Gastrointestinal Complaints and Correlations with Self-Reported Macronutrient Intake in Independent Groups of (Ultra)Marathon Runners Competing at Different Distances.

This study investigated the differences in gastrointestinal (GI) and exercise related complaints between groups of runners competing at different distances using web-based questionnaires. Total (severe) complaints were reported by 89.3% (49.7%) of the runners during the race vs. 70.6% (29.4%) after the race. Significant differences between groups were described for marathon (n = 98) and 60 km (n = 43) runners. During competition, runners reported the urge to urinate (47.7%), muscle cramps (43.6%) and belching (43.6%). The prevalence of bloating, flatulence, side ache and dizziness differed between distances (p < 0.02). There were small to moderate negative correlations between food and fluid intake and GI complaints. After competition (12 h), 70.6% of participants reported complaints, with muscle cramps (47.6%), flatulence (19.0%) and bloating (12.7%) being the most prevalent. Prevalence of belching, nausea, stomach cramps and muscle cramps differed between race distances (p < 0.04). There were small to high positive correlations between complaints during and after competition (p < 0.05). In conclusion, runners of all distances reported a high prevalence of GI and other exercise related complaints. There were some small differences in reporting type and severity of complaints between distances. Results showed small to strong correlations between complaints during and after competition and with nutrient intake, without a clear similar pattern for all distances.

Real-Time Observations of Food and Fluid Timing During a 120 km Ultramarathon.

The aim of the present case study was to use real-time observations to investigate ultramarathon runners' timing of food and fluid intake per 15 km and per hour, and total bodyweight loss due to dehydration. The study included 5 male ultramarathon runners observed during a 120 km race. The research team members followed on a bicycle and continuously observed their dietary intake using action cameras. Hourly carbohydrate intake ranged between 22.1 and 62.6 g/h, and fluid intake varied between 260 and 603 mL/h. These numbers remained relatively stable over the course of the ultra-endurance marathon. Runners consumed food and fluid on average 3-6 times per 15 km. Runners achieved a higher total carbohydrate consumption in the second half of the race (p = 0.043), but no higher fluid intake (p = 0.08). Energy gels contributed the most to the total average carbohydrate intake (40.2 ± 25.7%). Post-race weight was 3.6 ± 2.3% (range 0.3-5.7%) lower than pre-race weight, revealing a non-significant (p = 0.08) but practical relevant difference. In conclusion, runners were able to maintain a constant timing of food and fluid intake during competition but adjusted their food choices in the second half of the race. The large variation in fluid and carbohydrate intake indicate that recommendations need to be individualized to further optimize personal intakes.

Improving Oncology Nurses' Knowledge About Nutrition and Physical Activity for Cancer Survivors.

PURPOSE/OBJECTIVES: To assess what percentage of oncology nurses perceived themselves as having insufficient knowledge to provide advice on nutrition and/or physical activity (PA), which characteristics were associated with nurses' perception, and whether the content and information sources differed among those nurses.
. DESIGN: A cross-sectional study.
. SETTING: A web-based survey among oncology nurses in the Netherlands.
. SAMPLE: 355 oncology nurses provided advice on nutrition; of these, 327 provided advice on PA.
. METHODS: From May to July 2013, oncology nurses were invited to complete an online questionnaire. Pearson's chi-squared tests and uni- and multivariate logistic regression analyses were conducted.
. MAIN RESEARCH VARIABLES: Oncology nurses' perception of having sufficient or insufficient knowledge to be able to provide advice on nutrition and PA, the content of the advice, and the information sources on which the advice was based.
. FINDINGS: 43% of oncology nurses perceived themselves as having insufficient knowledge to provide advice on nutrition, and 46% perceived insufficient knowledge to provide advice on PA. Factors associated with perceiving insufficient knowledge on nutrition were being aged younger, having lower education, and providing counseling during treatment only. Those nurses were more likely to suggest taking oral nutritional supplements or visiting a dietitian and were less likely to provide information on fluid intake. Nurses perceiving insufficient knowledge about PA used oncology guidelines less often.
. CONCLUSIONS: Almost half of the oncology nurses providing advice on nutrition and PA perceived themselves as having insufficient knowledge to be able to provide such advice. In particular, younger oncology nurses and oncology nurses with an intermediate vocational education may benefit most from education about these topics. 
. IMPLICATIONS FOR NURSING: Educational training for oncology nurses should include nutrition and PA. Oncology nurses should collaborate with dietitians to discuss what information should be provided to patients by whom, and specific PA advice should be provided by a physical therapist.

Dietary Protein Intake and Distribution Patterns of Well-Trained Dutch Athletes.

Dietary protein intake should be optimized in all athletes to ensure proper recovery and enhance the skeletal muscle adaptive response to exercise training. In addition to total protein intake, the use of specific proteincontaining food sources and the distribution of protein throughout the day are relevant for optimizing protein intake in athletes. In the present study, we examined the daily intake and distribution of various proteincontaining food sources in a large cohort of strength, endurance and team-sport athletes. Well-trained male (n=327) and female (n=226) athletes completed multiple web-based 24-hr dietary recalls over a 2-4 wk period. Total energy intake, the contribution of animal- and plant-based proteins to daily protein intake, and protein intake at six eating moments were determined. Daily protein intake averaged 108±33 and 90±24 g in men and women, respectively, which corresponded to relative intakes of 1.5±0.4 and 1.4±0.4 g/kg. Dietary protein intake was correlated with total energy intake in strength (r=0.71, p <.001), endurance (r=0.79, p <.001) and team-sport (r=0.77, p <.001) athletes. Animal and plant-based sources of protein intake was 57% and 43%, respectively. The distribution of protein intake was 19% (19±8 g) at breakfast, 24% (25±13 g) at lunch and 38% (38±15 g) at dinner. Protein intake was below the recommended 20 g for 58% of athletes at breakfast, 36% at lunch and 8% at dinner. In summary, this survey of athletes revealed they habitually consume > 1.2 g protein/kg/d, but the distribution throughout the day may be suboptimal to maximize the skeletal muscle adaptive response to training.