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

Abstract

Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males

“…†, Sampling/measurements were performed on the 5th or 6th day where the serial blood sampling was performed during 24 h *For Loucks and Callister (1993) values of EI, EEE and EA are relative to body mass and not LBM Table 3 Summary of experimental studies investigating the response of hormones of the hypothalamic-pituitary-ovarian axis with divergent amounts of energy availability Arrows represent changes in groups with low energy availability (typically lower than 40-45 kcal/kg lean body mass/day). A graphical summary of the contents of the leanness or low body weight (such as weight bearing, weightcategorised or aesthetic sports), athletes with disordered eating, or simply populations with eating disorders (Gibbs et al 2013;Melin et al 2015;Staal et al 2018;Warren 2011), as well as observational studies linking endocrine, metabolic and other parameters with EA (Elliott-Sale et al 2018;Logue et al 2018Logue et al , 2020. In many cases, EA is estimated, which is further complicated by the fact that measuring it in the field is difficult and prone to errors due to limitations in the assessments of energy intake and expenditure (Burke et al 2018;Heikura et al 2017 Mountjoy et al 2018a) we believe that a critical overview of the concept of EA as well as an up-to-date summary of the main scientific findings is much needed.…”

Relative Energy Deficiency in an Elite Professional non-Endurance Male Caused by Short Period of Overtraining and Caloric Restriction: A Case Report

“…Without large-scale epidemiological studies in this area, data from male athletes is in short supply [6] . The RED-S model considers energy de ciency/low energy availability (LEA) as the central cause [7,8] . A previous study suggests that a high percentage (47.2%) of male athletes is at high risk for LEA [9] .…”

Þegar orkuna skortir – áhrif hlutfallslegs orkuskorts í íþróttum (RED-s) á heilsu og árangur

“…4,7 Algengi RED-s hefur verið metið allt að 60% hjá íþróttafólki en virðist mjög breytilegt milli ólíkra íþróttagreina og jafnvel sérhaefingar innan þeirra. 4,8,9 Áhaettan er talin hvað mest í úthaldsíþróttum, fagurfraeðilegum íþróttum (til daemis fimleikum og listdansi) og þyngdarflokkaíþróttum (til daemis júdó og glímu) þar sem mögulegir áhaettuþaettir geta verið kröfur tengdar líkamsþyngd, útliti og líkamslögun samhliða miklu þjálfunarálagi. 7,10,11 Vandamál sem þessi geta þó komið fram hjá einstaklingum í öllum íþróttagreinum og á mismunandi getustigum.…”

“…7,10,11 Vandamál sem þessi geta þó komið fram hjá einstaklingum í öllum íþróttagreinum og á mismunandi getustigum. 7,8,12 Markmið þessarar greinar er að gera grein fyrir stöðu þekk-ingar á áhrifum RED-s á heilsu og árangur íþróttafólks, mikilvaegi skimunar og snemmbaers inngrips.…”

“…Þó ekki sé haegt að fullyrða um orsakasamhengi milli stúku-heiladinguls-kynkirtlaöxulinn gaeti til að mynda verið háð magni tiltaekrar orku og hvort um RED-s er að raeða. 8,37 Þá er einnig þörf á frekari rannsóknum á sértaekum hormónabreytingum hjá körlum sem geta tengst RED-s. Má þar nefna að rannsóknum á körlum með minnkaðan styrk testósteróns ber ekki saman um áhrif á tíðni og magn LH-framleiðslu og þar gaeti eðli og tímalengd orkuskerðingar/RED-s haft sitt að segja. 12,37 RED-s gaeti einnig haft áhrif á frjósemi og kynhvöt.…”