Profiles for identifying problematic dietary habits in a sample of recreational Spanish cyclists and triathletes

Clinical Trials & Research

The main aim of the present study was to assess the dietary intake of Spanish recreational cyclists and triathletes. The main finding was that a large proportion of the present sample consumed an unbalanced diet, characterised by excess protein, and CHO and vitamin E deficiencies. Females and triathletes appear to follow a healthier diet than males and cyclists given that they consumed greater amounts of vegetables, fruits, nuts, wholegrain cereals and olive oil, in addition to consuming less refined cereals, soft drinks and alcoholic beverages including beer and wine. Females and triathletes also had a higher intake of unprocessed food and a lower intake of ultra-processed food than males and cyclists. A high proportion of triathletes who reported regular supplementation, demonstrated an excessive vitamin B3 intake. On the other hand, cyclists tended to belong to a group of individuals characterised by fibre, calcium, zinc, iodine, magnesium, and vitamin B1, B9 and D deficiencies, in addition to poor lipid quality.

The SENC recommends a minimum daily consumption of two servings of vegetables and up to three servings of fruit21. Values from the present study are consistent with these recommendations. When compared with the Spanish population we observe that average fruit and vegetable intake corresponds to approximately two servings a day, falling short of the five servings recommended22. Spanish SENC guidelines encourage individuals to eat pulses at least two to four times a week. The present study reported consumption of approximately 2.5 servings a week, this being higher than that previously reported for the Spanish population23. The present study shows an average consumption of meat and derivatives that corresponds to approximately 1.5 additional servings to the maximum of three recommended by the SENC. These outcomes are similar to those previously published in the Spanish population23 which revealed an average daily consumption of 146 g/day. The present study shows a higher intake of fish and seafood than that recommended by the SENC (2–3 portions per week). However, the average intake of 88.9 g/day was similar to that found in the Spanish population24. Dietary guidelines for the Spanish population21 recommended between 3 to 5 servings of eggs a week. Consumption in the present study was lower than this, whilst also being slightly lower than that previously reported in the Food Consumption Survey25 (32 g/day). With regards to olive oil consumption, similar trends have been reported previously by the ANIBES23 study, corresponding to 17.5 g/day.

The present study demonstrates different food consumption patterns between men and women. Women presented a higher intake of unprocessed food and a lower intake of ultra-processed food with higher levels of vegetables, fruits, nuts, wholegrain cereals and olive oil, alongside a lower intake of refined cereals, baked goods and pastries, sugar and sweets, and drinks and alcoholic beverages including beer and wine. These outcomes are similar to those reported by Fagerli and Wandel26 which showed women to follow a healthier diet than men. A possible explanation for this is that women are often more weight-conscious and believe that it may be advisable to limit carbohydrates and fat consumption. Further, this is the first study to show differences in food consumption patterns between recreational triathletes and cyclists. Triathletes showed a higher intake of unprocessed food and a lower intake of ultra-processed food with greater consumption of fish and seafood, vegetables, fruits, nuts, wholegrain cereals and olive oil, alongside lower consumption of refined cereals, and drinks and alcoholic beverages including beer and wine. A possible explanation for this might be that triathletes have a higher socioeconomic status16. Further, cyclists tend to follow “old” nutritional strategies passed through word of mouth, whereas triathletes, taking part in a “new” sport relative to cyclists, do not have this problem. However, this aspect needs to be more deeply studied.

Mean total CHO intake was 246.0 ± 88.1 g/day. This is slightly higher than the 185.4 ± 60 g/day reported in previous studies with Spanish populations27. However, findings uncovered by the present study (46.8% ± 7.1), represent values that are still below the lower limit of 50%-60% total energy recommended by the SENC28. The American College of Sport Medicine recommends that CHO intake should range from 6 to 10 g/kg of BM for athletes3. This is due to the fact that carbohydrate maintains blood glucose levels during exercise and replaces muscle glycogen. In the present study, participants average CHO consumption amounted to 3.5 ± 1.4 g/kg of BM in general and was higher in woman (4.2 ± 1.6 g/kg of BM) than in men (3.4 ± 1.4 g/kg of BM). Another study with non-elite athletes competing in endurance sports showed that between 23 and 54% of athletes did not consume the recommended amounts of CHO29.

Total fat intake should constitute more than 20% of total energy intake. Failing to reach this intake could impede correct absorption of lipid-soluble vitamins, whilst failing to provide sufficient essential fatty acids3. When engaging in moderate physical activity, 30% of energy from fat intake is recommended. This increases to 35% when engaging in high physical activity30. Values reported in the present study met SENC recommendations that total fat intake should account for 30–35% of total energy31. Similar results have been reported for the Spanish population with a total fat intake of 78.7 (26.5) g/day in 18–64-year-old adults27.

With regards to the quality of fats, in 201032 WHO/FAO recommended a maximum intake of SFA of 10% of total energy due to the association between SFA consumption and cardiovascular disease risk33. PUFA consumption should fall within a range of 6–11%, whilst MUFA intake can account for up to 15–20% of energy from total fat intake. Results from the ANIBES study in Spain showed SFA intake to be above recommended levels regardless of age and sexes27, with similar trends also emerging across most countries34. A healthier SFA intake (10.0 ± 2.5%) was found in the present sample of recreational Spanish athletes. It has been suggested that MUFA induces a protective effect against metabolic syndrome and cardiovascular disease risk factors35. Further, PUFA, especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), has been recommended for its potential benefits for human health36. In the present study, MUFA and PUFA intake was within recommended ranges (14.8 ± 3.5% and 6.4 ± 1.8, respectively), although slightly higher percentages were found in women than men. In general, these results are similar to the results reported in the ANIBES study27, however, this previous study did not find sex- or age-related differences.

In the present study, overall protein intake was well above current recommendations for the Spanish adult population, which stipulates an upper limit of 15% of total energy31, or a total protein intake of about 0.8 g/kg BM. Similar trends were observed by the Spanish National Survey of Dietary Intake24 and the European Food Safety Authority in 201237. The present study also showed higher protein intake than that recommended by the American Dietetic Association of Canada and American College of Sports for endurance athletes (1.2 to 1.4 g/kg BM/day)3. Protein is a crucial macronutrient for providing substrates for the repair and remodelling of muscle and body proteins38. In the present study, males reported the upper limit of this recommendation, whilst females exceeded this by consuming 1.7 ± 0.5 g/kg BM/day. A diet that is high in protein and low in CHO is not only typical in Western countries but typical of professional athletes in many different countries39,40. Individuals who consume this type of diet risk suffering metabolic acidosis, which can negatively impact athletic performance6.

The intake of all vitamins and minerals exceeded their respective RDA or AI, with the exception of vitamins D and E and, in some cases, calcium. Exercise stresses many of the metabolic pathways where micronutrients are required and exercise training may result in muscle biochemical adaptation that increases micronutrient needs. The most common vitamins and minerals of concern to athletes are calcium and vitamins D, C, E and B complex, alongside iron, magnesium and selenium41. Our study showed an excess of all of the above apart from vitamins D and E. Vitamin D is required for adequate calcium absorption and bone health31. However, as vitamin D is not only obtained from the diet but can also be obtained through sun exposure, vitamin D inadequacy may be diagnosed by evaluating serum total 25-(OH)-vitamin D. Low vitamin E intake is common within European and US populations and could be the result of the low stability of this vitamin in vegetable oils42.

Supplements are commercially available products used to complement the normal diet through the provision of additional vitamins, minerals, amino acids, etc43. Supplements are normally used because of the ergogenic effects of the vitamins or minerals they comprise on recovery from exercise and health10. However, consumers tend not to use this product for their intended purpose and they are not compatible with normal eating habits44. To our knowledge, this is the first research study to examine the prevalence of supplementation in recreational endurance athletes whilst also considering the two different sporting disciplines of cycling and triathlon. The proportion of participants that reported often taking supplements in our study is much lower than that reported in other studies with professional athletes45,46. The majority of participants who took supplements opted to take protein, multivitamins, minerals and omega-3. A certain degree of supplementation can be justified. For instance, some women may supplement with iron. Iron deficiency can impair muscle function and limit work capacity, resulting in impaired training adaptations and poorer performance47. The present study did not find differences in iron intake between women of different specialities. Both cyclists and triathletes generally met iron requirements. However, other supplements, such as multivitamins, are recommended only when deficiencies are present and only under professional supervision10. Nonetheless, a number of previous studies have shown that athletes most frequently consume multivitamins and mineral supplements without supervision, instead using them indiscriminately at their own discretion48. Protein supplementation also seems to be inappropriate as many participants already exceeded guideline amounts of protein through their regular diet alone.

The present study revealed a group of participants who tended to be triathletes, supplemented often and consumed an excessive amount of vitamin B3. Excessive vitamin B3 intake could provoke flushing, headaches, light-headedness, itching, nausea and vomiting. In addition, liver injury can occur in rare cases and progress to fulminant hepatic failure49. As the indiscriminate use of vitamin and mineral supplements may adversely affect physiological function and impair health50, it is recommended to consume high nutrient density food rather than nutritional supplements. Another group, mostly formed of cyclists, was characterised by deficiencies in vitamin B9, D and B1, in addition to calcium, zinc, iodine, magnesium and fibre deficiencies. Further, lipid quality within the cluster was generally poor. Even though a high percentage of the overall sample reported high micronutrient intake in general, we found a cluster of mostly cyclists whose consumption was less than the required amount. Perceptions that supplements could substitute a well-balanced diet may explain these deficiencies.

A limitation of the present study is its cross-sectional design, which inhibits examination of causal relationships, whilst the relatively small number of females could have masked further gender differences. Further, measurement error is an inherent risk of self-report questionnaires. However, the FFQ has previously demonstrated high validity and reliability within similar populations. We used the Willett method13 to exclude participants reporting excessively low or high energy intakes. An advantage of this method is that it provides a consistent protocol in cases where the dietary-report instrument employed does not allow for an accurate estimation of energy intake, as is the case with food frequency questionnaires. However, the method still assumes that all values exceeding a given value are inappropriate without considering the activity level of individuals. Height and weight were self-reported as opposed to directly measured due to time, financial resources and manpower constraints. While this method is less accurate than direct measurement, it has demonstrated good agreement and validity in healthy weight populations.

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