Low energy availability in female athletes : From the lab to the field

Journal article


Heikura, Ida A., Stellingwerff, Trent and Areta, Jose L.. (2022). Low energy availability in female athletes : From the lab to the field. European Journal of Sport Science. 22(5), pp. 709-719. https://doi.org/10.1080/17461391.2021.1915391
AuthorsHeikura, Ida A., Stellingwerff, Trent and Areta, Jose L.
Abstract

Decades of laboratory research have shown impairments to several body systems after only 4–5 days of strictly controlled consistent low energy availability (LEA); where energy availability (EA) = Energy Intake (EI) − Exercise Energy Expenditure (EEE)/Fat-Free Mass. Meanwhile, cross-sectional reports exist on the interrelatedness of LEA, menstrual dysfunction and impaired bone health in females (the Female Athlete Triad). These findings have demonstrated that LEA is the key underpinning factor behind a broader set of health and performance outcomes, recently termed as Relative Energy Deficiency in Sport (RED-S). There is utmost importance of early screening and diagnosis of RED-S to avoid the development of severe negative health and performance outcomes. However, a significant gap exists between short-term laboratory studies and cross-sectional reports, or clinically field-based situations, of long-term/chronic LEA and no definitive, validated diagnostic tests for RED-S exist. This review aims to highlight methodological challenges related to the assessment of the components of EA equation in the field (e.g. challenges with EI and EEE measures). Due to the uncertainty of these parameters, we propose the use of more chronic “objective” markers of LEA (i.e. blood markers). However, we note that direct extrapolations of laboratory-based outcomes into the field are likely to be problematic due to potentially poor ecological validity and the extreme variability in most athlete’s daily EI and EEE. Therefore, we provide a critical appraisal of the scientific literature, highlighting research gaps, and a potential set of leading objective RED-S markers while working in the field.

Keywordslow energy availability; relative energy deficiency in sport; diagnosis; female athletes
Year2022
JournalEuropean Journal of Sport Science
Journal citation22 (5), pp. 709-719
PublisherRoutledge
ISSN1746-1391
Digital Object Identifier (DOI)https://doi.org/10.1080/17461391.2021.1915391
PubMed ID33832385
Scopus EID2-s2.0-85105130216
Open accessPublished as green open access
Page range709-719
Author's accepted manuscript
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Open
Publisher's version
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All rights reserved
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Controlled
Output statusPublished
Publication dates
Online03 May 2021
Publication process dates
Accepted09 Apr 2021
Deposited17 Nov 2021
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