Perturbed energy balance and hydration status in ultra-endurance runners during a 24 h ultra-marathon

Costa, Ricardo J. S.; Gill, Samantha K.; Hankey, Joanne; Wright, Alice; Marczak, Slawomir

doi:10.1017/s0007114514000907

Cited by 99Thermoregulation and physiological responsesMuscle metabolism and nutritionSports Performance and Training

Perturbed energy balance and hydration status in ultra-endurance runners during a 24 h ultra-marathon

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Costa, Ricardo J. S., Gill, Samantha K., Hankey, Joanne, Wright, Alice, Marczak, Slawomir·2014·British Journal of Nutrition

DOI 10.1017/s0007114514000907

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Abstract

The present study aimed to assess the adequacy of energy, macronutrients and water intakes of ultra-endurance runners (UER) competing in a 24 h ultra-marathon (distance range: 122–208 km). The ad libitum food and fluid intakes of the UER ( n 25) were recorded throughout the competition and analysed using dietary analysis software. Body mass (BM), urinary ketone presence, plasma osmolality (P Osmol ) and volume change were determined at pre- and post-competition time points. Data were analysed using appropriate t tests, with significance set at P < 0·05. The total energy intake and expenditure of the UER were 20 ( sd 12) and 55 ( sd 11) MJ, respectively (control (CON) ( n 17): 12 ( sd 1) and 14 ( sd 5) MJ, respectively). The protein, carbohydrate and fat intakes of the UER were 1·1 ( sd 0·4), 11·3 ( sd 7·0) and 1·5 ( sd 0·7) g/kg BM, respectively. The rate of carbohydrate intake during the competition was 37 ( sd 24) g/h. The total water intake of the UER was 9·1 ( sd 4·0) litres (CON: 2·1 ( sd 1·0) litres), while the rate of water intake was 378 ( sd 164) ml/h. Significant BM loss occurred at pre- to post-competition time points ( P = 0·001) in the UER (1·6 ( sd 2·0) %). No significant changes in P Osmol values were observed at pre- (285 ( sd 11) mOsmol/kg) to post-competition (287 ( sd 10) mOsmol/kg) time points in the UER and were lower than those recorded in the CON group ( P < 0·05). However, plasma volume (P V ) increased at post-competition time points in the UER (10·2 ( sd 9·7) %; P < 0·001). Urinary ketones were evident in the post-competition samples of 90 % of the UER. Energy deficit was observed in all the UER, with only one UER achieving the benchmark recommendations for carbohydrate intake during endurance exercise. Despite the relatively low water intake rates recorded in the UER, hypohydration does not appear to be an issue, considering increases in P V values observed in the majority (80 %) of the UER. Population-specific dietary recommendations may be beneficial and warranted.

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In longer races (100 miles, 161 km), similar rates of carbohydrate ingestion may be typical for slower finishers (31 ± 9 g·h−1), lower than faster finishers (44 ± 33 g·h−1).
“In longer races (100 miles, 161 km), similar rates of CHO ingestion may be typical for slower finishers (31 ± 9 g·h− 1 [103];), both of which were lower than faster finishers (44 ± 33 g·h− 1)”
From International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing (2019) · cites this paper as [103]

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BackgroundSelf-citation
Two weeks of repetitive gut‐challenge reduce exercise‐associated gastrointestinal symptoms and malabsorption
Miall, A., Khoo, A., Rauch, C., Snipe, R. M. J., Camões‐Costa, V., Gibson, P. R., & Costa, R. J. S. (2017) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.12912 · Cited by 78 · see citing works
Self-citation
Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating
Jagim, A. R., Fields, J. B., Magee, M. K., Kerksick, C. M., & Jones, M. T. (2022) · Nutrients · doi:10.3390/nu14050986 · Cited by 89 · see citing works
“, Tour de France) may be the exception, as TDEE values have been reported to exceed 10,000 [85] and 6000 kcal·day−1”
Background
Nutrition in Ultra-Endurance: State of the Art
Nikolaidis, P. T., Veniamakis, E., Rosemann, T., & Knechtle, B. (2018) · Nutrients · doi:10.3390/nu10121995 · Cited by 70 · see citing works
“In turn, the energy expenditure is assessed using triaxial accelerometry [10], indirect calorimetry [12] or the energy equivalent of oxygen that can be calculated from heart rate recordings during the race [9,11].”
BackgroundMethod
Impact of 24-h high and low fermentable oligo-, di-, monosaccharide, and polyol diets on markers of exercise-induced gastrointestinal syndrome in response to exertional heat stress
Gaskell, S. K., Taylor, B., Muir, J. G., & Costa, R. J. S. (2019) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2019-0187 · Cited by 70 · see citing works
Self-citation
Energy, macronutrient and water intake during a mountain ultramarathon event: The influence of distance
Martinez, S., Aguilo, A., Rodas, L., Lozano, L., Moreno, C., & Tauler, P. (2018) · Journal of Sports Sciences · doi:10.1080/02640414.2017.1306092 · Cited by 60 · see citing works
“In fact, Costa et al. (2014) reported that in a 24-h ultramarathon water intake rates of 378 ml · h¯1, which are similar to the ones found in the present study, appeared to be sufficient to prevent significant degrees of hypohydration in themajority of the athletes.”
BackgroundResultInfluential
Application of Continuous Glucose Monitoring for Assessment of Individual Carbohydrate Requirement during Ultramarathon Race
Ishihara, K., Uchiyama, N., Kizaki, S., Mori, E., Nonaka, T., & Oneda, H. (2020) · Nutrients · doi:10.3390/nu12041121 · Cited by 61 · see citing works
“The lowest observed average was 31 g/h in slower runners [13].”
BackgroundMethodResultInfluential
Assessment of Exercise-Associated Gastrointestinal Perturbations in Research and Practical Settings: Methodological Concerns and Recommendations for Best Practice
Costa, R. J. S., Young, P., Gill, S. K., Snipe, R. M. J., Gaskell, S. K., Russo, I., & Burke, L. M. (2022) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2022-0048 · Cited by 56 · see citing works
Self-citation
Nutritional implications for ultra-endurance walking and running events
Williamson, E. (2016) · Extreme Physiology & Medicine · doi:10.1186/s13728-016-0054-0 · Cited by 53 · see citing works
“This is subsequently associated with poor recovery from exercise and sustained fatigue [14, 15].”
Background
Gastrointestinal Assessment and Therapeutic Intervention for the Management of Exercise-Associated Gastrointestinal Symptoms: A Case Series Translational and Professional Practice Approach
Gaskell, S. K., Rauch, C., & Costa, R. J. S. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.719142 · Cited by 51 · see citing works
Self-citation
The influence of vigorous running and cycling exercise on hunger perceptions and plasma acylated ghrelin concentrations in lean young men
Wasse, L. K., Sunderland, C. D., King, J. A., Miyashita, M., & Stensel, D. J. (2012) · Applied Physiology Nutrition and Metabolism · doi:10.1139/apnm-2012-0154 · Cited by 47 · see citing works
Diurnal versus Nocturnal Exercise—Effect on the Gastrointestinal Tract
Gaskell, S. K., Rauch, C., Parr, A., & Costa, R. J. S. (2020) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000002546 · Cited by 42 · see citing works
Self-citation
The Effects of a High-Protein Dairy Milk Beverage With or Without Progressive Resistance Training on Fat-Free Mass, Skeletal Muscle Strength and Power, and Functional Performance in Healthy Active Older Adults: A 12-Week Randomized Controlled Trial
Huschtscha, Z., Parr, A., Porter, J. A., & Costa, R. J. S. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.644865 · Cited by 40 · see citing works
Self-citation
Analysis of food and fluid intake in elite ultra-endurance runners during a 24-h world championship
Lavoué, C., Siracusa, J., Chalchat, É., Bourrilhon, C., & Charlot, K. (2020) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-020-00364-7 · Cited by 39 · see citing works
“It has been suggested that intake may increase with the level of performance [23] and thus recommendations are likely to be better followed in this population.”
BackgroundMethodResultInfluential
Case Study: Providing Nutritional Support to an Ultraendurance Runner in Preparation for a Self-Sufficient Multistage Ultramarathon: Rationed Versus Full Energy Provisions
Alcock, R., McCubbin, A. J., Camões‐Costa, V., & Costa, R. J. S. (2018) · Wilderness and Environmental Medicine · doi:10.1016/j.wem.2018.06.004 · Cited by 33 · see citing works
“Energy and macronutrient composition of dietary interventions were determined by dietary analysis software (Foodworks v7, Xyris Software, Australia), as previously reported.(6,12,21)”
Self-citation
Sodium Intake Beliefs, Information Sources, and Intended Practices of Endurance Athletes Before and During Exercise
McCubbin, A. J., Cox, G. R., & Costa, R. J. S. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0270 · Cited by 31 · see citing works
“55 56 Whilst previous studies have investigated beliefs and strategies for sodium ingestion during endurance 57 events (Costa et al., 2014; Costa et al., 2013; Hoffman & Stuempfle, 2014; Pfeiffer et al., 2012; 58 Winger et al., 2013), little is known about how endurance athletes perceive the role of sodium in 59 relat…”
BackgroundSelf-citation
Impact of 3-day high and low dietary sodium intake on sodium status in response to exertional-heat stress: a double-blind randomized control trial
McCubbin, A. J., Lopez, M. B., Cox, G. R., Caldwell Odgers, J. N., & Costa, R. J. S. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04199-2 · Cited by 30 · see citing works
Self-citation
Ad libitum drinking adequately supports hydration during 2 h of running in different ambient temperatures
Hoffman, M. D., Snipe, R. M. J., & Costa, R. J. S. (2018) · European Journal of Applied Physiology · doi:10.1007/s00421-018-3996-7 · Cited by 30 · see citing works
Self-citation
Multidisciplinary Analysis of Differences Between Finisher and Non-finisher Ultra-Endurance Mountain Athletes
Belinchón-deMiguel, P., Tornero-Aguilera, J. F., Dalamitros, A. A., Nikolaidis, P. Τ., Rosemann, T. J., Knechtle, B., & Clemente‐Suárez, V. J. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.01507 · Cited by 31 · see citing works
Impact of exercise duration on gastrointestinal function and symptoms
Gaskell, S. K., Burgell, R., Wiklendt, L., Dinning, P. G., & Costa, R. J. S. (2022) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00393.2022 · Cited by 30 · see citing works
Self-citation
Feeding Tolerance, Glucose Availability, and Whole-Body Total Carbohydrate and Fat Oxidation in Male Endurance and Ultra-Endurance Runners in Response to Prolonged Exercise, Consuming a Habitual Mixed Macronutrient Diet and Carbohydrate Feeding During Exercise
Rauch, C., McCubbin, A. J., Gaskell, S. K., & Costa, R. J. S. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2021.773054 · Cited by 29 · see citing works
“…test was deliberately undertaken 2 h postprandial (e.g., 2.9 ± 1.0 MJ, 29 ± 12 g protein, 97 ± 37 g carbohydrates, 18 ± 6 g fat, and 414 ± 235 ml water; Russo et al., 2021a) to reflect endurance athlete behavior before longer training sessions or competition (Costa et al., 2013, 2014).”
BackgroundInfluentialSelf-citation
Sports Dietitians Australia and Ultra Sports Science Foundation Joint Position Statement: A Practitioner Guide to the Prevention and Management of Exercise-Associated Gastrointestinal Perturbations and Symptoms
Costa, R. J. S., Gaskell, S. K., Henningsen, K., JEACOCKE, N. A., Martinez, I. G., Mika, A. S., Scheer, V., Scrivin, R., Snipe, R. M. J., Wallett, A. M., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02186-6 · Cited by 31 · see citing works
Self-citation
Current Trends in Ultramarathon Running
Spittler, J., & Oberle, L. (2019) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000654 · Cited by 26 · see citing works
“A closer match between energy expenditure and intake is associated with better performance (44,45).”
Background
Relationship of Carbohydrate Intake during a Single-Stage One-Day Ultra-Trail Race with Fatigue Outcomes and Gastrointestinal Problems: A Systematic Review
Arribalzaga, S., Viribay, A., Calleja-González, J., Fernández‐Lázaro, D., Castañeda-Babarro, A., & Mielgo‐Ayuso, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115737 · Cited by 24 · see citing works
“However, GI problems caused by CHO intake could be reduced by intestinal training and suitable hydration and nutrition strategy [8,42].”
BackgroundInfluential
The Effect of Gut-Training and Feeding-Challenge on Markers of Gastrointestinal Status in Response to Endurance Exercise: A Systematic Literature Review
Martinez, I. G., Mika, A. S., Biesiekierski, J. R., & Costa, R. J. S. (2023) · Sports Medicine · doi:10.1007/s40279-023-01841-0 · Cited by 29 · see citing works
Self-citation
Does exertional heat stress impact gastrointestinal function and symptoms?
Gaskell, S. K., Burgell, R., Wiklendt, L., Dinning, P. G., & Costa, R. J. S. (2022) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2022.10.008 · Cited by 22 · see citing works
Self-citation
The impact of exercise modality on exercise-induced gastrointestinal syndrome and associated gastrointestinal symptoms
Costa, R. J. S., Mika, A. S., & McCubbin, A. J. (2022) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2022.07.003 · Cited by 20 · see citing works
Self-citation
An exploratory study of the management strategies reported by endurance athletes with exercise-associated gastrointestinal symptoms
Scrivin, R., Costa, R. J. S., Pelly, F. E., Lis, D. M., & Slater, G. (2022) · Frontiers in Nutrition · doi:10.3389/fnut.2022.1003445 · Cited by 19 · see citing works
“, females exercising in the luteal or early menstrual phase of the menstrual cycle) (15), hypohydration (16, 17), individual feeding tolerance (7, 8, 11), predisposing or active functional gastrointestinal disease or disorders (5), gastrointestinal bacterial composition (e.”
BackgroundSelf-citation
Nutritional interventions for improving the endurance performance in athletes
Veeranna, R. P., Janhavi, P., Divyashree, S., & Peddha, M. S. (2020) · Archives of Physiology and Biochemistry · doi:10.1080/13813455.2020.1733025 · Cited by 21 · see citing works
“Furthermore, the rate of recovery may get compromised, leading to reduced training, and that may affect the performance as well as develop the risk of overtraining and illness (Costa et al. 2013, 2014).”
Background
Dietary Observations of Ultra-Endurance Runners in Preparation for and During a Continuous 24-h Event
Kinrade, E., & Galloway, S. D. R. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.765888 · Cited by 18 · see citing works
“…ultra-runners during competition have shown large variations in intake (25–71 g·h.−1), at elite and non-elite levels (Glace et al., 2002; Moran et al., 2011; Stuempfle et al., 2011; Costa et al., 2014; Wardenaar et al., 2015; Stellingwerff, 2016; Martinez et al., 2018; Lavoué et al., 2020).”
Background
Inflammatory Response to Ultramarathon Running: A Review of IL-6, CRP, and TNF-α
Waśkiewicz‬, Z., Mukhambet, Z. S., Azerbayev, D., & Bondarev, S. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26136317 · Cited by 16 · see citing works
Changes in Pain and Nutritional Intake Modulate Ultra-Running Performance: A Case Report
Best, R., Barwick, B., Best, A., BERGER, N. J. A., Harrison, C., Wright, M., & Sparrow, J. (2018) · Sports · doi:10.3390/sports6040111 · Cited by 16 · see citing works
“Meeting energy requirements is challenging [20,21] and achieving adequate carbohydrate (CHO) intake is preferable to maximise overall calorie consumption [15,20,21].”
Background
The Impact of Dietary Sodium Intake on Sweat Sodium Concentration in Response to Endurance Exercise: A Systematic Review
McCubbin, A. J., & da Costa, R. (2018) · International Journal of Sports Science · doi:10.5923/j.sports.20180801.05 · Cited by 15 · see citing works
Self-citation
Plasma Endogenous Endotoxin Core Antibody Response to Exercise in Endurance Athletes
Young, P., Rauch, C., Russo, I., Gaskell, S. K., Davidson, Z. E., & Costa, R. J. S. (2022) · International Journal of Sports Medicine · doi:10.1055/a-1827-3124 · Cited by 15 · see citing works
“The meal was consumed 2 h prior to the start of exercise, simulating real-life translational practice in the target population [47, 48].”
MethodSelf-citation
Association between dietary practice, body composition, training volume and sport performance in 100-Km elite ultramarathon runners
Citarella, R., Itani, L., Intini, V., Zucchinali, G., Scevaroli, S., Tannir, H., Masri, D. E., Kreidieh, D., & Ghoch, M. E. (2021) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2021.01.029 · Cited by 14 · see citing works
Are humans evolved specialists for running in the heat? Man vs. horse races provide empirical insights
Halsey, L. G., & Bryce, C. M. (2020) · Experimental Physiology · doi:10.1113/ep088502 · Cited by 13 · see citing works
“…et al., 2002; Beals et al., 2019; Bircher et al., 2006; Bourrilhon et al., 2009; Castellani et al., 2006; Clemente-Suárez, 2015; Coker et al., 2018; Costa et al., 2014; Diaz et al., 1991; Ebine et al., 2002; Edwards et al., 1993; Forbes-Ewen et al., 1989; Frykman et al., 2003; Fudge et al., 2006;…”
The Impact of a Dairy Milk Recovery Beverage on Bacterially Stimulated Neutrophil Function and Gastrointestinal Tolerance in Response to Hypohydration Inducing Exercise Stress
Costa, R. J. S., Camões‐Costa, V., Snipe, R. M. J., et al. (2020) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2019-0349 · Cited by 13 · see citing works
“Energy and nutritional intake was assessed and analyzed in accordance with the previously described procedures (Costa et al., 2014; Costa et al., 2013).”
MethodSelf-citation
Body Composition Changes During a 24-h Winter Mountain Running Race Under Extremely Cold Conditions
Chlíbková, D., Žákovská, A., Rosemann, T. J., Knechtle, B., & Bednar, J. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00585 · Cited by 12 · see citing works
“BM losses during a 24-h ultra-marathon were observed by Fellmann et al. (1988), Knechtle et al. (2010b), Chlíbková et al. (2014) and Costa et al. (2014) in their studies on races held at temperatures ranging from 0 to 20◦C.”
BackgroundInfluential
Carbohydrate intake and ketosis in self-sufficient multi-stage ultramarathon runners
Edwards, K. H., Elliott, B., & Kitic, C. M. (2019) · Journal of Sports Sciences · doi:10.1080/02640414.2019.1702269 · Cited by 9 · see citing works
“Likewise, in a 24 hour ultramarathon, urinary ketones were present in 90% of runners whose average CHO intake was 881 g (37 g·hr) (Costa et al., 2014).”
BackgroundInfluential
Maintained Hydration Status After a 24-h Winter Mountain Running Race Under Extremely Cold Conditions
Chlíbková, D., Nikolaidis, P. Τ., Rosemann, T. J., Knechtle, B., & Bednar, J. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2018.01959 · Cited by 9 · see citing works
“Body mass decreased post-race, however, BM decreases during 24-h ultra-marathons are common and were noted by Fellmann et al. (1988), Kao et al. (2008), Knechtle et al. (2011), and Costa et al. (2014).”
BackgroundMethodResultInfluential
From Metabolism to Medals: Contemporary Perspectives and Revisiting Carbohydrate Guidelines for Fueling Endurance Athletes during Exercise
Morton, J. P., Fell, J. M., Gonzalez, J. T., Hearris, M. A., Podlogar, T., Pugh, J. N., & Wallis, G. A. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101442 · Cited by 9 · see citing works
“Furthermore, for races with mean finish times ~12 – 24 h, intakes of between 30 and 66 g/h have been reported [168,172 – 174].”
Blood serum denaturation profile examined by differential scanning calorimetry reflects the effort put into ultramarathon by amateur long-distance runners
Michnik, A., Sadowska‐Krępa, E., Kiełboń, A., Duch, K., & Bańkowski, S. (2021) · Journal of Thermal Biology · doi:10.1016/j.jtherbio.2021.103013 · Cited by 8 · see citing works
Are pre‐race serum blood biomarkers associated with the 24‐h ultramarathon race performance?
Amatori, S., Sisti, D., Bertuccioli, A., Rocchi, M., Luchetti, F., Nasoni, M. G., Papa, S., Citarella, R., Perroni, F., & Benedetti, S. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12073 · Cited by 6 · see citing works
“In fact, energy deficits or disorders in fluid or electrolyte metabolism have been shown to limit the ultra ‐ endurance performance (Costa et al., 2014).”
Background
Carbohydrate Ingestion on Exercise Metabolism and Physical Performance
Noakes, T. D., Prins, P., Buga, A., D'Agostino, D. P., Volek, J. S., & Koutnik, A. P. (2025) · Endocrine Reviews · doi:10.1210/endrev/bnaf038 · Cited by 8 · see citing works
Repetitive Feeding-Challenge With Different Nutritional Densities on Markers of Gastrointestinal Function, Substrate Oxidation, and Endurance Exercise Performance
Martinez, I. G., Biesiekierski, J. R., Rauch, C., & Costa, R. J. S. (2025) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2024-0145 · Cited by 6 · see citing works
Self-citation
Longitudinal NMR-based Metabolomics Analysis of Male Mountain Ultramarathon Runners: New Perspectives for Athletes Monitoring and Injury Prevention
Schoumacher, M., Nguyen, J., Brevers, E., Cirillo, A., Campas, M., Grifnée, E., Demeuse, J., Huyghebaert, L., Massonnet, P., Dubrowski, T., et al. (2025) · Sports Medicine - Open · doi:10.1186/s40798-025-00879-w · Cited by 5 · see citing works
“Indeed, studies have shown that ultramarathon runners often fail to meet the recommended carbohydrate intake during endurance exercise [42].”
Carbohydrate knowledge, beliefs, and intended practices, of endurance athletes who report exercise-associated gastrointestinal symptoms
Scrivin, R., Costa, R. J. S., Pelly, F. E., Lis, D. M., & Slater, G. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1133022 · Cited by 5 · see citing works
“Observational field studies on endurance athletes without Ex-GIS have also found that CHO consumed during endurance events had no or minimal relationship with the development of gastrointestinal symptoms (1, 14, 16) or performance times (32).”
BackgroundInfluentialSelf-citation
The fastest 24-hour ultramarathoners are from Eastern Europe
Knechtle, B., Valero, D., Villiger, E., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-75260-0 · Cited by 5 · see citing works
Performance demands in the endurance rider
Williams, J. M., Douglas, J. L., Davies, E., Bloom, F., & Castejón‐Riber, C. (2020) · Comparative Exercise Physiology · doi:10.3920/cep200033 · Cited by 5 · see citing works
Personalized hydratation status in endurance and ultra-endurance: A review
Paternoster, N., Baggio, E., & Pelosi, E. (2020) · Mediterranean Journal of Nutrition and Metabolism · doi:10.3233/mnm-200434 · Cited by 5 · see citing works
“Generally, it’s recommended to drink from 350 to 500 ml/h, increasing the volume of ﬂuids proportionally to the raising of the atmospheric temperature [111, 112].”
Contribution of Solid Food to Achieve Individual Nutritional Requirement during a Continuous 438 km Mountain Ultramarathon in Female Athlete
Ishihara, K., Inamura, N., Tani, A., Shima, D., Kuramochi, A., Nonaka, T., Oneda, H., & Nakamura, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105153 · Cited by 5 · see citing works
“Interestingly, the median energy and carbohydrate intake in the fast-running pace were within the recommended energy and carbohydrate intake, mainly covered 100–160 km ultramarathon [5,6].”
Background
Uso de dispositivos digitales en el seguimiento de un Trail Runner. Estudio de caso (Use of digital devices to follow a Trail Runner. Case study)
Sánchez, R., & Nieto-Jiménez, C. (2020) · Retos · doi:10.47197/retos.v38i38.77105 · Cited by 4 · see citing works
Fluctuations in food and fluid intake during a 24-h World Championship: analysis of the deviation from nutritional programs
Charlot, K., Lavoué, C., Siracusa, J., Chalchat, É., Hertert, P., & Bourrilhon, C. (2022) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2022.2046443 · Cited by 4 · see citing works
“Observational studies have reported actual intake to be lower than that advised [7–10], lower for nonfinishers than finishers [4], and lower for slower than faster runners [7].”
Background
Changes in Physical Activity across the Lifetime of Current Ultra-Endurance Exercisers
Birkenhead, K. L., Lovell, G. P., Barr, S. I., et al. (2018) · Journal of Physical Activity Research · doi:10.12691/jpar-3-1-3 · Cited by 4 · see citing works
“[1,2,9,10,13,14,15,16] Research has also investigated the nutritional behaviours, [12,17,18,19,20,21] physiological responses, changes in body composition during prolonged events [5,22,23,24,25] and long term health and disease outcomes of ultra-endurance exercisers.”
Background
Побудова тренувального процесу кваліфікованих ультрамарафонців на дистанції 100 км: ретроспективний аналіз та сучасні підходи
Попов, С. (2022) · Теорія і методика фізичного виховання і спорту · doi:10.32652/tmfvs.2022.3.51-58 · Cited by 5 · see citing works
The Prevalence of Low Energy Availability in Cross-Country Skiers during the Annual Cycle
Андреевна, Б. Е., Lyudinina, A. Y., & Bojko, E. R. (2024) · Nutrients · doi:10.3390/nu16142279 · Cited by 3 · see citing works
“TEE was estimated with an equation rather than determined with the reference method (i.e., doubly-labeled water), which probably led to an overestimation of TEE in this study.”
Method
Changes in diet, and the relationship between diet and physical activity within and across the lifetime of current ultra-endurance exercisers
Birkenhead, K. L., Barr, S. I., Lovell, G. P., & Solomon, C. (2019) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.18.08882-5 · Cited by 3 · see citing works
Reliability of a Cryoscopic Micro-Osmometer Using 15-µL Plasma Samples to Measure Hydration Status in Varied Environmental Conditions
Scanlan, A. T., Richter-Stretton, G. L., Madueno, M. C., Borges, N. R., & Fenning, A. S. (2016) · Measurement in Physical Education and Exercise Science · doi:10.1080/1091367x.2016.1248767 · Cited by 3 · see citing works
“5%) (Russell, Benton, & Kingsley, 2012; Russell & Kingsley, 2012) and ultra-endurance running (3.5%; Costa et al., 2014).”
MethodInfluential
Menthol mouth swilling and endurance running performance in the heat
Best, R. J. (2020) · Wintec Research Archive (Waikato Institute of Technology) · Cited by 3 · see citing works
Continuous Glucose Monitoring Underreports Blood Glucose During a Simulated Ultraendurance Run in Eumenorrheic Female Runners
Dole, A., Sims, S. T., Gan, H., Gill, N., & Beaven, C. M. (2024) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2024-0068 · Cited by 2 · see citing works
The Impact of Ultra-Marathon Running on the Gut Microbiota as Determined by Faecal Bacterial Profiling, and Its Relationship with Exercise-Associated Gastrointestinal Symptoms: An Exploratory Investigation
Henningsen, K., Gaskell, S. K., Young, P., Mika, A. S., Henry, R., & Costa, R. J. S. (2025) · Nutrients · doi:10.3390/nu17203275 · Cited by 2 · see citing works
“A comprehensive dietary assessment and analysis was collected 72 h prior to the ultra-marathon, in accordance with the method described by Costa et al., 2014 [34].”
Self-citation
24-Hour Ultra-Marathon Running: A Narrative Review of Performance Factors and Physiological Impacts
Knechtle, B., Braschler, L., Weiss, K., Scheer, V., Đurić, S., Leite, L. B., Forte, P. M., Nikolaidis, P. Τ., Chlíbková, D., & Rosemann, T. J. (2026) · Sports Medicine - Open · doi:10.1186/s40798-026-00997-z · Cited by 2 · see citing works
“However, lower values of ~ 9.1 ± 4.0 L have also been described, corresponding to an hourly intake rate of ~ 0.38 ± 0.16 L [55].”
Influential
The Frequency and Severity of Gastrointestinal Symptoms in Rugby Players
Chantler, S., Wood-Martin, R., Holliday, A., Davison, G., Crabtree, D. R., Readhead, C., & Jones, B. L. (2024) · International Journal of Sports Medicine · doi:10.1055/a-2206-4751 · Cited by 2 · see citing works
Nutritional strategies for single and multi-stage ultra-marathon training and racing: from theory to practice
Aktitiz, S., Kuru, D., Ergün, Z., & Turnagöl, H. H. (2024) · Turkish Journal of Sports Medicine · doi:10.47447/tjsm.0807 · Cited by 2 · see citing works
Use of Critical Speed Models from World Record Data to Estimate Limits of Human Ultra-Endurance Running Performance
Manuel, G., & Bollinger, L. M. (2024) · International Journal of Strength and Conditioning · doi:10.47206/ijsc.v4i1.244 · Cited by 1 · see citing works
Assessment of Micro- and Macronutrient Intake in Male Competitive Athletes Using the Epic-Norfolk Food Frequency Questionnaire
Stupin, A., Perić, L., Jukić, I., Boris, A., Stanojević, L., & Drenjančević, I. (2025) · Life · doi:10.3390/life15030458 · Cited by 1 · see citing works
“For male cyclists [27,28], triathletes [29], and runners [30], the negative energy balance during the competition phase was even more pronounced, averaging 2177 kcal/day.”
Pathophysiology and treatment of exercise-associated hyponatremia
Altieri, B., Aini, I., Cannavale, G., Magnelli, C., Mancini, C., Zamponi, V., Isidori, A. M., Colao, A. A. L., Faggiano, A., Peri, A., et al. (2025) · Journal of Endocrinological Investigation · doi:10.1007/s40618-025-02673-7 · Cited by 1 · see citing works
“In EAH fluid overload may be shown not only by changes in electrolyte levels, but also by alterations in plasma volume [37, 38], and albumin concentration [39].”
A preliminary investigation to advance personalized nutrition strategies for athletes
Vincenti, A., Cena, H., Casali, P. M., Sergenti, C., & Giberti, H. (2024) · IEEE International Workshop on Sport, Technology and Research (STAR) · doi:10.1109/star62027.2024.10635945 · Cited by 1 · see citing works
“Research has established that consuming CHOs during exercise, tailored to the duration and intensity of the activity [6] effectively maintains blood glucose levels, thereby improving and reducing fatigue [7-10].”
Background
Liste alphabétique des données
Laure, P., & Dine, G. (2018) · Elsevier eBooks · doi:10.1016/b978-2-294-76041-9.00001-5
Ultra-endurance athletes’ food choices, nutrition knowledge and strategies to improve dietary intake and performance
Blennerhassett, C. (2018) · Edge Hill University
Les effets des régimes riches en lipides et faibles en glucides sur la performance lors des ultramarathons
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Sarcopenic Characteristics of Active Older Adults: A Cross-sectional Exploration.Preprint
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Self-citation
The Modern Concepts of Energy Balance and Energy Availability in Sports
Андреевна, Б. Е., & Lyudinina, A. Y. (2024) · Human Physiology · doi:10.31857/s0131164624060101
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Андреевна, Б. Е., & Lyudinina, A. Y. (2024) · Human Physiology · doi:10.1134/s0362119724701111
“According to several studies, most athletes engaged in cyclic sports have a negative EB (Table 1) both at the preparative period [19–27] and at the competitive period [22, 26, 28–34].”
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Costa, R. J. S., Gaskell, S. K., Henningsen, K., JEACOCKE, N. A., Martinez, I. G., Mika, A. S., Scheer, V., Scrivin, R., Snipe, R. M. J., Wallett, A. M., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02275-6
“…circulation that may contribute to systemic water retention (i.e., plasma albumin in response to thermophysiological strain and/or bioavailability of osmotic nutrients through race nutrition intake) [17–22]; and (3) excessive fluid intake (i.e., fluid overload) relative to losses [9, 10, 14–16].”
InfluentialSelf-citation
Hypohydration is evident in elite orienteering athletes during a two-day race: a descriptive study
Kerem, M., Öztürk, F., Taşkın, H. B., Dudak, E., & Ceylan, B. (2025) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-025-01300-5
“Therefore, it is recommended that athletes adopt strategies to increase fluid consumption [24].”
Acute Effects of Marathon and Ultramarathon Running on Body Composition in Trained Male Athletes
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“Given the physiological stressors associated with endurance events, the regulation of energy intake and hydration is crucial for maintaining performance and ensuring athlete safety both during and after competition [13].”
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“Athletes strive to match their energy expenditure, yet several previous studies have clearly pointed out that this is rarely achieved (12, 13), which consequently leads to a loss of muscle mass (14).”
Effects on glucose levels after running long-distance races
Chávez-Tapia, N. C., López-Sánchez, G. N., Uribe, M., et al. (2026) · Gazzetta Medica Italiana Archivio per le Scienze Mediche · doi:10.23736/s0393-3660.25.05899-1
Associations Between Hydration, Sodium Intake, and Body Mass in Ultra-Endurance Trail Runners Under Ecological Race Conditions: A Cross-Sectional Field Study
Amorim, R. M., Guilherme, L. Q., Filgueiras, M. D. S., Saborosa, G. P., Pires, G. F., Neumann, N. D. O., Scheer, V., Leite, L. B., Forte, P. M., Malheiro, A., et al. (2026) · Physiologia · doi:10.3390/physiologia6010021
“…hydration and electrolyte balance in ultra-endurance events, particularly in hot environments, methodological heterogeneity and context-specific designs limit the generalizability of findings to mountain trail races, resulting in variable and sometimes inconsistent conclusions [3,11,22].”
Digestive Vulnerability and Exercise Exposure as Correlates of Gastrointestinal Symptoms and Race Withdrawal in Endurance and Ultra-Endurance Athletes
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A Practitioner’s Guide to Identifying, Assessing, and Managing Gut Issues in Athletes
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The impact of (poly)phenol-rich sugarcane extract intervention on markers of gastrointestinal integrity and systemic inflammation in response to exertional-heat stress
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“Plasma osmolality range indicative of euhydration typically ranges between 280 and 300 mOsm·kg −1 [12,13], and endurance performance is impaired when exercise is performed in a hypohydrated state [14,15].”
Self-citation
The Effect of a Repetitive Feeding Challenge With Carbohydrate Versus Fat on Markers of Gastrointestinal Integrity and Systemic Outcomes in Response to Endurance Exercise
Martinez, I. G., Biesiekierski, J. R., Rauch, C., & Costa, R. J. S. (2026) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2026-0043
Self-citation
Tracking sleep in ultramarathon male runners before, during, and after a mountain race: Actigraphic evidence of sleep restriction
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Authors: Costa, R. J. S., Gill, S. K., Hankey, J., Wright, A., & Marczak, S.
Affiliations: Monash University (AU)
Coventry University (GB)
Corresponding author: Costa, Ricardo J. S.
ORCID: Costa, Ricardo J. S.
Hankey, Joanne
Venue: British Journal of Nutrition
Publisher: Cambridge University Press (CUP)
Published: 2014-05-13
Volume: 112
Issue: 3
Pages: 428-437
ISSN: 0007-1145 (ISSN-L)
1475-2662
DOI: 10.1017/s0007114514000907
OpenAlex: W2171842767
Cited by: 99
References: 59
Citations by year: 2026: 11 · 2025: 11 · 2024: 10 · 2023: 2 · 2022: 11 · 2021: 9 · 2020: 11 · 2019: 12 · 2018: 12 · 2017: 5 · 2016: 3 · 2015: 1 · 2012: 1
FWCI: 1.99
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.cambridge.org/core/terms (unspecified)
Locations: British Journal Of Nutrition (publishedVersion)
PubMed (publishedVersion)
Coventry University Open Collections (Coventry university) (submittedVersion)
Pure (Coventry University) (submittedVersion, other-oa)
The Open Collections (Coventry University) (submittedVersion)
Funders: Coventry University
Topics: Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords: ultra-endurance running, energy balance, negative energy balance, macronutrient intake, carbohydrate intake, water intake, hydration status, plasma osmolality, plasma volume, weight loss, urinary ketones, energy expenditure, fluid intake, endurance athletes, protein intake, dietary fat intake
MeSH terms: Adult, Body Water, Energy Intake, Diet, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Drinking, Energy Metabolism, Female, Gastrointestinal Diseases, Humans, Male, Middle Aged, Osmolar Concentration, Physical Endurance, Plasma Volume, Running

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Perturbed energy balance and hydration status in ultra-endurance runners during a 24 h ultra-marathon

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