Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performance

The impact of low energy availability risk on pre-competition physiological function in Chinese female combat athletes

BACKGROUND

Low energy availability (LEA) can negatively impact athletes' physiological function and performance. This study aims to examine the prevalence of LEA in Chinese female combat athletes and monitor changes in physiological function and performance during the pre-competition period.

METHOD

We assessed the incidence of low energy availability (LEA) and eating disorder (ED) risks in 84 female combat athletes (judo, freestyle wrestling, and sanda) from Beijing using the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Eating Disorder Examination Questionnaire (EDE-Q). From this group, 11 judo athletes who were preparing for competition were selected and divided into a low energy availability (LEA) group and a non-LEA group based on their energy availability levels. Dietary intake, training energy expenditure, body composition, resting metabolic rate, blood markers, and special judo fitness tests were monitored at 4 weeks, 2 weeks, and 0 weeks before the competition.

RESULTS

Among the 84 athletes, 45.2% of athletes (n = 38) were at increased risk of LEA, and 21.4% of athletes (n = 18) were classified as high in eating disorder risk. There were no significant differences in LEA and ED risk between elite and recreational athletes. Among the 11 athletes preparing for competition, 6 athletes (45.5%) were in a state of LEA at the initial stage (4 weeks before the competition), and by the competition week, all 11 athletes exhibited LEA. Additionally, athletes in the LEA group experienced significant reductions in VO2 and resting metabolic rate at 0 week of the competition compared to 4 weeks prior (p < 0.05). Thyroid function indicators and IGF-1 levels of LEA group also significantly decreased (p < 0.05). After completing the four-week pre-competition weight loss, heart rate recovery during the special judo fitness test improved significantly in both the LEA and non-LEA groups (p < 0.05).

CONCLUSION

The current study identified a risk of LEA among Chinese female combat sport athletes, with no significant difference in the prevalence of LEA between elite and recreational athletes. It is essential for Chinese coaches and sports medicine staff to implement LEA-related nutritional education across all performance levels. Moreover, preventive measures during training are recommended to mitigate the impact of LEA on physiological function during the pre-competition weight loss phase.

International society of sports nutrition position stand: nutrition and weight cut strategies for mixed martial arts and other combat sports

Following an extensive literature review, the International Society of Sports Nutrition (ISSN) has developed an official position on nutritional and weight cut strategies for combat sports. The type of combat sport, length of the fight camp, and time between weigh-in and competition are factors influencing nutritional and weight cut strategies. The following 16 points constitute the Position Statement of the Society; the Research Committee has approved them. 1. Combat sports have differing weight categories, official weigh-in times, and competition frequencies, influencing the nutritional and weight cut strategies for training and competition. 2. As the duration of a combat match increases, >4 min, contribution of the aerobic system can rise to >70%, yet anaerobic alactic pathways and anaerobic glycolytic pathways support high-output bursts. 3. During the off camp/general preparation phase, athletes should maintain a weight ranging 12% to 15% above the weight division requirement. 4. Supplements including creatine, beta-alanine, beta-hydroxy-beta-methylbutyrate, and caffeine have been shown to enhance performance and/or recovery during preparation phases, competition, and post-competition. 5. During fight camp, strategic decreases in calorie intake are necessary for an efficient longitudinal weight descent. Individual caloric needs can be determined using indirect calorimetry or validated equations such as Mifflin St. Jeor or Cunningham. 6. Protein should be prioritized during longitudinal weight descents to preserve lean body mass, and the timely delivery of carbohydrates supports training demands. Macronutrients should not drop below the following: carbohydrates 3.0-4.0 g/kg, protein 1.2-2.0 g/kg, and fat 0.5 to 1.0 g/kg/day. 7. Suitable losses in body mass range from 6.7% at 72 h, 5.7% at 48 h, and 4.4% at 24 h, prior to weigh-in. 8. Sodium restriction and water loading are effective for inducing polyuria and acute water loss. 9. During fight week, water-bound glycogen stores can be depleted through exercise and carbohydrate restriction, facilitating a 1% to 2% loss in body mass, with equivalent losses from a low-fiber intake of <10 g/day for 4 days. 10. During fight week, acute water loss strategies, including sauna, hot water immersion, and mummy wraps, can be used effectively with appropriate supervision (optimally ~2-4% of body mass within 24 h of weigh-in). 11. Post-weigh-in, rapid weight gain strategies are utilized to recover lost body fluid/mass before competition with the intent of gaining a competitive advantage. 12. Oral rehydration solutions (1 to 1.5 liters/h) combined with a sodium range of 50-90 mmol/dL should take precedence immediately post-weigh-in. 13. Fast-acting carbohydrates at a tolerable rate of ≤ 60 g/h should follow oral rehydration solutions. Post weigh-in intake of fiber should be limited to avoid gastrointestinal distress. 14. Post-weigh-in carbohydrate intake at 8-12 g/kg may be appropriate for combat athletes that undertook significant glycogen depletion strategies during fight week. About 4-7 g/kg may be suitable for modest carbohydrate restriction. 15. Post weigh-in, rehydration/refueling protocols should aim to regain ≥10% of body mass to mitigate declines in performance and the negative effects of rapid weight loss. 16. The long-term effects of frequent weight cuts on health and performance are unknown, necessitating further research.

Assessing the risk of low energy availability, bone mineral density and psychological strain in endurance athletes

BACKGROUND

Adequate energy intake is crucial for athletic performance and recovery. However, many endurance athletes experience Low Energy Availability (LEA), which, if prolonged, can detrimentally impact both health and performance.

METHODS

A total of 55 endurance athletes (23 females; 45  ±  13 years, 1.64  ±  0.06 m, 64.4  ±  11.4 kg and 32 males; 44  ±  13 years, 1.76  ±  0.18 m, 78.8  ±  9.2 kg) underwent physical assessments and completed questionnaires on dietary habits, training loads, and psychological stress. Dual-Energy X-ray Absorptiometry (DEXA) scans measured bone mineral density (BMD) in the lumbar L1-L4 spine, and body composition. Risk of LEA burnout, and psychological strain were assessed using sport-specific questionnaires.

RESULTS

Seventy-seven percent of female athletes were identified as at risk of LEA by the LEAF-Q. These females had higher body weight and fat percentage than those at low risk of LEA. Male athletes had a higher prevalence of low lumbar BMD (31%) compared to females, associated with older age, and longer training histories. Although only 9% of female athletes had low-BMD, those affected had a history of amenorrhea and were identified as at risk of LEA by the LEAF-Q.

CONCLUSION

A high proportion of endurance athletes had low-BMD and were at risk of LEA. This underscores the need for targeted nutritional strategies to mitigate the risks associated with LEA and promote overall athlete well-being.

How Healthy Are Our Students Really? Lifestyle-Related Health Risk Behaviour Patterns in Student Athletes and Nonathlete Students

Introduction: Students engage in one or more lifestyle-related risk behaviours that may predispose them to noncommunicable diseases (NCDs). Whilst student athletes (St-A) are often perceived as having healthier lifestyles compared to nonathlete students (NAS), it is unclear whether they exhibit better risk profiles. This study compares the prevalence and clustering of these lifestyle-related risk behaviours among NAS and St-A at a South African university. Methods: This cross-sectional study assessed the prevalence of alcohol consumption, cigarette smoking, inadequate fruit and vegetable intake and physical inactivity using a screening questionnaire. Differences between gender and athletic status were analysed using chi-square tests. Cluster analysis was employed to identify patterns of co-occurring risk behaviours within the combined cohort. Results: One hundred and forty-five St-A (n = 91 male, n = 54 female) and 143 NAS (n = 90 male, n = 53 female) were included. Similar alcohol use patterns were observed between St-A and NAS (p=0.737), but females consumed less alcohol than men (p=0.025). Smoking was less prevalent among St-A (18.6% vs. 32.2% NAS, p=0.020). Less than 10% of participants met fruit and vegetable intake recommendations, with females consuming more than males (p=0.002). St-A met the moderate activity guidelines more often (73.0% vs. 44.3%, p < 0.001) and the vigorous physical activity guidelines more often (71.5% vs. 37.1%, p < 0.001) than NAS. The cluster analysis identified a higher risk group (34.6% St-A) with multiple risk behaviours, and a healthier group (all meeting vigorous activity goals and none smoking). Conclusions: Both St-A and NAS engage in lifestyle-related risk behaviours. Further investigation into the interconnections of these behaviours and the implementation of university-based interventions is warranted.

Examination of Sex Differences in Energy Availability, Disordered Eating, and Compulsive Exercise Among Male and Female Adolescent Athletes

OBJECTIVE

The primary aim of this study was to examine sex differences in energy availability (EA) and its relationships with disordered eating, compulsive exercise, and body mass index (BMI) among adolescent athletes.

DESIGN

Cross-sectional study.

SETTING

University hospital pediatric sports medicine center.

PARTICIPANTS

Sixty-four participants (61% female) of ages 13 to 18 years, actively participating in at least 1 organized sport.

MAIN INDEPENDENT VARIABLE

Participant sex.

MAIN OUTCOME MEASURES

Average 7-day EA (kcal/kg FFM/d; calculated using participant-recorded dietary intake and exercise expenditure from a wrist-worn heart rate/activity monitor), Eating Disorder Examination Questionnaire (EDE-Q) score (range 0-6), Compulsive Exercise Test (CET) score (range 0-25), and age- and sex-adjusted BMI percentile.

RESULTS

There were no significant sex differences in EA (females: 40.37 ± 12.17 kcal/kg FFM/d; males: 35.99 ± 12.43 kcal/kg FFM/d; P = 0.29), EDE-Q (females: 0.68 ± 0.70; males: 0.68 ± 0.83; P = 0.99), or CET scores (females: 11.07 ± 0.44; males: 10.73 ± 0.63; P = 0.66). There were low and insignificant negative correlations between EA and EDE-Q and CET scores for female athletes (EDE-Q: r = -0.22, P = 0.18; CET: r = -0.21, P = 0.09) and male athletes (EDE-Q: r = -0.09, P = 0.66; CET: r = -0.35, P = 0.08). EA and BMI-for-age percentile were inversely correlated in both male (r = -0.451, P = 0.009) and female (r = -0.37, P = 0.02) participants.

CONCLUSIONS

In our sample of adolescent athletes, lower EA occurred in the absence of notable disordered eating or compulsive exercise behaviors, suggesting unintentional underfueling (and/or underreporting of energy intake), without significant sex differences. Low BMI can be an imperfect surrogate marker for low EA. These findings inform risk factors and screening practices for low EA among adolescent athletes.

Nutrition educational interventions for athletes related to low energy availability: A systematic review

Low energy availability (LEA) is a prevalent concern among athletes, often attributed to intentional or unintentional under-fueling behaviors. Nutritional and energy availability educational interventions are poised for successful LEA prevention, with a robust body of literature examining intervention effectiveness. Thus, this systematic review aimed to synthesize the available evidence on nutritional education interventions to address gaps in nutritional knowledge and combat LEA among athletes. Medical databases (MEDLINE, Web of Science) were systematically searched on July 11, 2023, and an updated search was conducted on July 26, 2024. Studies conducted among adult athletes who underwent nutritional education interventions with assessed effects on dietary knowledge, behaviors, and/or LEA outcomes were included. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale by two blinded assessors. Intervention methodology and primary outcomes related to nutritional interventions were extracted by a single assessor. Twelve articles were included (mean PEDro score: 5). Interventions ranged from 1 to 20 sessions, and 10- to 120-minute durations. Most studies employed in-person educational sessions on fueling and macro- and micro-nutrient intake for athletic performance. Half of included studies included LEA education. Intervention approaches were largely heterogeneous, although most programs had favorable outcomes for nutrition knowledge and fueling behaviors. Nutrition interventions appear to be beneficial for athletes in the context of LEA, though current approaches are largely heterogenous. Future research should seek to develop a translational nutritional education plan for broad application in athletes designed to increase nutritional knowledge and combat LEA.

The whole-body and skeletal muscle metabolic response to 14 days of highly controlled low energy availability in endurance-trained females

This study investigated the effects of 14 days low energy availability (LEA) versus optimal energy availability (OEA) in endurance-trained females on substrate utilization, insulin sensitivity, and skeletal muscle mitochondrial oxidative capacity; and the impact of metabolic changes on exercise performance. Twelve endurance-trained females (V̇O2max 55.2 ± 5.1 mL × min-1 × kg-1) completed two 14-day randomized, blinded, cross-over, controlled dietary interventions: (1) OEA (51.9 ± 2.0 kcal × kg fat-free mass (FFM)-1 × day-1) and (2) LEA (22.3 ± 1.5 kcal × kg FFM-1 × day-1), followed by 3 days OEA. Participants maintained their exercise training volume during both interventions (approx. 8 h × week-1 at 79% heart rate max). Skeletal muscle mitochondrial respiratory capacity, glycogen, and maximal activity of CS, HAD, and PFK were unaltered with LEA. 20-min time trial endurance performance was impaired by 7.8% (Δ -16.8 W, 95% CI: -23.3 to -10.4, p < .001) which persisted following 3 days refueling post-LEA (p < .001). Fat utilization was increased post-LEA as evidenced by: (1) 99.4% (p < .001) increase in resting plasma free fatty acids (FFA); (2) 270% (p = .007) larger reduction in FFA in response to acute exercise; and (3) 28.2% (p = .015) increase in resting fat oxidation which persisted during submaximal exercise (p < .001). These responses were reversed with 3 days refueling. Daily glucose control (via CGM), HOMA-IR, HOMA-β, were unaffected by LEA. Skeletal muscle O2 utilization and carbohydrate availability were not limiting factors for aerobic exercise capacity and performance; therefore, whether LEA per se affects aspects of training quality/recovery requires investigation.

Interrelationships between stress, eating attitudes, and metabolism in endurance athletes across a competitive season

A competitive sport season represents a multidimensional stressor where physical and psychological stress may render an athlete susceptible to energy deficiency (ED). Downstream effects of ED can include a reduction in measured-to-predicted resting metabolic rate (RMRratio), indicating metabolic compensation. A pathway linking stress, eating attitudes, and metabolic compensation has not been explored. To test if sport-specific stress is associated with eating attitudes and metabolism in endurance athletes (18-22 years) at different phases of a competitive season, we assessed two groups of athletes: 26 swimmers (15 female and 11 male) during peak season (PEAK), and 26 runners (female) across pre- (PRE) and off-season (OFF). Stress (RESTQ-52), eating attitudes (cognitive restraint (CR), drive for muscularity (DM), and body dissatisfaction), and metabolism (RMRratio) were assessed. In PRE, sport-specific stress and CR were negatively correlated with RMRratio (R = -0.58; p < 0.05, and R = -0.57; p < 0.05, respectively). In PEAK, sport-specific stress and DM were negatively correlated with RMRratio (R = -0.64; p < 0.05; R = -0.40; p < 0.05, respectively). DM was positively related to sport-specific stress (R = 0.55; p < 0.05). During OFF, there was no relation between RMRratio and sport-specific stress. In runners, there was a change in stress from PRE-to-OFF with highest reported stress during PRE (p < 0.05) versus OFF. Regression analyses revealed that sport-specific stress and CR were significant predictors of RMRratio during PRE and PEAK (p < 0.05), but not OFF (p > 0.05). Associations between stress, eating attitudes, and metabolic compensation in endurance athletes during PRE and PEAK season suggest that during heavier training, metabolic compensation may be linked to upstream eating attitudes associated with sport-stressors.

Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

Relative energy deficiency in sport (REDs) is a widely adopted model, originally proposed by an International Olympic Committee (IOC) expert panel in 2014 and recently updated in an IOC 2023 consensus statement. The model describes how low energy availability (LEA) causes a wide range of deleterious health and performance outcomes in athletes. With increasing frequency, sports practitioners are diagnosing athletes with "REDs," or "REDs syndrome," based largely upon symptom presentation. The purpose of this review is not to "debunk" REDs but to challenge dogmas and encourage rigorous scientific processes. We critically discuss the REDs concept and existing empirical evidence available to support the model. The consensus (IOC 2023) is that energy availability, which is at the core of REDs syndrome, is impossible to measure accurately enough in the field, and therefore, the only way to diagnose an athlete with REDs appears to be by studying symptom presentation and risk factors. However, the symptoms are rather generic, and the causes likely multifactorial. Here we discuss that (1) it is very difficult to isolate the effects of LEA from other potential causes of the same symptoms (in the laboratory but even more so in the field); (2) the model is grounded in the idea that one factor causes symptoms rather than a combination of factors adding up to the etiology. For example, the model does not allow for high allostatic load (psychophysiological "wear and tear") to explain the symptoms; (3) the REDs diagnosis is by definition biased because one is trying to prove that the correct diagnosis is REDs, by excluding other potential causes (referred to as differential diagnosis, although a differential diagnosis is supposed to find the cause, not demonstrate that it is a pre-determined cause); (4) observational/cross-sectional studies have typically been short duration (< 7 days) and do not address the long term "problematic LEA," as described in the IOC 2023 consensus statement; and (5) the evidence is not as convincing as it is sometimes believed to be (i.e., many practitioners believe REDs is well established). Very few studies can demonstrate causality between LEA and symptoms, most studies demonstrate associations and there is a worrying number of (narrative) reviews on the topic, relative to original research. Here we suggest that the athlete is best served by an unbiased approach that places health at the center, leaving open all possible explanations for the presented symptoms. Practitioners could use a checklist that addresses eight categories of potential causes and involve the relevant experts if and when needed. The Athlete Health and Readiness Checklist (AHaRC) we introduce here simply consists of tools that have already been developed by various expert/consensus statements to monitor and troubleshoot aspects of athlete health and performance issues. Isolating the purported effects of LEA from the myriad of other potential causes of REDs symptoms is experimentally challenging. This renders the REDs model somewhat immune to falsification and we may never definitively answer the question, "does REDs syndrome exist?" From a practical point of view, it is not necessary to isolate LEA as a cause because all potential areas of health and performance improvement should be identified and tackled.

Energy availability and its association with health-related outcomes among national athletes at risk of relative energy deficiency in sports (REDs)

ABSTRACT

Background

Low energy availability (LEA) occurs when athletes' energy intake fails to match the energy expended during exercise, resulting in insufficient energy to support essential functions for optimal health, a condition known as relative energy deficiency in sports (REDs).

Objective

This study aims to explore the prevalence of LEA among Malaysian national athletes and its associations with health-related outcomes.

Methods

A total of 43 athletes (51.2% males, aged 18-40) identified previously as having moderate or high risk of REDs through a questionnaire underwent comprehensive clinical assessments. Resting metabolic rate (RMR) was measured using indirect calorimetry, with an RMR ratio of <0.90 indicating LEA. Weight and height were measured, and fasting blood samples were analysed for ferritin, free triiodothyronine (fT3), follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol (female athletes) and testosterone (male athletes). Bone mineral density (BMD) of the lumbar spine and total left hip, as well as body composition, were measured using dual-energy X-ray absorptiometry (DXA).

Results

Out of the 43 athletes, 12 showed evidence of LEA, exhibiting at least one of the following characteristics: low estradiol levels (87.5%), low testosterone (75.0%), low fT3 (66.7%), low LH (58.3%), low FSH (58.3%), low ferritin (25.0%) and low BMD (8.3%). Notably, fT3, estradiol and testosterone were significant predictors for LEA.

Conclusions

A low but noteworthy incidence of LEA among Malaysian national athletes was associated with hormone imbalances. Awareness about LEA among athletes and sports personnel is essential for early detection and appropriate intervention.

The Role of Nutrition in Maintaining the Health and Physical Condition of Sports Volunteers

Nutrition plays a key role in maintaining health and physical condition, particularly for active individuals, including athletes. It can therefore be assumed that individuals performing physically demanding tasks during the organization of sporting events, such as volunteers, should also pay attention to their nutrition. While the importance of diet for athletes has been widely studied, the impact of nutrition on sports volunteers remains under-researched. Volunteers often have to cope with varying degrees of physical and mental exertion, which may affect their nutritional needs. A qualitative study was conducted using in-depth individual interviews (IDIs) with 17 sports volunteers who had experience in organizing various sporting events. Participants were purposefully selected based on specific inclusion criteria, which included active involvement in sports volunteering (with a minimum of two years of experience in volunteer activities) as well as volunteering experience at sports events of various scales. The interviews aimed to understand the eating habits, dietary awareness, and impact of nutrition on health and physical fitness. The data were transcribed and subjected to thematic analysis, focusing on coding responses and identifying recurring themes. Most participants did not place much importance on their diet, making random food choices due to a busy lifestyle and lack of time. Only a few volunteers consciously adjusted their diet when they had knowledge of the physically demanding tasks they were expected to perform during their volunteer work. The majority of volunteers relied on less reliable sources of nutritional information, such as blogs or social media, rather than credible sources of knowledge. This study revealed that many individuals involved in sports volunteering are unaware of the impact of diet on their fitness and health. There is a need for nutritional education for this group to improve their awareness of the importance of a balanced diet in the context of increased physical activity. It is also advisable to provide better nutritional conditions during sporting events and to promote the use of professional sources of information about healthy eating.

Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments

Research on lean, energy-deficient athletic and military cohorts has broadened the concept of the Female Athlete Triad into the Relative Energy Deficiency in Sport (REDs) syndrome. REDs represents a spectrum of abnormalities induced by low energy availability (LEA), which serves as the underlying cause of all symptoms described within the REDs concept, affecting exercising populations of either biological sex. Both short- and long-term LEA, in conjunction with other moderating factors, may produce a multitude of maladaptive changes that impair various physiological systems and adversely affect health, well-being, and sport performance. Consequently, the comprehensive definition of REDs encompasses a broad spectrum of physiological sequelae and adverse clinical outcomes related to LEA, such as neuroendocrine, bone, immune, and hematological effects, ultimately resulting in compromised health and performance. In this review, we discuss the pathophysiology of REDs and associated disorders. We briefly examine current treatment recommendations for REDs, primarily focusing on nonpharmacological, behavioral, and lifestyle modifications that target its underlying cause-energy deficit. We also discuss treatment approaches aimed at managing symptoms, such as menstrual dysfunction and bone stress injuries, and explore potential novel treatments that target the underlying physiology, emphasizing the roles of leptin and the activin-follistatin-inhibin axis, the roles of which remain to be fully elucidated, in the pathophysiology and management of REDs. In the near future, novel therapies leveraging our emerging understanding of molecules and physiological axes underlying energy availability or lack thereof may restore LEA-related abnormalities, thus preventing and/or treating REDs-related health complications, such as stress fractures, and improving performance.

Contemporary Themes in Dietary Intake in Rugby Union Players: A Narrative Review

Rugby union is an intermittent team sport with variability in body composition and match-play demands between positions which requires careful consideration for individual dietary requirements. While previous reviews have detailed the macronutrient intake in rugby players, none have discussed the further determinants of dietary intake in this population. Therefore, the purpose of the current review was to summarise the current evidence detailing dietary intake in rugby union players, report on contemporary nutritional research themes, and provide recommendations for athletes, nutritionists, and other stakeholders. In total, eighteen articles report on dietary intake in rugby players, with only one of these detailing dietary intake in female athletes. Recent studies have reported on both protein and carbohydrate periodisation practices in rugby union players; however, there is currently limited evidence as to the influence of these on performance, recovery, and well-being. Factors influencing eating patterns, the impact of sports nutritionists on dietary intake, and food consumption in catered and non-catered environments has been explored in isolated studies. Nutrition knowledge levels in rugby players have been reported in several studies; however, the influence this has on dietary intake in rugby players is unknown. Collectively, despite new contemporary themes emerging in the literature concerning dietary intake in rugby players, the studies are isolated; as such, there is limited scope to the translatability of information due to heterogeneity in sex, level of play, and location of participants. Given this, future research should aim to build upon the themes identified in this review in combination to support practitioners working within their specific environments. This will subsequently build towards the generation of rugby-specific recommendations.

Methods to Assess Energy Expenditure of Resistance Exercise: A Systematic Scoping Review

BACKGROUND

Nutrition guidance for athletes must consider a range of variables to effectively support individuals in meeting energy and nutrient needs. Resistance exercise is a widely adopted training method in athlete preparation and rehabilitation and therefore is one such variable that will influence nutrition guidance. Given its prominence, the capacity to meaningfully quantify resistance exercise energy expenditure will assist practitioners and researchers in providing nutrition guidance. However, the significant contribution of anaerobic metabolism makes quantifying energy expenditure of resistance exercise challenging.

OBJECTIVE

The aim of this scoping review was to investigate the methods used to assess resistance exercise energy expenditure.

METHODS

A literature search of Medline, SPORTDiscus, CINAHL and Web of Science identified studies that included an assessment of resistance exercise energy expenditure. Quality appraisal of included studies was performed using the Rosendal Scale.

RESULTS

A total of 19,867 studies were identified, with 166 included after screening. Methods to assess energy expenditure included indirect calorimetry (n = 136), blood lactate analysis (n = 25), wearable monitors (n = 31) and metabolic equivalents (n = 4). Post-exercise energy expenditure was measured in 76 studies. The reported energy expenditure values varied widely between studies.

CONCLUSIONS

Indirect calorimetry is widely used to estimate energy expenditure. However, given its limitations in quantifying glycolytic contribution, indirect calorimetry during and immediately following exercise combined with measures of blood lactate are likely required to better quantify total energy expenditure. Due to the cumbersome equipment and technical expertise required, though, along with the physical restrictions the equipment places on participants performing particular resistance exercises, indirect calorimetry is likely impractical for use outside of the laboratory setting, where metabolic equivalents may be a more appropriate method.

Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes?

Low energy availability, particularly when problematic (i.e., prolonged and/or severe), has numerous negative consequences for health and sports performance as characterized in relative energy deficiency in sport. These consequences may be driven by disturbances in endocrine function, although scientific evidence clearly linking endocrine dysfunction to decreased sports performance and blunted or diminished training adaptations is limited. We describe how low energy availability-induced changes in sex hormones manifest as menstrual dysfunction and accompanying hormonal dysfunction in other endocrine axes that lead to adverse health outcomes, including negative bone health, impaired metabolic activity, undesired outcomes for body composition, altered immune response, problematic cardiovascular outcomes, iron deficiency, as well as impaired endurance performance and force production, all of which ultimately may influence athlete health and performance. Where identifiable menstrual dysfunction indicates hypothalamic-pituitary-ovarian axis dysfunction, concomitant disturbances in other hormonal axes and their impact on the athlete's health and sports performance must be recognized as well. Given that the margin between podium positions and "losing" in competitive sports can be very small, several important questions regarding low energy availability, endocrinology, and the mechanisms behind impaired training adaptations and sports performance have yet to be explored.

Differences in Knowledge of Female Athlete Triad and Relative Energy Deficiency in Sport in Female Cross-Country Athletes

BACKGROUND

The female athlete triad (Triad) and relative energy deficiency in sport (REDs) describe potential health and performance consequences of low energy availability.

OBJECTIVE

We surveyed female cross-country athletes to assess differences in educational impact scores (EIS; knowledge score × confidence score factor) of Triad and REDs. Associations between EIS and participant characteristics (eg, mileage [current and peak], years of running experience, age, bone stress injury history, division level participation, academic area of study, Triad or REDs diagnoses, and Triad or REDs education) were explored.

MAIN OUTCOME MEASURE(S)

An evidence-based online survey was developed and administered via Qualtrics to female collegiate cross-country athletes (n = 275; age = 20 ± 1 years).

RESULTS

A weak correlation existed between peak career mileage and EIS (r = 0.195; P = .010). Educational impact scores significantly differed in athletes with a related academic area of study versus those without (21.91 ± 5.16 and 16.11 ± 5.54, respectively). Educational impact scores significantly differed in athletes with Triad and REDs diagnoses (21.69 ± 5.85 and 22.58 ± 6.82, respectively) versus those without (16.80 ± 6.54 and 17.20 ± 6.34, respectively). Educational impact scores were higher in those who had received Triad education versus those who had not (21.03 ± 6.86 and 18.12 ± 6.82, respectively). A significant interaction between peak career mileage and Triad diagnosis was found (P = .005).

CONCLUSIONS

Significant education-based and diagnosis differences suggest that Triad diagnoses correlate with peak career mileage. These findings support the facilitation of education to improve not only the treatment but also the prevention of Triad and REDs.

Identifying and Analyzing Low Energy Availability in Athletes: The Role of Biomarkers and Red Blood Cell Turnover

Low energy availability (LEA) is a growing concern that can lead to several problems for athletes. However, adaptation to LEA occurs to maintain balance over time, making diagnosis difficult. In this review, we categorize LEA into two phases: the initial phase leading to adaptation and the phase in which adaptation is achieved and maintained. We review the influence of LEA on sports performance and health and discuss biomarkers for diagnosing LEA in each phase. This review also proposes future research topics for diagnosing LEA, with an emphasis on the recently discovered association between red blood cell turnover and LEA.

Assessment of Nutritional Status and Energy Availability of Indian Boxers

BACKGROUND

Inadequate dietary intake and low energy availability (LEA) negatively impact athlete's health, recovery, and performance outcomes. Currently, there is no Indian study that assessed the energy availability (EA) of Indian boxers and studied the contributing factors to LEA. This study was undertaken with the objectives of assessing the EA of Indian boxers (lightweight category) and correlating it with contributing factors such as anthropometric measurements, body composition, dietary intake, nutrient intake, and exercise energy expenditure.

METHODS

This descriptive cross-sectional study recruited 30 state-level boxers of the lightweight category (females: nine) residing in Mumbai, Maharashtra, India, using purposive sampling. Body composition was assessed using a body composition monitor. Anthropometric measurements were assessed using standard methods. Three-day exercise energy expenditure was calculated. Three-day dietary intake was assessed, which included two training days and one rest day using the three-day multiple-pass method. Dietary intake assessment included intake of all the meals, snacks, sports foods, sports, and dietary supplements. EA was calculated and participants were classified as moderate EA (30-45 kcal/kg FFM/day) and low EA (< 30 kcal/kg FFM/day). Descriptive and inferential statistical tests were conducted using Statistical Product and Service Solutions (SPSS, version 23; IBM SPSS Statistics for Windows, Armonk, NY).

RESULTS

Male boxers had a mean age of 18.43±0.93 years, and females had a mean age of 18.44±0.88 years. Among boxers, 36.67% (n=11) of participants were underweight, 46.67% (n=14) had a normal BMI, and 16.67% (n=5) were overweight. The mean body fat (%) for boxers was 13.11±1.8. Participants had insufficient consumption of different food groups before and after the energy intake adjustment. Processed packaged food consumption was popular among the participants. Various kinds of sports foods and supplements were consumed by a few athletes. Dietary supplements were not common among participants. The nutrient intake of the participants was inadequate. Participants could not fulfill energy/kg/day, carbohydrate/kg/day, protein/kg/day, and fat/kg/day requirements by 29%, 36.2%, 34.8%, and 23.9%, respectively. Iron and calcium intake was inadequate among female participants by 1.4% and 12.8%, respectively. Among male boxers, the mean EA was 29.71±3.74 kcal/kg FFM/day, and the mean EA of female boxers was 28.3±3.95 kcal/kg FFM/day. Around 66.67% of boxers in the present study had LEA, while the rest had reduced EA. EA had a moderately significant inverse relationship with fat-free mass (%). Energy intake was significantly related to EA and total body muscle % significantly moderated that relationship. The influence of fat-free mass (%), EEE (kcal), and energy intake (kcal) on the EA (kcal/kg FFM/day) was significant using multiple linear regression analysis.

CONCLUSIONS

The majority of the participants could not meet the food intake and nutrient recommendations. The majority of the participants had LEA. The higher the energy and nutrient intake, the higher the EA in the present study. EA had a moderately significant inverse relationship with fat-free mass (%) and exercise energy expenditure.

Menstrual cycle disorders as an early symptom of energy deficiency among female physique athletes assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q)

Physique competitions are weight-sensitive sports in which stage presentation, aesthetic appearance and posing ability of the athletes are judged rather than physical performance. The aim of this study was to assess low energy availability among female physique athletes by using the LEAF-Q. The study involved 104 females who were physique athletes. Monthly cycle disorders were reported in 58.65% of the women, that is periods stopped for three consecutive months or longer (amenorrhea). This situation occurred before the research was conducted in 43.27% of athletes and during the research in 15.38%. The physique athletes claimed that menstruation changes occurred when there was an increased exercise intensity, frequency or duration. Absence from training due to injury was reported by 27.88% of the women. The LEAF-Q identified 46.15% of the physique athletes as at risk (score ≥ 8) of low energy availability and the physiological consequences related to RED-S. Women who had menstrual cycle disorders were younger and did more training per week. Among women with menstrual disorders, cramps or stomach ache which cannot be related to menstruation occurred more frequently (p = 0.004). Absence from training or lack of participation in competition due to injuries occurred more frequently in the score ≥ 8 group (p = 0.024) thank the ≤ score 8 group. In the score ≥ 8 group menstruation changes, that is less bleeding or cessation of menstruation (p = 0.035), occurred more frequently when there was an increase in exercise intensity, frequency or duration (p = 0.002).

Bone Mineral Density in Mountain, Road Cyclists and Untrained Controls: Exercise, Diet and Hormones

Purpose: The aim of the study was to compare bone mineral density (BMD) in the lumbar spine (LSBMD) and the femoral neck (FBMD) in male road cyclists (RC n = 39), mountain cyclists (MC n = 30) and controls (C n = 27) and to determine the factors associated with BMD in the same group of participants. Methods: BMD, fat mass (FM) and fat-free mass (FFM) were measured using DXA. Calcium intake (Cal), exercise energy expenditure (EEE) and energy availability (EA) were assessed using self-reported questionnaires. Samples for circulating hormones were also obtained. VO2max was estimated by a cycloergometric test. Results: After adjustment for body mass, in cyclists LSBMD (RC 0.98 ± 0.12; MC 0.98 ± 0.10 g/cm2) was significantly lower than in C (1.11 ± 0.10; p < .001), while FBMD resulted in no significant difference in cyclists compared to C (p = 0.213). EA (kcal/FFM/day) was different in cyclists and in C (p < .05). In C, EEE and EA were positively associated with LSBMD (R = 0.561, R = 0.656, respectively, p < .01), whereas only EA was associated with FBMD (R = 0.554, p < .05); a positive association between EA and FBMD was found in MC (R = 0.464, p < .05). A negative relationship between VO2max and LSBMD in RC (R = -0.418, p < .05) and a positive one between EEE and LSBMD in MC were found (R = 0.605, p < .001). CaI, free testosterone and cortisol were unrelated to BMD. Conclusion: Both the RC and MC had lower LSBMD than C, whereas no difference was found between the two groups of cyclists. The factors associated with BMD are manifold, vary in relation to the measurement site and are likely different in RC, MC and C.

A real-life snapshot: Evaluating exposures to low energy availability in male athletes from various sports

Problematic low energy availability (LEA) is the underlying cause of relative energy deficiency in sport (REDs). Male specific etiology, as well as the duration and degree of LEA exposures resulting in REDs remain to be adequately described. The present study aimed to assess occurrences of LEA (energy availability [EA] <25 kcal/kg fat-free mass/day) in male athletes from various sports over 7 days. Associations between number of LEA days, physiological measures, and body image concerns were subsequently evaluated. The athletes recorded their weighed food intakes and training via photo-assisted mobile application. Body composition and resting metabolic rates were measured, and venous blood samples collected for assessments of hormonal and nutrition status. Participants also answered the Low Energy Availability in Males Questionnaire (LEAM-Q), Eating Disorder Examination-Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI), and Muscle Dysmorphic Disorder Inventory (MDDI). Of 19 participants, 13 had 0-2, 6 had 3-5, and none had 6-7 LEA days. No associations were found between the number of LEA days with the physiological and body image outcomes, although those with greatest number of LEA days had highest EEE but relatively low dietary intakes. In conclusion, this group displayed considerable day-to-day EA fluctuations but no indication of problematic LEA.

Monitoring training, performance, biomarkers, and psychological state throughout a competitive season: a case study of a triathlete

INTRODUCTION

Ironman triathletes undergo high workloads during competition preparation which can result in nonfunctional overreaching or overtraining syndrome if not matched with adequate recovery.

PURPOSE

The purpose of this case study was to observe changes in physiological and psychological status over the course of a competitive season in a free-living triathlete.

METHODS

The subject was a 41-year-old triathlete competing in three 113.1-km events. Over the course of a 40-week period, the participant arrived at the laboratory every 4 weeks and underwent body composition testing via air displacement plethysmography, a blood draw for analysis of various biomarkers, and a treadmill-based lactate threshold test. Workload during training and competitions was monitored via a wearable heart rate-monitoring device.

RESULTS

Throughout the season, training volume remained high (12.5 ± 3.4 h/week) and body mass and fat-free mass (FFM) continuously decreased, while biomarkers including cortisol, testosterone, and markers of immunological status exhibited minor changes. Laboratory performance remained relatively consistent, while competition performance continually improved. Following the completion of the competitive period, training volume decreased, FFM remained below baseline levels, free cortisol increased, and both free and total testosterone decreased.

CONCLUSIONS

Workload and recovery seem to have been properly managed throughout the season, evidenced by minimal fluctuations in endocrine and immunological markers. The reason for changes observed in testosterone, cortisol, and body composition following the last competition is unclear, though it may be attributed to changes in stressors and recovery practices outside of training. It is recommended that athletes follow a structured plan during the transition period into the offseason to ensure recovery of physiological state and to set up a productive offseason.

Risk of low energy availability and nutrition knowledge among female team sport athletes

BACKGROUND

Nutrition knowledge influences adequate dietary intake in athletes. Inadequate dietary intakes can result in low energy availability (LEA) which can lead to relative energy deficiency in sport (RED-S). To date, there is little information on the relationship between nutrition knowledge and the risk of LEA in female team sport athletes. This study investigates if general and sports nutrition knowledge are associated with the risk of LEA in female team athletes.

METHODS

A cross-sectional design was used. Female athletes (>16 years) who participate in team sports in New Zealand were asked to complete an online questionnaire. The LEA in Females Questionnaire and the Abridged Sport Nutrition Knowledge Questionnaire were included. LEA risk and general/sports nutrition knowledge were assessed. The relationship between LEA risk and knowledge was analyzed using the Kruskal-Wallis Test of independent variables and χ2 tests.

RESULTS

Among 100 female athletes, 53% were at-risk for LEA, and 70% (N.=67) had poor nutrition knowledge. Athletes who were "at-risk" for LEA and those who were "not at-risk" for LEA did not differ statistically in terms of age (P=0.350) or BMI (P=0.576). Of those "not at risk" 54% had an A-NSK score between 50 and 60% (i.e., average knowledge), whereas 54% of the athletes who were "at risk" for LEA had poor nutrition knowledge. There was no statistical difference between the groups (P=0.273).

CONCLUSIONS

The poor nutrition knowledge and the high rates of those "at risk" of LEA among team sports athletes indicates the need for more nutrition education in this population.

Diet quality of NCAA Division I athletes assessed by the Healthy Eating Index

Optimizing diet quality is an important concept for college athletes. Purpose: To evaluate dietary quality of National Collegiate Athletic Association (NCAA) Division I athletes. Methods: Total 94 college athletes (n= 21 male, 73 female) from 19 different varsity teams at a single university completed a 24-hour dietary recall using the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. Diet quality was assessed using the Healthy Eating Index (HEI) with higher scores indicating better diet quality (range 0-100). Results: The average HEI score for the total sample was 59.2 ± 16.6 and only nine athletes achieved an HEI score ≥ 80. There were no significant differences in HEI scores between sexes, class, majors, sport played, or those who did or did not report taking previous nutrition coursework. Conclusions: The dietary quality was poor based on US dietary guidelines for the general population, which could have negative effects on health and performance.

The Effects of Acute Deep Seawater Supplementation on Muscle Function after Triathlon

(1) Background: Trainers and athletes have always sought to reduce the failure of muscle function during long endurance events. However, nowadays, it is a topic that is generating much debate in the scientific field. Currently, deep-sea water (DSW) intake seems to be a suitable hydration alternative for this type of endurance event. Therefore, the aim of this study was to determine whether DSW consumption during a triathlon event could preserve muscle function after exercise. (2) Methods: Nineteen trained male triathletes (age = 39.0 ± 4.25 years; BMI = 23.67 ± 1.81 kg/m2) randomly performed three triathlons, one of them consuming DSW (Totum SPORT 30 AB, Laboratories Quinton International, S.L., Spain), the other consuming isotonic placebo and the last with tap water-hydration. A vertical jump test with countermovement and an isometric muscle strength test were conducted before and after the triathlon test. (3) Results: There was a significant difference between treatment × time during the isometric muscle strength test. Based on the Tukey post hoc analysis, the peak net force decreased statistically in the placebo (p = 0.045) and control conditions (p = 0.026), but not in the experimental condition (p = 0.121). In addition, all of the conditions studied obtained similar results in the countermovement vertical jump after exercise. (4) Conclusions: As a result, consumption of DSW seems to delay the failure of muscle function specifically in isometric exercises but does not improve performance in sports. Thus, DSW does not alter muscle capacity in a negative way; therefore, its consumption may be recommended.

The effect of nutrition education sessions on energy availability, body composition, eating attitude and sports nutrition knowledge in young female endurance athletes

Nutrition knowledge plays a pivotal role in shaping dietary habits and food choices, particularly in the realm of sports nutrition. This study investigates the effects of a series of nutrition education sessions conducted by a registered dietitian on energy availability, various anthropometric measurements, eating attitudes, and sports nutrition knowledge in young female endurance athletes aged 15-18 years (football, basketball, volleyball) who engage in training for more than 10 h per week (n = 83). Participants were randomly divided into two groups with 45 individuals receiving six physical nutrition education lectures, and the remaining 38 participants receiving no nutrition education. Participants completed the low energy availability in females questionnaire (LEAF-Q), Eating Attitude Test (EAT-26), and Sports Nutrition Knowledge Questionnaire (SNKQ). Energy and nutrient intakes were evaluated through 3-day food records, while exercise energy expenditure was assessed using 3-day activity logs. All of the questionnaires were repeated after 6 months. At baseline, the prevalence of LEA among athletes was determined to be 63.8%. In the intervention group, energy availability (EA) and SNKQ scores increased, and LEAF-Q scores decreased significantly (p < 0.05). However, there was no significant change in EAT-26 scores between the two groups. Energy intake, weight, fat-free mass, and resting metabolic rate have been increased significantly in the intervention group (p < 0,05). These findings suggest that nutrition education proves beneficial in enhancing dietary intake, positively influencing body composition, and improving nutrition knowledge, ultimately contributing to increased energy availability in female athletes over the short term.

Female Athlete Triad and Relative Energy Deficiency in Sport (REDs): Nutritional Management

The female athlete triad (TRIAD) is a spectrum of disorders involving low energy availability (LEA), low bone mineral density, and menstrual disorders. It is increasingly common to use the term 'relative energy deficiency in sport' (RED), emphasising the extensive impact of LEA on the body. The aim of this narrative review was to gather original research encompassing female athletes across various sports as well as to collect findings on the potential of a nutrition-focused approach to prevent or treat the aforementioned disorders. A comprehensive search was conducted in PubMed and Scopus. Several challenges were identified regarding the adequacy of the energy availability, protein, and carbohydrate requirements in the diets of female athletes. Moreover, insufficient intake of vitamin D has been observed across all athlete groups studied. This insufficiency also extends to the average requirement for Ca, Mg, the Ca/P ratio, Zn, and Fe. To address those concerns, a nutritional approach is proposed in the latter part of this review. The factors that can improve the absorption of micronutrients have also been discussed. The TRIAD/REDs affect an ever-growing number of women and require appropriate therapeutic management, particularly through nutritional care. Therefore, cooperation within an interdisciplinary team comprising a physician, nutritionist, physiotherapist, and psychologist is crucial.

A comparative observational study of carbohydrate intake and continuous blood glucose levels in relation to performance in ultramarathon

Ultra-endurance events have gained global participation, whereas the critical factors of competition results remain to be well elucidated. This study used a nutritional approach to evaluate the association of competition results with carbohydrate intake and blood glucose control during a 100-mile ultramarathon. This observational study was conducted in the 2021 LAKE BIWA 100, which covered 100 miles (169 km) and 10,500 m elevation. The course was divided into 9 segments by aid station. According to the competition results, 22 participants (18 men and 4 women) were divided into higher finishers (n = 7), lower finishers (n = 9), and non-finishers (n = 6). The participants self-recorded their overall dietary intake throughout the race. Glucose levels were monitored every 15 min by a flash glucose monitoring system. Running speed in each segment was standardized to the average of the top five finishers for each gender. Among finishers, the carbohydrate intakes were significantly higher in the higher finishers than in the lower finishers during overall segments, especially in the first half of the race (p < 0.05). There was a significant positive correlation between running speed and carbohydrate intake in the lower finishers (rho = 0.700, p = 0.036). Two-way ANOVA analysis revealed that lowering glucose levels in each segment were more frequently observed in the lower finishers compared to the higher finishers (p = 0.012). Compared to the higher finishers, the lower finishers exhibited significantly greater fluctuations (⊿highest-lowest) in glucose levels (p < 0.001). The fluctuations in glucose levels were significantly and negatively correlated with the running speed of the finishers (rho =  - 0.612, p = 0.012). Faster runners consume high amounts of carbohydrates and maintain glucose levels during the 100-mile ultramarathon on the trail, especially at the beginning. Lowering and fluctuating glucose levels during the race are associated with lower running speed in endurance athletes.

Accuracy and precision of multiple body composition methods and associations with muscle strength in athletes of varying hydration: The Da Kine Study

BACKGROUND

Athletes vary in hydration status due to ongoing training regimes, diet demands, and extreme exertion. With water being one of the largest body composition compartments, its variation can cause misinterpretation of body composition assessments meant to monitor strength and training progress. In this study, we asked what accessible body composition approach could best quantify body composition in athletes with a variety of hydration levels.

METHODS

The Da Kine Study recruited collegiate and intramural athletes to undergo a variety of body composition assessments including air-displacement plethysmography (ADP), deuterium-oxide dilution (D2O), dual-energy X-ray absorptiometry (DXA), underwater-weighing (UWW), 3D-optical (3DO) imaging, and bioelectrical impedance (BIA). Each of these methods generated 2- or 3-compartment body composition estimates of fat mass (FM) and fat-free mass (FFM) and was compared to equivalent measures of the criterion 6-compartment model (6CM) that accounts for variance in hydration. Body composition by each method was used to predict abdominal and thigh strength, assessed by isokinetic/isometric dynamometry.

RESULTS

In total, 70 (35 female) athletes with a mean age of 21.8 ± 4.2 years were recruited. Percent hydration (Body Water6CM/FFM6CM) had substantial variation in both males (63-73 %) and females (58-78 %). ADP and DXA FM and FF M had moderate to substantial agreement with the 6C model (Lin's Concordance Coefficient [CCC] = 0.90-0.95) whereas the other measures had lesser agreement (CCC <0.90) with one exception of 3DO FFM in females (CCC = 0.91). All measures of FFM produced excellent precision with %CV < 1.0 %. However, FM measures in general had worse precision (% CV < 2.0 %). Increasing quartiles (significant p < 0.001 trend) of 6CM FFM resulted in increasing strength measures in males and females. Moreover, the stronger the agreement between the alternative methods to the 6CM, the more robust their correlation with strength, irrespective of hydration status.

CONCLUSION

The criterion 6CM showed the best association to strength regardless of the hydration status of the athletes for both males and females. Simpler methods showed high precision for both FM and FFM and those with the strongest agreement to the 6CM had the highest strength associations.

SUMMARY BOX

This study compared various body composition analysis methods in 70 athletes with varying states of hydration to the criterion 6-compartment model and assessed their relationship to muscle strength. The results showed that accurate and precise estimates of body composition can be determined in athletes, and a more accurate body composition measurement produces better strength estimates. The best laboratory-based techniques were air displacement plethysmography and dual-energy x-ray absorptiometry, while the commercial methods had moderate-poor agreement. Prioritizing accurate body composition assessment ensures better strength estimates in athletes.

Dynamic comparison the lower extremities length in students education in higher institutions

OBJECTIVE

Aim: Dynamic comparison of the lower limbs length, depending on the type of sport, followed by the construction of a mathematical model for predicting sports abilities.

PATIENTS AND METHODS

Materials and Methods: The comparison of the lower limbs length in dynamics was carried out on 132 students of higher education institutions of Bukovyna. While the primary study was carried out during September-October 2021, next study of these same students was conducted in September-October 2022. The main group consists of 92 (69.7%) students, the control group - 40 (30.30%) students aged 16 to 18 years. All students underwent an anthropometric study (determination of the length of the lower limbs) according to the method of P.P. Shaparenka. The comparesment of anthropometric parameters in the main group depending on the type of sport used the Kruskel-Wallis test (non-parametric analysis of variance) in order to identify a reliable difference in the average indicators of the respondents depending on the type of sport (the median of the distribution was considered as a measure of central tendency). In order to establish which pairs of age groups had a statistical difference in the medians, the Conover-Iman test was used. A paired t-test (t-test of paired samples) was performed to compare the length of the respondents' lower limbs during the first measurement and again one year later. Statistical analysis of the obtained data was performed using the licensed RStudio program.

RESULTS

Results: The distribution of the length of the right lower limb of the respondents of the main group by measurement shows that the average value of the length of the right lower limb has changed: a significant difference in the length of the right lower limb was found between the first (M = 88.812, SD = 5.287) and the second (M = 89.377, SD = 5.347) measurements; t (68) = -5.223, p < 0.001. The distribution of the length of the left lower limb shows that the average value of the length of the left lower limb has changed also: a significant difference in the length of the left lower limb was found between the first (M = 88.667, SD = 5.266) and the second (M = 89.435, SD = 5.309) measurements; t (68) = -8.289, p < 0.001.

CONCLUSION

Conclusions: In order to dynamically compare the length of the lower limbs for comprehensive control and selection of promising students in football, volleyball, handball and basketball, a mathematical model was derived for predicting the length of the lower limbs, in corresponding sports: right lower limb y = 0.506 x and left y = 0.507x, where y - is the length of the left lower limb, x - is the height. The coefficient of determination is 99.8%. A significant predictor for the length of both lower limbs is the height.

Energy balance and energy availability of female basketball players during the preparation period

OBJECTIVE

To determine the level of energy balance and energy availability (EA) in female basketball players during the preparation period.

METHODS

Fifteen basketball players (age: 19.53 ± 1.3 years; height: 173.6 ± 8.95 cm; weight: 67.55 ± 14.34 kg; training experience: 9.6 ± 2.7 years) and 15 age and body mass index-matched controls (age: 19.53 ± 1.1 years; height: 169.4 ± 5.06 cm; weight: 63.10 ± 6.14 kg) participated in the study. Resting metabolic rate (RMR) and body composition were measured by the indirect calorimetric method and dual-energy x-ray absorptiometry, respectively. A 3-day food diary was used to determine macronutrients and energy intake while a 3-day physical activity log was used to determine energy expenditure. Independent Samples t-test was used for data analysis.

RESULTS

The daily energy intake and expenditure of female basketball players were 2136.5 ± 594.9 kcal·day-1 and 2953.8 ± 614.5 kcal·day-1, respectively, indicating 817 ± 779 kcal·day-1 of negative energy balance. One hundred percent and 66.6% of the athletes failed to meet the carbohydrate and protein intake recommendations, respectively. EA of female basketball players was 33.04 ± 15.69 kcal·fat free mass-1·day-1 and the percentages of athletes who had negative energy balance, low EA, and reduced EA were 80%, 40%, and 46.7%, respectively. However, despite the low and decreased EA, the measured RMR to predicted RMR ratio (RMRratio) was 1.31 ± 0.17 and the body fat percentage (BF%) was 31.00 ± 5.21%.

CONCLUSION

This study shows that female basketball players have a negative energy balance during the preparation period which can be partly explained by insufficient carbohydrate intake. Although most of the athletes experienced low or reduced EA during the preparation period, the physiologically normal RMRratio and relatively high BF% indicate that this is a transient situation. In this regard, strategies to prevent the development of low EA and negative energy balance during the preparation period will contribute to positive training adaptations throughout the competition period.

Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review

The purpose of this narrative review is to identify health and performance consequences associated with LCA in female endurance athletes. The intake of carbohydrates (CHO) before, during, and after exercise has been demonstrated to support sport performance, especially endurance activities which rely extensively on CHO as a fuel source. However, low energy availability (LEA) and low carbohydrate availability (LCA) are common in female athletes. LEA occurs when energy intake is insufficient compared to exercise energy expenditure, and LEA-related conditions (e.g., Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S)) are associated with a myriad of health and performance consequences. The RED-S model highlights 10 health consequences and 10 performance consequences related to LEA. The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes. It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes. Furthermore, this review highlights current recommendations for CHO intake, as well as recent data on LCA prevalence and menstrual cycle considerations. A literature review was conducted on PubMed, Science Direct, and ResearchGate using relevant search terms (i.e., "low carbohydrate/energy availability", "female distance runners"). Twenty-one articles were identified and twelve met the inclusion criteria. The total number of articles included in this review is 12, with 7 studies illustrating that LCA was associated with direct negative health and/or performance implications for endurance-based athletes. Several studies included assessed male athletes only, and no studies included a female-only study design. Overall, the cumulative data show that female athletes remain underrepresented in sports science research and that current CHO intake recommendations and strategies may fail to consider female-specific adaptations and hormone responses, such as monthly fluctuations in estrogen and progesterone throughout the menstrual cycle. Current CHO guidelines for female athletes and exercising women need to be audited and explored further in the literature to support female athlete health and performance.

New Epidemic of Malnutrition in Young Slovenian Athletes

Objective

The syndrome of relative energy deficiency in sports (RED-S) is the result of a prolonged period of low energy availability in athletes and leads to the deterioration of health and physical performance. Our study aimed to investigate the prevalence of RED-S-related health and performance problems in young Slovenian athletes, comparing middle (14-17 years) with late (18-21 years) adolescents.

Methods

We analysd data of 118 young athletes (61 females, 57 males) who had nutritional assessments. Statistical analysis was carried out to determine the prevalence of RED-S-related problems. RED-S was diagnosed using the Relative Energy Deficiency Tool and the Sports Clinical Assessment Tool. Nutrition-related risk factors for RED-S were assessed with the use of a questionnaire and analysis of a three-day food diary.

Results

The majority of athletes had at least one RED-S-related health disorder. The number of health-related disorders was significantly higher in females 3.0 (0.2) compared to males 1.6 (0.2). It was also significantly higher in middle 2.6 (0.2) compared to 1.9 (0.3) late adolescents. Potential nutritional risk factors for RED-S were low carbohydrate intake, skipping meals before and after practice, a desire to lose weight, and a history of weight loss in the past year.

Conclusion

The prevalence of health-related RED-S disorders and performance problems in young athletes is concerning, and our study indicates that middle adolescents are more vulnerable to this than late adolescents. Our findings suggest that screening for RED-S symptoms and nutrition-related risk factors for RED-S should be included in regular medical examination of young athletes.

2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.

Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs

The 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) notes that exposure to low energy availability (LEA) exists on a continuum between adaptable and problematic LEA, with a range of potential effects on both health and performance. However, there is variability in the outcomes of LEA exposure between and among individuals as well as the specific manifestations of REDs. We outline a framework for a 'systems biology' examination of the effect of LEA on individual body systems, with the eventual goal of creating an integrated map of body system interactions. We provide a template that systematically identifies characteristics of LEA exposure (eg, magnitude, duration, origin) and a variety of moderating factors (eg, medical history, diet and training characteristics) that could exacerbate or attenuate the type and severity of impairments to health and performance faced by an individual athlete. The REDs Physiological Model may assist the diagnosis of underlying causes of problems associated with LEA, with a personalised and nuanced treatment plan promoting compliance and treatment efficacy. It could also be used in the strategic prevention of REDs by drawing attention to scenarios of LEA in which impairments of health and performance are most likely, based on knowledge of the characteristics of the LEA exposure or moderating factors that may increase the risk of harmful outcomes. We challenge researchers and practitioners to create a unifying and dynamic physiological model for each body system that can be continuously updated and mapped as knowledge is gained.

Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs

In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent or young adult, female athletes. Much of the existing physiology and concepts, however, are either based on or extrapolated from limited studies, and the comparison of studies is hindered by the lack of standardised protocols. In this review, we have evaluated and outlined current best practice methodologies to study REDs in an attempt to guide future research.This includes an agreement on the definition of key terms, a summary of study designs with appropriate applications, descriptions of best practices for blood collection and assessment and a description of methods used to assess specific REDs sequelae, stratified as either Preferred, Used and Recommended or Potential Researchers can use the compiled information herein when planning studies to more consistently select the proper tools to investigate their domain of interest. Thus, the goal of this review is to standardise REDs research methods to strengthen future studies and improve REDs prevention, diagnosis and care.

The associations between anthropometric characteristics and nutritional parameters in male elite rugby union players

The objective was to analyse the associations between anthropometric characteristics and diet in male rugby players according to the playing position. A cross-sectional study was developed. The forwards had higher body weight (107 kg) and fat mass (FM; 12%) than the backs (87.8 kg and 8.47%, respectively) (p < 0.05). The quality of diet needs to improve (KIDMED value of 5.87 and 6.36 for forwards and backs, respectively). Nutritional imbalances, such as deficits in carbohydrates, fibre, calcium, magnesium and vitamin D, and excess of fats, saturated fatty acid, cholesterol and sugars were found. Carbohydrates and proteins intake were significant associated (p < 0.05) with a minor FM. Forwards with a KIDMED index of less than 8 had a significantly higher FM than those who maintained an optimal diet (p < 0.05). The diet of rugby players should be more in line with dietary recommendations and take into account the player position to optimise sports performance.

Short Severe Energy Restriction with Refueling Reduces Body Mass without Altering Training-Associated Performance Improvement

PURPOSE

We investigated short-term (9 d) exposure to low energy availability (LEA) in elite endurance athletes during a block of intensified training on self-reported well-being, body composition, and performance.

METHODS

Twenty-three highly trained race walkers undertook an ~3-wk research-embedded training camp during which they undertook baseline testing and 6 d of high energy/carbohydrate (HCHO) availability (40 kcal·kg FFM -1 ·d -1 ) before being allocated to 9 d continuation of this diet ( n = 10 M, 2 F) or a significant decrease in energy availability to 15 kcal·kg FFM -1 ·d -1 (LEA: n = 10 M, 1 F). A real-world 10,000-m race walking event was undertaken before (baseline) and after (adaptation) these phases, with races being preceded by standardized carbohydrate fueling (8 g·kg body mass [BM] -1 for 24 h and 2 g·kg BM -1 prerace meal).

RESULTS

Dual-energy x-ray absorptiometry-assessed body composition showed BM loss (2.0 kg, P < 0.001), primarily due to a 1.6-kg fat mass reduction ( P < 0.001) in LEA, with smaller losses (BM = 0.9 kg, P = 0.008; fat mass = 0.9 kg, P < 0.001) in HCHO. The 76-item Recovery-Stress Questionnaire for Athletes, undertaken at the end of each dietary phase, showed significant diet-trial effects for overall stress ( P = 0.021), overall recovery ( P = 0.024), sport-specific stress ( P = 0.003), and sport-specific recovery ( P = 0.012). However, improvements in race performance were similar: 4.5% ± 4.1% and 3.5% ± 1.8% for HCHO and LEA, respectively ( P < 0.001). The relationship between changes in performance and prerace BM was not significant ( r = -0.08 [-0.49 to 0.35], P = 0.717).

CONCLUSIONS

A series of strategically timed but brief phases of substantially restricted energy availability might achieve ideal race weight as part of a long-term periodization of physique by high-performance athletes, but the relationship between BM, training quality, and performance in weight-dependent endurance sports is complicated.

Description of the menstrual cycle status, energy availability, eating behavior and physical performance in a youth female soccer team

The aim of the study was to describe the menstrual status and perception, risk of low energy availability (LEA) and the presence of orthorexia nervosa (ON) in youth female from a soccer team. Also, verify the possible effect of LEA and ON on physical performance. Data from 19 female players (14.6 ± 1.42 yr) belonging to a soccer team from Cyprus was taken during pre-season. The menstrual cycle status was evaluated by specific questions, LEA by the Low Energy Availability in Females Questionnaire (LEAF-Q), ON by the ORTO-R questionnaire and physical performance by jump, handgrip and cardiorespiratory exercise tests. Players were separated into the risk of LEA and ON. Comparison and correlation tests were performed with a significance set at p < 0.05. As the main results, 66.7% of players perceived that the menstrual period affects their performance in the game, 83.3% did not communicate with coaches about their menstrual cycle; the prevalence of risk of LEA was 26.3%; players with risk of LEA also presented higher scores ON; neither LEA nor ON presented a significant association with players performance. The findings highlighted that youth players perceived an impact of the menstrual period on performance, but did not communicate with the coach about it. Players with the risk of LEA and high values of ON seem not to be associated with a decrease in physical performance during the pre-season evaluation. Attention is required as the players were assessed once. Monitoring these parameters throughout the sports season is recommended to obtain better clarification about the topic.

Nutritional Considerations for the Vegan Athlete

Accepting a continued rise in the prevalence of vegan-type diets in the general population is also likely to occur in athletic populations, it is of importance to assess the potential impact on athletic performance, adaptation, and recovery. Nutritional consideration for the athlete requires optimization of energy, macronutrient, and micronutrient intakes, and potentially the judicious selection of dietary supplements, all specified to meet the individual athlete's training and performance goals. The purpose of this review is to assess whether adopting a vegan diet is likely to impinge on such optimal nutrition and, where so, consider evidence based yet practical and pragmatic nutritional recommendations. Current evidence does not support that a vegan-type diet will enhance performance, adaptation, or recovery in athletes, but equally suggests that an athlete can follow a (more) vegan diet without detriment. A clear caveat, however, is that vegan diets consumed spontaneously may induce suboptimal intakes of key nutrients, most notably quantity and/or quality of dietary protein and specific micronutrients (eg, iron, calcium, vitamin B12, and vitamin D). As such, optimal vegan sports nutrition requires (more) careful consideration, evaluation, and planning. Individual/seasonal goals, training modalities, athlete type, and sensory/cultural/ethical preferences, among other factors, should all be considered when planning and adopting a vegan diet.

Using Statistical Parametric Mapping as a statistical method for more detailed insights in swimming: a systematic review

Swimming is a time-based sport and hence strongly dependent from velocity. Most studies about swimming refer to velocity as discrete variable, i.e., 0-D (no time dimension). However, it was argued that using swimming velocity as a continuous variable (1-D, with time dimension) with Statistical Parametric Mapping (SPM) can bring deeper and detailed insights about swimming performance. Therefore, the aim of this study was to perform a systematic review about the current body of knowledge of using Statistical Parametric Mapping in a swimming context. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant articles. After screening, nine articles related to Statistical Parametric Mapping (SPM) analysis in swimming were retained for synthesis. Results showed that four articles (44.4%) aimed to understand the kinematics, isokinetic joint torque or electromyographic (EMG) pattern of the swimmer's shoulder either on land or during front crawl trials. Two articles (22.2%) focused on understanding the swimming velocity while performing the breaststroke stroke. One article (11.1%) analyzed the swimmers' propulsion at front-crawl stroke, another one (11.1%) compared swimming velocity during a complete stroke cycle in young swimmers of both sexes as a discrete variable and as a continuous variable. Also, one article (11.1%) analyzed the underwater undulatory velocity. In an EMG context, some findings verified in SPM are not possible to be discovered with traditional 0-D statistical methods. Studies about swimming velocity (breaststroke, freestyle, and underwater undulatory velocity) and propulsion (front-crawl) also highlighted the SPM advantages in comparison to traditional statistical methods. By using SPM, researchers were able to verify specifically where within the stroke cycle significant differences were found. Therefore, coaches can get more detailed information to design specific training drills to overcome hypothetical handicaps.

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.

Energy Availability and Nutritional Intake during Different Training Phases of Wheelchair Athletes

Optimizing nutritional intake and timing helps athletes to improve performance and long-term health. Different training phases can require varying nutritional needs. In this study, we conducted a descriptive assessment of dietary intake, energy availability (EA), and blood biochemical parameters in elite wheelchair athletes during distinct training phases. Data analyzed in this study were collected as part of a randomized controlled crossover trial exploring the feasibility of probiotics and prebiotic supplementation. Data were obtained from consecutive three-day diaries and blood samples, both collected at four different time points across four consecutive months. We included 14 athletes (mean (standard deviation) age 34 (9) years, eight females, and six males) active in different wheelchair sports. The mean daily nutritional intake (g/kg body mass) for females and males was 2.7 (0.9) and 4.0 (0.7) for carbohydrates, 1.1 (0.3) and 1.5 (0.3) for protein, and 0.8 (0.3) and 1.4 (0.2) for fat. EA did not change across the four time points in either female (p = 0.30) or male (p = 0.05) athletes. The mean EA was lower in female athletes compared to male athletes (p = 0.03). Low EA (≤30 kcal/ kg fat-free mass/day) was observed in female (58 (29) % of days) and male (34 (23) % of days) athletes. Iron deficiency with anemia was observed in two female athletes. Mean vitamin D levels were insufficient (<75 nmol/L). Macronutrient intake, EA, and blood biochemical parameters were suboptimal in this cohort of elite wheelchair athletes, especially in female athletes.

Low Bone Mineral Density and Associated Risk Factors in Elite Cyclists at Different Stages of a Professional Cycling Career

PURPOSE

This study aimed to assess the prevalence of low bone mineral density (BMD) in male and female elite cyclists at different stages of a professional cycling career and to identify potential risk factors of low BMD.

METHODS

In this cross-sectional study, 93 male and female early career, advanced career, and postcareer elite cyclists completed dual-energy x-ray absorptiometry at the hip, femoral neck, lumbar spine, and total body; blood sampling; assessment of training history and injuries; and the bone-specific physical activity questionnaire. Backward stepwise multiple regression analyses were conducted to explore associations between BMD and its potential predictors in early and advanced career (i.e., active career) cyclists.

RESULTS

With a mean Z -score of -0.3 ± 0.8, -1.5 ± 1.0, and -1.0 ± 0.9, low BMD ( Z -score < -1) at the lumbar spine was present in 27%, 64%, and 50% of the early, advanced, and postcareer elite male cyclists, respectively. Lumbar spine Z -scores of -0.9 ± 1.0, -1.0 ± 1.0, and 0.2 ± 1.4 in early, advanced, and postcareer elite female cyclists, respectively, indicated low BMD in 45%, 45%, and 20% of these female subpopulations. Regression analyses identified body mass index, fracture incidence, bone-specific physical activity, and triiodothyronine as the main factors associated with BMD.

CONCLUSIONS

Low BMD is highly prevalent in elite cyclists, especially in early career females and advanced career males and females. These low BMD values may not fully recover after the professional cycling career, given the substantial prevalence of low BMD in retired elite cyclists. Exploratory analyses indicated that low BMD is associated with low body mass index, fracture incidence, lack of bone-specific physical activity, and low energy availability in active career elite cyclists.

Support for inadvertent undereating in female adolescent athletes with clinical indicators of low energy availability

OBJECTIVES

This study evaluated pathways to low energy availability in a sample of female adolescent athletes (n = 464).

DESIGN

Cross-sectional.

METHODS

Participants (age 13-18 y) underwent assessments for height, weight, eating attitudes and behaviors, and menstrual function. Bone mineral density and body composition were evaluated by dual-energy x-ray absorptiometry in a subset of participants (n = 209). Athletes were classified with clinical indicators of low energy availability if they met criteria for 1) primary or secondary amenorrhea or 2) clinical underweight status (body mass index-for-age < 5th percentile). Disordered eating was assessed using the Eating Disorder Examination Questionnaire.

RESULTS

Thirty (6.5%) athletes exhibited clinical indicators of low energy availability, with higher estimates in leanness than non-leanness sports (10.9% vs. 2.1%, p < 0.005). Among athletes with clinical indicators of low energy availability, 80% (n = 24) did not meet criteria for disordered eating, eating disorder, or report the desire to lose weight. Athletes with (vs. without) clinical indicators of low energy availability exhibited lower lumbar spine (-1.30 ± 1.38 vs. -0.07 ± 1.21, p < 0.001) and total body (-0.30 ± 0.98 vs. 0.53 ± 0.97, p < 0.006) bone mineral density Z-scores.

CONCLUSIONS

A majority of female adolescent athletes with clinical indicators of low energy availability did not exhibit characteristics consistent with intentional dietary restriction, supporting the significance of the inadvertent pathway to low energy availability and need for increased nutrition education in this population.

Micronutrient supplement intakes among collegiate and masters athletes: A cross-sectional study

Objective

In our cross-sectional study, we evaluated micronutrient supplementation intake among Collegiate and Masters Athletes.

Methods

We conducted a cross-sectional study to assess micronutrient supplementation consumption in Collegiate and Masters Athletes, comparing sex and sport classification within each respective group. Micronutrient supplement consumption data were measured using a Food Frequency Questionnaire. A two-way analysis of variance was used to explore the differences among Collegiate and Masters Athletes' supplement intakes of the following vitamins and minerals: vitamins A, B6, B12, C, E, D, and calcium, folate, iron, magnesium niacin, riboflavin, selenium, thiamine, and zinc. When significant differences were found, a Bonferroni post hoc test was performed to identify specific group differences. The significance level was set a priori at p &lt; 0.05.

Results

A total of 198 athletes (105 females and 93 males) were included in the study. Participants were 36.16 ± 12.33 years of age. Collegiate male athletes had significantly greater vitamin A [1,090.51 ± 154.72 vs. 473.93 ± 233.18 mg retinol activity equivalents (RAE)/day] (p &lt; 0.036), folate [337.14 ± 44.79 vs. 148.67 ± 67.50 mcg dietary folate equivalents (DFE)/day] (p &lt; 0.027), and magnesium (65.35 ± 8.28 vs. 31.28 ± 12.48 mg/day) (p &lt; 0.031) intakes compared to Collegiate female athletes. Collegiate CrossFit Athletes (940.71 ± 157.54 mg/day) had a significantly greater vitamin C intake compared to Collegiate General Athletes (156.34 ± 67.79 mg/day) (p &lt; 0.005), Collegiate Triathletes (88.57 ± 148.53 mg/day) (p &lt; 0.027), Collegiate Resistance Training Athletes (74.28 ± 143.81 mg/day) (p &lt; 0.020), and Collegiate Powerlifters (175.71 ± 128.63 mg/day) (p &lt; 0.044). Masters females had significantly greater calcium intakes compared to Masters males (494.09 ± 65.73 vs.187.89 ± 77.23 mg/day, respectively) (p &lt; 0.002). Collegiate Runners (41.35 ± 6.53 mg/day) had a significantly greater iron intake compared to Collegiate Powerlifters (4.50 ± 6.53 mg/day) (p &lt; 0.024). Masters Swimmers (61.43 ± 12.10 mg/day) had significantly greater iron intakes compared to Masters General Athletes (13.97 ± 3.56 mg/day) (p &lt; 0.014), Masters Runners (17.74 ± 2.32 mg/day) (p &lt; 0.03), Masters Triathletes (11.95 ± 3.73 mg/day) (p &lt; 0.008), Masters CrossFit Athletes (15.93 ± 5.36 mg/day) (p &lt; 0.043), Masters Rowers (9.10 ± 3.36 mg/day) (p &lt; 0.003), and Masters Cyclists (1.71 ± 9.88 mg/day) (p &lt; 0.011). Masters Powerlifters (47.14 ± 9.65 mg/day) had significantly greater zinc intakes compared to Masters General Athletes (9.57 ± 2.84 mg/day) (p &lt; 0.015), Masters Runners (10.67 ± 1.85 mg/day) (p &lt; 0.017), Masters Triathletes (10.24 ± 2.98 mg/day) (p &lt; 0.020), Masters Rowers (9.33 ± 2.68 mg/day) (p &lt; 0.013), and Masters Cyclists (1.43 ± 7.88 mg/day) (p &lt; 0.019). There were no other significant differences among the other micronutrient supplement intakes between the sexes or among the sport classification.

Conclusion

We reported significant differences among female and male Collegiate and Masters Athletes. Additionally, we reported significant differences among Collegiate and Masters Athletes sport classifications. Further research should examine both dietary and micronutrient supplement intake among Collegiate and Masters Athletes to examine the extent that athletes exceed the Recommended Dietary Allowances (RDA), and the potential effects on health and performance.

Controlling Behavior, Sex Bias and Coaching Success in Japanese Track and Field

Coaching athletes is a complex and lengthy process. Recently, attention has been given to coaches over-controlling behavior toward the athletes' personal lives and possible sex bias, but the impact of these behaviors on coaching success is unclear. An anonymous survey was answered by 412 track and field coaches (male: 369; female: 43), comprising questions regarding controlling behaviors, sex bias, and personal background. A Chi-square test and logistic regression were performed to determine the factors related to the coach's characteristics and their success in coaching athletes (to national vs. non-national level). The results showed that controlling behaviors and sex-bias-related beliefs were present. The coaches who coached national-level athletes were more likely to be older, more experienced, and were national level athletes themselves. More national-level coaches reported controlling behaviors but fewer held sex bias beliefs than the non-national level coaches. However, the strength of these beliefs (scores for controlling behavior and sex bias) was not related to the coaching success.

The Low Energy Availability in Females Questionnaire (LEAF-Q) as a Useful Tool to Identify Female Triathletes at Risk for Menstrual Disorders Related to Low Energy Availability

BACKGROUND

Nutrition in sport is a priority; it is the basis for maintaining optimal health and a prerequisite for the high performance necessary for competitions. The aim of this study was to assess low energy availability and its possible consequences among female triathletes by using the Low Energy Availability in Females Questionnaire (LEAF-Q).

METHODS

The study involved 30 female triathetes. The LEAF-Q was used in the study. An analysis of the body composition was carried out with the seca device mBCA 515 medical Body Composition Analyzer.

RESULTS

Of the 30 female triathletes studied, 23.3% had a monthly cycle disorder, defined as an amenorrhea state for more than 90 days. No differences were found in injury rates or training days lost to injury due to menstrual disturbances. Menstruation changes were significantly greater due to increases in exercise intensity, frequency, and duration in the group experiencing menstrual disturbances (85.7 [95% CIs: 42.1-99.6] vs. 8.7 [95% CIs: 1.1-28.0]). The menstrual disorder group had a greater incidence of their periods stopping for more than 3 months than the group without menstrual disturbances.

CONCLUSIONS

The female triathletes did not show abnormalities in body weight or composition, and these were not related to the incidence of menstrual disturbances. However, 20% of the triathletes either had, at the time of the study, or had had in the past monthly cycle disorders that could indicate an immediate risk of low energy availability. The LEAF-Q identified 10% of the triathletes as at risk (score > 8) of low energy availability and the physiological and performance consequences related to relative energy deficiency in sports (RED-S).

Study the Effect of Relative Energy Deficiency on Physiological and Physical Variables in Professional Women Athletes: A Randomized Controlled Trial

Energy deficits are often observed in athletes, especially in female athletes, due to the high expenditure of sport and strict diets. Low energy availability can cause serious health problems and affect sport performance. The aim of this study was to evaluate the effects of different personalized dietary plans on physiological and physical factors related to energy deficit syndrome in female professional handball players. Twenty-one professional female handball players, aged 22 ± 4 years, 172.0 ± 5.4 cm and 68.4 ± 6.7 kg, divided into three groups (FD: free diet; MD: Mediterranean diet; and AD: high antioxidant diet), participated in this 12-week randomized controlled trial. Energy expenditure through indirect calorimetry, energy availability, 7 day dietary intake analysis, blood pressure, cholesterol, menstrual function, body composition by both anthropometry and bioelectrical impedance, and strength performance were assessed. All participants showed low energy availability (<30 kcal/lean mass per day); despite this, all had eumenorrhea. Significant improvements were found after the intervention in all components of body composition (p < 0.05). In the remaining variables, despite slight improvements, none were significant neither over time nor between the different groups. Low energy availability has been observed in all professional female handball players, which may lead to serious consequences. A longer period of intervention is required to assess the differences between diets and improvements in other parameters.

Energy and Macronutrients Intake in Indoor Sport Team Athletes: Systematic Review

Indoor team sports are characterized by matches that are shorter in duration and with frequent substitution (high-intensity intermittent). The main goal of teams is to best cover athletes' physiological demands, while meeting their dietary intake needs is critical. The aim of this study is to conduct a systematic review of the dietary intake of indoor team sports athletes and to analyze whether they comply with nutritional recommendations. A search of PubMed-MEDLINE, Web of Science, and Scopus databases from 2008 to July 2022 was conducted and 2727 documents were identified. The studies focused on adult professional or semi-professional volleyball, basketball, handball, or futsal athletes. Two independent researchers screened and extracted the data, with 20 documents included after they met the inclusion criteria. Most of the athletes, both men and women, did not meet the official recommendations based on under-consumption (energy and carbohydrates) or over-consumption (fats). In relation to protein, 28.6% of studies met the recommendations, with 50% of those who did not meet it being due to under-consumption. Although there are references on athletes' dietary intakes, there are no references considering sexes or types of sport. More adapted recommendations are needed in order to more precisely evaluate athletes' intake to know if they meet their real nutritional requirements.