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Low Energy Availability and Relative Energy Deficiency in the General Population and Athletes

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Sports Nutrition".

Deadline for manuscript submissions: closed (30 March 2023) | Viewed by 16775

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Dr. Ifigenia Giannopoulou

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Senior Lecturer in Exercise, Nutrition and Health Sciences, University of Brighton Hillbrow, Denton Road, Eastbourne BN20 7SR, UK
Interests: mindful eating and mental health in young adults; eating disorders in athletes; exercise and diet effects on mental health; lifestyle interventions of diet and exercise in peri- and postmenopausal women and older adults; obesity; type 2 diabetes
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Dear Colleagues,

Despite the importance of optimal nutrition for health and athletic performance, many athletes fail to match their energy intake to their exercise energy expenditure. Consequently, these individuals are at risk of low energy availability (LEA) and relative energy deficiency in sport (RED-S). LEA and RED-S are among the leading contributors to athletic illness and injury, with the potential ramifications having detrimental short- and long-term effects, i.e., disrupted resting metabolic rate, reductions in bone mineral density, suppressed immune responses, and increased risk of mood disorders, disordered eating, and mental health conditions.

LEA research has typically focused on female or elite-level athlete samples. Emerging research has used male and non-elite athlete samples, but more work is required to assess the psycho-physiological manifestations of LEA and RED-S in these populations. Given that LEA and RED-S are complex psycho-physiological disorders, more work is needed to assess psychological variables, rather than just the physiological factors, to allow the development of appropriate early diagnosis, monitoring strategies and interventions.

This Special Issue, “Low Energy Availability and Relative Energy Deficiency in Sports”, welcomes manuscripts related to elite competitive but also non-elite, athletic populations, with a focus on the assessment of the psycho-physiological variables associated with these conditions. Experimental papers, review articles, and commentaries are all welcome.

Dr. Ifigenia Giannopoulou
Guest Editor

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Keywords

low energy availability
relative energy deficiency in sport
energy imbalance
disordered eating
mood
mental health

Published Papers (5 papers)

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Research

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14 pages, 1299 KiB

Open AccessArticle

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

by Anneke Hertig-Godeschalk, Belinda Ruettimann, Ezra Valido, Marija Glisic, Jivko Stoyanov and Joelle L. Flueck

Nutrients 2023, 15(11), 2578; https://doi.org/10.3390/nu15112578 - 31 May 2023

Cited by 1 | Viewed by 1909

Abstract

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. Full article

(This article belongs to the Special Issue Low Energy Availability and Relative Energy Deficiency in the General Population and Athletes)

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20 pages, 1884 KiB

Open AccessArticle

Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs)

by Ida L. Fahrenholtz, Anna K. Melin, Ina Garthe, Siri Marte Hollekim-Strand, Andreas Ivarsson, Karsten Koehler, Danielle Logue, Petra Lundström, Sharon Madigan, Paulina Wasserfurth and Monica K. Torstveit

Nutrients 2023, 15(5), 1082; https://doi.org/10.3390/nu15051082 - 21 Feb 2023

Cited by 6 | Viewed by 4731

Abstract

Female endurance athletes are considered a high-risk group for developing Relative Energy Deficiency in Sport (REDs). Due to the lack of educational and behavioral intervention studies, targeting and evaluating the effects of the practical daily management of REDs, we developed the Food and nUtrition for Endurance athletes—a Learning (FUEL) program, consisting of 16 weekly online lectures and individual athlete-centered nutrition counseling every other week. We recruited female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47). Fifty athletes with symptoms of REDs and with low risk of eating disorders, with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a 16-week control period (n = 18) (CON). All but one completed FUEL, while 15 completed CON. We found strong evidence for improvements in sports nutrition knowledge, assessed via interviews, and moderate to strong evidence in the ratings concerning self-perceived sports nutrition knowledge in FUEL versus CON. Analyses of the seven-day prospective weighed food record and questions related to sports nutrition habits, suggested weak evidence for improvements in FUEL versus CON. The FUEL intervention improved sports nutrition knowledge and suggested weak evidence for improved sports nutrition behavior in female endurance athletes with symptoms of REDs. Full article

(This article belongs to the Special Issue Low Energy Availability and Relative Energy Deficiency in the General Population and Athletes)

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16 pages, 2627 KiB

Open AccessArticle

Dietary Intake, Serum Hormone Concentrations, Amenorrhea and Bone Mineral Density of Physique Athletes and Active Gym Enthusiasts

by Jaakko Mursu, Maija Ristimäki, Inga Malinen, Pirita Petäjä, Ville Isola, Juha P. Ahtiainen and Juha J. Hulmi

Nutrients 2023, 15(2), 382; https://doi.org/10.3390/nu15020382 - 12 Jan 2023

Cited by 2 | Viewed by 3095

Abstract

As the diet, hormones, amenorrhea, and bone mineral density (BMD) of physique athletes (PA) and gym enthusiasts (GE) are little-explored, we studied those in 69 females (50 PA, 19 GE) and 20 males (11 PA, 9 GE). Energy availability (EA, kcal·kgFFM⁻¹·d⁻¹ in DXA) in female and male PA was ~41.3 and ~37.2, and in GE ~39.4 and ~35.3, respectively. Low EA (LEA) was found in 10% and 26% of female PA and GE, respectively, and in 11% of male GE. In PA, daily protein intake (g/kg body mass) was ~2.9–3.0, whereas carbohydrate and fat intakes were ~3.6–4.3 and ~0.8–1.0, respectively. PA had higher protein and carbohydrate and lower fat intakes than GE (p < 0.05). Estradiol, testosterone, IGF-1, insulin, leptin, TSH, T4, T3, cortisol, or BMD did not differ between PA and GE. Serum IGF-1 and leptin were explained 6% and 7%, respectively, by EA. In non-users of hormonal contraceptives, amenorrhea was found only in PA (27%) and was associated with lower fat percentage, but not EA, BMD, or hormones. In conclusion, off-season dietary intakes, hormone levels, and BMD meet the recommendations in most of the PA and GE. Maintaining too-low body fat during the off-season may predispose to menstrual disturbances. Full article

(This article belongs to the Special Issue Low Energy Availability and Relative Energy Deficiency in the General Population and Athletes)

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25 pages, 3863 KiB

Open AccessArticle

Dietary Intake, Body Composition and Performance of Professional Football Athletes in Slovenia

by Matjaž Macuh, Jana Levec, Nenad Kojić and Bojan Knap

Nutrients 2023, 15(1), 82; https://doi.org/10.3390/nu15010082 - 24 Dec 2022

Cited by 3 | Viewed by 3037

Abstract

This is the first study to examine the nutritional status of professional Slovenian football players. This study aimed to analyze the dietary intake of elite football players during their preparation phase of the season and to investigate whether there is a relationship between energy and macronutrient intake with body composition and physical performance. Twenty-three footballers completed a three-day dietary and physical activity diary and underwent body composition measurements via bioelectrical impedance vector analysis (BIVA). Fifteen participants also took part in the Cooper treadmill test to assess their physical performance in correlation with their nutritional intake. Football players had an energy intake that was significantly too low for their needs, reflecting low energy availability. The average carbohydrate (CHO) intake was below the Union of European Football Associations (UEFA) recommendations, i.e., <4 g CHO/kg body weight (BW). Additionally, players had adequate intakes of protein and fat, and inadequate intakes of saturated fat, fiber, calcium and vitamin D. There was a positive correlation between protein intake and lean body mass. Additionally, a negative correlation was observed between body fat mass and carbohydrate intake as well as between performance with the percentage of energy intake from fat. Results of this study highlight what aspects of nutrition might be improved upon in professional football players to maximize performance, longevity and body composition of athletes, as well as the necessity of a nutritionist role in this process. Full article

(This article belongs to the Special Issue Low Energy Availability and Relative Energy Deficiency in the General Population and Athletes)

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Review

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18 pages, 378 KiB

Open AccessReview

Dietary Iron and the Elite Dancer

by Caitlin Attwell, Cory Dugan, Alannah K. A. McKay, Joanna Nicholas, Luke Hopper and Peter Peeling

Nutrients 2022, 14(9), 1936; https://doi.org/10.3390/nu14091936 - 5 May 2022

Cited by 1 | Viewed by 3174

Abstract

Dancers are an athlete population at high risk of developing iron deficiency (ID). The aesthetic nature of the discipline means dancers potentially utilise dietary restriction to meet physique goals. In combination with high training demands, this means dancers are susceptible to problems related to low energy availability (LEA), which impacts nutrient intake. In the presence of LEA, ID is common because of a reduced mineral content within the low energy diet. Left untreated, ID becomes an issue that results in fatigue, reduced aerobic work capacity, and ultimately, iron deficient anaemia (IDA). Such progression can be detrimental to a dancer’s capacity given the physically demanding nature of training, rehearsal, and performances. Previous literature has focused on the manifestation and treatment of ID primarily in the context of endurance athletes; however, a dance-specific context addressing the interplay between dance training and performance, LEA and ID is essential for practitioners working in this space. By consolidating findings from identified studies of dancers and other relevant athlete groups, this review explores causal factors of ID and potential treatment strategies for dancers to optimise absorption from an oral iron supplementation regime to adequately support health and performance. Full article

(This article belongs to the Special Issue Low Energy Availability and Relative Energy Deficiency in the General Population and Athletes)

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