Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 7, 1262-1268 2025 Publisher: Learning Gate DOI: 10.55214/25768484.v9i7.8878 © 2025 by the authors; licensee Learning Gate © 2025 by the authors; licensee Learning Gate History: Received: 9 May 2025; Revised: 26 June 2025; Accepted: 30 June 2025; Published: 15 July 2025 * Correspondence: okosta@ust.edu.al The CEAC-Q for endurance athletes in competition, verification of a useful and time-efficient instrument for knowledge evaluation Orkida Kosta1*, Ortensia Kosta2 1Sports University of Tirana, Faculty of Movement Sciences, Tirana, Albania; okosta@ust.edu.al (O.K.). 2University of Medicine, Faculty of Medicine, Tirana, Albania. Abstract: Despite strong evidence that increased carbohydrate (CHO) availability promotes endurance performance, athletes frequently report eating less CHO during competition. The absence of practical or time-efficient methods for assessing athletes' understanding of CHO may be a contributing factor to these findings. Therefore, we attempted to validate a novel questionnaire to immediately assess endurance athletes' awareness of competition CHO guidelines. The students completed three subsections of the questionnaire (CHO metabolism, CHO loading, and pre-event meal), with each subsection valued at 15 points. The CEAC-Q was completed by 100 individuals, 56 of whom were women and 44 were men. The total CEAC-Q scores did not differ among the subsections regarding population-level averages for low (0–39%), moderate (39–69%), and high (70–100%) knowledge (p < 0.001). The CEAC-Q provides practitioners with a valid and effective psychometric tool for assessing athletes' comprehension of CHO competition standards. This evaluation not only helps to identify knowledge gaps but also offers suggestions for future dietary interventions aimed at improving athletic performance. Keywords: Carbohydrates, CEAC-Q, Lifestyle, Sport nutrition. 1. Introduction Current dietary guidelines for carbohydrates (CHO) are based on a large amount of research showing the benefits of optimal CHO consumption for endurance performance before and during competition. Despite recommendations with substantial scientific evidence that adequate carbohydrate (CHO) intake can improve endurance performance, endurance athletes have been observed to fail to meet these criteria for competition [1-6]. Nutrition knowledge is an essential component driving general dietary behaviour [7] yet little is understood about endurance athletes knowledge of CHO guidelines and how they relate to practice within competition. Given that runners and triathletes have been shown to lack basic nutrition knowledge [5, 8] ignorance of CHO requirements may be the main contributing factor. We have created a new survey called the Carbohydrates for Endurance Athletes in Competition (CEAC-Q) to support this [6]. Adequate nutrition knowledge is an essential component to drive an athlete’s behaviour and optimise general dietary intake [9]. 2. Methods The questionnaire was developed based on the findings of recent sports nutrition research on CHO for endurance sports as well as the current American College of Sports Medicine (ACSM) guidelines. To complete the CEAC-Q, study participants had to be endurance athletes over the age of 18 who were actively training and competing in endurance sports events such triathlons, cycling, and running. The Declaration of Helsinki's criteria were followed in the conduct of this study. Each person online consented to participate and provided written informed permission after receiving the participant information statement. Using the CEAC-Q in Albanian, the current study evaluated an international 1263 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 7: 1262-1268, 2025 DOI: 10.55214/25768484.v9i7.8878 © 2025 by the authors; licensee Learning Gate cohort of endurance athletes' current CHO for competitive nutrition knowledge between January and March. Table 1. Demographics of endurance athletes and general population. Characteristic Frequency (n%) CEAC-Q score % ± SD P (Between groups ) All 100 Gender < 0.042 Female 56 53 ± 19 Male 44 45 ± 20 Age (years) 18 26 53 ± 19 < 0.001 19 32 52 ± 20 20 28 45 ± 20 21-28 14 40 ± 19 Education Highschoolcertificate/ Diploma 53 49 ± 19 < 0.001 Undergraduate 47 50 ± 21 Postgraduate Doctorate Sport Cycling 31 51± 20 < 0.045 Triathlon 4 42 ±19 Running 17 51± 20 Football 36 52± 21 Other 12 45 ±23 Competitive level Amateur 88 45 ±23 < 0.001 Professional 12 37 ±20 Table 1 summarizes the demographic information gathered about gender, age, education, sport, competition level, and years of competition, as well as whether athletes had previously worked with a dietitian or nutritionist and their main source of information on sports nutrition and its correlation with CEAC-Q scores. Table 2. Carbohydrate for Endurance Athletes during Competition Questionnaire Scoring Sheet (CEAC-Q). Section 1: Carbohydrate storage 1.Which factor(s) influence how much carbohydrate our body uses during exercise? Exercise intensity 52 (High) Exercise duration 22 Environment 3 Training status (fitness level,years of training) 16 Carbohydrate never 1(Low) Unsure 6 2. Which of the following carbohydrate related factors contribute to fatigue during exercise ? Low blood sugar levels only 9 Low muscle glycogen stores only 11 Low blood sugar AND muscle glycogen 65 (High) Carbohydrate not required 7 (Low) Unsure 8 3.In a carbohydrate loaded state carbohydrate is stored in the body as ; Muscle glycogen only 13 Liver glycogen only 4 Muscle glycogen (80%) and liver glycogen (20%) 54 (High) Muscle glycogen (20%) and liver glycogen (80%) 18 Carbohydrate is not stored in the body 1 (Low) Unsure 10 4. In a carbohydrate loaded state, total carbohydrate storage in the body is <200 g 11 200–400 g 24 1264 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 7: 1262-1268, 2025 DOI: 10.55214/25768484.v9i7.8878 © 2025 by the authors; licensee Learning Gate Section 1: Carbohydrate storage approximately: 400–600 g 27 Carbohydrate is not stored in the body 3 Unsure 35 5. Which source of carbohydrate stores is used to maintain normal blood sugar during exercise? Muscle glycogen only 15 Liver glycogen only 51 (High) Muscle and liver glycogen 17 Carbohydrate stores are not used to maintain blood sugar during exercise 6 Unsure 14 Section 2: Pre-Competition Carbohydrate Loading 6. Carbohydrate loading in the days before a competitive endurance event can increase endurance performance by? Carbohydrate loading cannot increase endurance performance 4 Increasing maximal speed or power output during prolonged exercise 7 Delaying the onset of fatigue during the late stages of prolonged exercise 67 (High) Unsure 22 7. Carbohydrate loading to maximise glycogen stores is most efective in improving performance in competitive events lasting: Less than 60 min 5 60–90 min 11 More than 90 min 64 (High) Carbohydrate loading is unnecessary 9 Unsure 11 8. When carbohydrate loading before competition, the recommended range of carbohydrate intake per day is? Less than 4 g per kilogram body mass 3 5–8 g per kilogram body mass 24 9–12 g per kilogram body mass 26 (High) More than 12 g per kilogram body mass 3 Carbohydrate loading is never required 6 Unsure 28 9. When competing WITHOUT carbohydrate loading, the recommended range of carbohydrate intake per day is? Less than 4 g per kilogram body mass 20 5–8 g per kilogram body mass 30 (High) 9–12 g per kilogram body mass 7 More than 12 g per kilogram body mass 3 Eating carbohydrate is never required before exercise 9 Unsure 31 10. To maximise muscle glycogen stores, carbohydrate loading (in combination with a tapering of training loads) is best followed for: 12–24 h before a competition 13 24–48 h before a competition 54 (High) A week before a competition 23 Carbohydrate loading is never required 2 Unsure 8 Section 3: Before Competition Carbohydrate Meal 11. How much carbohydrate should a meal eaten before competition contain Less than 1 g per kg body mass 6 1–4 g per kg body mass 38 (High) More than 4 g per kg body mass 21 Eating carbohydrate is never required before exercise 4 Unsure 31 12. When is eating a meal or snack rich in carbohydrate likely to improve performance? Before competition lasting LESS than 60 min 9 Before competition lasting MORE than 60 min 53 (High) Never 2 Always 25 Unsure 10 13. Eating a meal rich in carbohydrate in the hours before competition specifcally helps to: To increase MAINLY muscle glycogen stores 28(High) To increase MAINLY liver glycogen stores 17 Increase both muscle and liver glycogen stores 27 Eating carbohydrate before competition has no signifcant efect on carbohydrate stores 4 Unsure 24 14. A meal rich in carbohydrate should be eaten Less than 1 h before 1 1265 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 7: 1262-1268, 2025 DOI: 10.55214/25768484.v9i7.8878 © 2025 by the authors; licensee Learning Gate Section 1: Carbohydrate storage how many hours before competition 1–4 h before 58 (High) More than 4 h before 25 Eating carbohydrate is never required before exercise 3 Unsure 10 15. Which of the following statements is correct regarding carbohydrate intake and gastrointestinal distress: Eating carbohydrate before and during competition always results in gastrointestinal distress 2 The gut can NOT be trained to tolerate carbohydrate before and during competition 7 The gut CAN be trained to tolerate carbohydrate before and during competition 79 (High) Unsure 12 2.1. Section 1: Carbohydrate Metabolism and Utilization Question 4 showed low knowledge (F), questions 1, 2, 3 and 5 showed a reasonable comprehension of CHO metabolism and utilization. Particularly, there was little understanding of the overall storage of carbs (Question 4, 35% correct), the percentage of carbohydrates in the liver and muscle (Question 4, 54 % correct), and the function of the liver's glycogen reserves (Question 5, 51 % correct). The identification of blood sugar and muscle glycogen as factors linked to fatigue (Question 2, 60% correct) showed a moderate level of understanding. Overall awareness of the factors influencing carbohydrate usage was moderate (Question 1, 42% right), notwithstanding the uneven frequency of properly answered sub-questions. Although the length and intensity of knowledge were high (Question 1, 84% and 83% correct, respectively), the environment and training state were only moderately correctly identified as important factors (Question 1, 55% and 53% correct, respectively). 2.2. Section 2: Carbohydrate Loading Questions 8 and 9 demonstrated a low level of awareness on CHO-loading, while question 10 demonstrated a moderate level of understanding (Table 2). The determination of the quantity of carbohydrates needed for carbohydrate loading (Question 8, 26% correct) and for situations in which carbohydrate loading is not necessary (Question 9, 30 % correct) specifically demonstrated a lack of understanding. The average amount of time needed for carbohydrate loading was moderately understood (Question 10, 54% correct). 2.3. Section 3: Before Competition Carbohydrate Meal While questions 11 and 14 demonstrated a good understanding of CHO in the pre-event meal, questions 12 and 13 demonstrated a poor awareness of it (Fig. 2, Table 2). The identification of 1-4 g/kg CHO in the meal before competition (Question 11, 38% accurate) and the time period of 1- 4 hours prior to exercise (Question 14, 58% correct) in particular showed a respectable level of expertise. We discovered that eating CHO in the hours before exercise is mostly done to restore liver glycogen levels (Question 13, 28% correct) and that little is known about when pre-event carbohydrates are likely to increase performance (Question 11, 38% correct). 3. Discussion Knowledge levels were classified as low (less than 40%), intermediate (between 41 and 70%), and high (more than 70%). We discovered that knowledge levels were not significantly predicted by demographic factors. Our current findings of athletes' average CEAC-Q scores, which are similar to our validation study's findings of 46 ± 19% [10] support the idea that most athletes lack expertise (Figure 1). Although there were no variations in knowledge between CEAC-Q section scores, we did find significant disparities in understanding of specific questions. This implies that people are more likely to know less about nutrition if they are not exposed to as many reliable information sources. We employed a cohort of endurance athletes to assess the population's awareness of carbohydrate guidelines for 1266 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 7: 1262-1268, 2025 DOI: 10.55214/25768484.v9i7.8878 © 2025 by the authors; licensee Learning Gate competition using the previously validated CEAC-Q questionnaire [10]. Three knowledge levels were distinguished: low (less than 40%), moderate (between 41 and 70%), and high (more than 70%). We discovered that knowledge levels were not significantly predicted by demographic characteristics. The majority of the athletic population has limited knowledge, according to our most recent data on average CEAC-Q scores among athletes, which confirms the 46 ± 19% [10] results of our validation research (Fig. 1).Our results on CHO intake are in line with what has been previously documented in the literature, which indicates that endurance athletes typically consume 3.3–5.8 g · kg−1 [6, 7, 10-14] for CHO‐loading and 12–94 g · h−1 [10-12, 15-17] for CHO during competition. The study's primary conclusion is that there was no correlation between endurance athletes' food habits during competition and their understanding of the recommended CHO consumption. To the best of our knowledge, this is the first study conducted in Tirana to link athletes' theoretical knowledge and practice with their competitive CHO consumption. Although some endurance athletes were able to identify the latest CHO norms, this information isn't always used in real-world situations. Our findings imply that other obstacles and enabling factors might be just as significant in converting scientific knowledge into the best dietary practices for endurance athletes competing, even though theoretical knowledge is generally regarded as a fundamental component of best practice in nutrition [18]. A new frontier in the relationship between knowledge and practice is revealed when food intake is evaluated in conjunction with the CEAC-Q [19]. It is evident that endurance athletes have gaps in their theoretical understanding and dietary habits regarding CHO loading and ingestion during competition. Despite demonstrating disparities in knowledge across various demographics (Table 1), their predictive ability was poor, and in certain situations, their therapeutic applicability was in doubt. Overall, though, they imply that having access to high-quality information is linked to having more knowledge. When assessing athletes' degree of nutrition awareness, demographics are usually a significant factor [18]. The CEAC-Q scores of male athletes were significantly higher than those of female athletes; however, this difference is equivalent to an average of 0–5 more correct answers. In contrast to Trakman et al. [20] who found no difference in general nutrition knowledge between amateur and professional athletes, we found significant increases in CEAC-Q scores in athletes competing at a higher level and with more experience, with an average difference of 12 points between amateur recreational and professional athletes. Completing the CEAC-Q may initiate a series of thought processes that result in novel understandings or information [21]. Given their innate desire to obtain a competitive edge, athletes may attempt to fill in knowledge gaps between exams [22]. A different and minor random mistake in repeat tests implies strong reliability and construct validity since it suggests learning processes at work, and scores are expected to rise after self-education [23, 24]. In order to maximize endurance performance, nutritionists will be able to better understand why athletes don't meet required CHO intakes and create more effective, enhanced athlete nutrition education materials and programs [25]. 4. Conclusion In summary, our results show that there is a disconnect between practice and understanding of CHO competition standards. The causes of the mismatch are still unclear, which emphasizes the necessity for qualitative research examining athletes' justifications for the discrepancy. This could lead to fresh perspectives on how athletes can enhance their performance and pinpoint their potential, opportunities, and motivational requirements to maximize their dietary habits. Transparency: The authors confirm that the manuscript is an honest, accurate, and transparent account of the study; that no vital features of the study have been omitted; and that any discrepancies from the study as planned have been explained. This study followed all ethical practices during writing. 1267 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 7: 1262-1268, 2025 DOI: 10.55214/25768484.v9i7.8878 © 2025 by the authors; licensee Learning Gate Copyright: © 2025 by the authors. This open-access article is distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). References [1] A. Jeukendrup, "A step towards personalized sports nutrition: Carbohydrate intake during exercise," Sports medicine, vol. 44, no. Suppl 1, pp. 25-33, 2014. https://doi.org/10.1007/s40279-014-0148-z [2] T. Stellingwerff and G. R. 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