Ultramarathon runners, ultramarathoners, or ultrarunners participate in runs and races longer than 42,195 meters. They can be amateurs, recreational joggers, or professional athletes. Participation in such competitions is often motivated by the desire for personal achievements, general health, and psychological reasons (1). The age of participants varies greatly, but peak performances are often achieved at 35 or older (2). Additionally, men take part in such races more often than women, although the number of female participants has been increasing over the last years, reaching about 20% (3). Competitors derive satisfaction from covering such long distances. For example, an increase in their self-esteem has been noticed (1). However, ultramarathons can also cause stress and extreme strain on the body (4). Therefore, they require proper preparation and diet. Healthy nutrition has been shown to impact the results in ultra-endurance competitions (5, 6). During such races, there is a significant energy deficit, which is why a properly selected diet is so important. The source of energy supplied depends on the intensity of training. During less intense exercise, energy comes from fats (7), while during events, between them, and during very intense exercise, mainly from carbohydrates (6). Carbohydrates are obtained primarily from meals with a high glycemic index because they are an excellent source for synthesizing glycogen stored in muscles (8). This has been confirmed by studies, which showed a positive correlation between high carbohydrate consumption and the results in endurance sports (9).

Ultramarathon runners can suffer from many health problems. They often complain of gastrointestinal disorders, digestive problems (10), nausea (11), and bleeding (12, 13). They limit the performance of ultramarathon runners and are also often the reason for withdrawing from races (10, 14). There are also difficulties with maintaining homeostasis of the energy balance. Due to the high energy demand, there is a risk of an imbalance between its supply and actual energy expenditure. This may result in exercise-related hyponatremia or caloric deficit (2). Studies have shown that you should eat your favorite foods during competitions as they reduce the risk of digestive problems (15). Therefore, runners should consciously choose food products and know the main sources of energy in ultramarathons (16). However, it is not possible to fully meet the energy needs during the race, so participants must face weight loss during the run and an increased caloric deficit (17). This is also accompanied by dehydration (18). For this reason, they should drink plenty of fluids, but excessive drinking is not advisable (19). It can cause hyponatremia associated with excessive blood dilution or physical exertion (20).

Food choices are influenced by social, economic, and cultural factors (21). Gender has been found to impact eating behavior significantly. Women pay attention to the sensory attractiveness of food to a greater extent than men (22). Taking into account only the influence of gender, women more often believe that healthy eating is important. For men, the health aspect of food choices is less critical (23). This has an impact on the food choices made. Researchers have noticed this in women with higher education. At the same educational level, 85% of women chose healthy foods compared to 61% of men. Women eat more fruit, fiber, and less fat compared to men. It is also affected by upbringing. Additionally, it has been shown that women are more willing to introduce changes in their diet; it is particularly evident among people with low socioeconomic status (24).

Another aspect that significantly affects diet quality is the education level. Prior research supports that people with lower education show less interest in health (24) and have worse eating habits than those with higher education, who make better choices (25). Therefore, in better-educated people, the risk of being overweight and obese is lower in all ethnic groups (26).

Cigarette smoking also has an impact on diet. Active and passive smokers have shown higher consumption of processed foods and other unhealthy foods. Many studies indicate that the diet of smokers is poorer in valuable ingredients and of lower quality compared to non-smokers (27, 28). Yet another factor influencing eating habits is the socioeconomic situation. This has been confirmed by a study conducted on a group of students, which showed that students make food choices based on their financial situation. Individuals financially supported by or living with their parents eat healthier than their self-supporting peers. Other studies also suggest that socioeconomic status (lower education, limited income, unemployment) is associated with increased food insecurity, i.e., insufficient quality and quantity of nutritionally adequate food (29). They choose fast-food products because of their convenience and relatively low price (22). Additionally, individuals who live with roommates or family frequently have a better diet than people who live alone (30). Food security is defined as “the situation when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preference for an active and healthy life” (31). However, food security issues were not directly addressed in this study.

The level of nutritional knowledge also influences the choice of consumed products. It was found that the greater the nutrition knowledge, the better the eating habits (32, 33). The level of physical activity can affect the quality of the food eaten. Physical activity is associated with reduced unhealthy food intake, such as candy and fatty foods (34). However, amateur athletes are a particularly interesting group who do not always pay attention to choosing the right diet (35). This is because of their approach to sports, which they treat as a hobby rather than a profession. However, it should be noted that participation in amateur competitions is often associated with a healthy lifestyle, which positively affects physical and mental health (36). This study aimed to evaluate the nutritional behavior of amateur ultrarunners, both men and women. We examined the relationship between the level of knowledge about nutrition and the choice of specific products, both healthy and unhealthy. Because the human diet depends not only on the level of nutritional knowledge, we also assessed the impact of factors such as gender, smoking, and education on the food choices of ultramarathoners.

In today’s world, participation in ultrarunning is becoming more and more popular, also among amateurs (42). However, the mere desire to do sports does not give people sufficient knowledge about proper and rational nutrition (43). Other factors influence the choice of the right diet. Therefore, this study aimed to examine the impact of nutritional knowledge, smoking, and education on the frequency of consuming healthy and unhealthy products. Due to awareness of the influence of gender on food choices, the respondents were divided into two groups: men and women.

The nutritional knowledge of the respondents was measured using the KomPAN questionnaire and categorized as good, sufficient, or insufficient. The analysis of the results showed a relationship between nutritional knowledge and the frequency of meals consumed. In the case of women, lower knowledge was associated with a lower index corresponding to a healthy diet. In turn, in the case of men, lower knowledge about nutrition was associated with a higher index corresponding to an unhealthy diet. In both cases, the same trend is noticeable. This is consistent with the results of other studies, according to which people who perform better on a test related to nutrition knowledge are more likely to eat healthy food (44, 45). On the other hand, some unhealthy products (sausages, frankfurters, etc.) were more often chosen by women with sufficient nutritional knowledge compared to women with insufficient knowledge. This may be because the respondents have never been under the care of a dietitian, and their dietary choices may be based on their own beliefs or experience. Research shows that even some athletes in sports clubs have never had dietary consultations, which may significantly affect the frequency of choosing specific food products (46).

Individuals practicing sports are often involuntarily associated with healthy habits, i.e., they consume little alcohol or do not smoke cigarettes (47). Meanwhile, studies have repeatedly shown that anti-healthy behaviors also often appear in people practicing sports (48, 49). This study’s results indicate that smoking men are less likely to reach for unhealthy products than non-smokers. However, it should be remembered that the vast majority of respondents were smokers, which may significantly affect the results of this study. However, an interesting observation arises here that amateur ultrarunners are still mostly susceptible to unhealthy addictions, despite practicing sports.

The assessment of the relationship between food choices and education was also the subject of this research. The level of education can affect diet quality, food choices, and the diet itself (50). Among the surveyed group of amateur ultramarathoners, 71.1% were men. Both among women and men, most of the respondents had higher education. Despite numerous studies showing that women care more about their diet and food choices (23, 51), no statistically significant differences were found between the level of education and the frequency of healthy eating habits in women training ultrarunning in this study. It was similar in the case of men, where there was no correlation between the level of education and the HDI-10 and UDI-14 scores (Table 4).

In addition to the quantity and quality of nutritional products consumed, frequency of consumption is also important. This study shows that women with sufficient nutritional knowledge consumed statistically more products such as cold cuts, sausages, or frankfurters than women with good and insufficient nutritional knowledge. Consumption of sweetened beverages was statistically significant only in women with sufficient nutritional knowledge. Women with insufficient nutritional knowledge used alcoholic beverages more often than women with good and sufficient knowledge (Figure 3A). Men with insufficient knowledge consumed statistically more sweets than men with good and sufficient knowledge. A similar relationship occurred with alcoholic beverages (Figure 3B).

On the one hand, the results indicate that individuals with less knowledge about nutrition may more often choose unhealthy products, which is confirmed in the literature (52). However, on the other hand, it should be noted that the vast majority of respondents obtained only sufficient results regarding nutrition knowledge. This indicates that despite the respondents doing sports and trying to lead a healthy lifestyle, they do not necessarily have adequate nutrition knowledge. In the case of amateurs, nutrition and nutritional knowledge do not necessarily have to be related and correlated with the achievement of specific sports results but rather constitute a mechanism leading to the achievement of generally understood good health, which is confirmed by other studies (53). For example, it would seem that prolonged training and frequent heavy competition should promote unhealthy eating habits in men (Table 5). However, it should be remembered that the research was carried out on a group of amateurs who, despite doing sports, do not necessarily eat healthy food. Amateurs undertaking ultramarathon training and competing for recreation have increased energy expenditure (54). To balance it, they must ensure an adequate supply of energy. It is unimportant for them to achieve good results in the competition, so they allow themselves to deviate from healthy food. They often exert themselves to a higher level of energy expenditure, which is then covered by unhealthy snacks and other unhealthy products (55, 56). For professional runners, proper nutrition and diet can affect athletic performance, which is the main goal, in contrast to amateur runners (57). Although ultrarunning training does not promote unhealthy dietary choices, it should be noted that unhealthy dietary choices do occur among amateur runners, as confirmed by the results of our study (55, 58).

However, this research has some limitations, including unequal gender distribution. As mentioned before, men dominate among ultrarunners (3, 37), as confirmed by this study. The study group itself is also not too large, but this may be due to the period in which the study was conducted (the beginning of the COVID-19 lockdown in Poland). People were forced to put their usual hobbies on hold, so they talked less about them on social media (59). In the future, similar studies should take into account a longer period given to complete the questionnaire but also attempt to reach ultrarunners not only online but also through sports clubs. It would be interesting to check the eating habits of runners during training, and not just between them. The study also did not consider SES (60), which could have significantly impacted the respondents’ food choices. Similarly, the study did not take into account issues related to food security, which could also translate into the respondents’ use of a particular diet. SES and food security should also be included in future research to understand these relationships better. This research is a preliminary study; however, despite some limitations, it shows in a fairly extensive way the dependence of dietary choices of amateur ultrarunners on various factors. Expanding this topic could draw runners’ attention to their nutrition.

Maintaining a healthy diet is especially important for people practicing sports; therefore, nutritional knowledge is at a higher level in people who are more active and have higher education compared to people who are less physically active and have lower education.

Both in the case of women and men, the level of nutrition knowledge was associated with changes in the HDI-10 and UDI-14 scores. Women with sufficient knowledge about nutrition obtained statistically lower HDI-10 scores compared to women with good nutrition knowledge. However, no similar relationship was found in men. There was also no significant effect of education on food choices and the frequency of consumption of specific products. Interestingly, it was noticed that male smokers had lower UDI-14 scores.

Such results may be due to the specifics of the study group, which consisted of amateur ultrarunners, which means that they are not necessarily well-educated in nutrition and positive health behavior. It was similar in the case of the selection of food products (from the healthy and unhealthy categories), where nutrition knowledge did not always correspond with the healthiest choices. For example, regardless of the level of knowledge, men consumed UDI-14 products such as white rice, plain pasta, small groats, yellow cheese, or sweetened drinks with the same frequency. In turn, regardless of the level of knowledge, women consumed HDI-10 products such as fermented milk drinks, fish, legume seed dishes, or fruit with the same frequency. This may be because, for amateurs practicing sports, diet is not always put in the first place, as the physical activity and the fun that comes from it are much more important.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Bioethics Committee at the Wroclaw Medical University (no. KB-601/2021). The patients/participants provided their written informed consent to participate in this study.

AK and MKe contributed to conception and design of the study. AK organized the database. MKr performed the statistical analysis. AK, MKr, ML, and MKe wrote sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

The presented research results, implemented under the topic according to the records in the SIMPLE system with the number SUBZ.Z604.23.006 were financed from the subvention awarded by the Minister of Science and Higher Education, Poland.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.