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Nancy I. Williams, Clara V. Etter and Jay L. Lieberman

An understanding of the health consequences of abnormal menstrual function is an important consideration for all exercising women. Menstrual disturbances in exercising women are quite common and range in severity from mild to severe and are often associated with bone loss, low energy availability, stress fractures, eating disorders, and poor performance. The key factor that causes menstrual disturbances is low energy availability created by an imbalance of energy intake and energy expenditure that leads to an energy deficit and compensatory metabolic adaptations to maintain energy balance. Practical guidelines for preventing and treating amenorrhea in exercising women include evidence-based dietary practices designed to achieve optimal energy availability. Other factors such as gynecological age, genetics, and one’s susceptibility to psychological stress can modify an individual’s susceptibility to menstrual disturbances caused by low energy availability. Future research should explore the magnitude of these effects in an effort to move toward more individualized prevention and treatment approaches.

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Ida A. Heikura, Louise M. Burke, Dan Bergland, Arja L.T. Uusitalo, Antti A. Mero and Trent Stellingwerff

, and BMD measurements via dual-energy X-ray absorptiometry, followed by 7-day food and training logs on the second week of the camp. Female athletes filled out a validated Low Energy Availability in Females Questionnaire (LEAF-Q 23 ). Hemoglobin Mass Total Hbmass was measured with the adapted 2-minute

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Amelia Carr, Kerry McGawley, Andrew Govus, Erik P. Andersson, Oliver M. Shannon, Stig Mattsson and Anna Melin

conducted in consultation with a registered dietitian. Long-Term Energy Deficiency The prevalence of conditions related to a long-term energy deficiency was assessed in the female participants using the Low Energy Availability in Females Questionnaire (LEAF-Q; Melin et al., 2014 ). Currently, there is no

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Laurie Stickler, Trisha Armstrong, Alyssa Polso and Melissa Smith

Context:

Low energy availability has been identified through research as the cornerstone of the female athlete triad, yet reasons for nutritional choices among female collegiate athletes are poorly understood.

Objective:

To explore the perspectives of female collegiate cross country runners on eating behaviors and attitudes toward health.

Design:

Phenomenologic qualitative study with individual, semistructured interviews.

Methods:

Ten collegiate female cross country runners, ages 18–22, participated in the study. All interviews were audiotaped then transcribed. Three researchers independently coded data and developed themes and subthemes before meeting and negotiating findings.

Results:

The following four themes were identified: health behaviors, nutritional knowledge, internal and external factors, and health attitudes.

Conclusions:

This study contributes to understanding “the why” behind health behaviors of female collegiate cross country runners. This developmental understanding may assist in interpreting the behavioral causes of low energy availability; thus, both management and prevention of the triad may be aided by this information.

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Julien Louis, Fabrice Vercruyssen, Olivier Dupuy and Thierry Bernard

Master athletes are often considered exemplars of successful aging, thanks to their capacity to maintain a high sports performance during their entire life. A high training capacity, regular participation in sporting competitions, and delayed alterations in body composition and physiological capacities have been listed among the main factors contributing to impressive master athletes’ performances. However, there is a paucity of data on the metabolism and dietary habits of master athletes, and the question of whether they need to adapt their nutrition to the aging process remains open. Herein, the authors presented a contemporary overview of the metabolic challenges associated with aging, including the risk of low energy availability, anabolic resistance, and periods of metabolic crisis due to forced immobilization. After assembling scientific evidence to show that master athletes must adapt their dietary intake, the authors proposed a summary of nutritional recommendations for master athletes and suggested the next stage of research.

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Dan Benardot, Wes Zimmermann, Gregory R. Cox and Saul Marks

Competitive diving involves grace, power, balance, and flexibility, which all require satisfying daily energy and nutrient needs. Divers are short, well-muscled, and lean, giving them a distinct biomechanical advantage. Although little diving-specific nutrition research on performance and health outcomes exists, there is concern that divers are excessively focused on body weight and composition, which may result in reduced dietary intake to achieve desired physique goals. This will result in low energy availability, which may have a negative impact on their power-to-weight ratio and health risks. Evidence is increasing that restrictive dietary practices leading to low energy availability also result in micronutrient deficiencies, premature fatigue, frequent injuries, and poor athletic performance. On the basis of daily training demands, estimated energy requirements for male and female divers are 3,500 kcal and 2,650 kcal, respectively. Divers should consume a diet that provides 3–8 g/kg/day of carbohydrate, with the higher values accommodating growth and development. Total daily protein intake (1.2–1.7 g/kg) should be spread evenly throughout the day in 20 to 30 g amounts and timed appropriately after training sessions. Divers should consume nutrient-dense foods and fluids and, with medical supervision, certain dietary supplements (i.e., calcium and iron) may be advisable. Although sweat loss during indoor training is relatively low, divers should follow appropriate fluid-intake strategies to accommodate anticipated sweat losses in hot and humid outdoor settings. A multidisciplinary sports medicine team should be integral to the daily training environment, and suitable foods and fluids should be made available during prolonged practices and competitions.

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Katie J. Thralls, Jeanne F. Nichols, Michelle T. Barrack, Mark Kern and Mitchell J. Rauh

Early detection of the female athlete triad is essential for the long-term health of adolescent female athletes. The purpose of this study was to assess relationships between common anthropometric markers (ideal body weight [IBW] via the Hamwi formula, youth-percentile body mass index [BMI], adult BMI categories, and body fat percentage [BF%]) and triad components, (low energy availability [EA], measured by dietary restraint [DR], menstrual dysfunction [MD], low bone mineral density [BMD]). In the sample (n = 320) of adolescent female athletes (age 15.9± 1.2 y), Spearman’s rho correlations and multiple logistic regression analyses evaluated associations between anthropometric clinical cutoffs and triad components. All underweight categories for the anthropometric measures predicted greater likelihood of MD and low BMD. Athletes with an IBW ≤85% were nearly 4 times more likely to report MD (OR = 3.7, 95% CI [1.8, 7.9]) and had low BMD (OR = 4.1, 95% CI [1.2, 14.2]). Those in <5th percentile for their age-specific BMI were 9 times more likely to report MD (OR 9.1, 95% CI [1.8, 46.9]) and had low BMD than those in the 50th to 85th percentile. Athletes with a high BF% were almost 3 times more likely to report DR (OR = 2.8, 95% CI [1.4, 6.1]). Our study indicates that low age-adjusted BMI and low IBW may serve as evidence-based clinical indicators that may be practically evaluated in the field, predicting MD and low BMD in adolescents. These measures should be tested for their ability as tools to minimize the risk for the triad.

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Charlotte P. Guebels, Lynn C. Kam, Gianni F. Maddalozzo and Melinda M. Manore

It is hypothesized that exercise-related menstrual dysfunction (ExMD) results from low energy availability (EA), defined as energy intake (EI)—exercise energy expenditure (EEE). When EI is too low, resting metabolic rate (RMR) may be reduced to conserve energy.

Purpose:

To measure changes in RMR and EA, using four methods to quantify EEE, before/after a 6-month diet intervention aimed at restoring menses in women with ExMD; eumenorrheic (Eumen) active controls (n = 9) were also measured.

Methods:

Active women with ExMD (n = 8) consumed +360 kcal/d (supplement) for 6 months; RMR was measured 2 times at 0 months/6 months. EI and total energy expenditure (TEE) were estimated using 7-day diet/activity records, with EA assessed using four methods to quantify EEE.

Results:

At baseline, groups did not differ for age, gynecological age, body weight, lean/fat mass, VO2max, EI and EA, but mean TEE was higher in ExMD (58.3 ± 4.4kcal/kgFFM/d; Eumen = 50.6 ± 2.4; p < .001) and energy balance (EB) more negative (–10.3 ± 6.9 kcal/kgFFM/d; Eumen=-3.0 ± 9.7; p = .049). RMR was higher in ExMD (31.3 ± 1.8 kcal/kgFFM/d) vs. Eumen (29.1 ± 1.9; p < .02). The intervention increased weight (1.6 ± 2.0kg; p = .029), but there were no significant changes in EA (0-month range = 28.2–36.7 kcal/kgFFM/d; 6-month range = 30.0–45.4; p > .05), EB (6 months = –0.7 ± 15.1 kcal/kgFFM/d) or RMR (0 months = 1515 ± 142; 6 months = 1522 ± 134 kcal/d). Assessment of EA varied dramatically (~30%) by method used.

Conclusions:

For the ExMD group, EI and weight increased with +360 kcal/d for 6 months, but there were no significant changes in EB, EA or RMR. No threshold EA value was associated with ExMD. Future research should include TEE, EB and clearly quantifying EEE (e.g.,>4 MET) if EA is measured.

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Margo L. Mountjoy, Louise M. Burke, Trent Stellingwerff and Jorunn Sundgot-Borgen

prevention and treatment programs from IFs all the way down to grassroots sports. The term “RED-S” was coined by the International Olympic Committee in 2014 ( Mountjoy et al., 2014 ), expanding the female athlete triad model to recognize that low energy availability (LEA), which underpins both the triad and

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-0329 Negative Consequences of Low Energy Availability in Natural Male Bodybuilding: A Review Petter Fagerberg * 1 07 2018 28 4 385 402 10.1123/ijsnem.2016-0332 ijsnem.2016-0332 ORIGINAL RESEARCH Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite