Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes
Journal article
Heikura, Ida A., Uusitalo, Arja L. T., Stellingwerff, Trent, Bergland, Dan, Mero, Antti A. and Burke, Louise M.. (2018). Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. International Journal of Sport Nutrition and Exercise Metabolism. 28(4), pp. 403-411. https://doi.org/10.1123/ijsnem.2017-0313
Authors | Heikura, Ida A., Uusitalo, Arja L. T., Stellingwerff, Trent, Bergland, Dan, Mero, Antti A. and Burke, Louise M. |
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Abstract | We aimed to (a) report energy availability (EA), metabolic/reproductive function, bone mineral density, and injury/illness rates in national/world-class female and male distance athletes and (b) investigate the robustness of various diagnostic criteria from the Female Athlete Triad (Triad), Low Energy Availability in Females Questionnaire, and relative energy deficiency in sport (RED-S) tools to identify risks associated with low EA. Athletes were distinguished according to benchmarks of reproductive function (amenorrheic [n = 13] vs. eumenorrheic [n = 22], low [lowest quartile of reference range; n = 10] versus normal testosterone [n = 14]), and EA calculated from 7-day food and training diaries (< or >30 kcal·kg−1 fat-free mass·day−1). Sex hormones (p < .001), triiodothyronine (p < .05), and bone mineral density (females, p < .05) were significantly lower in amenorrheic (37%) and low testosterone (40%; 15.1 ± 3.0 nmol/L) athletes, and bone injuries were ∼4.5-fold more prevalent in amenorrheic (effect size = 0.85, large) and low testosterone (effect size = 0.52, moderate) groups compared with others. Categorization of females and males using Triad or RED-S tools revealed that higher risk groups had significantly lower triiodothyronine (female and male Triad and RED-S: p < .05) and higher number of all-time fractures (male Triad: p < .001; male RED-S and female Triad: p < .01) as well as nonsignificant but markedly (up to 10-fold) higher number of training days lost to bone injuries during the preceding year. Based on the cross-sectional analysis, current reproductive function (questionnaires/blood hormone concentrations) appears to provide a more objective and accurate marker of optimal energy for health than the more error-prone and time-consuming dietary and training estimation of EA. This study also offers novel findings that athlete health is associated with EA indices. |
Keywords | bone health; metabolic hormones; RED-S; reproductive hormones; Triad |
Year | 2018 |
Journal | International Journal of Sport Nutrition and Exercise Metabolism |
Journal citation | 28 (4), pp. 403-411 |
Publisher | Human Kinetics Publishers |
ISSN | 1526-484X |
Digital Object Identifier (DOI) | https://doi.org/10.1123/ijsnem.2017-0313 |
Scopus EID | 2-s2.0-85048211967 |
Open access | Published as green open access |
Page range | 403-411 |
Funder | Canadian Sport Institute |
Australian Catholic University (ACU) | |
Australian Institute of Sport (AIS) | |
Finnish Sport Institute Foundation | |
Finnish Sport Research Foundation | |
Research Group | Mary MacKillop Institute for Health Research |
Author's accepted manuscript | License All rights reserved File Access Level Open |
Publisher's version | License All rights reserved File Access Level Controlled |
Output status | Published |
Publication dates | |
Online | 2018 |
https://acuresearchbank.acu.edu.au/item/8689v/low-energy-availability-is-difficult-to-assess-but-outcomes-have-large-impact-on-bone-injury-rates-in-elite-distance-athletes
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AM_Heikura_2018_Low_energy_availability_is_difficult_to.pdf | |
License: All rights reserved | |
File access level: Open |
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