Risk of Low Energy Availability in National and International Level Paralympic Athletes: An Exploratory Investigation

Kelly Pritchett,Savannah Glasgow,Alicia Difolco,Katy Williams,Elizabeth Broad,Susannah Scaroni,Robert Pritchett,Trent Stellingwerff,Trent Stellingwerff,Patricia Roney

doi:10.3390/nu13030979

Abstract

(1) Background: The purpose of this study was to examine the symptoms of low energy availability (LEA) and risk of relative energy deficiency in sport (RED-S) symptoms in para-athletes using a multi-parameter approach. (2) Methods: National level para-athletes (n = 9 males, n = 9 females) completed 7-day food and activity logs to quantify energy availability (EA), the LEA in Females Questionnaire (LEAF-Q), dual energy X-ray absorptiometry (DXA) scans to assess bone mineral density (BMD), and hormonal blood spot testing. (3) Results: Based on EA calculations, no athlete was at risk for LEA (females < 30 kcal·kg−1 FFM·day−1; and males < 25 kcal·kg−1 FFM·day−1; thresholds for able-bodied (AB) subjects). Overall, 78% of females were “at risk” for LEA using the LEAF-Q, and 67% reported birth control use, with three of these participants reporting menstrual dysfunction. BMD was clinically low in the hip (<−2 z-score) for 56% of female and 25% of male athletes (4) Conclusions: Based on calculated EA, the risk for RED-S appears to be low, but hormonal outcomes suggest that RED-S risk is high in this para-athlete population. This considerable discrepancy in various EA and RED-S assessment tools suggests the need for further investigation to determine the true prevalence of RED-S in para-athlete populations.

Highlights

Low energy availability (LEA) was initially described in female able-bodied (AB)athletes as the underpinning etiology of the female athlete triad
LEA in Females Questionnaire (LEAF-Q) scores suggested that 78% of female participants were “at risk”, while the average score represented an “at risk” score (8.8 ± 4.2) for LEA based on menstrual history and physiological symptoms of insufficient energy intake
Quantitative screening tools (BMD and blood spot tests) may be difficult to use as diagnostic measures when assessing LEA until para-specific relative energy deficiency in sport (RED-S) norms are developed

Summary

Introduction

Low energy availability (LEA) was initially described in female able-bodied (AB)athletes as the underpinning etiology of the female athlete triad (triad). Well-controlled laboratory-based studies in active AB females have demonstrated a minimum EA of 45 kcal·kg FFM−1 ·day−1 is required for optimal health, with LEA defined as

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