Dataset Information

Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention.

ABSTRACT: Low energy availability (LEA) represents a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health. When compared to the normal population, athletes are particularly at risk to experience LEA and the reasons for this are manifold. LEA may result from altered dietary behaviours that are caused by body dissatisfaction, the belief that a lower body weight will result in greater performance, or social pressure to look a certain way. Pressure can also be experienced from the coach, teammates, and in this day and age through social media platforms. While LEA has been extensively described in females and female athletes have started fighting against the pressure to be thin using their social media platforms, evidence shows that male athletes are at risk as well. Besides those obvious reasons for LEA, athletes engaging in sports with high energy expenditure (e.g. rowing or cycling) can unintentionally experience LEA; particularly, when the athletes' caloric intake is not matched with exercise intensity. Whether unintentional or not, LEA may have detrimental consequences on health and performance, because both short-term and long-term LEA induces a variety of maladaptations such as endocrine alterations, suppression of the reproductive axis, mental disorders, thyroid suppression, and altered metabolic responses. Therefore, the aim of this review is to increase the understanding of LEA, including the role of an athlete's social environment and the performance effects related to LEA.

SUBMITTER: Wasserfurth P

PROVIDER: S-EPMC7483688 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention.

Wasserfurth Paulina P Palmowski Jana J Hahn Andreas A Krüger Karsten K

Sports medicine - open 20200910 1

Low energy availability (LEA) represents a state in which the body does not have enough energy left to support all physiological functions needed to maintain optimal health. When compared to the normal population, athletes are particularly at risk to experience LEA and the reasons for this are manifold. LEA may result from altered dietary behaviours that are caused by body dissatisfaction, the belief that a lower body weight will result in greater performance, or social pressure to look a certai ...[more]

PMID: 32910256

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Project description:A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.

Project description:BackgroundLow energy availability (EA) can be detrimental for athlete health. Currently, it is not known what the threshold for low EA in men is, and what effects it may have on performance.MethodsThis study was set to determine potential effects of low EA by modulating male participants' exercise energy expenditure and controlling energy intake and consequently manipulating EA in three progressive stages (reducing EA by 25%%, and 75 %). Performance was measured with three specific tests for explosive power, endurance, and agility. Blood was drawn, resting energy expenditure was monitored and two questionnaires were repetitively used to address any changes in eating behaviors and well-being.ResultsRepeated measured design showed poorer performance (power output 391.82 ± 29.60 vs. 402.5 ± 40.03 W, p = 0.001; relative power output 5.53 ± 0.47 vs. 5.60 ± 0.47 W/kg, p = 0.018; explosive power 0.28 ± 0.04 vs. 0.32 ± 0.05 m, p = 0.0001, lactate concentration 7.59 ± 2.29 vs 10.80 ± 2.46 mmol/L, p = 0.001). the quartile range for testosterone was lower (2.33 ± 1.08 vs. 2.67 ± 0.78, p = 0.026) and there was a tendency for lower triiodothyronine (4.15 ± 0.61 vs. 4.46 ± 0.54 pmol/L, p = 0.072). Eating behaviors and well-being were worse (46.64 ± 7.55 vs. 24.58 ± 7.13, p = 0.011 and 15.18 ± 2.44 vs. 17.83 ± 3.54, p = 0.002). The intervention also resulted in lower body fat (8.44 ± 3.15 vs. 10.2 ± 2.5%, p = 0.013).ConclusionsAnalysis showed that most of the negative effects occurred in the range of 9-25 kCal·kg∙FFM·d-1. This is the range where we suggest a threshold for LEA in men could be. Reducing EA impaired explosive power first, then endurance. It was associated with a reduction in testosterone, triiodothyronine and there was a tendency for reduced IGF-1, but hormones were more resilient to changes in EA. Psychological assessment of eating behaviors and well-being proved to be very useful, whereas monitoring resting energy expenditure did not.

Project description:The purpose of this narrative review is to identify health and performance consequences associated with LCA in female endurance athletes. The intake of carbohydrates (CHO) before, during, and after exercise has been demonstrated to support sport performance, especially endurance activities which rely extensively on CHO as a fuel source. However, low energy availability (LEA) and low carbohydrate availability (LCA) are common in female athletes. LEA occurs when energy intake is insufficient compared to exercise energy expenditure, and LEA-related conditions (e.g., Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S)) are associated with a myriad of health and performance consequences. The RED-S model highlights 10 health consequences and 10 performance consequences related to LEA. The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes. It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes. Furthermore, this review highlights current recommendations for CHO intake, as well as recent data on LCA prevalence and menstrual cycle considerations. A literature review was conducted on PubMed, Science Direct, and ResearchGate using relevant search terms (i.e., "low carbohydrate/energy availability", "female distance runners"). Twenty-one articles were identified and twelve met the inclusion criteria. The total number of articles included in this review is 12, with 7 studies illustrating that LCA was associated with direct negative health and/or performance implications for endurance-based athletes. Several studies included assessed male athletes only, and no studies included a female-only study design. Overall, the cumulative data show that female athletes remain underrepresented in sports science research and that current CHO intake recommendations and strategies may fail to consider female-specific adaptations and hormone responses, such as monthly fluctuations in estrogen and progesterone throughout the menstrual cycle. Current CHO guidelines for female athletes and exercising women need to be audited and explored further in the literature to support female athlete health and performance.

Dataset Information

Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention.

Publications

Reasons for and Consequences of Low Energy Availability in Female and Male Athletes: Social Environment, Adaptations, and Prevention.

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