using linear mixed-effects models (LMMs) to account for the hierarchical structure of the data, with repeated observations nested within participants and participants clustered within clubs, consistent with the club-level randomization." (p. 5, Section 2.7) Detailed Analysis: Criterion S requires randomisation among whole institutions or implementing units. The ERCT specification states that "school" here means the educational institution or unit implementing the intervention, and explicitly lists clubs and sites as qualifying units. In this trial the intervention was delivered inside sports clubs, and the club was the unit randomised. The selection process is described in detail: clubs were drawn from the official Catalan registry of women's handball clubs, assigned sequential codes, contacted in random order until four agreed, and then allocated 1:1 to intervention and control. The number of units (four) and their arm assignment (two per arm) are reported, and the statistical model explicitly nests participants within clubs consistent with the cluster design. The club is the implementing institution for this intervention, so randomising clubs satisfies the school-level requirement as the standard defines it. The cluster count is small, which the authors flag as a limitation for variance estimation, but the level of randomisation is nonetheless institutional. Criterion S is met because whole clubs, the institutions implementing the intervention, were the unit of random allocation.
  • I

    Independent Conduct

    • The same two-author team designed the programme, delivered it, collected the data and analysed the results, with no independent or third-party evaluator involved.
    • "Secondly, the nutrition education program was previously developed and tested in a pilot study by the same research group in a population with similar characteristics." (p. 11)
    • Relevant Quotes: 1) "Prior to the development of the main study, a pilot project (30) was conducted between September 2023 and October 2024, which allowed for the refinement of the intervention protocol and the optimization of both the intervention procedures and the data collection strategies." (p. 2, Section 2.1) 2) "Secondly, the nutrition education program was previously developed and tested in a pilot study by the same research group in a population with similar characteristics, ensuring that the intervention was evidence-based and appropriate for the target group." (p. 11, Section 4.5) 3) "The topics addressed in the intervention were determined from: (a) findings from the focus group, (b) results of the nutrition knowledge questionnaire administered during the pre-intervention phase, and (c) insights gained from the previously conducted pilot project." (p. 3, Section 2.5) 4) "While individual allocation was not concealed, outcome assessors and data analysts were blinded to group assignments." (p. 2, Section 2.2) 5) "All questionnaires were completed under the supervision of the principal investigator to prevent discussion or exchange of information among respondents." (p. 3, Section 2.6.1) 6) "MV-P: Formal analysis, Investigation, Methodology, Writing - original draft, Writing - review & editing. AF-C: Conceptualization, Formal analysis, Funding acquisition, Methodology, Writing - review & editing." (p. 12, Author contributions) 7) Reference 34: "Vazquez-Espino K, Fernandez-Tena C, Lizarraga-Dallo MA, Farran-Codina A. Development and validation of a short sport nutrition knowledge questionnaire for athletes." (p. 13, References) Detailed Analysis: Criterion I requires that the evaluation be conducted independently of those who designed the intervention, with data collection, analysis and conclusions carried out by a party without a stake in the result. Here the same two-author team designed the intervention, delivered the study, collected the data, analysed it, and wrote the conclusions. The authors state plainly that "the nutrition education program was previously developed and tested in a pilot study by the same research group." The primary outcome instrument (NUKYA) was itself co-developed by the corresponding author. The principal investigator personally supervised questionnaire completion, and the author contribution statement assigns formal analysis to both authors. No external evaluation agency, third-party data-collection contractor, or independent oversight body is named anywhere in the paper. The ClinicalTrials.gov record for NCT07460102 lists Andreu Farran-Codina himself as the lead sponsor, confirming that the trial was not sponsored or overseen by an independent body. The statement that "outcome assessors and data analysts were blinded to group assignments" is a bias-reduction measure within the same team, and is in tension with the fact that both listed authors performed formal analysis and that participants and delivery staff were unblinded. Blinding within an in-house team is not the same as independent conduct. Criterion I is not met because the intervention was designed, delivered, measured, analysed and reported by a single research group with no external or third-party evaluator.
  • Y

    Year Duration

    • The interval from intervention start to the final follow-up assessment was roughly four to five months, well below 75% of an academic year.
    • "Future interventions should incorporate longer follow-up periods, greater educational intensity, and the integration of behavioral, motivational, and environmental components." (p. 11)
    • Relevant Quotes: 1) "A parallel-group cluster randomized controlled trial (RCT) in sports club settings was implemented to evaluate a three-week nutrition education intervention targeting adolescent female handball players in Catalonia, Spain." (p. 2, Section 2.1) 2) "Week 0-4 Pre-intervention ... Week 9 Post-intervention ... Week 22-25 Follow-up" (Figure 1, p. 3) 3) "The study design included four phases (Figure 1): pre-intervention, intervention, post-intervention, and a follow-up conducted 3 months after the completion of the intervention." (p. 3, Section 2.4) 4) "This RCT demonstrates that a brief, three-week nutrition education intervention is effective in significantly improving SNK among adolescent female handball players." (p. 11, Section 5) 5) "Future interventions should incorporate longer follow-up periods, greater educational intensity, and the integration of behavioral, motivational, and environmental components to facilitate the translation of knowledge into practice." (p. 11, Section 5) 6) "Additionally, the short duration of the present intervention (three group sessions) and ongoing adolescent growth likely limited observable changes." (p. 11, Section 4.4) Detailed Analysis: Criterion Y requires that outcomes be measured at least 75% of an academic year (roughly seven months or more of a nine-to-ten month cycle) after the intervention begins. The timeline in Figure 1 places the educational sessions just after the pre-intervention window (weeks 0-4) and the final follow-up assessment at weeks 22-25. The interval from intervention start to final measurement is therefore approximately 18 to 21 weeks, or about four to five months. That is roughly half an academic year and falls clearly short of the 75% threshold. The authors themselves repeatedly characterise the study as short-term and recommend that future work "incorporate longer follow-up periods," confirming that no year-length tracking was carried out. Criterion Y is not met because the interval from intervention start to final outcome measurement was only about four to five months, well short of 75% of an academic year.
  • B

    Balanced Control Group

    • The extra dietitian sessions and materials are themselves the treatment variable under test, so the business-as-usual wait-list control is balanced by design.
    • "Therefore, the aim of this study was to evaluate the effect of a short nutrition education intervention on SNK, dietary intake, and body composition in young athletes." (p. 2)
    • Relevant Quotes: 1) "The IG received a nutrition education program consisting of three 30-min face-to-face group sessions delivered by a registered dietitian. The CG did not receive any nutrition education intervention during the study period." (p. 1, Abstract) 2) "During the initial contact with the athletes in the IG, a focus group session lasting 30 to 60 min was conducted to thoroughly explore their expectations, perceived barriers, and interests regarding nutrition." (p. 3, Section 2.5) 3) "Following the conclusion of the sessions, the visual materials used in each meeting along with a guide entitled 'Nutrition for Young Athletes' were sent to the coaches via email, who distributed the guide to the players and their families." (p. 3, Section 2.5) 4) "The CG did not participate in any educational activities during the intervention phase. These participants were instructed to maintain their usual dietary habits and to avoid seeking additional nutritional information or counseling for the duration of the study. This group received the same nutrition education intervention upon completion of the study." (p. 3, Section 2.5) 5) "Therefore, the aim of this study was to evaluate the effect of a short nutrition education intervention on SNK, dietary intake, and body composition in young athletes." (p. 2, Section 1) 6) "Its duration was established trying to maximize its viability in a real-world setting, outside the framework of a research study." (p. 3, Section 2.5) 7) "Participants trained three times per week for 1.5 h per session, in addition to one competitive match during the weekend, with no differences between the intervention and control groups." (p. 7, Section 3) Detailed Analysis: Applying the criterion B decision tree: extra resources were present in the intervention arm. The IG received a 30-60 min focus group, three 30-min dietitian-led sessions, and a printed/electronic guide distributed via coaches; the CG received none of these during the study period. The next question is whether those additional resources are the treatment variable rather than a separable add-on. They plainly are. The whole object under test is the nutrition education programme itself, described as a brief, low-cost, real-world-feasible package; there is no separate "method" being isolated from the delivery time. The stated aim is "to evaluate the effect of a short nutrition education intervention," so the added dietitian contact time and materials constitute the intervention, not a confound layered on top of it. Under the standard's exception, the control group may therefore remain business-as-usual by design, and the paper documents that the CG was kept at that baseline and received the identical programme after the study closed (a wait-list design). The magnitude of the difference also supports balance: the total additional exposure is about 90 minutes of sessions plus one focus group, against a background in which both arms trained three times per week for 1.5 h plus a weekend match with no between-group difference. Core educational and athletic inputs were otherwise equivalent across arms. Criterion B is met because the additional dietitian contact time and materials are integral to the nutrition education programme being tested against a business-as-usual control, and the control group was documented at that standard baseline with a wait-list offer of the same programme afterwards.

• Level 3 Criteria

  • R

    Reproduced

    • The only precursor study is the same authors' own pilot, and an internet search found no independent team that has replicated this trial.
    • "Prior to the development of the main study, a pilot project (30) was conducted between September 2023 and October 2024, which allowed for the refinement of the intervention protocol." (p. 2)
    • Relevant Quotes: 1) "Prior to the development of the main study, a pilot project (30) was conducted between September 2023 and October 2024, which allowed for the refinement of the intervention protocol and the optimization of both the intervention procedures and the data collection strategies." (p. 2, Section 2.1) 2) Reference 30: "Veloso-Pulgar M, Farran-Codina A. Effect of a nutritional education intervention on sports nutrition knowledge, dietary intake, and body composition in female athletes: a pilot study. Nutrients. (2025) 17:2560." (p. 13, References) 3) "The consistent improvements in SNK observed in both the pilot study (30) and the present RCT align with evidence synthesized in a recent systematic review, which demonstrated that structured nutrition education interventions lead to significant improvements in SNK among young female athletes across a wide range of sports disciplines (43)." (p. 10, Section 4.1) 4) "Despite the positive effects reported across studies, the existing literature highlights considerable heterogeneity in the design and implementation of nutrition education interventions. Variability in delivery modality, session frequency, duration, and the professional background of educators limits the identification of the specific components driving intervention success and reduces comparability across studies." (p. 10, Section 4.1) 5) "Finally, a key strength of this study lies in its real-world applicability ... the program offers a feasible approach that can be realistically implemented and replicated in similar populations." (p. 11, Section 4.5) Detailed Analysis: Criterion R requires that this specific study be independently replicated by a different research team, published in a peer-reviewed outlet. The only prior study of this same programme is the authors' own pilot (reference 30, Veloso-Pulgar and Farran-Codina, 2025), which is by definition not independent: it shares both authors with the present paper. The paper cites other nutrition education trials (Tektunali Akman et al., Gao et al., Vicente et al., Aguilo et al., Valliant et al.) and two systematic reviews, but these evaluate different programmes in different populations with different formats and durations, and the authors expressly note the "considerable heterogeneity in the design and implementation" of such interventions, which "reduces comparability across studies." Those are related literature, not replications of this trial. An internet search was carried out for this verification, covering the ClinicalTrials.gov record for NCT07460102, the Frontiers article page, and general web/literature searches for the ATHENEA project and for replications of this club-randomised handball nutrition education trial. No independent replication by any other research team was found; the only closely related work returned was by the same authors (the 2025 Nutrients pilot and their 2025 systematic review in Nutrition Research Reviews). No verbatim quote from any replication study can be provided because no such study exists to quote. The paper was published on 8 May 2026 and states replication only as an aspiration ("can be realistically implemented and replicated in similar populations"), which is forward-looking rather than evidence of an existing replication. Criterion R is not met because the only prior study of this programme is the same authors' pilot and an internet search found no independent replication of this trial.
  • A

    All-subject Exams

    • Criterion E is not met and outcomes were limited to sports nutrition knowledge alone, with no other subjects assessed.
    • "The primary outcome was SNK. Secondary outcomes included adherence to the MD (KIDMED index), dietary intake variables, and anthropometric and body composition parameters." (p. 4)
    • Relevant Quotes: 1) "The primary outcome was SNK. Secondary outcomes included adherence to the MD (KIDMED index), dietary intake variables, and anthropometric and body composition parameters." (p. 4, Section 2.7) 2) "SNK was evaluated using the Nutrition Knowledge Questionnaire for Young and Adult Athletes (NUKYA) (34) at baseline, post-intervention, and follow-up." (p. 4, Section 2.6.1) 3) "Furthermore, the IG exhibited significant improvements across all four questionnaire domains from baseline to post-intervention and from baseline to follow-up (p < 0.001)." (p. 7, Section 3.1) 4) "Sections: Macronutrients ... Micronutrients ... Hydration ... Periodization" (Table 3, p. 8) 5) "The EAT-26 was used as a screening tool and not for diagnostic purposes." (p. 4, Section 2.6.1) Detailed Analysis: Criterion A requires that impact be measured across all main subjects of the curriculum using standardised exam-based assessments, and the standard states explicitly that if criterion E is not met then criterion A cannot be met. Criterion E is not met here, because the outcome instruments are research questionnaires, a dietary adherence index, self-reported food records and bioimpedance measurements rather than standardised exams. That alone is decisive. Independently of the E prerequisite, the outcome coverage is also narrow. The only knowledge measured is sports nutrition knowledge, subdivided into four nutrition domains (macronutrients, micronutrients, hydration, periodization). No academic subject whatsoever - mathematics, language, science, or any other part of the participants' school curriculum - was assessed, and the study makes no attempt to detect spillover effects on other areas of these adolescents' schooling. The setting is a sports club rather than a school, but the standard's concern about unmeasured effects in non-target areas is untested either way. Criterion A is not met because criterion E fails and because outcomes were confined to a single narrow knowledge domain with no coverage of other subjects.
  • G

    Graduation Tracking

    • Criterion Y is not met and tracking ended about three months after the programme, with no graduation outcome measured, planned, or reported in any later publication.
    • "The follow-up evaluation, conducted 3 months after the intervention, coincided with the beginning of the subsequent competitive season." (p. 3)
    • Relevant Quotes: 1) "The study design included four phases (Figure 1): pre-intervention, intervention, post-intervention, and a follow-up conducted 3 months after the completion of the intervention." (p. 3, Section 2.4) 2) "Week 22-25 Follow-up" (Figure 1, p. 3) 3) "The follow-up evaluation, conducted 3 months after the intervention, coincided with the beginning of the subsequent competitive season." (p. 3, Section 2.4) 4) "Future interventions should incorporate longer follow-up periods, greater educational intensity, and the integration of behavioral, motivational, and environmental components." (p. 11, Section 5) 5) "Lastly, there were participant losses during the study, mainly due to changes of sports clubs, discontinuation of sports activity for personal reasons, or loss of interest after receiving the intervention, which could affect the sample size and the generalizability of the results." (p. 11, Section 4.5) 6) ClinicalTrials.gov record NCT07460102, verified directly on 21 July 2026: Overall Status "COMPLETED", Completion Date 19 December 2025 (ACTUAL). Detailed Analysis: Criterion G requires tracking participants through to graduation from their educational stage, and the standard specifies that if criterion Y is not met then criterion G cannot be met. Criterion Y is not met, which settles the matter. Substantively, the evidence points the same way: data collection ended at the weeks 22-25 follow-up, roughly three months after the three-week programme finished. Participants spanned ages 12 to 19 and multiple competition categories, so they were at widely differing points in their schooling, and no educational or athletic graduation endpoint was defined or measured. The authors describe the need for longer follow-up as future work. For this verification an internet search was performed for subsequent publications by the same authors that might track this cohort further. The only related outputs found were the earlier 2025 Nutrients pilot study and the authors' 2025 systematic review in Nutrition Research Reviews; neither tracks the ATHENEA cohort beyond the reported follow-up. The ClinicalTrials.gov record NCT07460102 was checked directly and shows the trial as completed on 19 December 2025 with no extension or long-term follow-up arm. No follow-up publication tracking this cohort to graduation was found, and no verbatim quote can be supplied because no such publication exists. Criterion G is not met because criterion Y fails and because measurement stopped roughly three months after the intervention with no graduation endpoint of any kind, and no later publication tracking the cohort to graduation could be located.
  • P

    Pre-Registered

    • Despite the paper's claim of prospective registration, the ClinicalTrials.gov record shows first submission on 18 February 2026, a year after the trial started and after data collection had ended.
    • "The trial was prospectively registered at ClinicalTrials.gov (NCT07460102)." (p. 2) - contradicted by the registry record, which shows Study First Submit Date 18 February 2026 against an actual study start date of 3 February 2025.
    • Relevant Quotes: 1) "The trial was prospectively registered at ClinicalTrials.gov (NCT07460102)." (p. 2, Section 2.1) 2) "Clinical trial registration: ClinicalTrials.gov, identifier (NCT07460102)." (p. 1, Abstract) 3) "This study was conducted as part of the Assessment of Training in Healthy Habits and Nutrition Education for Adolescent Athletes (ATHENEA) project, which received ethical approval from the Bioethics Committee of the University of Barcelona (initial protocol: IRB00003099, June 30, 2023; modified protocol: IRB00003099, October 14, 2025)." (p. 2, Section 2.1) 4) "Participant recruitment was conducted between February and March 2025." (p. 3, Section 2.3) 5) "The study was conducted from February 2024 to December 2025." (p. 3, Section 2.4) 6) "Statistical analyses were conducted according to a predefined plan adapted from our previously published pilot study (30)." (p. 4, Section 2.7) 7) ClinicalTrials.gov record NCT07460102, retrieved and verified directly on 21 July 2026: Study First Submit Date 18 February 2026; Study First Post Date 10 March 2026; Start Date 3 February 2025 (ACTUAL); Primary Completion Date 31 October 2025; Completion Date 19 December 2025; Overall Status COMPLETED; Lead Sponsor Andreu Farran-Codina. Detailed Analysis: Criterion P requires that the full protocol be registered before data collection begins, with the registration date verifiably preceding the start of data collection. The paper asserts prospective registration but supplies no registration date. Direct verification of the registry record for this verification pass contradicts the claim: NCT07460102 was first submitted on 18 February 2026 and first posted on 10 March 2026, whereas the registry's own actual start date for the trial is 3 February 2025 and the actual completion date is 19 December 2025. Registration therefore occurred roughly a year after enrolment began and about two months after all data collection had finished. This is retrospective registration, which is precisely the situation the criterion exists to exclude, since a plan filed after the results are known offers no protection against selective reporting. The ethics approvals cited (initial June 2023, modified October 2025) are institutional review board decisions, not public pre-registration of hypotheses and analysis plans, and the modified protocol postdates the primary outcome data collection window. The statistical analysis plan is described only as "adapted from our previously published pilot study" rather than deposited in advance. Criterion P is not met because the ClinicalTrials.gov registration was submitted on 18 February 2026, after the trial had started in February 2025 and after data collection concluded in December 2025.