A systematic review and meta-analysis was recently published in the Journal of Science and Medicine In Sport, examining the association between diet and running-related injuries (RRIs). This review of 15 prospective cohort studies included nearly 6,000 adult distance runners (~2400 female), with 9 ultimately included in the meta-analysis.
Sex-specific associations were revealed in this analysis; among female runners, a lower energy (calorie) and total fat intake were associated with an increase in both RRIs and bone stress injuries (BSIs). Low dietary fiber was also associated with a higher risk for RRIs and BSIs in both male and female runners, all with a moderate degree of confidence. Somewhat surprisingly, protein, carbohydrate, alcohol, and calcium intake were not associated with injury in either gender.
Among females, injured runners consumed 449 kcal less per day than uninjured runners, and the increase in risk appears to be directly related to calorie intake, not a consequence of a lower weight or body mass index. Similarly, injured female runners consumed 20% of calories from fat, on average, compared to 27-29% in uninjured runners. Male runners consumed around 30% of calories from fat, with no differences observed between injured and uninjured runners.
The authors suggest that fat-soluble nutrients play a role in musculoskeletal health, hormone production, cellular function, and the body’s inflammatory response (e.g., omega-3 fatty acids), etc., which may provide a mechanism for the elevated risk. No association was observed between disordered eating and either RRIs or BSIs, though the evidence quality was low, and lacking for male runners. The authors also point to the lack of evidence (and need for future study) for many nutrients that may influence injury risk, such as iron, magnesium, and other vitamins and minerals.