Prevalence Of Low Energy Availability Research Articles

Measurement ofenergy availability in highly trained male endurance athletes and examination of its associations with bone health and endocrine function.

Despite the introduction of Relative Energy Deficiency in Sport (RED-s) in 2014, there is evidence to suggest that male endurance athletes still present with a high prevalence of low energy availability (LEA). Previous findings suggest that energy availability (EA) status is strongly correlated with impairments in endocrine function such as reduced leptin, triiodothyronine (T3), and insulin, and elevated bone loss. This study aimed to report the current EA status, endocrine function and bone health of highly trained Irish male endurance athletes. In this cross-sectional study, participants (n = 3 triathletes; n = 10 runners) completed a 7-day testing period during the competition season using lab-based measures, to ascertain EA status, hormone level and rates of bone metabolism. Serum blood samples were obtained to assess hormone levels and markers of bone metabolism. Mean EA was < 30kcal/kg lean body mass (LBM)/day in 76.9% of athletes. There was a strong association between LEA and low carbohydrate intake, and lower LBM. Mean levels of insulin, IGF-1 and leptin were significantly lower than their reference ranges. Elevated mean concentrations of β-CTX and a mean P1NP: β-CTX ratio < 100, indicated a state of bone resorption. The EA level, carbohydrate intake, hormone status and bone metabolism status of highly trained male endurance athletes are a concern. Based on the findings of this study, more frequent assessment of EA across a season is recommended to monitor the status of male endurance athletes, in conjunction with nutritional education specific to EA and the associated risks.

Risk and prevalence of Relative Energy Deficiency in Sport (REDs) among professional female football players.

A high prevalence of low energy availability (LEA) has been reported in female football players. This is of concern as problematic LEA may evolve into a syndromic pattern known as relative energy deficiency in sport (REDs). Given the difficulties in accurately assessing LEA, our study shifts emphasis to measurable indicators of REDs, serving as proxies for health detriments caused by LEA. The present cross-sectional study aimed to quantify the risk of REDs and to assess the prevalence of indicators indicative of the syndrome. 60 players (tiers 3 and 4) from three Norwegian football teams were analyzed as a single cohort but also stratified based on player position and menstrual status. The proportion of players at risk for REDs was 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with no primary indicators, while 20%, 7%, and 2% presented with one, two, and three primary indicators, respectively. Regarding secondary indicators, 57% had none, 33% had one, and 10% had two indicators. For associated indicators, 30% had none, 42% had one, 18% had two, 8% had three, and 2% had four indicators. Player position did not affect the prevalence of REDs indicators. Among noncontraceptive users (n=27), secondary amenorrhea (AME) was reported by 30%. These findings indicate that health and performance teams should prioritize universal health promoting strategies rather than selective or indicative strategies. Particularly, focus on nutritional periodization to secure sufficient energy availability, mitigating the risk of problematic LEA and REDs should be addressed.

Risk of low energy availability, eating disorders and food insecurity amongst development female rugby league players.

There have been several published studies on the prevalence of low energy availability (LEA) risk amongst North American and European endurance athletes. Yet the prevalence and risk factors amongst rugby league players are less well understood. This study assessed the prevalence of low energy availability risk, eating disorder risk, and food security amongst players from a female National Rugby League squad in Australia. Players from one Australian professional rugby league club volunteered to participate in the study. An online questionnaire was conducted to determine the prevalence of low energy availability (Low Energy Availability in Females Questionnaire [LEAF-Q]), eating disorder risk (Eating Disorders Inventory [EDI-3]), and food security. Differences between those "at risk" and "not at risk" based on their total LEAF-Q score were determined. Of the 28 players, 64% (N.=18) were at risk of LEA. Raw scores for the EDI-3 subscales, body dissatisfaction (P=0.043), bulimia (P=0.002), composite score (P=0.038), were significantly higher for those at risk and not at risk of LEA. Forty percent of players had some level of food insecurity. The results suggest LEA risk is similar to other populations and those at risk of LEA are more likely to have an elevated clinical risk of eating disorders. Food security is also an issue in this population and could contribute to LEA risk for some. Future research is needed amongst team sports athletes to understand interplay between eating disorder risk and food insecurity with LEA risk.

Risk of Low Energy Availability in New Zealand National Team and U20 Female Football Representatives

Background: Rates of low energy availability (LEA) in female footballers range from 12% to 66%, studies are limited, and no research has yet looked at the prevalence of LEA in a cohort of international players. Due to the negative consequences of LEA, more research is needed for a thorough investigation into prevalence rates and the associated risk factors of LEA within international environments. Methods: Twenty-two members of the New Zealand under 20 (U20) and National Women’s football teams (20.8 ± 3.5 years) participated in this study. Participants completed an online questionnaire composed of five independent validated surveys to assess LEA risk (Low Energy Availability in Females Questionnaire), eating disorder risk (Eating Disorder Examination Questionnaire), sleep quality (Athlete Sleep Score Questionnaire), nutrition knowledge, (Abridged Sport Nutrition Questionnaire), and mood (Profile of Mood States Questionnaire). Results: 59.1% (n = 13) of participants were identified as being at risk of problematic LEA. Players reporting menstrual disturbances (amenorrhea or oligomenorrhea) were 2.25 times more likely to be at risk of LEA than those who did not report a menstrual disturbance. Menstrual status (R = −.46, p = .030) and Profile of Mood States Questionnaire (r = −.46, p = .032) were significantly and positively associated with risk of LEA (R = −.46, p = .030). Conclusions: A significant proportion (59.1%) of players in the New Zealand national and U20 female football team are at risk of LEA. The positive and predictive relationship observed between mood disturbances, menstrual status, and risk of LEA suggests that regular monitoring of mood and menstrual cycle health may be used for the early identification of problematic LEA in national-level female footballers in New Zealand.

Under-Fuelling for the Work Required? Assessment of Dietary Practices and Physical Loading of Adolescent Female Soccer Players during an Intensive International Training and Game Schedule.

Previous studies demonstrate that "under-fuelling" (i.e., reduced carbohydrate (CHO) and energy intake (EI) in relation to recommended guidelines) is prevalent within adult female soccer players, the consequence of which may have acute performance and chronic health implications. However, the dietary practices of adolescent female soccer players, a population who may be particularly at risk for the negative aspects of low energy availability (LEA), are not well documented. Accordingly, we aimed to quantify EI and CHO intake, physical loading and estimated energy availability (EA) in elite national team adolescent female soccer players (n = twenty-three; age, 17.9 ± 0.5 years) during a 10-day training and game schedule comprising two match days on day six (MDa) and nine (MDb). The players self-reported their EI via the remote food photography method, whilst the physical loading and associated exercise energy expenditure were assessed via GPS technology. The relative CHO intake was significantly greater (all p < 0.05) on the day before the first match (MD-1a) (4.1 ± 0.8 g·kg-1), on the day before the second match (MD-1b) (4.3 ± 1.1 g·kg-1), MDa (4.8 ± 1.2 g·kg-1) and MDb (4.8 ± 1.4 g·kg-1) in comparison to most other days (<4 g·kg-1). The mean daily measured EA over the 10-day period was 34 ± 12 kcal·kg FFM-1·day-1 (with six players, i.e., 34%, presenting LEA), though, when adjusting the energy intake for potential under-reporting, these values changed substantially (44 ± 14 kcal·kg FFM-1·day-1, only one player was classed as presenting LEA). Such data suggest that the prevalence of LEA amongst female team sport athletes may be over-estimated. Nonetheless, players are still likely under-fuelling for the work required in relation to the daily CHO recommendations (i.e., >6 g·kg-1) for intensive training and game schedules. These data provide further evidence for the requirement to create and deliver targeted player and stakeholder education and behaviour change interventions (especially for younger athletes) that aim to promote increased daily CHO intake in female soccer players.

Prevalence of low energy availability in 25 New Zealand elite female rowers – A cross sectional study

ObjectivesTo quantify energy availability (EA) in elite female rowers, determine its association with bone mineral density (BMD), and examine the ability of the low energy availability in females-questionnaire (LEAF-Q) and brief eating disorder in athletes-questionnaire (BEDA-Q) to distinguish between low and normal EA. DesignObservational cross-sectional study. MethodsTwenty-five elite female rowers participated in the study. EA was calculated by means of a 4-day food intake diary and analysis of training load. Low energy availability (LEA) was defined as EA <30 kCal * kg−1 * FFM−1 * day−1. Dual-energy X-ray absorptiometry (DXA) was used to assess fat free mass (FFM) and BMD Z-scores. LEA risk was assessed using the LEAF-Q and BEDA-Q. ResultsThe mean EA was 23.2 ± 12.2 kCal * kg−1 * FFM−1 * day−1. Prevalence of LEA was 64 %. The mean BMD Z-score was 1.6 ± 0.6 (range: 0.7 to 2.9). Athletes with LEA had a significantly higher BEDA-Q score than the group with normal EA (mean 0.30 ± 0.17 vs. 0.09 ± 0.11, P < 0.05), but LEAF-Q score was not different between groups (mean 10.4 ± 4.6, 8.2 ± 4.5, P = 0.29). ConclusionLow energy availability is common amongst elite female rowers in New Zealand and is positively correlated with higher scores on the BEDA-Q. Bone mineral density was normal irrespective of EA status.

Male Army ROTC Cadets Fail to Meet Military Dietary Reference Intakes and Exhibit a High Prevalence of Low Energy Availability and Poor Sleep Quality.

The purpose of this study was to assess the dietary habits, prevalence of low energy availability (EA), and sleep quality in a cohort of male army Reserve Officer Training Corps (ROTC) cadets, and to investigate the relationship between EA and sleep quality as well as EA and various body composition variables that are important for tactical readiness. Thirteen male army ROTC cadets (22.2 ± 4.1 yrs; BMI: 26.1 ± 2.3) had their EA and body composition assessed using diet and exercise records alongside bioelectrical impedance analysis. Cadets also completed a validated sleep questionnaire. Sixty-two percent of participants presented with clinically low EA (<30 kcal/kg fat-free mass [FFM]) and none met the optimum EA threshold (≥45 kcal/kg FFM). Dietary analysis indicated that 15%, 23%, 46%, 23%, and 7% of cadets met the Military Dietary Reference Intakes (MDRI) for calories, carbohydrates, protein, fat, and fiber, respectively. Additionally, 85% of cadets exhibited poor sleep quality. Significant associations between EA and fat mass/percent body fat were shown (p < 0.05). There was, however, no statistically significant correlation between EA and sleep quality. The present study found a high prevalence of low EA and sleep disturbance among male army ROTC cadets and that many were unable to meet the MDRIs for energy and macronutrient intake. Further, low EA was associated with higher percent body fat and fat mass but not sleep quality.

Pre-Season Nutritional Intake and Prevalence of Low Energy Availability in NCAA Division III Collegiate Swimmers.

There is limited information regarding the dietary habits and energy availability (EA) of collegiate athletes. Therefore, the purpose of the present study is to assess the nutrient intakes, dietary habits, and prevalence of low EA (<30 kcals/kg FFM) in a group of National Collegiate Athletic Association (NCAA) Division III male and female swimmers. Energy and nutrient intake, body composition, and exercise energy expenditure was assessed in 30 (n = 15 males, n = 15 females) NCAA Division III swimmers during pre-season using three-day diet and seven-day activity records alongside multi-frequency, bioelectric impedance analysis. A validated screening tool was used to assess for low EA in the female swimmers. Mean EA in male and female athletes was 32.7 ± 12 and 34.9 ± 13.7 kcals/kg FFM, respectively, and was not significantly different between the sexes (p = 0.65). Twenty percent of swimmers (n = 3 males, n = 3 females) presented with optimal EA, 37% (n = 5 males, n = 6 females) presented with sub-optimal EA, and 43% (n = 7 males, n = 6 females) presented with low EA. Swimmers who presented with a low EA consumed significantly less calories, carbohydrates, and proteins than non-low EA swimmers (p < 0.02). The validated screening tool failed to classify 50% of female swimmers who presented with low EA. Only eight athletes achieved the USDA MyPlate recommendation for fruits, whereas three athletes achieved the recommendation for vegetables, with no differences between the sexes (p > 0.05). The present findings show that there was a high prevalence of low EA during the pre-season among male and female collegiate swimmers that was not fully captured using a validated screening tool for females. Low EA occurred alongside lower intakes of calories, carbohydrates, and proteins, and the majority of swimmers did not meet the United States Department of Agriculture recommendations for fruit and vegetable intake. These data stress the need for improved dietary intakes in NCAA Division III collegiate swimmers.

Prevalence of low energy availability and associations with seasonal changes in salivary hormones and IgA in elite male Gaelic footballers.

Evidence suggests low energy availability (LEA) is prevalent in elite male Gaelic football (GF) players. Previous research in male and female team sports found LEA may negatively impact endocrine function. The aim of this study was to examine the seasonal variations in energy availability (EA) and its associations with salivary measures in elite male GF players across the competitive season. Energy availability was assessed using field-based methods in conjunction with salivary testosterone (s-T), cortisol (s-C) and immunoglobin A (s-IgA) concentrations at pre-season (PRE), in-season (IN) and post-season (POST). 38% reported LEA at PRE, 33% at IN, and 28.5% at POST. s-C, s-T and s-IgA levels were within normal ranges at PRE, IN and POST. Salivary cortisol declined significantly from PRE to IN, remaining reduced at POST. Salivary testosterone decreased significantly from PRE to IN but was significantly elevated at POST compared to IN. Salivary IgA was significantly greater at POST than IN. No significant associations were found between s-C or s-T and EA at any time point. Pre-season s-IgA exhibited a significant inverse association with PRE EA. Decreased s-IgA flow rate and s-IgA secretion rate were significantly associated with decreased EA at PRE. Reduced carbohydrate (CHO) intake was also associated with decreased s-IgA secretion rate at PRE. This study suggests that LEA is prevalent in elite male GF players, but is not associated with s-C or s-T. However, EA is associated with s-IgA which may impact the immune system. Therefore, education and interventions surrounding the prevalence and associations of EA should be implemented in this population.

Energy expenditure, dietary intake and energy availability in female professional football players

ObjectivesTo quantify energy expenditure and intake in professional female footballers playing on a national and/or international level. Second, to determine the prevalence of low energy availability among these players, defined...

Prevalence Of Low Energy Availability In High Level Kenyan Middle- And Long-distance Runners

Because of the negative health consequences of low energy availability (LEA), researchers have developed criteria based on energy availability (EA) to determine when athletes are at threat of physiological and performance disturbances. The proposed LEA criteria are: ≤30 kcal/kg/LBM/day - high risk, 30-45 kcal/kg/LBM/day - moderate risk and ≥ 45 kcal/kg/LBM/day - no risk (Melin et al., IJSNEM, 2019). These criteria, however, are based almost entirely on White (Caucasian) racial populations. PURPOSE: This study evaluated the prevalence of LEA and its potential impact on the hormonal profile of high-level Kenyan male and female middle- and long-distance runners. METHODS: A cross-sectional observational design approach was used in which high-level Kenyan male and female (n = 30 and n = 26 respectively) middle- and long-distance runners were examined (IAAF scores >1000 points). For LEA, food and training diaries were collected from the participants and exercise energy expenditure was calculated from the VO2max results and training diaries. To be conservative and not underestimate EA, we examined the three highest energy intake days in our analysis, and to compensate for potential underreporting, applied a previously published dietary correction factor (Õnnik et al., EJAP 2021). Resting blood hormonal measurements consisted of luteinizing hormone, follicle-stimulating hormone, prolactin, oestradiol, free thyroxine, thyroid-stimulating hormone, testosterone, triiodothyronine, insulin and cortisol. RESULTS: For the female sample ~ 13% were at no risk, ~31% were at moderate risk, and ~ 66% at a high risk for LEA. For the male sample ~ 4% were at no risk, ~9% were at a moderate risk, and ~ 87% were at a high risk for LEA. The hormonal values observed were variable, but within the normal expected range for healthy men and women in each of the respective measures (Feingold et al., Endotext 2000). CONCLUSIONS: Our main findings were 1) the majority of our runners (men and women) were at high risk for LEA and, 2) surprisingly no abnormalities in the hormonal values were evident even though LEA risk was high and hormonal disturbances are a hallmark of LEA. Perhaps EA criteria for deciding LEA risk level, which are based primarily on White racial populations, are not appropriate for African-based populations.

Investigating the prevalence of low energy availability, disordered eating and eating disorders in competitive and recreational female endurance runners

ABSTRACT Eating disorders (ED), disordered eating (DE) and low energy availability (LEA) can be detrimental to health and performance. Previous studies have independently investigated the prevalence of ED, DE or LEA; however, limited studies have combined methods identifying risk within female runners. The aim of this study was to identify the prevalence of ED, DE and LEA in United Kingdom-based female runners and associations between age, competition level and running distance. The Female Athlete Screening Tool (FAST) and Low Energy Availability in Females Questionnaire (LEAF-Q) were used in a cross-sectional study design. A total of n = 524 responses eligible for analysis were received. A total of n = 248 (47.3%), n = 209 (40%) and n = 49 (9.4%) athletes were at risk of LEA, DE and ED, respectively. LEAF-Q scores differed based upon age (Age: H(3) = 23.998, p ≤ .05) and competitive level (Comp: H(1 ) = 7.682, p ≤ .05) whereas FAST scores differed based on age (Age: F(3,523) = 4.753, p ≤ .05). Tukey’s post-hoc tests showed significantly higher FAST scores in 18–24 years compared to all other age categories (p ≤ .05). Stepwise multiple regression demonstrated age and competitive level modestly predicted LEAF-Q scores (R 2 adj = 0.047, F(2,523) = 13.993, p ≤ .05, VIF = 1.0) whereas age modestly predicted FAST scores (R 2 adj = 0.022, F(1,523) = 12.711, p ≤ .05, VIF = 1.0). These findings suggest early identification, suitable screening methods and educational intervention programmes should be aimed at all levels of female endurance runners. Highlights A total of 524 female endurance completed a self-administered, online questionnaire screening for low energy availability, disordered eating and eating disorders risk. Age and competitive level modestly predicted low energy availability and age modestly predicted disordered eating and eating disorders in female endurance runners. A higher percentage of 18- to 24-year-old female endurance runners were at greater risk of low energy availability, disordered eating and eating disorders compared to other age categories. These findings highlight the need for regular screening in order to aid early interventions to prevent potential decrements in performance and health as endurance runners mature.

Study protocol: prevalence of low energy availability and its relation to health and performance among female football players

Enduring low energy availability (LEA) is associated with several potentially serious physiological and mental conditions. LEA has been found highly prevalent among female elite athletes within endurance sports, thus hampering...

Analysis of female athlete triad in adolescent female Bharatanatyam dancer using low energy availability questionnaire

Background: The aim of this study was to assess adolescent Bharatanatyam female dancers for female athlete triad (FAT) which includes low energy availability (LEA), musculoskeletal injury profile, gastrointestinal function and menstrual dysfunction using in females LEAF questionnaire.Methods: The approval was taken from the institutional review board of K. J. Somaiya college of physiotherapy. A pre-designed, pre-validated, questionnaire was distributed in the google form layout, among population according to the inclusion and exclusion criteria; asking for consent to confirm their willingness to participate voluntarily. After confirmation, the participants were directed to complete the LEAF questionnaire, maintaining their confidentiality. Data collected was analyzed using descriptive statistics.Results: A total of 82 participants took part in this study. The cumulative incidence of musculoskeletal injuries is about 50%. 35.4% of population experienced gaseous or bloated abdomen apart from menstrual function and 32.9% experienced cramps or stomach ache which were not related to menses. 7.3% of population reported primary amenorrhea, 35.8% reported secondary amenorrhea and 18.6% reported oligomenorrhea. Thus, overall, 34.5% population reported all the components of FAT.Conclusions: Prevalence of LEA in Bharatanatyam female dancers was reported amongst which prevalence of musculoskeletal injuries was high amongst the participants followed by menstrual dysfunction. LEA might have been interpreted as a usual or needed procedure to achieve better performance in past, but now it is recognized that it may lead to several negative consequences. Therefore, timely screening of dancers along with adequate training protocol will help alleviate LEA.

Prevalence of Low Energy Availability in Collegiate Women Soccer Athletes.

(1) Background: Limited information exists on the prevalence of low energy availability (LEA) in collegiate team sports. The purpose of this study was to examine the prevalence of LEA in collegiate women soccer players. (2) Methods: Collegiate women soccer athletes (n = 18, height: 1.67 ± 0.05 m; body mass: 65.3 ± 7.9 kg; body fat %: 24.9 ± 5.6%) had their body composition and sport nutrition knowledge assessed in the pre-season. Energy availability was assessed mid-season using a 4-day dietary log and activity energy expenditure values from a team-based monitoring system. A validated screening tool was used to screen for LEA. (3) Results: The screening tool classified 56.3% of athletes as at risk of LEA (<30 kcal/kg of FFM); however, the actual dietary intake identified 67% as LEA. Athletes identified as non-LEA consumed significantly more absolute (p = 0.040) and relative (p = 0.004) energy than LEA athletes. (4) Conclusions: There was a high prevalence of LEA among collegiate women soccer athletes. Although previously validated in women endurance athletes, the LEA screening tool was not effective in identifying those at risk of LEA in this sample of athletes.

Prevalence of Low Energy Availability in Competitively Trained Male Endurance Athletes.

Background and Objectives: Relative energy deficiency in sport (RED-S) has been introduced as a broad-spectrum syndrome leading to possible dysfunction in numerous physiological systems, driven primarily by low energy availability (EA). Research in females has identified specific EA cut-points indicative of risk level for developing physiological and performance disturbances. Cut-points in males have yet to be evaluated. This study examined the prevalence of low EA in competitive (non-elite), recreationally trained (CRT) male endurance athletes. Materials and Methods: Subjects were 108 CRT (38.6 ± 13.8 y; 12.2 ± 5.4 h/wk training) male endurance athletes (runners, cyclists, triathletes) who completed a descriptive survey online via Qualtrics® and returned 3 day diet and exercise training records. EA was calculated from returned surveys and training records. Resting metabolic rate (RMR) and lean body mass (LBM) were estimated from self-reported survey data. Prevalence of risk group was categorized based on the female cut-points: At risk (AR) ≤30 kcal/kg LBM, moderate risk (MR) = 30–45 kcal/kg LBM, or no risk (NR) ≥45 kcal/kg LBM. Results: In this sample, 47.2% (n = 51) were classified as AR, 33.3% (n = 36) as MR, and 19.4% (n = 21) as NR for low EA. Cyclists had lower EA (26.9 ± 17.4 kcal/kg LBM, n = 45) than runners (34.6 ± 13.3 kcal/kg LBM, n = 55, p = 0.016) and all other sport categories (39.5 ± 19.1 kcal/kg LBM, n = 8, p = 0.037). Conclusions: The findings indicate this sample had a high prevalence of risk for low EA, at 47.2%. Only 19.4% of participants were at no risk, meaning ~80% of participants were at some degree of risk of experiencing low EA. Cyclists were at greater risk in this cohort of low EA, although why this occurred was unclear and is in need of further investigation. Future research should address whether the current female cut-points for low EA are appropriate for use in male populations.

Increased Female Athlete Triad Knowledge Following a Brief Video Educational Intervention

To assess female high school athletes’ changes in Female Athlete Triad (Triad) knowledge following a brief educational intervention.Triad knowledge questionnaires were completed by female high school athletes before and after either an educational video intervention or control group activities.Four high schools in the Pacific Northwest.Ninety-three female high school athletes (15.9±1.2 years) participating in basketball, cheerleading, track & field, softball, soccer, golf, tennis, and volleyball.The 10-minute Social Cognitive Theory-based educational video highlighted Triad etiology, progression, impact on sports performance, and fueling strategies to decrease Triad risk.Triad knowledge score out of 7; proportion of participants who correctly answered each question.Mann-Whitney U tests assessed differences in pre and post intervention Triad knowledge scores between the control and intervention group. The McNemar test compared the proportion of participants (intervention group) who correctly answered individual Triad knowledge questions pre vs. post-intervention.Participants in the intervention group achieved greater increases in Triad knowledge following the intervention, than did control participants (P<0.001). For each Triad question, improvements in the proportion of participants (intervention group) who answered correctly was observed (P<0.05).The Triad educational video was an effective and timeefficient method for increasing Triad knowledge among female high school athletes.

Energy Availability in Athletics: Health, Performance, and Physique.

The reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events. In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters. Health concerns with functional hypothalamic amenorrhea include impaired bone health, elevated risk for bone stress injury, and cardiovascular disease. Furthermore, LEA negatively affects recovery, muscle mass, neuromuscular function, and increases the risk of injuries and illness that may affect performance negatively. LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior. Long-term LEA causes metabolic and physiological adaptations to prevent further weight loss, and athletes may therefore be weight stable yet have impaired physiological function secondary to LEA. Achieving or maintaining a lower body mass or fat levels through long-term LEA may therefore result in impaired health and performance as proposed in the Relative Energy Deficiency in Sport model. Preventive educational programs and screening to identify athletes with LEA are important for early intervention to prevent long-term secondary health consequences. Treatment for athletes is primarily to increase energy availability and often requires a team approach including a sport physician, sports dietitian, physiologist, and psychologist.

The prevalence of low energy availability in active females in Ireland

The prevalence of low energy availability in active females in Ireland

Female Recreational Exercisers at Risk for Low Energy Availability.

Low energy availability (LEA) describes the disruption in normal physiological function existent when insufficient energy intake is combined with exercise. To conserve energy a range of endocrine adaptations occur, impairing health and athletic performance. The prevalence of LEA has not been fully established especially among recreational exercisers. Determining recreational exercisers at risk of LEA may help to maximize prevention, early diagnosis and treatment. The design of this study was a cross-sectional online survey. One-hundred and nine female recreational exercisers, with a mean age of 23.8 (SD 6.9) years were recruited via gyms and fitness centers throughout NZ. Participants completed an online questionnaire including questions from the LEAF-Q (Low Energy Availability in Females Questionnaire). A total of 45.0% (CI, 35.4%, 54.8%) of participants were classified as "at risk" of LEA. For every extra hour of exercise per week the odds of being at risk of LEA were 1.13 times greater (CI 1.02, 1.25, p = .016). All participants reporting previous stress fracture injuries (n = 4) were classified as at risk for LEA. Significantly more subjects participating in an individual sport were classified as at risk for LEA (69.6%, CI 24.3%, 54.8%) compared with team sports (34.8%, CI 18.7%, 40.5%) (p = .006). The high prevalence of female recreational exercisers at risk of LEA is of concern, emphasizing the importance of increasing awareness of the issue, and promoting prevention and early detection strategies, so treatment can be implemented before health is severely compromised.