Ci a ion: Jiménez-Al ageme, R.;
Ma ínez-Sanz, J.M.; Rome o-Ga cía,
D.; Giménez-Monzo, D.; He nández
Apa icio, S.; Sanchez-Oli e , A.J.;
Sosped a, I. Do Spanish T ia hle es
Consume Spo s Supplemen s
Acco ding o Scien i ic E idence? An
Analysis o he Consump ion Pa e n
Acco ding o Sex and Le el o
Compe i ion. Nu ien s 2023,15, 1330.
h ps://doi.o g/10.3390/
nu15061330
Academic Edi o : Lau i Bye ley
Recei ed: 11 Feb ua y 2023
Re ised: 1 Ma ch 2023
Accep ed: 6 Ma ch 2023
Published: 8 Ma ch 2023
Copy igh : © 2023 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
nu ien s
A icle
Do Spanish T ia hle es Consume Spo s Supplemen s Acco ding
o Scien i ic E idence? An Analysis o he Consump ion Pa e n
Acco ding o Sex and Le el o Compe i ion
Rubén Jiménez-Al ageme 1,2,3 , JoséMiguel Ma ínez-Sanz 2,4,* , Da id Rome o-Ga cía1,2 ,
Daniel Giménez-Monzo 2,5, Samuel He nández Apa icio 1, An onio Jesús Sanchez-Oli e 2,6
and Isabel Sosped a 2,4
1Facul y o Heal h Sciences, Uni e si y o Alican e, 03690 Alican e, Spain
2Food and Nu i ion Resea ch G oup (ALINUT), Uni e si y o Alican e, 03690 Alican e, Spain
3Physio he apy Depa men , Facul y o Heal h Sciences, Eu opean Uni e si y o Gas eiz—EUNEIZ,
01013 Vi o ia-Gas eiz, Spain
4Nu sing Depa men , Facul y o Heal h Sciences, Uni e si y o Alican e, 03690 Alican e, Spain
5Depa men o Communi y Nu sing, P e en i e Medicine and Public Heal h and His o y o Science Heal h,
Uni e si y o Alican e, 03690 Alican e, Spain
6Depa amen o de Mo icidad Humana y Rendimien o Depo i o, Facul ad de Ciencias de la Educación,
Uni e sidad de Se illa, 41004 Se illa, Spain
*Co espondence: [email p o ec ed]
Abs ac :
Backg ound: The use o spo s supplemen s (SS) o imp o e spo s pe o mance is e y
common in a hle es. In he case o ia hle es, he physiological cha ac e is ics o he spo may equi e
he use o ce ain SS. Al hough he consump ion o SS is widesp ead in his spo , e y ew s udies
ha e in es iga ed i hus a . The aim is o analyze he pa e n o SS consump ion by ia hle es
acco ding o sex and he compe i i e le el. Me hodology: This is a desc ip i e c oss-sec ional s udy
on he consump ion and habi ual use o SS o 232 Spanish- ede a ed ia hle es. Da a we e collec ed
h ough a alida ed ques ionnai e. Resul s: O e all, 92.2% o he a hle es consumed SS, bu no
signi ican di e ences we e ound in e ms o compe i ion le el o sex. Ye , signi ican di e ences
we e ound ega ding he le el o compe i ion o o al SS (p= 0.021), he o al numbe o G oup
A supplemen s om he AIS classi ica ion (p= 0.012), and o he e gogenic aids (p= 0.003). The
mos -consumed SS we e ba s, spo s d inks, spo s gels, and ca eine (83.6%, 74.1%, 61.2%, and
46.6%, espec i ely). Conclusions: The consump ion o SS by ia hle es is high, and he numbe
o SS consumed ises om he egional o he na ional and in e na ional le els. The ou SS mos
consumed we e included in ca ego y A o he AIS (g ea es scien i ic e idence).
Keywo ds: spo s supplemen s; ia hlon; spo nu i ion; scien i ic e idence; spo pe o mance
1. In oduc ion
The ia hlon is an endu ance and indi idual spo included in he Olympic Games
since he yea 2000 [
1
] and has g own in popula i y since i s appea ance in 1974. I
is cha ac e ized by ha ing h ee spo s disciplines: swimming, cycling, and unning,
which a e ca ied ou consecu i ely, wi h he aim o comple ing he compe i ion in he
sho es possible ime [
2
]. This spo o e s a wide ange o e en o ma s, anging om
he mixed elay ace, which las s abou 20 min, o he sp in dis ance ace, which las s
app oxima ely one hou , and he long-dis ance ia hlon (I onman), which akes place
o e a pe iod o 8 o 9 h a he eli e le el. In addi ion o he high aining olumes
ypically equi ed o endu ance spo s, aining o h ee di e en spo ing disciplines
simul aneously equi es a la ge numbe o aining sessions e e y week [
3
,
4
]. T aining a
such high olumes can inc ease he likelihood o illness and inju y. Ne e heless, ecen
Nu ien s 2023,15, 1330. h ps://doi.o g/10.3390/nu15061330 h ps://www.mdpi.com/jou nal/nu ien s
Nu ien s 2023,15, 1330 2 o 11
ad ancemen s in knowledge in his a ea can minimize hese isks while simul aneously
op imizing pe o mance [5].
Spo s pe o mance in ia hlons depends on ac o s such as an h opome ic cha ac-
e is ics, physiological capaci y, echnical skills, and he compe i ion s a egy ca ied ou
by he ia hle e [
6
]. This spo places high physical and physiological demands on he
a hle e [
7
,
8
]. In addi ion, ac o s such as ca bohyd a e (CH) in ake, hyd a ion, and ad e se
esul s ela ed o nu i ion and acclima iza ion o he a hle e a e de e mining ac o s [
9
,
10
].
The e o e, i is no uncommon o ia hle es o eso o spo s supplemen s (SS) o comple-
men hei die and enhance hei pe o mance du ing compe i ions, especially in long- e m
compe i ions [
11
,
12
]. T ia hle es ypically compe e in a sel -su icien o semi-sel -su icien
egimen, which equi es hem o b ing hei own ood and hyd a ion, some imes wi h he
assis ance o supplies p o ided by o ganize s. This is one eason why he use o SS can
be ad an ageous, as i allows hem o op imize space and weigh in hei spo s equip-
men [
13
]. T aining sessions a e usually conduc ed in a sel -su icien o semi-sel -su icien
manne depending on he du a ion and whe he he ia hle e has ex e nal suppo [
12
,
13
].
SS can be de ined as any ood, ood componen , nu ien , o non- ood componen
in en ionally inges ed as pa o a egula die o achie e a speci ic e ec on heal h o
pe o mance [
9
]. The Aus alian Ins i u e o Spo (AIS) [
14
] ca ego izes SS in o ou
g oups (A, B, C, and D) based on he deg ee o scien i ic e idence. G oup A comp ises
SS compa ible wi h use in speci ic si ua ions in spo s, using e idence-based p o ocols.
G oup B includes SS equi ing u he in es iga ion and ha should be used cau iously.
G oup C includes SS wi hou e idence o bene icial e ec s. Las ly, G oup D includes
p ohibi ed subs ances o subs ances wi h a high isk o con amina ion ha could esul in a
posi i e an i-doping es .
Cu en ly, be ween 30 o 100% o eli e and ama eu a hle es consume SS o imp o e
hei spo s pe o mance [
10
,
11
,
15
–
22
]. The mos signi ican ac o s ha in luence SS con-
sump ion a e he kind o physical ac i i y pe o med, he a hle e’s le el o compe i i eness,
and sex. In pa icula , SS consump ion ends o be highe among a hle es engaged in mo e
compe i i e le els o spo and among male a hle es (in he same spo ) [
21
,
22
]. Among he
mos -consumed SS, we ind p oduc s such as ca bohyd a e d inks, p o ein ba s, spo s gels,
ca eine, whey p o ein, c ea ine, o b anched-chain amino acids (BCAAs) [10,11,15–22].
Al hough he bibliog aphy is sca ce, some s udies can be ound on he use o SS in
endu ance spo s, speci ically in moun ain unne s and open-wa e swimme s [
20
–
22
],
wi h hese endu ance a hle es consuming SS such as spo ba s (81.9–62.9%), spo s d inks
(75–60.5%), ca eine (39.4–48.6%), and spo s gels (52.9%). On he o he hand, o he wo ks
ha e analyzed he nu i ional in ake in hese ypes o compe i ions [
23
–
25
], bu o da e,
no esea ch has been ca ied ou exclusi ely in ia hle es o s udy he p e alence and
consump ion pa e ns o SS. The e o e, he aim o his s udy was o analyze he pa e n o
SS consump ion by ia hle es by s udying he di e ences based on sex and he compe i i e
le el ( egional, na ional, and in e na ional). Rega ding he main hypo heses o his wo k,
he ollowing a e p oposed:
Hypo hesis 1 (H1).
The ype o supplemen s ha a e mos consumed a e simila acco ding o he
sex o he a hle es.
Hypo hesis 2 (H2).
The o al consump ion o SS by a hle es a a highe compe i i e le el is highe .
Hypo hesis 3 (H3).
Di e ences in he consump ion and ype o SS a e no expec ed be ween
ia hle es and o he endu ance a hle es such as swimme s and moun ain unne s.
Nu ien s 2023,15, 1330 3 o 11
2. Ma e ials and Me hods
2.1. Type o S udy
This is a desc ip i e and c oss-sec ional s udy on he consump ion and egula use
o SS by Spanish ia hle es. The sample size calcula ion was pe o med wi h Rs udio
so wa e ( e sion 3.15.0, Rs udio Inc., Bos on, MA, USA). The signi icance le el was se a
p io i a p= 0.05. The s anda d de ia ion (SD) was se acco ding o he o al SS da a om
p e ious s udies on eli e Spanish a hle es (SD = 2.1) [
26
]. Wi h an es ima ed e o (d) o
0.27, he sample size needed was 232 subjec s. The s udy popula ion was selec ed by non-
p obabilis ic, non-inju y, con enience sampling among ia hlon ede a ions and ia hlon
clubs h oughou Spain.
2.2. Pa icipan s and Sample Size
The sample consis ed o 232 ia hle es who we e aged 34.79
±
9.93 yea s old. Among
hem, 165 we e men and 67 we e women, and all we e o legal age. The pa icipan s had
compe ed in egional, na ional, and in e na ional compe i ions o a leas wo yea s and
had no su e ed om any inju ies o illnesses in he six mon hs p io o he su ey. The
pa icipan s’ compe i i e le el a ied om egional compe i ions (held a he p o incial
and egional le el) o na ional compe i ions (held h oughou Spain) and in e na ional com-
pe i ions (held wo ldwide). Table 1p o ides in o ma ion on he age, basic an h opome ic
cha ac e is ics, and yea s o spo s expe ience o he s udy pa icipan s.
Table 1.
Desc ip i e da a o he spo s supplemen s consumed in he di e en ca ego ies es ablished
by he AIS [14], based on sex and le el o compe i ion.
Compe i i e
Le el Sex Age (Yea ) Heigh (cm) * Body Mass (kg) * BMI * Expe ience (Yea s)
Regional Male (n= 97) 36.38 ±10.18 177.56 ±6.36 72.83 ±9.26 23.06 ±2.26 5.18 ±3.33
Female (n= 34) 36.35 ±7.99 164.68 ±6.29 59.68 ±9.29 21.97 ±2.74 3.82 ±2.35
Na ional Male (n= 52) 33.37 ±9.52 176.73 ±5.80 68.73 ±7.23 21.97 ±1.73 5.12 ±3.18
Female (n= 23) 28.81 ±10.72 163.96 ±5.51 55.46 ±5.94 20.62 ±1.81 5.09 ±3.07
In e na ional Male (n= 16) 34.69 ±9.51 176.75 ±6.77 74.94 ±10.48 24.04 ±3.68 3.31 ±2.80
Female (n= 10) 34.00 ±10.89 163.60 ±6.83 59.60 ±5.46 22.24 ±1.11 4.30 ±3.71
Da a p esen ed as M
±
SD; BMI, body mass index; * heigh and weigh a e sel - epo ed; he BMI was calcula ed
based on ha da a.
2.3. Ins umen s
The s udy u ilized a ques ionnai e ha had been p e iously used in simila s ud-
ies
[17,19–22,27]
. The selec ed supplemen consump ion ques ionnai e was alida ed o
con en , applicabili y, s uc u e, and p esen a ion [
28
]. I con ains a o al o 35 ques ions
di ided in o h ee main sec ions. The i s sec ion collec s an h opome ic da a such as age,
weigh , heigh , as well as pe sonal da a such as sex and social da a such as he au onomous
communi y o esidence. This sec ion has six ques ions. The second sec ion includes nine
ques ions ha co e he p ac ice o spo s and i s con ex , such as yea s o p ac ice and
he numbe o compe i ions. The las and mos ex ensi e sec ion ocuses on die and he
consump ion o supplemen s. I includes 20 ques ions, such as wha supplemen s he e-
sponden s consumed, why hey consumed hem, who ad ised hem, whe e hey pu chased
hem, when hey ook hem, and hei pe cep ion o he esul s a e consump ion. The
ques ionnai e can be iewed in he Supplemen a y Ma e ial sec ion.
2.4. P ocedu e
To selec he sample o his s udy, we con ac ed ia email he ep esen a i es o
each egional ia hlon ede a ion in Spain as well as ia hlon clubs egis e ed wi h hese
ede a ions. We in o med hem abou he s udy’s cha ac e is ics and eques ed hei collab-
o a ion. Once hey ag eed o pa icipa e, we sen hem an email con aining a link o he
supplemen consump ion ques ionnai e, which he ia hle es could comple e olun a ily,
elec onically, and anonymously. The p o ocol adhe ed o he Decla a ion o Helsinki o
Nu ien s 2023,15, 1330 4 o 11
human esea ch and was app o ed by he e hics commi ee o he Uni e si y o Alican e
wi h ile numbe UA-2021-02-01.
2.5. S a is ical Analysis
To e i y whe he he a iables had a no mal dis ibu ion, a Kolmogo o –Smi no es
was applied, and Le ene’s es was used o e i y homoscedas ici y. The quan i a i e da a
ob ained a e p esen ed as mean (M) + SD, while he quali a i e a iables a e exp essed as
pe cen ages and equencies. An ANOVA was pe o med acco ding o sex (male, emale),
le el o compe i ion ( egional, na ional, and in e na ional), and he in e ac ion be ween sex
and le el o compe i ion o analyze he di e ences in he o al consump ion o SS as well as
he SS consumed om he di e en ca ego ies de ined by he AIS [
14
]. When signi ican
di e ences we e ound be ween g oups, a pai wise compa ison was pe o med using he
Bon e oni co ec ion o mul iple compa isons. Rega ding he analysis o he a hle es who
consumed SS, he eason o consump ion, he place whe e hey ob ained hem, and who
ad ised hem o consume hem, a chi-squa e (X2) es was used o e i y he exis ence
o no o di e ences be ween a hle es o di e en sex and le el o compe i ion. As o
he SS ha we e consumed by a leas 10% o he sample, a chi-squa e es (X2) was also
pe o med o e i y possible di e ences acco ding o sex o le el o compe i ion. The le el
o s a is ical signi icance was es ablished as p< 0.05. The s a is ical analysis was ca ied
ou wi h he S a is ical Package o Social Sciences .20 so wa e o Windows (SPSS) (IBM,
A monk, NY, USA).
3. Resul s
F om he o al sample, 92.2% decla ed consuming SS. Rega ding he le el o compe i-
ion, no signi ican di e ences we e ound (F = 0.637; p= 0.727) ega ding he consump ion
o supplemen s, showing ha 91.6%, 92%, and 96.2% o egional, na ional, and in e na ional
ia hle es, espec i ely, consumed SS. Al hough he pe cen ages o consump ion in all
h ee ca ego ies we e simila , he e was an inc eased end be ween egional, na ional, and
in e na ional a hle es. Rega ding sex, no signi ican di e ences we e ound ei he (F = 0.952;
p= 0.329), wi h he esul s indica ing ha 93.3% o men and 89.6% o women consumed SS.
Rega ding he esponse o he pa icipan s on hei easons o consuming SS, i
was obse ed ha 82.33% consumed i o imp o e pe o mance, 31.47% o ake ca e o
hei heal h, and 21.98% o bo h easons. The es o he answe s e e ed o alle ia ing
die a y de ici s, heal h issues, o necessi y. As o he momen in which he a hle es
usually consumed SS, we ound ha mos a hle es (64.22%) consumed hem du ing aining
and compe i ions.
Wi h espec o he main indi iduals who mo i a ed he ia hle es o consume SS, he
main mo i a o was he die i ian-nu i ionis (D-N) (41.6%), ollowed by he coach (40.7%),
eamma es (23.8%), and he physical aine (16%). Howe e , wi hin each compe i i e
le el, hese da a a ied. Among he egional le el ia hle es, he main mo i a o was he
coach (40.8%), ollowed by he D-N (38.5%); a he na ional le el, he main one was he
D-N (46.7%), ollowed by he coach (42.7%); a he in e na ional le el, he main one was he
D-N (42.3%), ollowed by he coach and eamma e (bo h 34.6%). Wi h ega d o he place o
pu chase o he SS, i was obse ed ha ia hle es pu chased hem mos ly online (60.6%),
ollowed by specialized s o es (45.9%), wi h hese alues being e y simila wi hin all he
compe i i e le els analyzed. Table 2shows he mean and s anda d de ia ion o he o al
sample, wi h he sample segmen ed based on sex and on he le el o compe i ion.
Table 3shows he esul s o he ANOVA o he SS consumed acco ding o he di e en
ca ego ies es ablished by he AIS [
14
] and based on sex, le el o compe i ion, and hei
in e ac ion in addi ion o he mean and s anda d de ia ion o he la e . Rega ding sex, no
signi ican di e ences we e ound in any consump ion o supplemen s (
F = 0.203–2.651
;
p= 0.105–0.652
). Acco ding o he le el o compe i ion, signi ican di e ences we e ob-
se ed o he o al spo s supplemen s (F = 3.919; p= 0.021), o he o al supplemen s om
G oup A (F = 4.477; p= 0.012), and o he e gogenic aids (F = 5.801; p= 0.003) belonging o
Nu ien s 2023,15, 1330 5 o 11
his las g oup o supplemen s. Finally, in he in e ac ion be ween sex and compe i ion le el,
he only signi ican di e ence ound was in he consump ion o e gogenic aids (
F = 3.067
;
p= 0.049) belonging o he G oup A supplemen s.
Table 2.
Desc ip i e da a o he spo s supplemen s consumed in he di e en ca ego ies es ablished
by he AIS [14], based on sex and le el o compe i ion.
Sex Compe i i e Le el To al
Male Female Regional Na ional In e na ional
To al SS 8.39 ±0.75 8.28 ±0.47 7.37 ±0.44 9.39 ±0.83 9.92 ±1.33 8.31 ±0.40
G oup A
Spo oods 4.28 ±0.33 4.44 ±0.19 4.03 ±0.19 4.83 ±0.33 5.00 ±0.57 4.40 ±0.17
Medical supplemen s 0.94 ±0.14 0.60 ±0.07 0.59 ±0.08 0.88 ±0.12 0.73 ±0.20 0.70 ±0.07
E gogenic aids 0.76 ±0.13 1.00 ±0.08 0.80 ±0.09 1.17 ±0.13 0.88 ±0.18 0.93 ±0.07
To al 6.03 ±0.50 6.05 ±0.28 5.45 ±0.27 6.88 ±0.50 6.65 ±0.75 6.05 ±0.24
G oup B 0.63 ±0.12 0.50 ±0.07 0.48 ±0.07 0.48 ±0.11 0.96 ±0.25 0.53 ±0.06
G oup C 1.73 ±0.25 1.66 ±0.19 1.38 ±0.17 2.00 ±0.31 2.27 ±0.89 1.68 ±0.15
G oup D 0.00 ±0.00 0.00 ±0.00 0.00 ±0.00 0.00 ±0.00 0.00 ±0.00 0.00 ±0.00
Da a p esen ed as M ±SD; SS, spo supplemen s.
Table 3.
ANOVA o he spo s supplemen s consumed in he di e en ca ego ies es ablished by he
AIS [14], based on sex, le el o compe i ion, and hei in e ac ion.
Sex Compe i i e Le el Sex ×Compe i i e Le el
Va iable FpFp
Regional Na ional In e na ional
Fp
Male Female Male Female Male Female
To al SS 0.394 0.531 3.919 0.021 7.51 ±0.61 6.97 ±1.03 8.81 ±0.83 10.70 ±1.25 11.19 ±1.50 7.90 ±1.90 1.804 0.167
G oup A
Spo oods 0.708 0.401 2.589 0.077 4.07 ±0.26 3.91 ±0.43 4.86 ±0.35 4.74 ±0.53 5.31 ±0.63 4.50 ±0.80 0.185 0.831
Medical supplemen s 2.651 0.105 2.776 0.059 0.54 ±0.10 0.73 ±0.17 0.67 ±0.14 1.35 ±0.20 0.75 ±0.25 0.70 ±0.31 1.662 0.192
E gogenic aids 2.025 0.156 5.801 0.003 0.94 ±0.10 0.41 ±0.17 1.10 ±0.14 1.35 ±0.21 1.06 ±0.25 0.60 ±0.32 3.067 0.049
To al 0.203 0.652 4.477 0.012 5.58 ±0.37 5.09 ±0.63 6.61 ±0.51 7.48 ±0.76 7.12 ±0.92 5.90 ±1.16 0.980 0.377
G oup B 0.309 0.579 2.689 0.070 0.48 ±0.09 0.47 ±0.16 0.36 ±0.13 0.74 ±0.19 1.00 ±0.23 0.90 ±0.29 1.073 0.344
G oup C 0.972 0.325 2.301 0.102 1.37 ±0.23 1.41 ±0.39 1.79 ±0.32 2.48 ±0.48 3.00 ±0.58 1.10 ±0.73 2.810 0.062
G oup D - - - - - - - - - - - -
Da a p esen ed as M ±SD; SS, spo supplemen s.
Table 4shows he pai -wise compa ison be ween he di e en ca ego ies a e he
Bon e oni adjus men o he measu ed a iables wi h signi ican di e ences depending
on sex, le el o compe i ion, and hei in e ac ion. Rega ding he le el o compe i ion,
signi ican di e ences we e obse ed when he egional/au onomous le el was compa ed
wi h he na ional le el (p= 0.029–0.002) in bo h he o al numbe o spo s supplemen s
and he e gogenic aids and he o al numbe o G oup A supplemen s consumed, wi h
he consump ion a he na ional le el being highe in all cases. Finally, in he in e ac ion
be ween sex and he le el o compe i ion, signi ican di e ences we e only ound when
compa ing women a he na ional le el wi h hose a he egional le el (p= 0.002), wi h he
la e ha ing a lowe consump ion o e gogenic aids.
Table 4. Pos hoc compa ison be ween he a iables wi h signi ican di e ences.
Va iable Compa ison be ween G oups M ±SD pCI 95%
Compe i i e le el
To al SS
Regional–Na ional −2.51 ±0.96 0.029 −4.830 o −0.187
Regional–In e na ional −2.30 ±1.35 0.271 −5.562 o 0.961
Na ional–In e na ional 0.21 ±1.43 1.000 −3.234 o 3.650
G oup A
E gogenic aids
Regional–Na ional −0.55 ±0.16 0.002 −0.936 o −0.159
Regional–In e na ional −0.16 ±0.23 1.000 −0.70 o 0.39
Na ional–In e na ional 0.39 ±0.24 0.310 −0.185 o 0.967
To al
Regional–Na ional −1.71 ±0.59 0.012 −3.129 o −0.299
Regional–In e na ional −1.18 ±0.82 0.462 −3.128 o 0.809
Na ional–In e na ional 0.53 ±0.87 1.000 −1.564 o 2.633
Sex ×Compe i i e le el
G oup A
E gogenic aids
Male
Regional–Na ional −0.16 ±0.18 1.000 −0.585 o 0.269
Regional–In e na ional −0.12 ±0.28 1.000 −0.795 o 0.546
Na ional–In e na ional 0.03 ±0.29 1.000 −0.677 o 0.744
Female
Regional–Na ional −0.94 ±0.26 0.002 −1.567 o −0.305
Regional–In e na ional −0.19 ±0.34 1.000 −1.029 o 0.653
Na ional–In e na ional 0.75 ±0.36 0.126 −0.138 o 1.633
SS, spo supplemen s.
Nu ien s 2023,15, 1330 6 o 11
Table 5shows hose supplemen s ha we e consumed by mo e han 10% o he sample,
based on sex and le el o compe i ion. I was obse ed ha ba s, d inks, spo s gels, and
ca eine a e he mos -consumed supplemen s by he sample (83.6%, 74.1%, 61.2%, and
46.6%, espec i ely). Rega ding he signi ican di e ences based on sex, i was ound ha
women consumed mo e i on han men (p= 0.001) bu less ca eine han men (p= 0.0017).
Rega ding he le el o compe i ion, i was obse ed ha in e na ional le el ia hle es
consumed mo e spo s gels (p= 0.047), while na ional le el ia hle es consumed mo e
whey p o ein (p= 0.005) and glu amine (p= 0.019).
Table 5.
Dis ibu ion (%) o he mos -consumed supplemen s based on sex and compe i i e le el
acco ding o he ca ego ies es ablished by he AIS [14].
Ca ego y Supplemen To al (%) Sex (%) Compe i i e Le el (%)
M F pR N I p
G oup A
Spo oods
Reco e y shake 30.6 30.3 31.3 0.876 26.0 36.0 38.5 0.210
Spo s ba s 83.6 86.1 77.6 0.115 83.2 85.3 80.8 0.847
P o ein ba s 40.9 40.6 41.8 0.868 43.5 37.3 38.5 0.661
Spo s d inks 74.1 77.0 67.2 0.122 73.3 74.7 76.9 0.920
CH gaine s 19.0 20.6 14.9 0.317 16.0 21.3 26.9 0.354
Spo s con ec ione y 22.0 22.4 20.9 0.799 21.4 25.3 15.4 0.555
Elec oly es 27.2 27.3 26.9 0.950 23.7 30.7 34.6 0.367
Spo s gels 61.2 59.4 65.7 0.374 55.7 64.0 80.8 0.047
Mal odex in 13.8 14.5 11.9 0.602 10.7 20.0 11.5 0.165
Whey p o ein 29.7 27.9 34.3 0.330 21.4 42.7 34.6 0.005
Vege al p o ein 14.2 12.7 17.9 0.306 13.0 13.3 23.1 0.389
Medical
supplemen s
I on 17.7 12.1 31.3 0.001 13.0 22.7 26.9 0.091
Mul i i amins 20.7 21.8 17.9 0.505 18.3 28.0 11.5 0.121
Vi amin D 18.1 15.2 25.4 0.067 15.3 24.0 15.4 0.273
E gogenic aids
B alanine 13.8 14.5 11.9 0.602 11.5 17.3 15.4 0.484
Ca eine 46.6 51.5 34.3 0.017 42.0 53.3 50.0 0.271
C ea ine monohyd a e 27.2 30.9 17.9 0.044 22.9 36.0 23.1 0.112
G oup B
An ioxidan s/ i amin C 15.1 12.7 20.9 0.115 12.2 14.7 30.8 0.054
Ca ni ine 11.6 12.1 10.4 0.719 10.7 12.0 15.4 0.787
Collagen 12.5 11.5 14.9 0.477 15.3 4.0 23.1 0.014
G oup C
BCAA 23.7 23.6 23.9 0.968 19.1 32.0 23.1 0.110
Glu amine 19.4 20.0 17.9 0.715 13.0 28.0 26.9 0.019
Magnesium 24.6 23.6 26.9 0.605 22.9 22.7 38.5 0.218
M, male; F, emale; R, egional; N, na ional, I, in e na ional; BCAA, b anched-chain amino acids.
4. Discussion
The main objec i e o his s udy was o desc ibe he consump ion pa e n o di e en
SS conside ing he possible di e ences acco ding o sex and compe i i e le el o a sample o
ia hle es. F om he o al sample, 92.2% decla ed consuming SS, wi h his alue being e y
simila o he esul s ob ained in endu ance a hle es such as moun ain unne s (93.84%) [
20
],
al hough i was highe han open-wa e swimme s (79.5%) [
22
] and in o he spo s such
as encing, sailing, o ennis, whe e a lowe p e alence o supplemen consump ion was
desc ibed (46.9, 52.4, and 61.4, espec i ely) [
17
,
29
,
30
]. These di e ences may be due
o he di e en physiological equi emen s be ween spo s and o he di e en eeding
oppo uni ies in aining and compe i ions, as in he case o open-wa e swimming, in
which oppo uni ies a e de e mined by he dis ibu ion o he es [22]. Bo h ail unning
and ia hlon a e highly demanding spo s in e ms o ene gy subs a es and wa e and
sodium equi emen s. Hence, bo h spo s show a simila consump ion o SS, especially
when i s objec i e is o co e ene gy equi emen s and eplace he loss o wa e and
elec oly es [
8
,
12
,
13
]. In addi ion, a di e ence in SS consump ion was ound be ween
ia hle es a di e en compe i i e le els, wi h he numbe o SS consumed being highe in
a hle es om a medium-high compe i i e le el when compa ed wi h he basic le el, wi h
Nu ien s 2023,15, 1330 7 o 11
hese esul s simila o hose p e iously ound in s udies wi h di e en Spanish a hle es.
Al hough some s udies ha e analyzed he p e alence o SS consump ion in endu ance
spo s, he p esen one is one o he i s s udies on ia hle es wi h a ep esen a i e sample
o 232 indi iduals.
In his popula ion o ia hle es, he main eason o consuming SS was o imp o e
spo s pe o mance, ollowed by heal h ca e, which coincides wi h wha was obse ed in
o he s udies [
16
,
17
,
19
,
29
–
31
]. Rega ding he pe son who ad ised he ia hle e o consume
SS, he D-N heal h p o essional was he mos consul ed by a hle es ahead o coaches and
colleagues o guide hei in ake o SS. This esul is con a y o ha ob ained in o he
s udies [
16
,
17
,
27
,
29
,
32
], which indica ed ha he pe son who de e mined SS consump ion
was no an expe in his ield. I is impo an o conside ha many a hle es decide o
use SS as pa o hei nu i ional s a egy and ob ain ad ice, on mos occasions, om
pe sonnel who a e unquali ied in spo s nu i ion. In his sense, a hle es who ecei e
ad ice om a D-N end o ha e be e ea ing habi s, which include pe iodiza ion o
nu i ion and consump ion o SS, wi h b oad scien i ic suppo in e ms o pe o mance
imp o emen [33,34].
Rega ding he days in which SS we e usually consumed, he ia hle es epo ed con-
suming hem mos ly bo h du ing aining and in compe i ions (64.2%), wi h hese alues
being highe han ha ound in p e ious s udies in moun ain unne s (44.4%) [
20
] and
open-wa e swimme s (39.4%) [
22
], which could be explained by he equency and ype
o aining and he high physiological demand (ca bohyd a es, wa e , and elec oly es)
imposed by his discipline [
5
,
8
]. In his sense, he nu i ional needs o ia hle es du ing
aining o acing could be co e ed wi h he in ake o wa e , sodium, and ca bohyd a es
in he shape o SS. In ac , he cu en guidelines in spo s nu i ion o hese ypes o
spo s disciplines ecommend an in a-compe i ion/ aining in ake o 500 mL o liquids,
300–600 mg o sodium, and 60 o 120 g o ca bohyd a es pe hou [
12
,
35
,
36
]. In addi ion,
he pos -exe cise nu i ional eco e y is pe o med h ough he in ake o ca bohyd a es and
p o eins (0.8 g ca bohyd a e/kg body weigh plus 0.2–0.4 g p o ein/kg body weigh ) [
12
,
35
],
wi h eco e y shakes and p o ein powde being he mos -consumed supplemen s a e
ba s, spo s d inks, gels, and ca eine. To pu hese ecommenda ions in o p ac ice, he ype
o compe i ion mus be aken in o accoun (dis ance, o og aphy, expec ed wea he , sup-
plies, e c.) as well as he in e pe sonal a iables o he ia hle es (age, yea s o expe ience,
ood ole ance, spo s equipmen , e c.) [37,38].
On he o he hand, he place whe e he a hle es buy he SS could de e mine hei co ec
usage [
39
–
41
]. A hle es decla ed a g ea e pu chase o SS h ough he In e ne , ollowed
by specialized s o es and pha macies. I should be no ed ha pu chasing SS online can
be p oblema ic and isky, as he possibili y o ob aining lowe -quali y o e en illegal SS
inc eases due o he possible lack o speci ic legisla ion in he coun y o o igin [40–42].
S a is ically signi ican di e ences we e ound in he consump ion o supplemen s
om G oup A o he AIS classi ica ion [
14
], acco ding o he compe i i e le el, o he
o al SS (F = 3.919, p> 0.021), o he o al g oup A (F = 4.477, p< 0.012), and speci ically
o e gogenic aids (F = 5.801, p< 0.03), wi h he na ional-compe i ion-le el g oup ha ing
he highes consump ion o e gogenic aids (1.17
±
0.13 na ional; 0.88
±
0.18 in e na ional;
0.80 ±0.09
egional/au onomous). Howe e , hese di e ences we e only signi ican when
compa ing he egional le el wi h he na ional le el. Simila ly, s a is ically signi ican di -
e ences we e ound in he in e ac ion wi h sex and compe i i e le el (F = 3.067,
p< 0.049
)
o he ca ego y o e gogenic aids, wi h na ional-le el women consuming he mos supple-
men s in his subg oup (1.35
±
0.21) compa ed o men in he same ca ego y (1.10
±
0.14),
wi h hese di e ences p o ing signi ican when compa ing women a egional and na ional
compe i i e le els. These esul s coincide in pa wi h hose obse ed in o he s udies,
whe e G oup A was he mos -consumed SS g oup and he gene al end being ha he
highe compe i i e le el, he g ea e he consump ion o spo s ood, medical supplemen s,
and e gogenic aids [
16
,
21
,
27
,
31
]. The ac ha his sample o ia hle es did no ollow
his end could be explained by he % o indi iduals who consul ed he D-N o plan he
Nu ien s 2023,15, 1330 8 o 11
in ake o supplemen s in each compe i i e ca ego y, wi h na ional-le el a hle es consul ing
he D-N he mos , ollowed by he in e na ional a hle es, and las ly, egional a hle es. In
addi ion, he in e na ional a hle es decla ed a g ea e pu chase o SS h ough he In e ne ,
ollowed by egional and na ional a hle es. These esul s suppo he impo ance o ha ing
quali ied people such as he D-N o p o ide ad ice on he consump ion o SS wi h a b oad
suppo om scien i ic e idence and he isks o buying SS o e he In e ne (p e iously
discussed), which could be in luencing he consump ion o SS acco ding o he compe i i e
le el [40,43].
In e ms o a e age supplemen consump ion wi hin each AIS g oup, G oup A had
he highes a e age consump ion o supplemen s, wi h 6.05
±
0.24 compa ed o G oups B
(
0.53 ±0.06
) and C (1.68
±
0.15). Howe e , i should be no ed ha he high consump ion wi hin
g oup A was mainly due o he high consump ion o supplemen s in he spo s ood subg oup
(4.4 ±0.17), wi h less consump ion epo ed o he o he subg oups wi hin his g oup.
I should be no ed ha he ou mos -consumed supplemen s we e ound wi hin G oup
A o he AIS classi ica ion, indica ing a high deg ee o cu en scien i ic e idence [
14
]. In ac ,
spo s ba s, spo s d inks, spo s gels, and ca eine we e he mos -consumed supplemen s
by ia hle es, as hese SS a e e y impo an when i comes o p o iding ene gy in he
o m o ca bohyd a es, p e en ing dehyd a ion and hypona emia du ing aining o
compe i ions, and o eco e y a e hese sessions [
13
,
44
,
45
]. These esul s a e simila o
hose ob ained in p e ious esea ch, which showed ha in gene al, he mos -consumed SS
we e iso onic o spo s d inks, ene gy ba s, and gels [16,17,19,24,29–31].
I we analyze he esul s acco ding o sex, we ind ha on one hand, he ou mos -
consumed SS coincided in bo h sexes, and he consump ion o his ype o SS, such as spo s
d inks, spo s gels, and spo s ba s, was be o e o du ing aining and/o compe i ion,
while he p o ein powde s, p o ein ba s, and mixed mac onu ien supplemen g oups
we e used a e aining and/o compe i ion, wi h hei consump ion con ibu ing owa ds
eaching he ecommended nu ien in akes. On he o he hand, in medical supplemen s
wi hin G oup A, s a is ically signi ican di e ences we e ound in i on consump ion when
compa ing i acco ding o sex, wi h his consump ion being highe in women, which would
be jus i ied by he high p e alence o anemia in emale a hle es [
46
] and he use o i on SS
o p e en anemia in emale a hle es. [
46
]. In he g oup o e gogenic aids, ca eine was he
mos -consumed SS, wi h his consump ion being highe in men han in women. Gi en ha
i is one o he SS wi h he mos scien i ic e idence, i s use is usually common in endu ance
spo s [
20
,
22
]. Acco ding o he EFSA, he consump ion o 3 mg/kg o ca eine one hou
be o e exe cising imp o es pe o mance in endu ance spo s, and i he dose is inc eased
o 4–6 mg/kg, he eeling o i edness is educed [47].
Spo s pe o mance is in luenced by a ious ac o s, and a hle es usually p esen
an inc ease in body empe a u e and swea a e when p ac icing spo s, which leads o
an inc eased loss o luids and elec oly es [
13
,
45
]. These ac o s jus i y ha he sample
p esen ed a high consump ion o spo s ba s and d inks, as wa e imbalances du ing
aining o compe i ions can lead o a dec ease in pe o mance [
35
,
45
,
48
]. Spo s oods
(spo s gels, spo s d inks, and spo s ba s) p o ide a hle es wi h ene gy and nu ien s in a
simple way han con en ional oods, which is why hey se e as suppo in si ua ions o
high spo s demand o a imes when he e is di icul y in accessing con en ional ood [
9
].
Spo s d inks a e a good op ion o eplenishing luids, elec oly es, and ca bohyd a es
du ing and a e exe cise [
49
], and spo s ba s can also be use ul du ing and a e exe cise,
as hey p o ide ca bohyd a es, p o eins, and mic onu ien s [9,48–50].
A key piece o in o ma ion ound in he p esen s udy was ha he consump ion o
SS om G oup C (supplemen s ha ha e li le o no e idence o bene icial e ec s) was
1.73 ±0.25
, double he amoun o consump ion o SS om G oup B (supplemen s ha ha e
some bene i , bu mo e esea ch is needed), which was 0.63
±
0.5, wi h simila esul s also
obse ed in p e ious s udies wi h moun ain unne s [
21
]. This should be conside ed when
dealing wi h a hle es in nu i ion consul a ions, and i is also an in e es ing esea ch opic
in nu i ion educa ion p og ams [33,40,41].
Nu ien s 2023,15, 1330 9 o 11
Limi a ions
The ques ionnai e used o e alua e SS consump ion was a alida ed ool, al hough one
o i s limi a ions was ha he consump ion in o ma ion was collec ed in a sel - epo ed and
e ospec i e manne based on he memo y o he ia hle es. This could lead o e o s in
he numbe and ype o decla ed SS. In gene al, a hle es end o wo y abou hei die and
aining, as hei pe o mance depends on i , and hey a e usually knowledgeable abou
hei ea ing habi s. This could make hem be e ecall hei ood in ake and SS as compa ed
o he gene al popula ion. This is one o he i s s udies o use a signi ican sample
in his ype o popula ion. As u u e esea ch lines, e o s can be made o collabo a e
wi h ede a ions in o he coun ies, o ob ain a ep esen a i e SS consump ion pa e n
wo ldwide, and o e i y whe he SS consump ion is simila in all o hem acco ding o he
compe i i e le el and sex.
5. Conclusions
The consump ion o supplemen s by ia hle es was high when compa ed o o he
spo s disciplines, pe haps due o he high physiological equi emen s du ing aining and
compe i ion. A a compe i i e le el, he consump ion o SS was di e en a he na ional-
in e na ional le el when compa ed o he egional le el. In addi ion, di e ences we e
ound in he consump ion o some supplemen s acco ding o sex. The mos -consumed
SS by ia hle es we e ba s, spo s d inks, spo s gels, and ca eine, all included in G oup
A, he ca ego y wi h he mos scien i ic e idence o da e. Simila ly, a la ge pa o he
a hle es ob ained ad ice om a D-N, which would explain why mos o he SS consumed
by a hle es we e pa o G oup A as well as he di e ences in SS consump ion a di e en
compe i i e le els.
Supplemen a y Ma e ials:
The ollowing suppo ing in o ma ion can be downloaded a : h ps:
//www.mdpi.com/a icle/10.3390/nu15061330/s1, File S1: CONSUMO DE SUPLEMENTOS NU-
TRICIONALES EN TRIATLETAS.
Au ho Con ibu ions:
Concep ualiza ion, J.M.M.-S., I.S. and R.J.-A.; me hodology, J.M.M.-S., I.S.,
R.J.-A., D.R.-G., D.G.-M. and A.J.S.-O.; da a cu a ion, R.J.-A. and S.H.A.; o mal analysis, R.J.-A.,
D.R.-G., D.G.-M. and S.H.A.; in es iga ion, J.M.M.-S., I.S., R.J.-A., D.G.-M., S.H.A. and A.J.S.-O.;
isualiza ion, J.M.M.-S., D.G.-M. and I.S.; w i ing—o iginal d a p epa a ion, R.J.-A., D.G.-M.,
D.R.-G.
and A.J.S.-O.; w i ing— e iew and edi ing, J.M.M.-S., I.S., R.J.-A., D.G.-M., S.H.A., D.R.-G.
and A.J.S.-O. All au ho s ha e ead and ag eed o he published e sion o he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Ins i u ional Re iew Boa d S a emen :
The s udy was conduc ed in acco dance wi h he Decla a ion
o Helsinki and app o ed by he E hics Commi ee o Uni e si y o Alican e ( ile no. UA-2021-02-01).
In o med Consen S a emen :
In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen :
The da a p esen ed in his s udy a e a ailable in he ables o his
a icle. The da a p esen ed in his s udy a e a ailable on eques om he co esponding au ho .
Acknowledgmen s:
Au ho s a e g a e ul he all egional ia hlon clubs and ede a ions o Spain o
hei suppo and collabo a ion in he de elopmen o his s udy. In addi ion, we a e g a e ul o Ma io
Fon (a na i e English speake ) o his e iew o he English g amma and s yle o he cu en epo .
This s udy is pa o he doc o al hesis o Rubén Jiménez Al ageme and is included in “Valo ación
Nu icional de la Muje en Depo e de Resis encia—VANMUD” (Re : GRE21-13A).
Con lic s o In e es : The au ho s decla e no con lic o in e es .
Abb e ia ions
SS: Spo Supplemen s, AIS: Aus alian Ins i u e o Spo , BMI: Body–Mass Index, BCAAs: B anched-
Chain Amino Acids, CH: Ca bohyd a es, D-N: die i ian-nu i ionis .
