Analysis of health claims regarding creatine monohydrate present in commercial communications for a sample of European sports foods supplements.

OBJECTIVE: To analyse the information on health claims present in the labelling of creatine monohydrate (CM) products. DESIGN: A descriptive study of a selection of products marketed as CM, with health claims, and that met the inclusion/exclusion criteria, was conducted using the Amazon and Google Shopping websites. The adequacy and compliance of the health claims were evaluated with the European legislative requirements (European Food Safety Authority and European Commission). The results were discussed with scientific evidence criteria from the Academy of Nutrition and Dietetics, International Olympic Committee, and International Society of Sports Nutrition, as well as the systematic review carried out by Mielgo-Ayuso in 2019. SETTING: Health claims in the commercial communications of a sample of CM supplements, in relation to current legislation and scientific knowledge. PARTICIPANT: A total of 554 CM products were obtained. RESULTS: Of the total sample, only 167 met the inclusion/exclusion criteria. Of these, 30·5 % recommended a CM dose of 5·0-5·9 g/d, while 29·9 % recommended 3·0 to 3·9 g/d. As for the health claims, 'Enhances physical performance' appeared in 73·1 % of the supplements, in most cases referring to a dosage of 3·0 to 3·9 g/d for these products. The rest of the declarations were not adequate or needed to be modified. CONCLUSION: Only 25 % of the health claims complied with the criteria established by the scientific reference documents. Most of the declarations must be modified or eliminated, as they could be considered fraudulent and/or misleading for the consumer.

Caffeine Health Claims on Sports Supplement Labeling. Analytical Assessment According to EFSA Scientific Opinion and International Evidence and Criteria.

Caffeine is a food supplement widely consumed by athletes, but it has not been established. So far, the veracity of their labeling in terms of the dosage and cause/effect relationship aimed at the consumer. The aim is to analyze the health claims and the dosage presented on the labeling of caffeine supplements and to evaluate if they follow the European Food Safety Authority (EFSA) and international criteria. A descriptive cross-sectional study of a sample of caffeine supplements was carried out. The search was done through the Amazon and Google Shopping web portals. In order to assess the adequacy of the health claims, the guidelines of reference established by European Food Safety Authority were compared to the Academy of Nutrition and Dietetics, International Olympic Committee, and Australian Institute of Sport guidelines; in addition, recent systematic reviews were addressed. A review of labels of 42 caffeine supplements showed that, in less than 3% of the products were the health claims supported by the recommendations and by the labeled quantity of caffeine. The claims that fully complied the recommendations were, "improves or increases endurance performance", "improves strength performance", or "improves short-term performance". In most cases, the recommended dosage was 200 mg/day for these products, which is the minimum for the caffeine effects to be declared. The rest of the health claims were not adequate or need to be modified. Most of the health claims identified indicated an unproven cause and effect, which constitutes consumer fraud, and so must be modified or eliminated.

Influence of economic crisis on dietary quality and obesity rates.

The objective was to investigate how socio-economic changes have modified body mass index values and dietary patterns in the Spanish population. A comparative cross-sectional analysis of the last two iterations of the Spanish National Health Survey (SNSH) was done. The independent variables were sex, age, education level, employment situation, and social class. Outcome variables were: poor diet quality and obesity. Economic crisis increases the probability to become obese and to have a poor diet and employment situation is the variable that showed the greatest differences between years. While in 2006 to be unemployed did not represent a risk to have a poor diet [odds ratio (OR): 0.74; p<.005], in 2012 it did (OR: 1.27; p<.005). Economic changes can modify diet quality and nutritional status, increasing the risk to have a poor diet or to be obese.

Development and Validation of a New Questionnaire Assessing Feeding Styles in Toddlers: Toddler Feeding Style Questionnaire (TFSQ).

PURPOSE: To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ). DESIGN AND METHODS: An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12-24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested. RESULTS: The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p < .01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months. CONCLUSIONS: The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers. PRACTICE IMPLICATIONS: Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness.

Nutritional Status and Cardiometabolic Risk Factors in Institutionalized Adults with Cerebral Palsy.

Background and Objectives: Cerebral palsy (CP) is a set of permanent disorders that limit physical activity and increase the risk of developing other diseases, such as metabolic syndrome (MS). Adequate nutrition can contribute to the prevention of associated symptoms. The main objective of this study is to evaluate the nutritional status and the prevalence of cardiometabolic risk factors in adults with CP and Gross Motor Function Classification System (GMFCS) levels between IV and V. Materials and Methods: A sample of 41 adults with CP and GMFCS levels from IV to V were studied. The variables used in the study were age, sex, weight, height, mean age, and GMFCS level range. To evaluate nutritional status, body mass index and the Mini Nutritional Assessment (MNA), a nutritional screening tool, were used. To assess cardiometabolic risk, data on obesity, central obesity, blood pressure, fasting plasma glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were collected. Results: More than 80% of the population studied was malnourished or at risk of malnutrition, according to the MNA tool classification ranges, and around 35% of the studied population was within the underweight range. Regarding cardiometabolic risk factors, only one adult with CP was diagnosed with MS. Conclusions: The studied population of adults with CP and GMFCS levels between IV and V is not a population at risk of MS; however, the high prevalence of malnutrition, as well as some of the most prevalent cardiovascular risk factors, should be taken into consideration.

The combined effect of family environment and parents' characteristics on the use of food to soothe children.

Parental feeding practices, such as the use of food to soothe, can be shaped by various factors, including the family environment and parents' psychological characteristics and capacities. To our knowledge, the combined effect of these factors has not been studied. Furthermore, parental feeding practices have mainly been studied in women, resulting in a gender gap in the research. This study aims to investigate the combined effect of family environment and parental characteristics on the likelihood of using food to soothe children, taking the gender of both parents into account. This cross-sectional study included a sample of 846 parents (36.3% men) of 1-year-old children from different regions of Spain. Participants completed an online survey that included questionnaires to measure whether parents used food to soothe children, the family environment, parents' characteristics, and their psychological capacities. Binary logistic regression analyses were performed to identify associations between the variables. The final model showed that, within the family environment, higher levels of dyadic adjustment between couples (OR = 0.965; p = .026) were associated with a reduced likelihood of using food to soothe children, whereas the psychological characteristic of parental fatigue (OR = 1.053; p = .007) appeared to be associated with an increased likelihood. Also associated with an increased likelihood of this practice were higher parental sense of competence (OR = 1.028; p = .029) and the attention dimension of emotional intelligence (OR = 1.043; p = .007). Our study suggests that using food to soothe children may be influenced by factors at different levels, from the quality and adjustment of the couple's relationship to parental fatigue, self-competence, and emotional intelligence. For future research, it may be worthwhile contextualizing parental practices to gain a better understanding of children's behavior.

Are the Dietary-Nutritional Recommendations Met? Analysis of Intake in Endurance Competitions.

BACKGROUND: In recent decades 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 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.

Paternal feeding practices and styles: a systematic review.

CONTEXT: Studies on parenting, including feeding styles and practices in general, have focused mainly on mothers. Consequently, there is a gap with respect to fathers in the scientific literature. OBJECTIVE: This study's main objective is to determine paternal feeding styles toward children aged 0 to 18 years and to identify those most commonly used by men. DATA SOURCES: The PubMed, Scopus, Web of Science, Cochrane, and PsycINFO databases were consulted. DATA EXTRACTION: Articles that were not published in English, Spanish, or Italian were excluded, as well as those that referred to other subjects, those whose sample did not include men, or those studying children with pathologies that could influence their diet. All the articles ultimately included were assessed using the STROBE checklist. DATA ANALYSIS: A total of 183 articles were found. Of these, 13 were included in the review. No trend was found for paternal parenting style, and disparities existed among the authoritative, authoritarian, and permissive styles. In terms of feeding practices, men were more likely to use coercion. The most reported feeding styles were authoritarian and permissive. CONCLUSIONS: The findings of systematic review suggest cultural and gender differences exist with respect to parenting styles and feeding styles and practices. In terms of paternal parenting styles, there is some disparity. However, when it comes to feeding, men showed a tendency toward an authoritarian feeding style and coercive feeding practices.

Are the Consumption Patterns of Sports Supplements Similar among Spanish Mountain Runners?

BACKGROUND: The use of sports supplements (SS) to improve sports performance is widespread in all types of athletes, however, the specific characteristics of mountain races may require the use of certain SS. Despite being a sport where the consumption of SS seems widespread, few studies have been conducted in this regard. The objective of this study is to analyze the pattern of SS consumption of mountain runners in relation to the degree of scientific evidence, sex, and level of competition. METHODS: Descriptive and cross-sectional study on the consumption and habitual use of SS of 357 federated mountain runners in Spain. Data were collected through a validated questionnaire. RESULTS: From the total sample, 93.84% of the athletes stated that they consumed SS, with no differences observed based on the competitive level or in terms of sex; however, there were significant differences according to the competitive level in terms of the number of SS consumed, with consumption being greater at a higher competitive level (p = 0.009). The most consumed SS were sports bars (66.1%), sports drinks (60.5%), sports gels (52.9%), and caffeine (46.2%). CONCLUSIONS: The consumption of SS in mountain races is high, and the number of SS consumed is higher as the competition level increases. The four SS most consumed by the participants in this study were all included in category A in the classification of the Australian Institute of Sport (AIS), this category is the one with the greatest scientific evidence.

Development of an Instrument to Evaluate the Intake of Liquids, Food and Supplements in Endurance Competitions: Nutritional Intake Questionnaire for Endurance Competitions-NIQEC.

BACKGROUND: In the last few years endurance sports have experienced a great increase in the number of competitions and participants. Dietary-nutritional planning is key for performing well during such competitions. To date, there is no questionnaire expressly developed to be able to analyze the consumption of liquids, foods, and supplements, as well as gastrointestinal problems in these events. This study describes the development of the Nutritional Intake Questionnaire for Endurance Competitions (NIQEC). METHODS: The study was composed in the following phases: (1) Bibliographic search for the most important nutrients, (2) focus groups (17 dietitian-nutritionists and 15 experienced athletes) and generation of items, (3) Delphi surveys, and (4) cognitive interviews. RESULTS: After an initial shaping of the questionnaire with the items that emerged in the focus groups, their relevance was evaluated by means of the Delphi survey, which showed more than 80% approval for most items. Finally, the cognitive interviews indicated that the questionnaire was simple and complete for its purpose. The final NIQEC (n = 50 items) was divided in 5 sections: Demographic data; sports data; consumption of liquids, food and supplements before, during, and after the competition; gastrointestinal complaints, and dietary-nutritional planning for the competition. CONCLUSIONS: The NICEQ is a useful tool that allows collecting information from participants on sociodemographic factors and gastrointestinal complaints, and estimating the intake of liquid, food, and supplements, for endurance competitions.

Do Spanish Triathletes Consume Sports Supplements According to Scientific Evidence? An Analysis of the Consumption Pattern According to Sex and Level of Competition.

BACKGROUND: The use of sports supplements (SS) to improve sports performance is very common in athletes. In the case of triathletes, the physiological characteristics of the sport may require the use of certain SS. Although the consumption of SS is widespread in this sport, very few studies have investigated it thus far. The aim is to analyze the pattern of SS consumption by triathletes according to sex and the competitive level. METHODOLOGY: This is a descriptive cross-sectional study on the consumption and habitual use of SS of 232 Spanish-federated triathletes. Data were collected through a validated questionnaire. RESULTS: Overall, 92.2% of the athletes consumed SS, but no significant differences were found in terms of competition level or sex. Yet, significant differences were found regarding the level of competition for total SS (p = 0.021), the total number of Group A supplements from the AIS classification (p = 0.012), and for the ergogenic aids (p = 0.003). The most-consumed SS were bars, sports drinks, sports gels, and caffeine (83.6%, 74.1%, 61.2%, and 46.6%, respectively). CONCLUSIONS: The consumption of SS by triathletes is high, and the number of SS consumed rises from the regional to the national and international levels. The four SS most consumed were included in category A of the AIS (greatest scientific evidence).

Energy and Macronutrients Intake in Indoor Sport Team Athletes: Systematic Review.

Indoor team sports are characterized by matches that are shorter in duration and with frequent substitution (high-intensity intermittent). The main goal of teams is to best cover athletes' physiological demands, while meeting their dietary intake needs is critical. The aim of this study is to conduct a systematic review of the dietary intake of indoor team sports athletes and to analyze whether they comply with nutritional recommendations. A search of PubMed-MEDLINE, Web of Science, and Scopus databases from 2008 to July 2022 was conducted and 2727 documents were identified. The studies focused on adult professional or semi-professional volleyball, basketball, handball, or futsal athletes. Two independent researchers screened and extracted the data, with 20 documents included after they met the inclusion criteria. Most of the athletes, both men and women, did not meet the official recommendations based on under-consumption (energy and carbohydrates) or over-consumption (fats). In relation to protein, 28.6% of studies met the recommendations, with 50% of those who did not meet it being due to under-consumption. Although there are references on athletes' dietary intakes, there are no references considering sexes or types of sport. More adapted recommendations are needed in order to more precisely evaluate athletes' intake to know if they meet their real nutritional requirements.

Evaluation of Body Composition in CrossFit® Athletes and the Relation with Their Results in Official Training.

CrossFit® is a high-intensity sport that combines weightlifting, gymnastic skills, and cardiovascular exercises. To find the anthropometric references that define the optimal body composition, it is essential to first find an optimal body composition for one's physical preparation. The objective of this study is to describe the anthropometric characteristics of 27 Spanish CrossFit® athletes, 19 males aged 39 years old (24-44) and 8 females aged 28 years old (23-40), and how these characteristics influenced their performance. The athletes performed the Fran, Cindy, and Kelly workouts, establishing minimum marks, and the CrossFit Total workout to assess maximum strength. Significant differences were not found in time and repetitions between sexes in skill training, although there was a positive correlation r = 0.876 (p < 0.001) between muscle mass and the Total CrossFit result. We can conclude that the CrossFit® athlete has a low amount of fat mass and a small relative size, which is an advantage when training with bodyweight exercises, and a high muscle mass that provide benefits when strength training. In addition, despite executing movements from a multitude of disciplines, the physical demands for lifting heavy loads resulted in the anthropometric values of athletes being more similar to elite weightlifting athletes than in other sports.

Analysis of the Consumption of Sports Supplements in Open Water Swimmers According to the Competitive Level.

BACKGROUND: Sports supplements (SS) are widely consumed by many types of athletes to improve their performance. These SS are classified according to their level of scientific evidence, by the ABCD system from the Australian Institute of Sport (AIS). In open water swimming, their use may be necessary due to the physiological challenges posed by this sport discipline. However, there is currently little literature on the use of SS in open water swimmers. The aim of this work is to analyze the pattern of consumption of SS by open water swimmers, by studying the differences according to the competitive level (regional vs. national). METHODS: Descriptive and cross-sectional study on the consumption and use of SS by federated open water swimmers in Spain in the 2019/2020 and 2020/2021 seasons. The data were collected through a validated questionnaire. RESULTS: 79.5% of the participants consumed SS, with significant differences according to their level, being higher in athletes at the national level. The most-consumed SS by the swimmers studied were sports drinks, energy bars, caffeine, vitamin C, and vitamin D. CONCLUSIONS: It was observed that the consumption of SS in open water swimmers was high, and of the five most-consumed SS, four of them belonged to the category of greatest scientific evidence.

Analysis of staphylococcal enterotoxin A in milk by matrix-assisted laser desorption/ionization-time of flight mass spectrometry.

Staphylococcal enterotoxin A (SEA) is an exotoxin excreted mainly by Staphylococcus aureus and nowadays is the most prevalent compound in staphylococcal food poisoning worldwide. SEA is highly heat-resistant, and usual cooking times and temperatures are unlikely to completely inactivate it. A procedure for extraction of this toxin based on protein precipitation with a mixture of dichloromethane and acidified water was used before SDS-PAGE separation of soluble proteins. Finally, bands of interest were excised from the gel and in-gel enzymatic digestion was done. SEA from pasteurized milk was detected with matrix-assisted laser-desorption/ionization-time of flight (MALDI-TOF) mass spectrometry. Nineteen peptides (range 800-2400 Da) were identified as products of trypsin cleavage of the SEA standard with a score of 204 and 73% coverage of the protein sequence, whereas thirteen peptides were revealed for SEA extracted from milk with a score of 148 and 58% sequence coverage obtained. This procedure has been applied successfully for identification of SEA in milk.

Antibacterial activity of the enniatin B, produced by Fusarium tricinctum in liquid culture, and cytotoxic effects on Caco-2 cells.

The enniatins (ENs) are bioactive compounds of hexadepsipeptidic structure produced by several strains of Fusarium sp. The EN B was purified from extracts of Fusarium tricinctum growth on liquid culture of potato dextrose broth (PDB), using a semipreparative liquid chromatography (LC) followed by an analytical LC. The purity and the structure of the isolated compound were confirmed by the determination of the extinction coefficient and with electrospray ionization-mass spectrometry (ESI-MS) study. The pure fraction of EN B was utilized to determine the antibiotic effects on several bacterial strains that are considered normally pathogens of the intestinal tract: Escherichia coli, Enterococcus faecium, Salmonella enterica, Shigella dysenteriae, Listeria monocytogenes, Yersinia enterocolitica, Clostridium perfringens, Pseudomonas aeruginosa, and Staphylococcus aureus, and to study the cytotoxic effects on Caco-2 differentiated and undifferentiated cells. The results obtained demonstrated that in several antibiograms, EN B induced the inhibition of the grown microorganisms tested and no significant differences over control were detected when Caco-2 cells were exposed to EN B, at any of the concentrations used.

Assessment of Spanish Food Consumption Patterns during COVID-19 Home Confinement.

People's eating habits and lifestyle can have a negative impact on health. In situations of difficulty or socioeconomic crisis, these habits tend to be modified, leading to unhealthy dietary patterns that result in an increase of chronic non-communicable diseases (NCDs). Previous studies have indicated that, due to the state of alarm imposed in Spain to combat the spread of COVID-19, an increase in the purchase of non-core products occurred, along with a decrease in the daily physical activity of the population. This could be a risk factor for COVID-19 infection. The objective of this observational study was to analyze the dietary pattern of the Spanish population during home confinement and to compare it with the pattern of habitual consumption collected in the last National Health Survey, analyzing the possible changes. More than half of the respondents in the sample increased their consumption of sweets and snacks during confinement, while the consumption of fresh products decreased. Most claimed to be emotionally hungry, leading to an increase in their daily energy intake. The stress and anxiety generated by confinement could be the cause of the increased consumption of products rich in sugars and saturated fats, which are associated with greater stress and anxiety.

Assessment of the microbiological safety of dried spices and herbs commercialized in Spain.

Spices and herbs are natural products or their blends that must be free of extraneous matter content. Conventional production of these products implicates a number of hygienic problems so spices and herbs may be exposed to a wide range of microbial contamination during pre- and post-harvest and they can present high microbial counts. In this study, we have analyzed the microbial quality of 53 samples of spices and dry herbs collected from Spanish markets detecting a contamination of samples of spices with mesophilic aerobic counts (10%) and Enterobacteriaceae (20%). The analysis from herbs showed that the percentage of contamination was 26% in both microbiological values. Pathogenic microorganisms like Staphylococcus aureus, Yersinia intermedia, Shigella spp., Enterobacter spp., Acinetobacter calcoaceticus and Hafni alvei were also isolated from spices and herbs. These unsatisfactory results showed a poor microbiological quality. Spices and dry herbs are used as ingredients in a variety of products prepared in different ways, this fact suggests the need to provide a control system to improve the quality of herbs and spices.

Development of a Sport Food Exchange List for Dietetic Practice in Sport Nutrition.

Food exchange lists have been widely used in dietary practice in health and disease situations, but there are still no exchange lists for sports foods. The aim of this study was to apply a previous published methodology to design food exchange lists to the development of a sports food exchange list, with sport products available in Spain. A cross-sectional study of the nutritional composition of sports foods, regarding macronutrients and energy, was carried out. A total of 322 sports foods from 18 companies were selected, taking into account their interest in sports practice and with nutritional data provided by companies. Sports foods were divided into seven groups: sports drinks; sports gels; sports bars; sports confectionery; protein powders; protein bars; and liquid meals. A sports food composition database based on portion size usually consumed by athletes and/or recommended in commercial packaging was created. Within each sports foods group, different subgroups were defined due to differences in the main and/or secondary macronutrient. The definition of each exchange list with the amounts-in grams-of each sports food within each group and subgroup, was done using statistical criteria such as mean, standard deviation, coefficient of variation, and Z value. Final exchange values for energy and macronutrient have been established for each group and subgroup using a methodology to design food exchange lists previously published by the authors. In addition, those products with high Z values that can provide greater variability in dietary planning were included. The usefulness of sport foods lists as well as the use of an exchange system in the dietary practice of sports nutrition is discussed, and examples of how to use them with athletes are presented. This first sport foods exchange list showed in this study, with commercial sports products available in Spain, can be a novel tool for dietetic practice and also can allow sport nutrition professionals to develop another sport food list using the methodology described in this paper. Its management would allow dietitians to adapt dietary plans more precisely to the training and/or competition of the athlete.

Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations.

During the last few years, the numbers of competitors in endurance and ultra-endurance sports modalities have increased significantly. This type of competition is an extreme challenge for athletes. Therefore, they have an increased the risk of developing medical and nutritional problems. The aim of the work is to estimate the incidence of nutrition-related adverse outcomes in endurance and ultra-endurance sports, considering the variables that influence them. A critical review was carried out based on the PubMed database, by means of a search strategy based on keywords separated by Boolean connectors. For all the results obtained in a period from 2008 to 2019, a series of inclusion/exclusion criteria was applied to select only the studies that fitted the objective of the present study. Results and discussion: Of the 871 publications identified, 33 met the inclusion criteria. The adverse outcomes found included exercise-associated hyponatremia (EAH), heat stroke by exertion (EHS), gastrointestinal (GI) problems, dehydration, and hypothermia; the provision of misinformation to athletes about nutrient intake and hydration during competition was identified as the main cause. Conclusions: The main adverse outcomes in endurance and ultra-endurance sports modalities are EAH, GI inconveniences, and EHS. These problems can affect the performance and health status of the athlete during and post-competition. Several nutritional guidelines have been suggested that can prevent these adverse outcomes, and it is essential to individualize and adjust the nutritional intake and hydration status according to the characteristics of each competition.