Assessment of Dietary Intake, Energy Status, and Factors Associated With RED-S in Vocational Female Ballet Students

Abstract

Elite ballet dancers are at risk of health issues associated with Relative Energy Deficiency in Sport (RED-S). This study determined the nutritional status, estimated energy status, and assessed factors related to RED-S in vocational female ballet students. Using a cross-sectional study design, we measured dietary intake (food diaries and 24 h dietary-recall) and energy expenditure (accelerometry) in vocational female ballet students (n = 20; age: 18.1 ± 1.1 years; body mass index: 19.0 ± 1.6 kg·m2; body fat: 22.8 ± 3.4%) over 7 days, including 5 weekdays (with dance training) and 2 weekend days (without scheduled dance training). Furthermore, we assessed eating behaviors, menstrual function, risk of RED-S (questionnaires), and body composition (dual x-ray absorptiometry). Energy and macronutrient intakes of vocational ballet students were similar during weekdays and weekend days (P > 0.050), whereas total energy expenditure was greater on weekdays than weekend days (P < 0.010; 95% CI: 212, 379). Energy balance was lower on weekdays (−425 ± 465 kcal·day−1) than weekend days (−6 ± 506 kcal·day−1, P = 0.015; 95% CI: −748, −92). Exercise energy expenditure was greater on weekdays (393 ± 103 kcal·day−1) than weekend days (213 ± 129 kcal·day−1; P < 0.010; 95% CI: 114, 246), but energy availability was similar between time periods (weekdays 38 ± 13 kcal·kg FFM·day−1; weekend days 44 ± 13 kcal·kg FFM·day−1; P = 0.110). Overall, 35% of participants had an energy intake <1,800 kcal·day−1, 44% had reduced energy availability (30–45 kcal·kg FFM·day−1), and 22% had low energy availability (<30 kcal·kg FFM·day−1). Menstrual dysfunctions were reported in 40% of participants; 15 and 25% reported oligomenorrhea and secondary amenorrhea, respectively; while 65% were classified at risk of RED-S (based on the Low Energy Availability in Females Questionnaire). All participants had adequate bone health (bone mineral density Z-score: 1.1 ± 0.9 SD), but 20% had <85% expected body weight. The observation of an energy deficit in vocational female ballet students was primarily attributed to an inability to plan energy intake and thereby meet higher energy requirements during ballet training weekdays. Screening for factors associated with RED-S and tailoring education programs to inform energy and nutrition requirements for health and training are recommended in elite young ballet students.

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

“…Recent studies have investigated the prevalence of low EA in various sports [8,[13][14][15][16][17][18][19][20][21][22]. Prevalence ranges from 22% to 58% (Table 1).…”

Energy Availability With or Without Eating Disorder Risk in Collegiate Female Athletes and Performing Artists

“…[1][2][3] Prevalence of LEA has been documented within O n l i n e F i r s t predominately college-aged athletes. [7][8][9][10][11][12] While the exact etiology of LEA is not precisely known, energy availability (EA) is the amount of dietary energy remaining after exercise and available for other physiological functions of organs, muscles, etc. EA reaches low levels by either unintentional or intentional methods (i.e., disordered eating, clinical eating disorder, inadvertent undereating).…”

“…Our study is the first to examine a variety of female competitive athletes/performing artists in a free-living environment (real time) and to examine LEA with or without an eating disorder risk concurrently. Comparatively, previous literature has primarily focused on LEA or eating disorder risk independently within individual sports (e.g., indoor volleyball, soccer, gymnastics, ballet), [7][8][9]11,12,30 with limited research on both LEA and eating disorder risk among multiple sports and within the collegiate setting. 21,31 Overall, the LEA prevalence reported in this study (81%) is significantly higher than previously reported LEA levels in gymnasts (44.8%), soccer players during pre-season (26.3%) and midseason (33.3%), and in-season volleyball players (20%).…”

Knowledge and Use of Nutritional Supplements in Different Dance Disciplines

“…Not only sufficient energy intake but also a suitable nutrient selection is required to achieve optimal fitness in dance. While ballet dancers often have problems with inadequate energy intake (Civil et al, 2018), there is a problem of poor nutrition selection among modern dance styles (fast food, cold diet), whose outcome is the insufficient consumption of micronutrients. Nutritional supplements can help meet energy requirements when nutritional intake is too low, but, nevertheless, due to poor nutritional knowledge of dancers (Hunt, 2011;Pacy, Khalouha, & Koutedakis, 1996), professional nutritional counselling is advised.…”