AUTHOR=Vardardottir Birna , Gudmundsdottir Sigridur Lara , Tryggvadottir Ellen Alma , Olafsdottir Anna S. 

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

JOURNAL=Frontiers in Sports and Active Living

VOLUME=Volume 6 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/sports-and-active-living/articles/10.3389/fspor.2024.1390558

DOI=10.3389/fspor.2024.1390558

ISSN=2624-9367

ABSTRACT=Problematic low energy availability (EA) is the underlying culprit of Relative Energy Deficiency in Sport (REDs), and its consequences have been suggested to be exacerbated when accompanied by low carbohydrate (CHO) intakes.

This study compared dietary intake, nutrition status, and occurrence of REDs symptoms in groups of female athletes, displaying different patterns of EA and CHO intake.

Female athletes (n=41, median age 20.4 y) from various sports, weighed and recorded their food intake and training for seven consecutive days via a photo-assisted mobile application. Participants were divided into four groups based on patterns of EA and CHO intakes: sufficient-to-optimal EA and sufficient-to-optimal CHO intake (SEA+SCHO), SEA and low CHO intake (SEA+LCHO), low energy availability and SCHO (LEA+SCHO), and LEA and LCHO (LEA+LCHO). SEA patterns were characterised by EA ≥30 and LEA by EA <30 kcal/kg FFM, and SCHO patterns characterised by CHO intake ≥3.0 and LCHO <3.0 g/kg BW for most of the registered days. Body composition was measured with Dual Energy X-Ray Absorptiometry (DXA), resting metabolic rate with indirect calorimetry, and serum blood samples were collected for evaluation of nutrition status. Behavioural risk factors and self-reported symptoms of REDs were assessed with the Low Energy Availability in Females Questionnaire (LEAF-Q), Eating Disorder Examination Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI), and Muscle Dysmorphic Disorder Inventory (MDDI).

In total, 36.6% were categorised as SEA+SCHO, thereof 5 out of 16 ball sport, 7/10 endurance, 1/7 aesthetic, 2/5 weight-class, and 0/3 weight-class athletes. Of LEA+LCHO athletes (19.5% of all), 50% came from ball sports. Aesthetic and endurance athletes reported greatest training demands, with weekly training hours higher for aesthetic compared to ball sports (13.1±5.7 vs. 6.7±3.4 h, p=0.012). Two LEA+LCHO and one SEA+LCHO athlete exceeded the EDE-QS cut-off. LEA+LCHO evaluated their sleep and energy levels worse, and both LEA groups rated their recovery worse compared to SEA+SCHO.

Repeated exposures to LEA and LCHO are associated with a cluster of negative implications in female athletes. In terms of nutritional strategies, sufficient EA and CHO intakes appear to be pivotal in preventing REDs.