Low energy availability, menstrual dysfunction, and impaired bone health: A survey of elite para athletes

Abstract

Introduction: The Female Athlete Triad (Triad) is a syndrome describing three interrelated conditions: low energy availability (LEA), menstrual dysfunction, and low bone mineral density (BMD). Relative Energy Deficiency in Sport (RED-S) expands the Triad to include multiple physiologic consequences of LEA in both sexes. The purpose of this study is to determine the prevalence of factors associated with the Triad/RED-S in an elite para athlete population. Methods: Athletes were U.S. elite para athletes training to qualify for the 2016 or the 2018 Paralympic Games. Participants completed an online questionnaire characterizing nutrition, menstrual status (in females), bone health, and awareness of the Triad/RED-S. Results: The athletes were 260 elite para athletes (150 male, 110 female). While few reported prior eating disorder (3.1%), 32.4% had elevated Eating Disorder Examination Questionnaire (EDE-Q) pathologic behavior subscale scores. Most athletes (95 male, 65 female) were attempting to change their body composition or weight to improve performance. Forty-four percent of premenopausal females had oligomenorrhea/amenorrhea. Bone stress injury was reported in 9.2% of athletes; of these, 54.5% (n = 12) had low BMD. Less than 10% of athletes reported awareness of the Triad/RED-S. Conclusions: Factors associated with the Triad/RED-S are present in an elite para athlete population, regardless of sex or sport type. Awareness of the Triad/RED-S in para athletes is low. The consequences of LEA in para athlete populations are poorly understood. However, the high prevalence of factors observed suggests value in advancing screening tools and education efforts to optimize health in this population.

Disordered eating and eating disorders in male elite athletes: a scoping review

“… 77 The lack of prognosis of DE in male elite athletes represents another knowledge gap, since only two conflicting studies on the prognosis of weight cycling among male athletes competing in weight-class sports were found. 81 82 Moreover, the only study on DE in male elite para athletes found similar rates of DE among male elite non-para athletes, 72 although they may be at greater risk of DE consequences. 77 …”

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

“…The risk of low EA has been investigated using surrogate markers or self-reported symptoms of low EA in various athlete populations including elite para-athletes [34], adolescent/young adult [35,36] and Olympic athletes [40], female sprinters [41], male jockeys [39] and recreationally active individuals [33,37], and ranges from 14% to 63% ( Table 3). The largest cross-sectional study investigating self-reported health and performance outcomes linked to low EA and RED-S [5] placed emphasis on including body systems beyond reproductive function and bone health such as metabolic, haematological, psychological and cardiovascular health and gastrointestinal function.…”

Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes

“…The EDE-Q covers risk factors including behaviours associated with DEI and EEEtendencies that lead towards intentional LEA. The EDE-Q has been used in adults and adolescents of both sexes [42,43], in athletic populations and elite para athletes [22,44]. It was used as a surrogate marker for LEA, and measured Triad components in female athletic populations [45,46].…”