Definitions

  • After often high exercise energy expenditures have been accounted for, the body relies on having sufficient dietary energy left to support its basic functions. This remaining energy is referred to as energy availability (EA) and expressed in relation to fat free mass (FFM). Sufficient EA is fundamental for successful athletic career while prolonged low EA (LEA) may result in a range of health and performance decrements.

    Problematic LEA refers to severe and/or prolonged exposures to LEA, resulting in disrupted functions of one or more body systems. Such disruptions can subsequently impair sport performance.

    Adaptable LEA refers to short-term and/or benign LEA exposures that may stimulate training adaptations without compromising health.

  • REDs describes the various health and performance complications of problematic LEA.

  • Carbohydrate availability refers to the amount of carbohydrates available for the demands of exercise. Low carbohydrate availability has recently emerged as a special risk factor of REDs and its consequences.

A real‐life snapshot: Evaluating exposures to low energy availability in male athletes from various sports

Published 2024 in Physiological Reports (available in open access).

The aim of this paper was to assess occurrences of LEA in male athletes from various sports over seven days. Associations between number of LEA days, physiological measures, and body image concerns were subsequently evaluated.

Main results were that substantial day-to-day EA fluctuations but not continuous LEA were observed among the 19 participants. The number of LEA days was inversely associated with average intakes of energy, carbohydrates, and iron. In contrast, exercise energy expenditure was positively associated with the number of LEA days. However, the number of LEA days was not associated with any of the objective or subjective outcomes. In other words, this group of male athletes displayed considerable day‐to‐day EA fluctuations but no indication of problematic LEA.

Patterns of energy availability and carbohydrate intake differentiate between adaptable and problematic low energy availability in female athletes

Published 2024 in Frontiers in Sports & Active Living (available in open access).

This paper compared dietary intake, nutrition status and occurrence of REDs symptoms in groups of female athletes (n=41), displaying different patterns of EA and carbohydrate intake over seven days. Based on a graphical presentation of individual day-to-day patterns of EA and nutrient intake, participants were manually divided into four groups based on patterns of EA and CHO intake:

SEA + SCHO: sufficient to optimal energy availability + sufficient to optimal carbohydrate intake.

SEA + LCHO: sufficient to optimal energy availability + low carbohydrate intake.

LEA + SCHO: low energy availability + sufficient to optimal carbohydrate intake.

LEA + LCHO: low energy availability + low carbohydrate intake.

The results provide evidence that females displaying patterns of both LEA and low carbohydrate intakes (LEA + LCHO) are at increased risk of REDs. That was indicated by more symptoms of disordered eating, insufficient dietary intakes, as well as poorer self-reported recovery and energy levels in the LEA + LCHO group compared to SEA + SCHO especially. Accordingly, restrictive eating behaviours appeared to be a greater contributor to the risk of REDs than high energy expenditures. The high prevalence of insufficient vitamin D status was also among concerning findings, especially for the LEA + LCHO group.

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

Published 2023 in BMJ Open Sport & Exercise Medicine (available in open access).

This paper reports associations of subjective symptoms of REDs with disordered eating, body image concerns and compulsive exercise behaviours in male and female athletes (n=83). In total, 8.4% (10.7% of females) of participants scored above cut-off on the Eating Disorder Examination - Questionnaire Short (EDE-QS), 19.3% on Exercise Addiction Inventory (EAI) and 13.3% on the Muscle Dysmorphic Disorder Inventory (MDDI). Compared to those at low or no risk according to the Low Energy Availability in Females Questionnaires (LEAF-Q), females considered at risk of REDs scored higher on all administered questionnaires, in addition to having lower whole-body BMD and absolute resting metabolic rate. Findings for males were more benign, with no associations observed between serum testosterone and the various independent outcomes. However, a higher score on a questionnaire screening for muscle dysmorphia was associated with higher/worse Low Energy Availability in Males Questionnaire (LEAM-Q) sleep and fitness scores. Indicating that males with symptoms of muscle dysmorphia are likely to experience physical pain or fatigue often and have impaired sleep.

How Do We Assess Energy Availability and REDs Risk Factors in Para Athletes?

I co-authored this review paper, published 2022 in Nutrients (available in open access).

The aim of this narrative review was to highlight the main practical and research challenges faced when assessing EA and risk factors of REDs in Para athletes. We also provide suggestions for future progress in this important area of sports nutrition.