Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes

Heikura, Ida A.; Uusitalo, Arja; Stellingwerff, Trent; Bergland, Dan; Mero, Antti; Burke, Louise M.

doi:10.1123/ijsnem.2017-0313

Cited by 230 publications

(289 citation statements)

References 33 publications

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“…It was reported that LEA induced through dietary restrictions resulted in significant decreases in leptin and insulin, but no changes in IGF‐1, ghrelin, testosterone, or free T 3 in recreationally active participants. Contrary to these results, evidence from cross‐sectional studies by Heikura et al and Hooper et al suggests significantly lower testosterone levels are associated with LEA (21 kcal/kg LBM/d) in both middle‐ and long‐distance runners and racewalkers. Additionally, McMurray et al reported elevations in human growth hormone (HGH) and significant decreases in IGF‐1 in wrestlers under conditions of LEA (<30 kcal/kg LBM/d).…”

Section: Resultsmentioning

confidence: 69%

“…Table summarizes the methods of assessing energy availability used across the cross‐sectional studies. Energy intake was measured via food frequency questionnaire or 3‐ to 7‐day food diaries using household measures or weighed records . One study measured energy intake 3 days per month .…”

Section: Resultsmentioning

confidence: 99%

“…One study measured energy intake 3 days per month . Exercise energy expenditure was assessed by training logs, heart rate monitoring, or through use of the SenseWear Armband . Four out of seven studies (57%) derived resting metabolic rate (RMR) from predictive equations, two studies (29%) measured RMR using a ventilated canopy hood system, and one study did not report any measurement of RMR .…”

Section: Resultsmentioning

confidence: 99%

“…Clinical LEA (<30 kcal/kg LBM/d) or subclinical LEA (36 ± 6 kcal/kg LBM/d) was prevalent in all of the cross‐sectional studies (Table ). Participants included jockeys, wrestlers, cyclists, and endurance athletes . Dolan et al investigated the nutritional and lifexmlstyle factors in 27 jockeys, 21 of these submitted written food diaries, and results indicated that all of those who recorded their energy intake were in a state of LEA (12 kcal/kg LBM/d).…”

Section: Resultsmentioning

confidence: 99%

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Low energy availability in male athletes: A systematic review of incidence, associations, and effects

2020

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The Female Athlete Triad has recently been suggested to be a threat to male athletes. This review aims to examine the evidence, and associated effects, of low energy availability (LEA) in male athletes. A comprehensive search of PubMed and SPORTDiscus was performed. Three RCT and seven CS studies were included that measured energy availability and included well-trained males. Clinical LEA (<30 kcal/kg LBM/d) or subclinical LEA (36 ± 6 kcal/kg LBM/d) was evident within all CS studies, documenting 25% of middle-and long-distance runners and racewalkers and 70% of cyclists with LEA. Two out of three RCTs and three out of seven CS studies reported disrupted endocrine functioning, particularly reduced testosterone levels, in association with LEA. One CS study reported that up to 40% of cyclists with LEA had low BMD. One CS study assessed metabolic health, reporting those with suppressed levels spent more time in a severe energy deficit. This review highlights that LEA appears prevalent across male athletic populations, in particular endurance and weight class athletes, and is a potentially serious threat to bone, endocrine, and metabolic health. Future larger scale longitudinal studies, using appropriate study designs, should be undertaken to confirm these threats. K E Y W O R D Sbone health, endocrine function, energy availability, exercise physiology, metabolic health, sports nutrition

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Section: Resultsmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Low energy availability in male athletes: A systematic review of incidence, associations, and effects

2020

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“…A full gynaecological history is required, including menstrual and urogynaecology assessment, use of contraception, previous pregnancies and future pregnancy plans. While measurement of energy availability is difficult to assess and often inaccurate, it can be estimated using food diaries and exercise logs and can be supplemented with fitness technology equipment such as heart rate monitors.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Sports gynaecology

Jones

L’Heveder

Saso

et al. 2019

The Obstetric & Gynaecologis

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While the physiological, psychosocial and obstetric health benefits of exercise are well established, there is less awareness of the health implications of long-term intense exercise. Relative Energy Deficiency in Sport (RED-S) represents a complex inter-relationship of health consequences that arise as a result of low energy availability. The common presentations of elite sportswomen to gynaecologists include menstrual abnormalities, delayed menarche, subfertility and urinary incontinence. Gynaecology input, including screening, recognition and management, can minimise the risk of consequences and optimise health, fertility and performance. Learning objectivesTo understand the short-term and long-term impacts of elite sport on gynaecological health.To describe the gynaecologist's role in the screening, investigation and management of elite sportswomen. Ethical issuesElite sportswomen should be fully informed about the potential health implications of long-term vigorous exercise to enable autonomous decision making. While it is the role of the coach to optimise performance, it is the physician's responsibility to prioritise the health of sportswomen, even if this is at the expense of performance level, ability to train or competition rules. To reach an elite level, training is often necessary from childhood; however, many girls will not have capacity, and the health consequences of RED-S can cause them irreversible problems.

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Factors that affect menarche in Japanese national‐level track‐and‐field athletes

et al. 2021

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Objectives: The minimum body mass index (BMI) required to menarche and the relationship between the training onset age of sports and menarche is not fully understood. The aim of this study is to elucidate the minimum BMI required to attain menarche in female adolescent athletes competing at a national level, and to determine how the occurrence of menarche is associated with training onset age in track-and-field athletes.Methods: Overall, 134 sprinters and 44 long-distance (LD) runners of ninthgrade females at a national level were enrolled and an anonymous questionnaire was administered.Results: As BMI increased, the proportion of athletes who had attained menarche increased. The BMI cutoff values for menarche were 17.3 and 17.1 kg/m 2 for sprinters and LD runners, respectively. Menarche had not occurred in almost 50% of the LD runners who began training at elementary school, and among LD runners, those who began training at elementary school had 18.4 higher odds of not attaining menarche until the age of 15 years as opposed to those who started training after elementary school. Conclusions:The BMI cutoff values could be an indicator for menarche in sprinters and LD runners. For LD runners, starting to compete at elementary school could be a risk factor for delayed menarche.

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Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes

Cited by 230 publications

References 33 publications

Low energy availability in male athletes: A systematic review of incidence, associations, and effects

Low energy availability in male athletes: A systematic review of incidence, associations, and effects

Sports gynaecology

Factors that affect menarche in Japanese national‐level track‐and‐field athletes

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