Diet, risk of disordered eating and running-related injury in adult distance runners: A systematic review and meta-analysis of prospective cohort studies

Distance running is a popular and accessible form of exercise, offering significant physical and mental health benefits. However, the risk of running-related injuries (RRIs) remains a persistent concern for both competitive and recreational runners. While factors such as training load, biomechanics, and prior injuries are well-documented contributors to injury risk, the role of diet and eating behaviors in injury prevention and recovery is less clearly understood. Nutrition plays a crucial role in energy availability, muscle function, bone health, and overall physiological resilience, yet research on its direct connection to running-related injuries remains fragmented.

This review examines the relationship between dietary intake, risk of disordered eating, and the likelihood of sustaining a running-related injury. By analyzing findings from prospective cohort studies, it highlights potential dietary patterns that may contribute to or mitigate injury risk. Given the variability in study designs, injury definitions, and dietary assessments, understanding these connections requires a careful examination of the available evidence. The following key points outline the most relevant takeaways, offering insights into how nutrition may influence injury risk in distance runners.

Dietary Intake and Running-Related Injuries (RRIs):

• Female runners with lower total energy intake (-449 kcal/day) and lower fat intake (-20 g/day) were more likely to sustain injuries.
• Runners (both sexes) with lower dietary fiber intake (-3 g/day) were at higher risk of injury.

Macronutrient Impact:

• No significant association was found between protein, carbohydrate, or calcium intake and running-related injuries.
• Fat intake was a key factor in female runners, possibly due to its role in hormone regulation and musculoskeletal health.

Disordered Eating Risk and RRIs:

• The risk of disordered eating did not significantly influence injury risk in female runners.
• Studies on male runners were limited, indicating a research gap in this area.

Alcohol and RRIs:

• No consistent association was found between alcohol intake and injury risk.
• Definitions of “high alcohol intake” varied across studies, making it difficult to draw clear conclusions.

Research Gaps and Limitations:

• Lack of studies on male runners regarding disordered eating and dietary impacts on injury.
• Inconsistent definitions of running-related injuries across studies.
• Varied statistical methods limited the ability to compare dietary factors across studies.

Practical Implications:

• Female runners should ensure sufficient energy and fat intake to reduce injury risk.
• Higher dietary fiber intake may have protective effects but should be balanced to avoid energy deficiencies.
• More high-quality, longitudinal studies are needed to better understand these relationships, especially in male runners.