756 FO74 – Dietary habits and incident knee- and shoulder injuries in adolescent handball: a cohort study with 1149 male and female players

Background Studies indicate that inadequate dietary habits such as low meal frequency and intake of low-energy-dense foods are associated with injuries in adolescent athletes from weight-sensitive sports. This association has been less studied in team sports. Objective To investigate the association between meal frequency, meal timing and nutritional quality, respectively, and incident knee- and shoulder injuries in adolescent handball players. Design Prospective study based on the Swedish Handball Cohort. Setting Swedish handball-profiled secondary schools. Participants Players free from knee and shoulder injuries at baseline, followed 1–3 seasons 2020–2023, including 1149 participants (53% male, mean age 16.7 ± 0.9 years) and 1717 player seasons. Assessment of Risk Factors Meal frequency, meal timing in relation to training/games and intake frequency of foods (i.e., fruits/vegetables, wholegrain etc.), generating a nutritional quality score of 0–12 according to national dietary guidelines, were assessed in a baseline web-survey. Main Outcome Measurements The Oslo Sports Trauma Research Center Overuse Injury Questionnaire was used to assess a substantial injury through weekly follow-ups. An event was registered when the first substantial knee and/or shoulder injury occurred. Cox proportional hazard regression analyses (adjusted for previous injury, dietary supplements, playing position, sleep, sex, and school) including cumulative exposure time-to-event of minutes of playing handball were performed, generating adjusted hazard rate ratios (HRR) with 95% confidence intervals (CI). Results Each increase in nutritional score was associated with a HRR of 1.07 (95% CI 1.01–1.14). Each increase in daily meals generated a HRR of 1.01 (95% CI 0.91–1.11) and each additional meal timed with training/games generated a HRR of 1.00 (95% CI 0.92–1.08). Conclusions Higher nutritional score was associated with incident injuries in adolescent handball players, but not meal frequency or meal timing. These results suggest that sports nutrition recommendations rather than national dietary guidelines may be of clinical importance in adolescent handball.