How Do We Assess Energy Availability and RED-S Risk Factors in Para Athletes?

Abstract

Low energy availability (LEA) is considered to be the underlying cause of a number of maladaptations in athletes, including impaired physiological function, low bone mineral density (BMD), and hormonal dysfunction. This is collectively referred to as ‘Relative Energy Deficiency in Sport’ (RED-S). LEA is calculated through assessment of dietary energy intake (EI), exercise energy expenditure (EEE) and fat-free mass (FFM). The incidence of LEA in Paralympic athletes is relatively unknown; however, there are legitimate concerns that Para athletes may be at even higher risk of LEA than able-bodied athletes. Unfortunately, there are numerous issues with the application of LEA assessment tools and the criterion for diagnosis within the context of a Para population. The calculation of EEE, in particular, is limited by a distinct lack of published data that cover a range of impairments and activities. In addition, for several RED-S-related factors, it is difficult to distinguish whether they are truly related to LEA or a consequence of the athlete’s impairment and medical history. This narrative review outlines deficits and complexities when assessing RED-S and LEA in Para athletes, presents the information that we do have, and provides suggestions for future progress in this important area of sports nutrition.

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

“…Dual-energy X-ray absorptiometry (DXA) is the most well-accepted tool for the measurement of BMD, but there are limitations in using standard population comparison reporting (eg, Z-scores); normative, reference datasets are determined from measurements in able-bodied populations and stratified by age-matched, sex-matched and limited race/ethnicity-matched categories to determine diagnostic cut-offs for ‘low BMD for age’ and ‘osteoporosis’ 119 120. Therefore, there is a need for research in a wide variety of para athletes to develop BMD assessment techniques and reference ranges appropriate for the para athlete population 112…”

Body dissatisfaction, disordered eating and exercise behaviours: associations with symptoms of REDs in male and female athletes

“… 20 Paralympic athletes (n=4) were excluded from the present analysis due to observed deviances in total body bone mineral density (BMD) and some of the blood biomarkers, which are likely attributed more to physical disabilities rather than REDs. 21 Therefore, their data deserve a special consideration and will be reported elsewhere. For athletes over the age of 18 years, completion of the online questionnaire equalled approval for participation in the initial part of the research.…”

“…Athletes were categorised into five different sport groups (aesthetic, ball, endurance, power and weight-class sports), based on the approach developed and used in a previous study 20. Paralympic athletes (n=4) were excluded from the present analysis due to observed deviances in total body bone mineral density (BMD) and some of the blood biomarkers, which are likely attributed more to physical disabilities rather than REDs 21. Therefore, their data deserve a special consideration and will be reported elsewhere.…”

Resting metabolic rate for energy availability assessment in high-performance sports

“…Тому актуальним завданням спортивної науки є пошук біомаркерів, які можуть бути додатково використані для більш точної оцінки доступності енергії. Одним із таких маркерів може бути основний обмін (ОО), оскільки він відображає витрати енергії на підтримання життєдіяльності організму [14,17,24,27].…”

“…У разі тривалого дефіциту надходження енергії з раціону харчування ОО може знижуватись порівняно з нормальними значеннями [4,12,25]. Тому визначення основного обміну потенційно є інформативним для оцінки доступності енергії [14,17,24,27].…”