Abstract
s the number of endurance events has increased, as well as the number of athletes participating in them. Adequate nutritional and water planning is essential to maintain optimal sports performance and to reduce the incidence of gastrointestinal problems. The main objective of this study is to determine the dietary intake and compliance with nutritional recommendations of athletes in two endurance competitions, as well as to assess the incidence of gastrointestinal complaints. Methods: An observational and cross-sectional study was carried out on the consumption of liquids, food, and supplements in 42 triathletes and mountain runners (MRs) participating in a Vi-Half-Gasteiz triathlon and the Ultra
study is to determine the dietary intake and compliance with nutritional recommendations of athletes in two endurance competitions, as well as to assess the incidence of gastrointestinal complaints. Methods: An observational and cross-sectional study was carried out on the consumption of liquids, food, and supplements in 42 triathletes and mountain runners (MRs) participating in a Vi-Half-Gasteiz triathlon and the Ultra Sierra de Cazorla trail run. At the completion of the trials, participants completed a validated questionnaire (NIQEC). Results: The mean caloric intake during the test of the participants in this study was 192.17 kcal/h, while the mean carbohydrate intake was 43.67 g/h, the mean sodium intake was 267.43 mg/h, and the mean caffeine intake was 15.53 mg/h, with no significant differences between the two sports. The amount of liquids consumed by the participants was 421.21 mL/h, with no significant differences between the triathletes and MRs. As for gastrointestinal problems, it was observed that the participants presented gastrointestinal discomfort in 61.9% of the cases. Conclusions: The intakes of energy, carbohydrates, water, sodium, and caffeine were lower than the current recommendations. There were no differences in the energy, carbohydrate, water, sodium, and caffeine intakes between the triathletes and mountain runners. Gastrointestinal problems showed a high prevalence in these athletes. Keywords:nutrition; endurance; sport supplements; foods; triathlon; trail running 1. Introduction Participation in endurance and ultra-endurance events has experienced great growth in recent decades [1,2]. Among the most practiced is the triathlon, characterized by three sports disciplines: swimming, cycling, and running, which are carried out consecutively, in order to complete the competition in the shortest possible time [3]. This sport offers a wide range of event formats, one of the most popular being the middle distance (1900 m swimming, 90 km cycling, and 21.1 km running) [4]. On the other hand, mountain races (MRs), are characterized by being competitions developed in different environments, from Nutrients2024,16, 189.
Nutrients2024,16, 189 2 of 11 low to medium and high mountain paths with various slopes and technical difficulties, in the shortest possible time and respecting the natural environment. [5]. These can be classified according to the distance covered, finding races from less than 21 km to more than 200 km [5], and ultramarathons can be defined as those covering more than 42.2 km [6]. Carbohydrates (CHO) are the main and most important nutrient for the physical development of the endurance athlete [7,8] because as the sporting event progresses, glycogen levels are progressively reduced, and the amount of fuel available is less [1,7,9]. The type of sport, duration, and intensity will determine the amount of carbohydrates to be consumed during physical activity. For endurance events, lasting more than 2.5–3 h and with a competitive-level intensity, the amount should be 90 g per hour [8–10]. It is of special importance to consider also the timing of intake. Regarding CHO, as a filling strategy, the consumption of 7–12 g/kg 24 h prior and 10–12 g/kg 36–48 h prior to the event is recommended in tests longer than 90 min of duration, as well as consuming between 1–4 g/kg between 1 and 4 h prior [11]. The type of CHO will also depend on the duration and the athlete’s preferences [10,12], trying to avoid high-fiber, high-fat, and high-protein options [12–14]. After exercise, CHO intake is important to replenish glycogen stores, to contribute to the energy needs of the immune system, and to repair damaged tissues [15]. An intake of 0.8–1 g/kg/h of rapidly absorbed carbohydrates is recommended during the first 4 h post-exercise, continuing the rest of the day until having reached 5–7 g/kg, with the inclusion of proteins (0.2–0.4 g/kg/h or 25–30 g/h) being recommended [16]. Intestinal training is essential to increase the rate of CHO oxidation and to avoid the development of gastrointestinal problems during exercise, allowing carbohydrate oxidation by up to 120 g/h [17]. In addition, the combined intake of different types of carbohydrates increases their oxidation rate and reduces the possibility of presenting digestive problems [2,7,13]. On the other hand,
being recommended [16]. Intestinal training is essential to increase the rate of CHO oxidation and to avoid the development of gastrointestinal problems during exercise, allowing carbohydrate oxidation by up to 120 g/h [17]. In addition, the combined intake of different types of carbohydrates increases their oxidation rate and reduces the possibility of presenting digestive problems [2,7,13]. On the other hand, maintaining an adequate state of hydration is essential to main- tain optimal physical development [18]. The goal should be to prevent both dehydration and overhydration, which can contribute to the development of exercise-associated hy- ponatremia (EAH) [19]. During intense physical activity or when weather conditions are adverse, it is advisable to take intakes of 0.6–1 l/h, dividing the intake into smaller intakes of 150–250 mL every 15–20 min and always with an isotonic content [20]. Along with these recommendations, to prevent the aforementioned EAH, sodium should be included; the recommended amount of sodium per hour of competition is between 300–600 mg/h [19]. One of the main problems in these sports is gastrointestinal discomfort, including reflux, heartburn, belching, bloating, stomach cramps or pain, nausea, vomiting, or diar- rhea [14,21]. The intake of nutrients such as fats, fiber, proteins, or highly concentrated CHO solutions has been associated with an increased occurrence of gastrointestinal problems during physical activity [21,22]. Despite the above, previous research, such as the work of Jimenez-Alfageme et al. [23], Martinez et al. [24], or Pfeiffer et al. [22], shows that endurance athletes do not reach the recommended energy intakes or an appropriate water and electrolyte intake. The present study is one of the first to compare dietary–nutritional intakes and the incidence of gastrointestinal problems in different long-term endurance sports. In addition, the previous literature is very limited in these types of descriptions. Therefore, the aim of this study is to evaluate nutrient intake and water consumption, as well as the presence of gastrointestinal problems in triathletes participating in the middle-distance triathlon Vi Half Gasteiz 2022 and in mountain runners participating in the Spanish Cup Ultra Sierra de Cazorla 2022. 2. Materials and Methods 2.1. Design This is an observational
types of descriptions. Therefore, the aim of this study is to evaluate nutrient intake and water consumption, as well as the presence of gastrointestinal problems in triathletes participating in the middle-distance triathlon Vi Half Gasteiz 2022 and in mountain runners participating in the Spanish Cup Ultra Sierra de Cazorla 2022. 2. Materials and Methods 2.1. Design This is an observational and cross-sectional study on the consumption of nutrients, fluids, and supplements and the occurrence of gastrointestinal discomfort by triathletes participating in the Vi Half Gasteiz 2022 middle-distance triathlon and mountain runners participating in the Ultra Sierra de Cazorla 2022. The sample size was calculated with the
Nutrients2024,16, 189 3 of 11 Rstudio software (version 3.15.0, Rstudio Inc., Boston, MA, USA). The significance level was set a priori atp= 0.05. The standard deviation (SD) was set according to the carbohydrate intake (g/h) data from previous studies on ultra marathon runners (SD = 15.2) [24]. With an estimated error (d) of 4.6, the sample size needed was 42 subjects. The study population was selected by non-probabilistic, non-injury, convenience sampling among organizing institutions of competition. The protocol followed, at all times, the World Medical Asso- ciation codes and Declaration of Helsinki for research in humans and was approved by the ethics committee of the University of Alicante with the file number UA-2022-02-01. In addition, the study design as well as the development of the manuscript followed the STROBE statement [25]. 2.2. Participants and Sample Size There were a total of 42 athletes, 32 triathletes, and 10 mountain runners whose anthropometric and sports characteristics are detailed in Table. All participants were of legal age; had participated in regional, national, and/or international competitions for at least 1 year; and had not suffered injury or illness in the previous 6 months to completing the questionnaire. The competitive level was classified as regional (competitions at the provincial and/or autonomous community level), national (competitions throughout Spain), and international (competitions throughout the world). All the athletes included in this study participated voluntarily, giving their prior consent for their participation. Table shows the mean and standard deviation of the descriptive data of the sample, segmented according to the sport they performed. Table 1.Descriptive data of the participants according to the sport they practice. Variables Sports (Mean±SD) Triathlon (n= 32) MR ( n= 10) Age (years) 41.84 ±10.23 43.90 ±5.62 Height (m) 1.75 ±0.06 1.68 ±0.06 Body mass (kg) 69.98 ±7.13 61.92 ±7.78 Body mass index–BMI (kg/m 2 ) 22.82±1.57 21.86 ±1.49 Years of experience 8.31 ±8.00 7.30 ±3.37 Training session per week 6.06 ±1.95 5.00 ±1.33 Training hours per week 10.16 ±3.18 10.30 ±3.09 2.3. Instruments A validated online self-administered NIQEC questionnaire, developed specifically to obtain fluid, food, and supplement intake and to determine the incidence
mass (kg) 69.98 ±7.13 61.92 ±7.78 Body mass index–BMI (kg/m 2 ) 22.82±1.57 21.86 ±1.49 Years of experience 8.31 ±8.00 7.30 ±3.37 Training session per week 6.06 ±1.95 5.00 ±1.33 Training hours per week 10.16 ±3.18 10.30 ±3.09 2.3. Instruments A validated online self-administered NIQEC questionnaire, developed specifically to obtain fluid, food, and supplement intake and to determine the incidence of gastrointesti- nal complaints in endurance competitions, was used [26]. The questionnaire consists of 50 questions and contains five main sections: (1) sociodemographic data; (2) sports data; (3) food, liquid, and supplement intake in the hour before, during, and in the hour after the competition; (4) possible gastrointestinal complaints; and (5) dietary–nutritional planning of the test. The coding of the variables and the estimation of energy and macronutrients was carried out by a trained dietitian–nutritionist, using the Spanish Database of Food Composition (BEDCA) [27] and the data sheets of each sports supplement consumed by the athletes. The questionnaire can be viewed in the Supplementary Material. 2.4. Procedure To select the study participants, the Vihalf Gasteiz 2022 triathlon organizers and the national representatives of the Spanish Federation of Mountain and Climbing Sports (FEDME) were contacted by e-mail to inform them of the characteristics of this study and to request their collaboration. The questionnaire was sent the day after the celebration of the competitions where, after accepting to participate, the link to the NIQEC questionnaire with instructions was made available to the participants, who filled it in voluntarily, telematically, and anonymously.
Nutrients2024,16, 189 4 of 11 2.5. Statistical Analysis All the variables collected were analyzed by means of descriptive statistics, obtaining the mean and standard deviation, as are shown in the tables. In order to analyze the differences in the intakes before, during, and after the sporting event, depending on the sport performed, an analysis of variance (ANOVA) was performed. In addition, a bivariate correlation was performed between the final time of the athletes and the intakes performed both during and before the event. The association between these variables was measured as follows: r < 0.3, low association; r = 0.3–0.5, moderate association; and r > 0.5, high association. As for the categorical variables, the chi-square test (X2) was performed with the aim of analyzing the frequency of gastrointestinal problems during the sporting event of the total sample and according to the sport they performed. The minimum level of statistical significance was set atp< 0.05. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25.0 (IBM, Armonk, NY, USA). 3. Results According to the sport practiced by the athletes, Table ance did not show significant differences in any of the variables analyzed (F = 0.006–0.611; p= 0.938–0.439). Table 2.Descriptive data and ANOVA of the intakes per kilograms of weight of the participants before the competition, according to the sport they performed. Variables Sports (Mean±SD) ANOVA Triathlon (n= 32) MR (n= 10) F p Energy/body mass (kcal/kg) 5.80 ±5.97 6.13 ±5.91 0.023 0.880 CHO/body mass (g/kg) 1.09 ±1.28 1.00 ±1.16 0.037 0.848 Proteins/body mass (g/kg) 0.15 ±0.16 0.16 ±0.16 0.026 0.873 Lipids/body mass (g/kg) 0.13 ±0.18 0.16 ±0.17 0.271 0.605 Sodium/body mass (mg/kg) 4.98 ±6.18 6.80 ±7.15 0.611 0.439 Caffeine/body mass (mg/kg) 0.28 ±0.65 0.26 ±0.35 0.006 0.938 Fluid/body mass (mL/kg) 9.83 ±7.49 12.91±20.27 0.532 0.470 Kcal: kilocalories; kg: kilograms; CHO: carbohydrates; g: grams; mg: milligrams; mL: milliliters. Analyzing the intakes during the competitions, as shown in Table, which shows the total intakes, the analysis of variance only found significant differences for the consumption of sodium (F = 8.617;p= 0.005) and fluids (F = 13.099;p= 0.001), with the
Fluid/body mass (mL/kg) 9.83 ±7.49 12.91±20.27 0.532 0.470 Kcal: kilocalories; kg: kilograms; CHO: carbohydrates; g: grams; mg: milligrams; mL: milliliters. Analyzing the intakes during the competitions, as shown in Table, which shows the total intakes, the analysis of variance only found significant differences for the consumption of sodium (F = 8.617;p= 0.005) and fluids (F = 13.099;p= 0.001), with the consumption of mountain runners being higher in both cases. However, as shown in Table, which shows the hourly intakes, the analysis of variance showed no significant differences in any of the variables analyzed (F = 0.001–2.764;p= 0.980–0.104). Table 3.Descriptive data and ANOVA of the total intakes of the participants during the sporting event, according to the sport performed. Variables Sports (Mean±SD) ANOVA Triathlon (n= 32) MR ( n= 10) F p Energy (kcal) 1100 ±435 1364 ±798 1.821 0.185 CHO (g) 205.10 ±79.21 303.80 ±187.31 1.525 0.224 Proteins (g) 8.05 ±8.24 12.14 ±7.98 1.903 0.175 Lipids (g) 7.35 ±10.32 9.79 ±13.35 0.368 0.548 Sodium (mg) 1437 ±1047 2881 ±2104 8.617 0.005 Caffeine (mg) 88.90 ±149.10 179.27 ±365.99 1.314 0.259 Fluid (mL) 2275 ±1003 4211 ±2495 13.099 0.001 Kcal: kilocalories; kg: kilograms; CHO: carbohydrates; g: grams; mg: milligrams; mL: milliliters.
Nutrients2024,16, 189 5 of 11 Table 4.Descriptive data and ANOVA of the hourly intakes of the participants during the sporting event, according to their sport. Variables Sports (Mean±SD) ANOVA Triathlon (n= 32) MR ( n= 10) F p Energy/hour (kcal/h) 205.10 ±79.22 154.79 ±96.91 2.764 0.104 CHO/hour (g/h) 46.56 ±18.99 34.88 ±23.31 2.586 0.116 Proteins/hour (g/h) 1.45 ±1.41 1.23 ±0.60 0.218 0.643 Lipids/hour (g/h) 1.28 ±1.73 1.00 ±1.25 0.218 0.643 Sodium/hour (mg/h) 269.95 ±188.26 289.40±165.54 0.086 0.771 Caffeine/hour (mg/h) 15.99 ±25.62 15.75 ±27.44 0.001 0.980 Fluid/hour (mL/h) 422.40 ±175.51 447.15±231.54 0.130 0.720 Kcal: kilocalories; kg: kilograms; CHO: carbohydrates; g: grams; mg: milligrams; mL: milliliters. As for after the event intakes, Table significant differences for caffeine consumption (F = 7.106;p= 0.011), as mountain runners did not consume caffeine after exercise. Table 5.Descriptive data and ANOVA of the intakes per kilograms of weight of the participants after the sporting event, according to the sport they performed. Variables Sports (Mean±SN) ANOVA Triathlon (n= 32) MR (n= 10) F p Energy/body mass (kcal/kg) 7.79 ±6.28 9.09 ±7.25 0.304 0.584 CHO/body mass (g/kg) 1.03 ±0.75 0.98 ±0.73 0.037 0.849 Proteins/body mass (g/kg) 0.23 ±0.25 0.40 ±0.43 2.452 0.125 Lipids/body mass (g/kg) 0.29 ±0.32 0.37 ±0.36 0.461 0.501 Sodium/body mass (mg/kg) 12.08 ±14.24 17.10±19.290.799 0.377 Caffeine/body mass (mg/kg) 0.28 ±0.33 0.00 ±0.00 7.106 0.011 Fluid/body mass (mL/kg) 10.72 ±6.02 10.39 ±7.25 0.020 0.887 Kcal: kilocalories; kg: kilograms; CHO: carbohydrates; g: grams; mg: milligrams; mL: milliliters. As presented in Table, and on the one hand, regarding the intakes performed during the event, energy/hour (r =−0.346;p= 0.025) and HC/hour (r =−0.380;p= 0.013) showed a moderate negative correlation with the final time. This means that the higher the energy and carbohydrate intake per hour, the lower the final time, or the other way around. On the other hand, with respect to the intakes before the event, only a moderate positive correlation was found between fat consumption per kilogram of weight and final time (r = 0.348;p= 0.024), indicating, in this case, that the higher the fat consumption, the longer the final time, or the other way around. Table 6.Bivariate
or the other way around. On the other hand, with respect to the intakes before the event, only a moderate positive correlation was found between fat consumption per kilogram of weight and final time (r = 0.348;p= 0.024), indicating, in this case, that the higher the fat consumption, the longer the final time, or the other way around. Table 6.Bivariate correlation between the final time of the athletes in their corresponding events and the intakes before and during the event. During the Competition Before the Competition Intakes Final Time Intakes Final Time Energy/hour (kcal/h) r =−0.346;p= 0.025 Energy/body mass (kcal/kg) r = 0.228; p= 0.146 CHO/hour (g/h) r = −0.380;p= 0.013 CHO/body mass (g/kg) r = 0.122; p= 0.440 Proteins/hour (g/h) r = 0.059;p= 0.710 Proteins/body mass (g/kg) r = 0.286; p= 0.067 Lipids/hour (g/h) r = 0.062; p= 0.696 Lipids/body mass (g/kg) r = 0.348; p= 0.024 Sodium/hour (mg/h) r = 0.092; p= 0.561 Sodium/body mass (mg/kg) r = 0.293; p= 0.059 Caffeine/hour (mg/h) r = 0.164;p= 0.299 Caffeine/body mass (mg/kg) r = 0.044; p= 0.784 Fluid/hour (mL/h) r = 0.036; p= 0.821 Fluid/body mass (mL/kg) r = 0.239; p= 0.128 Kcal: kilocalories; kg: kilograms; CHO: carbohydrates; g: grams; mg: milligrams; mL: milliliters. Table according to the sport they were performing, with 61.9% of the cases showing some type of
Nutrients2024,16, 189 6 of 11 gastrointestinal discomfort. On the one hand, significant differences were only observed in the urge to defecate (X2 = 3.948;p= 0.047), where mountain runners had a higher frequency. On the other hand, and regarding the most frequent gastrointestinal problems, for the total sample and for the triathletes, the most frequent were belching (50.0% and 43.8%, respectively), gas (45.2% and 43. 8%, respectively), and stomach pain (45.2% and 40.6%, respectively), and for the mountain runners, the most frequent were belching (70.0%), reflux (60.0%), nausea (60.0%), stomach pain (60.0%), and the urge to defecate (70.0%). Table 7.Frequency (%) of gastrointestinal problems suffered by the total number of athletes and according to their sport. Gastrointestinal ComplaintsTotal (%) Triathlon (%) MR (%) Statistics Values X2 p Belching 50.0 43.8 70.0 2.100 0.147 Heartburn 40.5 37.5 50.0 0.494 0.482 Reflux 42.9 37.5 60.0 1.575 0.209 Bloating 38.1 34.4 50.0 0.789 0.374 Gas 45.2 43.8 50.0 0.120 0.729 Dizziness 38.1 34.4 50.0 0.789 0.374 Nausea 40.5 34.4 60.0 2.077 0.150 Vomiting 38.1 34.4 50.0 0.789 0.374 Flatus 40.5 37.5 50.0 0.494 0.482 Stomach pain 45.2 40.6 60.0 1.155 0.283 Intestinal pain left 38.1 34.4 50.0 0.789 0.374 Intestinal pain right 40.5 37.5 50.0 0.494 0.482 Urge to defecate 42.9 34.4 70.0 3.948 0.047 Def. normal consistency 38.1 34.4 50.0 0.789 0.374 Abnormal def. loose stools 38.1 34.4 50.0 0.789 0.374 Def. diarrhea 38.1 34.4 50.0 0.789 0.374 Def. bloody stool 38.1 34.4 50.0 0.789 0.374 Def.: Defecation. 4. Discussion This study measured the nutritional and fluid intakes and gastrointestinal discomfort in middle-distance triathlon runners and mountain runners with the use of a NIQEC questionnaire in a population of 42 athletes in total (n= 42). Among the main findings of this study is the appearance of significant differences in the total fluid and sodium consumption during the test, being higher in mountain runners. However, no significant differences appeared between the intakes of the different athletes neither the hour before nor during the test, calculated for each hour of competition, nor in the hour after, except in the case of caffeine which was mostly
Description
This article analyzes dietary intake in endurance competitions.