1
|
Martinho DV, Field A, Naughton R, Ribeiro AS, Rebelo A, Gouveia ÉR, Sarmento H. Nutritional perspectives in female soccer: a scoping review. J Int Soc Sports Nutr 2024; 21:2366427. [PMID: 38961627 PMCID: PMC11225636 DOI: 10.1080/15502783.2024.2366427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The purpose of the review was to evaluate the literature exploring nutritional habits and practices in female soccer players. METHODS The PRISMA-ScR Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews were followed. Searches of Web of Science, PubMed and Scopus databases were conducted for studies exploring the nutritional habits and practices of female soccer players. RESULTS A total of 72 studies were included in the scoping review. Studies on female soccer players mainly focused on daily energy expenditure, daily energy and macronutrient intake and hydration status. A negative energy balance was consistent across studies, and the ingestion of CHO appears below the current recommendations. Female soccer players are predominately in negative energy balance, which may indicate that they are at risk of low energy availability. A high use of nutritional supplements is apparent in female soccer, whilst a large proportion of players commence training dehydrated. CONCLUSIONS The current findings have implications for practitioners relating to the planning, management, monitoring, and implementation of nutritional intake and training and competition schedules.
Collapse
Affiliation(s)
- Diogo V. Martinho
- University of Coimbra, Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
- Interactive Technologies Institute, Laboratory of Robotics and Engineering Systems, Funchal, Portugal
| | - Adam Field
- Manchester Metropolitan University, Department of Sport and Exercise Science, Institute of Sport, Manchester, UK
| | - Robert Naughton
- University of Huddersfield, School of Human and Health Sciences,Huddersfield, UK
| | - Alex S. Ribeiro
- University of Coimbra, Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - André Rebelo
- Universidade Lusófona, CIDEFES, Centro de Investigação em Desporto, Educação Física e Exercício e Saúde, Lisboa, Portugal
- COD, Center of Sports Optimization, Sporting Clube de Portugal, Lisboa, Portugal
| | - Élvio R. Gouveia
- Interactive Technologies Institute, Laboratory of Robotics and Engineering Systems, Funchal, Portugal
- University of Madeira, Department of Physical Education and Sport, Funchal, Portugal
| | - Hugo Sarmento
- University of Coimbra, Research Unit for Sport and Physical Activity, Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| |
Collapse
|
2
|
Lu Y, Chen Y, Zhao Y, Wang Y, Chen H, Zhang F, Li X. Analysis of the effects of eating and emotions on reproductive axis function in patients with functional hypothalamic amenorrhea. J Psychosom Obstet Gynaecol 2024; 45:2375718. [PMID: 38975957 DOI: 10.1080/0167482x.2024.2375718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/30/2024] [Indexed: 07/09/2024] Open
Abstract
Objective: To investigate the effects of eating and emotions on reproductive axis function in patients with functional hypothalamic amenorrhea (FHA). Methods: A retrospective cohort study was conducted to summarize the clinical and endocrine characteristics of 58 patients with FHA at initial diagnosis and to follow up the recovery of ovulation and spontaneous menstruation in the patients to investigate these biochemical indicators and their effects on recovery outcomes. Results: Among patients with FHA, 13.8% (8/58) and 15.5% (9/58) had above moderately severe depressive and severe anxiety symptoms respectively, and 25.9% (15/58) were at high risk for eating disorders. 34.5% (20/58) were included assessed as having recovered. The non-recovered group had higher scores on the Patient Health Questionnaire (PHQ-9) (p = .022) and higher scores on the Eating Attitude Test-26 (EAT-26) (p = .03) as well as bulimia and food preoccupation (p = .041). Follicle diameter >5 mm at initial diagnosis was an independent factor influencing recovery of reproductive axis function (odds ratio = 7.532; 95% confidence interval, 1.321-42.930; p = .023). Conculsions: Mood disorders and a certain risk of eating disorders were present in FHA.These, together with weight loss, endocrine and follicle size, could influence the outcome.
Collapse
Affiliation(s)
- Ye Lu
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yao Chen
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuting Zhao
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yulu Wang
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Hang Chen
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Feifei Zhang
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xin Li
- Department of Reproductive Endocrinology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| |
Collapse
|
3
|
Vigh-Larsen JF, Junge N, Cialdella-Kam L, Tomás R, Young L, Krustrup P, Mohr M, Nybo L. Testing in Intermittent Sports-Importance for Training and Performance Optimization in Adult Athletes. Med Sci Sports Exerc 2024; 56:1505-1537. [PMID: 39004796 DOI: 10.1249/mss.0000000000003442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
ABSTRACT Performance in intermittent sports relies on the interplay between multiple physiological systems determining the capacity to perform short explosive efforts as well as repeated intense actions with limited recovery over the course of an entire game. Testing should reflect these demands to allow for sport- and position-specific capacity analyses that eventually may translate into optimized training and improved performance. This may include individual load management and optimized training prescription, intensity targeting for specific positions or individual athletes, as well as benchmarking for monitoring of training progression and enhanced engagement of athletes. This review provides an overview of available tests in different exercise domains identified as relevant (from assessment of single explosive actions to intermittent endurance capacity), forming the basis for recommendations on how to compose a comprehensive yet feasible test battery that may be integrated into the seasonal competition and training plan. The test procedures should cover the performance spectrum of relevance for the individual athlete-also in team sports to account for positional differences. We emphasize the benefits of sport-specific tests, highlight parameters of importance for test standardization, and discuss how the applied test battery may be supplemented with secondary tests directed toward specific energy systems to allow for more in-depth analyses when required (e.g., in terms of an underperforming athlete). The synergy between testing and tracking of match performance (utilizing time-motion or global positioning systems) is highlighted, and although tracking cannot substitute for testing, combining the tools may provide a comprehensive overview of the physiological demands and performance during competition contextualized to the athletes' maximal exercise capacity.
Collapse
Affiliation(s)
| | - Nicklas Junge
- Department of Nutrition, Exercise and Sport Sciences, University of Copenhagen, Copenhagen, DENMARK
| | - Lynn Cialdella-Kam
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA
| | - Rita Tomás
- Portugal Football School, Federação Portuguesa de Futebol Avenida das Seleções, Oeiras, PORTUGAL
| | - Laura Young
- American College of Sports Medicine, Indianapolis, IN
| | | | | | - Lars Nybo
- Department of Nutrition, Exercise and Sport Sciences, University of Copenhagen, Copenhagen, DENMARK
| |
Collapse
|
4
|
Lichtenstein MB, Hertz SPT, Johansen KK, Rytter J, Sundgot-Borgen J, Torstveit MK, Holm L, Melin AK. Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes? Clin J Sport Med 2024:00042752-990000000-00216. [PMID: 39012244 DOI: 10.1097/jsm.0000000000001257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/28/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The main objective of this study was to investigate the risk of eating disorders, exercise addiction, depression, and low energy availability (LEA) in Danish female and male elite compared with sub-elite athletes. DESIGN A cross-sectional study. SETTING An online survey. PARTICIPANTS A total of 410 elite athletes (mean age 20.1 years, 51% females) and 206 sub-elite athletes (mean age 21.3 years, 52% females) from 15 different sports.Assessment of Risk Factors: Eating Disorders, exercise addiction, depression, and LEA. MAIN OUTCOME MEASURES The Sick Control, One Stone (6.5 kg), Fat, Food, the Eating Disorder Examination-Questionnaire, the Exercise Addiction Inventory, the Major Depression Inventory, and the Low Energy Availability in Females Questionnaire or the Low Energy Availability in Males Questionnaire. RESULTS We found that more female sub-elite athletes compared with elite athletes had risk of eating disorders (EDs) (37.4% vs 23.4%; P < 0.012) and the same was found for males (23.2% vs 10.4%; P = 0.005). More athletes with risk of EDs had risk of exercise addiction (12.8 vs 5.4%, P = 0.006), depression (27.3 vs 4.2%, P < 0.001), and LEA (females 55.1 vs 40.7%, P = 0.024, and males 29.4 vs 13.7%, P = 0.036, respectively) compared with athletes without risk of EDs. CONCLUSIONS Sub-elite athletes have a higher risk of eating disorders compared with elite athletes. Regular screening of ED symptoms and associated conditions in elite and especially sub-elite athletes may ensure early identification.
Collapse
Affiliation(s)
- Mia Beck Lichtenstein
- Department of Psychology, University of Southern Denmark, Denmark
- Centre for Digital Psychiatry, Odense, Denmark
| | | | | | - Josefine Rytter
- Department of Psychology, University of Southern Denmark, Denmark
- Centre for Digital Psychiatry, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
- Department of Sports Medicine, the Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Team Danmark, The Danish Elite Sport Institution, Broendby, Denmark; and
- Department of Sports Science, Linnaeus University, Växjö/Kalmar, Sweden
| | - Jorunn Sundgot-Borgen
- Department of Psychology, University of Southern Denmark, Denmark
- Centre for Digital Psychiatry, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
- Department of Sports Medicine, the Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Team Danmark, The Danish Elite Sport Institution, Broendby, Denmark; and
- Department of Sports Science, Linnaeus University, Växjö/Kalmar, Sweden
| | | | - Lars Holm
- Team Danmark, The Danish Elite Sport Institution, Broendby, Denmark; and
| | - Anna K Melin
- Department of Sports Science, Linnaeus University, Växjö/Kalmar, Sweden
| |
Collapse
|
5
|
Suzuki D, Suzuki Y. Identifying and Analyzing Low Energy Availability in Athletes: The Role of Biomarkers and Red Blood Cell Turnover. Nutrients 2024; 16:2273. [PMID: 39064716 PMCID: PMC11279570 DOI: 10.3390/nu16142273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/28/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Low energy availability (LEA) is a growing concern that can lead to several problems for athletes. However, adaptation to LEA occurs to maintain balance over time, making diagnosis difficult. In this review, we categorize LEA into two phases: the initial phase leading to adaptation and the phase in which adaptation is achieved and maintained. We review the influence of LEA on sports performance and health and discuss biomarkers for diagnosing LEA in each phase. This review also proposes future research topics for diagnosing LEA, with an emphasis on the recently discovered association between red blood cell turnover and LEA.
Collapse
Affiliation(s)
- Daisuke Suzuki
- Department of Biological Production Science, United Graduate School of Agricultural Science, Tokyo University of Agriculture and Technology, Fuchu 183-8509, Tokyo, Japan;
| | - Yoshio Suzuki
- Graduate School of Health and Sports Science, Juntendo University, Inzai 276-1695, Chiba, Japan
| |
Collapse
|
6
|
McGuire A, Warrington G, Walsh A, Byrne T, Doyle L. Measurement of energy availability in highly trained male endurance athletes and examination of its associations with bone health and endocrine function. Eur J Nutr 2024:10.1007/s00394-024-03433-8. [PMID: 38953963 DOI: 10.1007/s00394-024-03433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/17/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Despite the introduction of Relative Energy Deficiency in Sport (RED-s) in 2014, there is evidence to suggest that male endurance athletes still present with a high prevalence of low energy availability (LEA). Previous findings suggest that energy availability (EA) status is strongly correlated with impairments in endocrine function such as reduced leptin, triiodothyronine (T3), and insulin, and elevated bone loss. This study aimed to report the current EA status, endocrine function and bone health of highly trained Irish male endurance athletes. METHODS In this cross-sectional study, participants (n = 3 triathletes; n = 10 runners) completed a 7-day testing period during the competition season using lab-based measures, to ascertain EA status, hormone level and rates of bone metabolism. Serum blood samples were obtained to assess hormone levels and markers of bone metabolism. RESULTS Mean EA was < 30 kcal/kg lean body mass (LBM)/day in 76.9% of athletes. There was a strong association between LEA and low carbohydrate intake, and lower LBM. Mean levels of insulin, IGF-1 and leptin were significantly lower than their reference ranges. Elevated mean concentrations of β-CTX and a mean P1NP: β-CTX ratio < 100, indicated a state of bone resorption. CONCLUSION The EA level, carbohydrate intake, hormone status and bone metabolism status of highly trained male endurance athletes are a concern. Based on the findings of this study, more frequent assessment of EA across a season is recommended to monitor the status of male endurance athletes, in conjunction with nutritional education specific to EA and the associated risks.
Collapse
Affiliation(s)
- Amy McGuire
- Department of Sport and Early Childhood Studies, Technological University of the Shannon, Limerick, Ireland.
- ACTIVE Research Group, Technological University of the Shannon, Limerick, Ireland.
| | - Giles Warrington
- Department of Physical Education and Social Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Adam Walsh
- Department of Sport and Exercise Science, South East Technological University, Cork Road, Waterford, Ireland
| | - Thomas Byrne
- Department of Sport and Exercise Science, South East Technological University, Cork Road, Waterford, Ireland
| | - Lorna Doyle
- Department of Sport and Exercise Science, South East Technological University, Cork Road, Waterford, Ireland
| |
Collapse
|
7
|
Blagrove RC, Brooke-Wavell K, Plateau CR, Nahman C, Hassan A, Stellingwerff T. The Role of Musculoskeletal Training During Return to Performance Following Relative Energy Deficiency in Sport. Int J Sports Physiol Perform 2024; 19:623-628. [PMID: 38834182 DOI: 10.1123/ijspp.2023-0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/24/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. PURPOSE This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie, strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. CONCLUSIONS REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term.
Collapse
Affiliation(s)
- Richard C Blagrove
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Katherine Brooke-Wavell
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Carolyn R Plateau
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Carolyn Nahman
- Child and Adolescent Psychiatry, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Amal Hassan
- Institute of Sport, Exercise and Health, London, United Kingdom
| | - Trent Stellingwerff
- Canada Sport Institute-Pacific, Victoria, BC, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
8
|
Roffler A, Fleddermann MT, de Haan H, Krüger K, Zentgraf K. Menstrual cycle tracking in professional volleyball athletes. Front Sports Act Living 2024; 6:1408711. [PMID: 39005625 PMCID: PMC11239427 DOI: 10.3389/fspor.2024.1408711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction The menstrual cycle may affect well-being and physical performance of elite female athletes by interfering with the function of multiple physiological systems. The aim of this study was to characterize the symptoms of the menstrual cycle and their frequency in elite female volleyball players. Methods Twenty professional female volleyball players were instructed to track their menstrual symptoms over the course of the first German national league season using the FitrWoman® tracking app. The app recorded the cycle length, duration, and intensity of the period as well as the occurrence and frequency of frequent cycle symptoms. The reported symptoms were then categorized into four categories (frequently, sometimes, rare, never) in order to create an individual Menstrual Symptom index (MSi) for each athlete. Results The most frequently occurring symptoms among all players without hormonal contraception (non-HC; n = 15) were "stomach cramps" (n = 15), "sleep disturbances" (n = 11), and "tiredness" (n = 11). The average number of symptoms counted per cycle was 11.8 (±17.7) and the average calculated MSi within the team was 12.9 (±10.7) points for non-HC users. The HC players (n = 4) also regularly experienced symptoms such as "sleep disturbances" or "tendered breasts". The most common symptoms "stomach cramps" and "disturbed sleep" occurred more frequently during menstruation, while symptoms such as "bloating", "cravings" or "tendered breasts" did also peak before menstruation. Discussion Menstrual cycle symptoms can be highly individual within a professional sports team. The calculation of the MSi seems to be a simple and accessible method to describe and overview the intensity and prevalence of symptoms in top female athletes in sports games.
Collapse
Affiliation(s)
- Andrea Roffler
- Department of Movement Science and Training in Sports, Institute of Sport Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Marie-Therese Fleddermann
- Department of Movement Science and Training in Sports, Institute of Sport Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Hanna de Haan
- Department of Performance Psychology, German Sport University Cologne, Köln, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus-Liebig University Giessen, Giessen, Germany
| | - Karen Zentgraf
- Department of Movement Science and Training in Sports, Institute of Sport Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| |
Collapse
|
9
|
Smith A, Wyler H, van Wijnkoop M, Colangelo J, Liebrenz M, Buadze A. Body Mass Index Trends for the Top Five Finishers in Men's Grand Tour and Monument Cycling Events from 1994-2023: Implications for Athletes and Sporting Stakeholders. Sports (Basel) 2024; 12:178. [PMID: 39058069 PMCID: PMC11280562 DOI: 10.3390/sports12070178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Weight-related issues can be prevalent in elite-level sports, especially in men's road cycling, where riders may exhibit harmful behaviours, with potentially adverse outcomes for mental and physical health. This study investigated Body Mass Index (BMI) values amongst the top five finishers in the three Grand Tours and the five Monuments races between 1994 and 2023 to assess longitudinal patterns. Publicly available height and weight figures were sourced from ProCyclingStats and BMI scores were calculated for n = 154 and n = 255 individual athletes for the Grand Tours and Monuments, respectively. Two analyses were conducted with correlations and ANOVAs: the first included the BMIs of all top-five finishes and the second focussed on the BMIs of new top-five entrants. The results from both analyses revealed consistent mean BMI decreases over the years and larger effect sizes were apparent in the Grand Tours compared to the Monuments. Although lower BMIs are associated with certain performance advantages, these declining trajectories suggest a need for enhanced awareness in the cycling community and possible regulatory measures and educational programmes to promote the sustainable wellbeing of riders. This may be particularly pertinent given the wider evidence of unhealthy weight-related attitudes and behaviours throughout the sport.
Collapse
Affiliation(s)
- Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland (M.v.W.)
| | - Helen Wyler
- Department of Forensic Psychiatry, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland (M.v.W.)
- Faculty of Behavioural Sciences and Psychology, University of Lucerne, 6002 Lucerne, Switzerland
| | - Moritz van Wijnkoop
- Department of Forensic Psychiatry, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland (M.v.W.)
| | - Jill Colangelo
- Department of Forensic Psychiatry, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland (M.v.W.)
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland (M.v.W.)
| | - Anna Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland;
| |
Collapse
|
10
|
Gimunová M, Bozděch M, Bernaciková M, Fernandes R, Kumstát M, Paludo A. The relationship between low energy availability, injuries, and bone health in recreational female athletes. PeerJ 2024; 12:e17533. [PMID: 38915384 PMCID: PMC11195543 DOI: 10.7717/peerj.17533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
Background Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence in recreational female athletes previously. The aim of this study was to analyse the relationship between low energy availability in females questionnaire (LEAF-Q), bone mineral density (BMD), and postural stability in recreational athletes. Methods Recreational female athletes (n = 24, age: 23.71 ± 2.94, Tier I) completed LEAF-Q, postural stability measurement during quiet stance (Zebris platform FDM; GmbH) and their BMD was measured using DXA (Hologic QDR Horizon A). Non-parametric statistical tests were used to analyse the relationships between LEAF-Q, BMD, and postural stability and to compare differences between participants divided by the LEAF-Q score and its subscales. Results Risk of LEA was observed in 50% of recreational athletes participating in this study. Up to 46% of participants perceived menstrual bleeding changes related to training and 37.50% experienced menstrual dysfunction. Body composition and body weight fluctuations were observed to affect postural stability and BMD. With the risk score for LEA, the BMD and postural stability were not negatively affected in recreational athletes. However, the high number of recreational athletes in the risk score for LEA and menstrual dysfunctions highlights the need for public health programs aimed to increase awareness of LEA and its health consequences and for open communication about the menstrual cycle. Future longitudinal studies observing LEA, BMD, menstrual function, postural stability, and their interrelationship in female athletes are needed to increase the knowledge of this topic.
Collapse
Affiliation(s)
- Marta Gimunová
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Michal Bozděch
- Department of Physical Education and Social Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Martina Bernaciková
- Department of Physical Activities and Health Sciences, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Romulo Fernandes
- Laboratory of InVestigation in Exercise–LIVE, Department of Physical Education, Sao Paulo State University (UNESP), Sao Paulo, Brazil
| | - Michal Kumstát
- Department of Sport Performance and Exercise testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| | - Ana Paludo
- Department of Sport Performance and Exercise testing, Faculty of Sports Studies, Masaryk University, Brno, Czech Republic
| |
Collapse
|
11
|
Khatib MA, Aljaaly EA, Hafiz MS, Alamri A, Alzahrani W. The risk of low energy availability among athlete females in Saudi Arabia: a cross-sectional study. Front Public Health 2024; 12:1411724. [PMID: 38873295 PMCID: PMC11169597 DOI: 10.3389/fpubh.2024.1411724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Low energy availability (LEA) is a state of inadequate energy reserves that results from a negative energy balance. This condition can lead to severe health risks such as amenorrhea and osteoporosis. Various causes for LEA, such as eating disorders and exercise addiction, have been reported in the literature. However, data in Saudi Arabia are lacking. This cross-sectional study measures the prevalence of LEA, eating disorders, and exercise addiction among adult females in Saudi Arabia and identifies possible associated risk factors. Methods The sample comprised 119 female athletes who filled out an online survey adapted from the LEA in Females Questionnaire, the Eating Disorder Examination Questionnaire, and the Exercise Addiction Inventory. Results Participants showed a high prevalence of LEA (66.4%), eating disorder (33.6%), and exercise addiction (10.1%), confirming the association between normal weight and LEA in females living in Saudi Arabia (p < 0.00). Discussion and conclusion With an increasing number of females in the country interested in following a healthy lifestyle, there is a need to raise the awareness of the population on the issues of LEA, eating disorders, and exercise addiction and their effects on the body by developing educational programs about energy intake and healthy physical activity routines.
Collapse
Affiliation(s)
- Mai A. Khatib
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Food, Nutrition, and Lifestyle Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Obesity Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Elham A. Aljaaly
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Adult Podiatric Adolescent Obesity Clinic, MNT Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maryam S. Hafiz
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alkhuzama Alamri
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wejdan Alzahrani
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
12
|
Moran M, Ryan L, Doherty R, Biggins M, Keane KM. The Effect of Sleep on the Health and Dietary Behaviours of GAA Athletes. Nutrients 2024; 16:1660. [PMID: 38892593 PMCID: PMC11174625 DOI: 10.3390/nu16111660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Decreased sleep quality and duration is associated with an array of negative health outcomes. Evidence suggests athletes are susceptible to sleep inadequacies that may in turn affect their health and dietary behaviours. This study aimed to explore the sleep profile of both male and female Gaelic games players, at an elite and sub-elite level and compare how poor sleep relates to subjective health complaints and food cravings. One hundred and seventy Gaelic games players completed the Pittsburgh Sleep Quality Index (PSQI), Subjective Health Complaints Inventory (SHC) and Food Cravings Questionnaire-Trait-Reduced (FCQ-T-r). Participants were categorised into two groups: poor sleepers (PSQI ≥ 5) and good sleepers (PSQI < 5). Outcome measures of health and food cravings were analysed across the groups, Mann-Whitney U tests were used to assess differences, and Spearman's rank-order correlations were used to determine relationships between variables. Sixty-seven % of athletes were categorised as poor sleepers. There were no significant differences in PSQI scores across genders (p = 0.088) or playing level (p = 0.072). Poor sleepers experienced significantly increased SHC (p < 0.001) and female athletes had significantly more SHC compared to males (p < 0.001). Female athletes experienced more food cravings than males (p = 0.013). However, there were no significant differences in food cravings between good and poor sleepers (p = 0.104). The findings suggest a high prevalence of poor sleepers amongst GAA athletes. Furthermore, a significant relationship exists between poor sleep and health complaints with females at a higher risk of worsened health complaints and higher food cravings. Sleep screening and education interventions to enhance sleep in GAA athletes are advocated.
Collapse
Affiliation(s)
- Matt Moran
- Department of Sport, Exercise and Nutrition, Atlantic Technological University, H91 T8NW Galway, Ireland (L.R.)
| | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, Atlantic Technological University, H91 T8NW Galway, Ireland (L.R.)
| | - Rónán Doherty
- Sports Lab North West, Atlantic Technological University Donegal, Letterkenny Campus, Port Road, F92 FC93 Letterkenny, Ireland;
- Sport Ireland Institute, National Sport Campus, Abbotstown, D15 Y52H Dublin, Ireland
| | - Michelle Biggins
- Sport Ireland Institute, National Sport Campus, Abbotstown, D15 Y52H Dublin, Ireland
| | - Karen M. Keane
- Department of Sport, Exercise and Nutrition, Atlantic Technological University, H91 T8NW Galway, Ireland (L.R.)
| |
Collapse
|
13
|
W Constantini N, Alves E, L Mountjoy M, E Ackerman K. Relative energy deficiency in military (RED-M). BMJ Mil Health 2024; 170:191-192. [PMID: 36702526 DOI: 10.1136/military-2022-002341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Naama W Constantini
- Orthopaedics, Heidi Rothberg Sport Medicine Center, Jerusalem, Israel
- Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Alves
- Medicina Física e de Reabilitação, Centro Hospitalar Universitário de Lisboa Norte EPE, Lisboa, Portugal
| | - M L Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
- International Olympic Committee Games Group, Lausanne, Switzerland
| | - K E Ackerman
- Wu Tsai Female Athlete Program, Boston, Massachusetts, USA
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Ellis DG, Morton JP, Close GL, Donovan TF. Energy Expenditure of Elite Male and Female Professional Tennis Players During Habitual Training. Int J Sport Nutr Exerc Metab 2024; 34:172-178. [PMID: 38281487 DOI: 10.1123/ijsnem.2023-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Understanding the daily energy expenditure of athletes during training is important to support recovery, adaptation, and the maintenance of performance. The aim of the current research was to assess the total daily energy expenditure (TDEE) and the acute energy expenditure (EE) of tennis training sessions during habitual training of elite tennis players. Using a cohort study design, 27 (n = 10, male; age; 22.3 ± 3.2 years and n = 17, female; age: 23.8 ± 3.5 years) elite singles tennis players were assessed for TDEE and tennis training EE. Using Actiheart activity monitors during a 2- to 5-day training period, male players were analyzed for 26 days and 33 (1.3 ± 0.5 sessions/day) tennis training sessions, and female players for 43 days and 58 (1.2 ± 0.4 sessions/day) tennis training sessions. Male TDEE (4,708 ± 583 kcal/day) was significantly higher than female (3,639 ± 305 kcal/day). Male absolute and relative tennis training EEs (10.2 ± 2.3 kcal/min and 7.9 ± 1.4 kcal·hr-1·kg-1) were significantly higher than those of females (7.6 ± 1.0 kcal/min and 6.8 ± 0.9 kcal·hr-1·kg-1). The resting metabolic rate was assessed via indirect calorimetry. The physical activity level for both groups was 2.3 AU. The TDEE of male and female players during habitual training now highlights the continual cycle of high energy demands experienced by the elite tennis player. The broad ranges of TDEE and EE reported here suggest individual assessment and nutritional planning be prioritized, with a particular focus on carbohydrate requirements.
Collapse
Affiliation(s)
- Daniel G Ellis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Lawn Tennis Association, London, United Kingdom
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Tim F Donovan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| |
Collapse
|
15
|
Xu X, Sarfraz M, Nasrullah U. Health hazards in sports: Exploring the influence of despotic leadership and perceived organizational politics on well-being. Heliyon 2024; 10:e29136. [PMID: 38601699 PMCID: PMC11004656 DOI: 10.1016/j.heliyon.2024.e29136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
In recent years, the concept of despotic leadership has garnered considerable attention in sports. Despotic leadership significantly reflecting leaders' deviant behavior has today heightened the risk of health hazards in the workplace. In addition, the perceived organizational politics have also yielded a deleterious result on employees' well-being. In the dynamic landscape of healthcare, understanding the implications of organizational behavior on well-being is paramount for risk management. This study elucidates the relationships between despotic leadership, perceived organizational politics, workplace incivility, emotional exhaustion, person-organization unfit, and health harm, which can pose significant risks in a healthcare setting. The quantitative study was conducted using an empirical survey with respondents representing sports organizations. A Partial Least Squares Structural Equation Model (PLS-SEM) was used to analyze data from 429 participants using Smart PLS. The study findings suggest that despotic leadership and perceived organizational politics can lead to increased risks, manifested as workplace incivility, emotional exhaustion, and person-organization unfit. These organizational risks subsequently translate to tangible health harm for employees. Mediation analyses revealed that workplace incivility, emotional exhaustion, and person-organization unfit mediate the detrimental health outcomes rooted in leadership and organizational politics. The study underscores the urgent need for risk management strategies to foster a healthier organizational culture and leadership approach in healthcare settings. This will ensure enhanced employee well-being and a reduction in associated health risks, thus aligning with best practices in healthcare policy.
Collapse
Affiliation(s)
- Xiaowei Xu
- Institute of Physical Education, Henan University, Kaifeng, China
- Sports Education Center, Zhejiang Shuren University, Hangzhou, China
| | | | - Urooj Nasrullah
- College of Business, Concordia University Chicago, 7400 Augusta St, River Forest, IL, 60305, United States
| |
Collapse
|
16
|
Love AA, Zickgraf HF, Sonneville KR, Mankowski A, Carson TL, Hazzard VM. Cross-sectional and longitudinal associations between higher weight and eating disorder risk among collegiate athletes. J Sci Med Sport 2024; 27:270-275. [PMID: 38331631 DOI: 10.1016/j.jsams.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES To examine whether higher weight status is associated with increased eating disorder risk in athletes. DESIGN Study 1 used cross-sectional (N = 942) and longitudinal (N = 483) data collected over a five-year period from Division I athletes at a Midwestern university. Study 2 used cross-sectional data from athletes competing at various levels at universities across the United States (N = 825). METHODS Weight and height were measured in Study 1 and self-reported in Study 2; higher weight was defined as body mass index ≥ 25 kg/m2. Eating disorder risk was assessed with preliminary (Study 1) and final (Study 2) versions of the Eating Disorders Screen for Athletes. Study 1 examined weight status in relation to both concurrent and one-year changes in Eating Disorder Screen for Athletes score. Study 2 examined weight status in relation to both the Eating Disorders Screen for Athletes score and elevated eating disorder risk using the established Eating Disorders Screen for Athletes cut-off. All models adjusted for gender and sport type; Study 2 additionally adjusted for race/ethnicity, age, and competition level. RESULTS Across studies, higher weight status was significantly associated with increased eating disorder risk among athletes. This association was observed both cross-sectionally and longitudinally, and the prevelence of elevated eating disorder risk was 43 % greater among athletes with higher weight status than among those without higher weight status. CONCLUSIONS Despite existing stereotypes that eating disorders tend to occur with low weight status, findings highlight the importance of screening all athletes for eating disorders, regardless of their weight status.
Collapse
Affiliation(s)
- Anna A Love
- Department of Psychology, University at Albany, State University of New York, United States of America.
| | - Hana F Zickgraf
- Department of Pediatrics, Emory University, United States of America; Rogers Behavioral Health, United States of America
| | - Kendrin R Sonneville
- Department of Nutritional Sciences, University of Michigan School of Public Health, United States of America
| | | | - Traci L Carson
- Department of Obstetrics and Gynecology, Emory University, United States of America
| | - Vivienne M Hazzard
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, United States of America
| |
Collapse
|
17
|
Tektunalı Akman C, Gönen Aydın C, Ersoy G. The effect of nutrition education sessions on energy availability, body composition, eating attitude and sports nutrition knowledge in young female endurance athletes. Front Public Health 2024; 12:1289448. [PMID: 38550312 PMCID: PMC10973170 DOI: 10.3389/fpubh.2024.1289448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
Nutrition knowledge plays a pivotal role in shaping dietary habits and food choices, particularly in the realm of sports nutrition. This study investigates the effects of a series of nutrition education sessions conducted by a registered dietitian on energy availability, various anthropometric measurements, eating attitudes, and sports nutrition knowledge in young female endurance athletes aged 15-18 years (football, basketball, volleyball) who engage in training for more than 10 h per week (n = 83). Participants were randomly divided into two groups with 45 individuals receiving six physical nutrition education lectures, and the remaining 38 participants receiving no nutrition education. Participants completed the low energy availability in females questionnaire (LEAF-Q), Eating Attitude Test (EAT-26), and Sports Nutrition Knowledge Questionnaire (SNKQ). Energy and nutrient intakes were evaluated through 3-day food records, while exercise energy expenditure was assessed using 3-day activity logs. All of the questionnaires were repeated after 6 months. At baseline, the prevalence of LEA among athletes was determined to be 63.8%. In the intervention group, energy availability (EA) and SNKQ scores increased, and LEAF-Q scores decreased significantly (p < 0.05). However, there was no significant change in EAT-26 scores between the two groups. Energy intake, weight, fat-free mass, and resting metabolic rate have been increased significantly in the intervention group (p < 0,05). These findings suggest that nutrition education proves beneficial in enhancing dietary intake, positively influencing body composition, and improving nutrition knowledge, ultimately contributing to increased energy availability in female athletes over the short term.
Collapse
Affiliation(s)
- Cansu Tektunalı Akman
- Department of Nutrition and Dietetics, Institute of Health Sciences, Medipol University, Istanbul, Türkiye
| | - Canan Gönen Aydın
- Department of Sports Medicine, University of Health Sciences, Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Gülgün Ersoy
- Department of Nutrition and Dietetics, Institute of Health Sciences, Medipol University, Istanbul, Türkiye
| |
Collapse
|
18
|
Scanlon S, Norton C. Investigating Nutrition and Hydration Knowledge and Practice among a Cohort of Age-Grade Rugby Union Players. Nutrients 2024; 16:533. [PMID: 38398857 PMCID: PMC10891571 DOI: 10.3390/nu16040533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Optimal athletic performance relies on meeting specific nutritional requirements, encompassing adequate calorie intake, macronutrient intake, and hydration. Misinformation or misconceptions about these necessities are prevalent among young athletes. This study investigated nutrition and hydration knowledge and practices among 28 male rugby union players aged 16 to 17, participating in Munster Rugby's 2023 Summer Age-Grade Development Programme, specifically the U18's Schools Squad. The Nutrition for Sport Knowledge Questionnaire assessed nutrition knowledge, while the Hydration Assessment Questionnaire evaluated hydration knowledge. Urinalysis for hydration status utilised urine specific gravity measurements pre-exercise on five separate days (1.018 ± 0.008 Usg). Dietary intake was recorded using a 3-day estimated food intake record on the Libro App, analysed with Nutritics software(Version 9.50). Suboptimal nutrition knowledge (49.6 ± 8.2%) and dietary practices were observed, with incongruent nutrient intakes compared to recommendations for adolescent athletes. While superior hydration knowledge (79.0 (77.3, 83.6) %) was evident, pre-exercise urine specific gravity readings indicated significant variation (p < 0.001) and signs of dehydration (USG > 1.020 Usg). No statistically significant correlations were found between knowledge and practices. The study highlights suboptimal nutrition and hydration knowledge and practices in youth athletes, suggesting the need for tailored support and educational interventions to enhance their overall health and performance. Further investigation into barriers and facilitators to dietary adherence is recommended for more effective interventions.
Collapse
Affiliation(s)
- Shane Scanlon
- Department of Physical Education and Sport Sciences, University of Limerick, V94 T9PX Limerick, Ireland
| | - Catherine Norton
- Department of Physical Education and Sport Sciences, University of Limerick, V94 T9PX Limerick, Ireland
- Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
- Sport & Human Performance Research Centre, University of Limerick, V94 T9PX Limerick, Ireland
| |
Collapse
|
19
|
Amawi A, AlKasasbeh W, Jaradat M, Almasri A, Alobaidi S, Hammad AA, Bishtawi T, Fataftah B, Turk N, Saoud HA, Jarrar A, Ghazzawi H. Athletes' nutritional demands: a narrative review of nutritional requirements. Front Nutr 2024; 10:1331854. [PMID: 38328685 PMCID: PMC10848936 DOI: 10.3389/fnut.2023.1331854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024] Open
Abstract
Nutrition serves as the cornerstone of an athlete's life, exerting a profound impact on their performance and overall well-being. To unlock their full potential, athletes must adhere to a well-balanced diet tailored to their specific nutritional needs. This approach not only enables them to achieve optimal performance levels but also facilitates efficient recovery and reduces the risk of injuries. In addition to maintaining a balanced diet, many athletes also embrace the use of nutritional supplements to complement their dietary intake and support their training goals. These supplements cover a wide range of options, addressing nutrient deficiencies, enhancing recovery, promoting muscle synthesis, boosting energy levels, and optimizing performance in their respective sports or activities. The primary objective of this narrative review is to comprehensively explore the diverse nutritional requirements that athletes face to optimize their performance, recovery, and overall well-being. Through a thorough literature search across databases such as PubMed, Google Scholar, and Scopus, we aim to provide evidence-based recommendations and shed light on the optimal daily intakes of carbohydrates, protein, fats, micronutrients, hydration strategies, ergogenic aids, nutritional supplements, and nutrient timing. Furthermore, our aim is to dispel common misconceptions regarding sports nutrition, providing athletes with accurate information and empowering them in their nutritional choices.
Collapse
Affiliation(s)
- Adam Amawi
- Department of Exercise Science and Kinesiology, School of Sport Science, The University of Jordan, Amman, Jordan
| | - Walaa AlKasasbeh
- Department of Physical and Health Education, Faculty of Educational Sciences, Al-Ahliyya Amman University, Amman, Jordan
| | - Manar Jaradat
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Amani Almasri
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Sondos Alobaidi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Aya Abu Hammad
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Taqwa Bishtawi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Batoul Fataftah
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| | - Nataly Turk
- Department of Family and Community Medicine, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Hassan Al Saoud
- Department of Exercise Science and Kinesiology, School of Sport Science, The University of Jordan, Amman, Jordan
| | - Amjad Jarrar
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Oxford Brookes Center for Nutrition and Health, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Hadeel Ghazzawi
- Department of Nutrition and Food Technology, School of Agriculture, The University of Jordan, Amman, Jordan
| |
Collapse
|
20
|
Coates AM, Thompson KMA, Grigore MM, Baker RE, Pignanelli C, Robertson AA, Frangos SM, Cheung CP, Burr JF. Altered carbohydrate oxidation during exercise in overreached endurance athletes is applicable to training monitoring with continuous glucose monitors. Scand J Med Sci Sports 2024; 34:e14551. [PMID: 38093477 DOI: 10.1111/sms.14551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE The purpose of the study was to investigate whether carbohydrate utilization is altered during exercise in overreached endurance athletes and examine the utility of continuous glucose monitors (CGM) to detect overreaching status. METHODS Eleven endurance athletes (M:8, F:3) completed a 5-week training block consisting of 1 week of reduced training (PRE), 3 weeks of high-intensity overload training (POST), and 1 week of recovery training (REC). Participants completed a Lamberts and Lambert Submaximal Cycling Test (LSCT) and 5 km time-trial at PRE, POST, and REC time points, 15 min following the ingestion of a 50 g glucose beverage with glucose recorded each minute via CGM. RESULTS Performance in the 5 km time-trial was reduced at POST (∆-7 ± 10 W, p = 0.04,η p 2 = 0.35) and improved at REC (∆12 ± 9 W from PRE, p = 0.01,η p 2 = 0.66), with reductions in peak lactate (∆-3.0 ± 2.0 mmol/L, p = 0.001,η p 2 = 0.71), peak HR (∆-6 ± 3 bpm, p < 0.001,η p 2 = 0.86), and Hooper-Mackinnon well-being scores (∆10 ± 5 a.u., p < 0.001,η p 2 = 0.79), indicating athletes were functionally overreached. The respiratory exchange ratio was suppressed at POST relative to REC during the 60% (POST: 0.80 ± 0.05, REC: 0.87 ± 0.05, p < 0.001,η p 2 = 0.74), and 80% (POST: 0.93 ± 0.05, REC: 1.00 ± 0.05, p = 0.003,η p 2 = 0.68) of HR-matched submaximal stages of the LSCT. CGM glucose was reduced during HR-matched submaximal exercise in the LSCT at POST (p = 0.047,η p 2 = 0.36), but not the 5 km time-trial (p = 0.07,η p 2 = 0.28) in overreached athletes. CONCLUSION This preliminary investigation demonstrates a reduction in CGM-derived glucose and carbohydrate oxidation during submaximal exercise in overreached athletes. The use of CGM during submaximal exercise following standardized nutrition could be employed as a monitoring tool to detect overreaching in endurance athletes.
Collapse
Affiliation(s)
- Alexandra M Coates
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Kyle M A Thompson
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Monica M Grigore
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Ryleigh E Baker
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Christopher Pignanelli
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Alexa A Robertson
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Sara M Frangos
- Mitochondrial Metabolism Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Christian P Cheung
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Jamie F Burr
- The Human Performance and Health Research Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
21
|
Henninger K, Pritchett K, Brooke NK, Dambacher L. Low Energy Availability, Disordered Eating, Exercise Dependence, and Fueling Strategies in Trail Runners. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 16:1471-1486. [PMID: 38288400 PMCID: PMC10824294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Under fueling, disordered eating (DE), exercise dependence (EXD), and high training demands relative to energy intake may increase the risk of low energy availability (LEA) in endurance and ultra-endurance athletes. The purpose of this study was to evaluate the prevalence of LEA risk and relationship with risk of DE, EXD, and fueling habits during training and competition in endurance runners. Trail runners between the age of 18-40 (n = 1,899; males: n = 510, females: n = 1,445) completed a 45-question survey using Qualtrics that included training and racing characteristics, questions regarding carbohydrate intake during training and competition, the Low Energy Availability in Females Questionnaire (LEAF-Q), the Disordered Eating Screen for Athletes (DESA-6), and the Exercise Dependence Scale-21 (EDS-21). Among all runners, 43% of runners were at risk for LEA, 43% were at risk for DE, and 87.3% reported symptoms related to EXD. LEAF-Q scores were positively correlated with EDS-21 (r = 0.33, p < 0.001) and DESA-6 scores (r = 0.29, p < 0.001). From the population, 47.6% of athletes reported taking in less than the recommended carbohydrate guidelines during endurance events lasting > 2.5 hours. In females, athletes at risk for LEA appear less likely to fuel sufficiently than athletes not at risk for LEA (p < 0.001). Risk of LEA, DE, and EXD appears to be high in endurance runners. Furthermore, meeting carbohydrate recommendations during training and competition should be emphasized to avoid negative health outcomes associated with LEA in endurance runners.
Collapse
Affiliation(s)
- Keely Henninger
- Professional Trail Runner and Independent Scientist, Portland, OR, USA
| | - Kelly Pritchett
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA
| | - Namrita Kumar Brooke
- Department of Health and Movement Sciences, University of West Florida, Pensacola, FL, USA
| | - Leah Dambacher
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA
| |
Collapse
|
22
|
Jouhki I, Sarin HV, Jauhiainen M, O'Connell TM, Isola V, Ahtiainen JP, Hulmi JJ, Perola M. Effects of fat loss and low energy availability on the serum cardiometabolic profile of physique athletes. Scand J Med Sci Sports 2024; 34:e14553. [PMID: 38268074 DOI: 10.1111/sms.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/26/2024]
Abstract
Low energy availability (LEA) is a health concern for athletes, although it may paradoxically lead to improved cardiometabolic health in the general population. We investigated the associations between LEA, body composition, and serum cardiometabolic profile in 23 physique athletes (DIET) and 21 controls (CONT) during a 5-month pre-competition diet (MID), followed by 1 week of increased energy availability (COMP) and a 5-month weight regain period (POST). Quantification of 250 serum metabolome variables was conducted by NMR spectroscopy, body composition by dual-energy x-ray absorptiometry, dietary intake by food diaries, and exercise levels by training logs. Body fat percentage decreased from 19.5 ± 7.0% to 8.3 ± 5.3% (p < 0.001) in DIET through increased exercise levels and decreased energy intake, while CONT maintained those constant. In MID, DIET had increased (FDR < 0.01) HDL cholesterol, HDL particle size and number, and decreased (FDR < 0.05) VLDL lipids, serum triglycerides, and low-grade inflammation (glycoprotein acetyls) compared to baseline and CONT. The changes were associated with reduced android fat mass (-78 ± 13%) and energy intake (-28 ± 10%). In COMP, most of the metabolic changes found in MID persisted, except for altered triglycerides in all lipoprotein classes. After weight regain in POST, serum metabolome, body composition, energy intake, and exercise levels had reverted to baseline levels. In conclusion, fat loss and LEA may have beneficial yet transient effects on the serum cardiometabolic profile of lean individuals. Especially the HDL lipidome and lipoprotein triglycerides offer potential novel biomarkers for detecting LEA in athletes.
Collapse
Affiliation(s)
- I Jouhki
- Genomics and Biomarkers Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - H V Sarin
- Genomics and Biomarkers Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Jauhiainen
- Minerva Foundation Institute for Medical Research, Minerva Foundation, Helsinki, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - T M O'Connell
- Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - V Isola
- Faculty of Sport and Health Sciences, NeuroMuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - J P Ahtiainen
- Faculty of Sport and Health Sciences, NeuroMuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - J J Hulmi
- Faculty of Sport and Health Sciences, NeuroMuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - M Perola
- Genomics and Biomarkers Unit, Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
23
|
Stenqvist TB, Melin AK, Torstveit MK. Relative Energy Deficiency in Sport (REDs) Indicators in Male Adolescent Endurance Athletes: A 3-Year Longitudinal Study. Nutrients 2023; 15:5086. [PMID: 38140345 PMCID: PMC10745353 DOI: 10.3390/nu15245086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Longitudinal measurements of Relative Energy Deficiency in Sport (REDs) among adolescent male elite athletes are lacking. We aimed to monitor REDs indicators and their possible impact on performance in elite high-school cross-country skiing and biathlon athletes (n = 13) (16.3 ± 0.4 years, 179.4 ± 7.6 cm, 63.6 ± 8.2 kg body mass (BM), and peak oxygen uptake (VO2peak): 61.5 ± 5.3 mL/kg BM/min) every 6 months for 3 years. Protocols included assessments of energy availability (EA), body composition and bone mineral density (BMD), resting metabolic rate (RMR), disordered eating behavior, exercise addiction, VO2peak, and muscle strength. Data were analyzed using a linear mixed model. At baseline, 38% had low lumbar BMD (Z-score ≤ -1), and overall, bone health increased only slightly. VO2peak and muscle strength improved (p < 0.001), RMR decreased (p = 0.016), and no change was observed in EA or physiological or psychological REDs indicators. Conclusively, many of these young male athletes had poor bone health at baseline, and most either lost or did not achieve the expected pubertal bone mineral accrual, although no other indication of REDs was observed, while performance improved during the study period. Our findings highlight the importance of elite sports high schools focusing on screening for early detection of impaired bone health in male athletes.
Collapse
Affiliation(s)
- Thomas Birkedal Stenqvist
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway;
| | - Anna Katarina Melin
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 351 95 Vaxjo, Sweden;
| | - Monica Klungland Torstveit
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway;
| |
Collapse
|
24
|
Scheffer JH, Dunshea-Mooij CAE, Armstrong S, MacManus C, Kilding AE. Prevalence of low energy availability in 25 New Zealand elite female rowers - A cross sectional study. J Sci Med Sport 2023; 26:640-645. [PMID: 37802760 DOI: 10.1016/j.jsams.2023.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/14/2023] [Accepted: 09/19/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To quantify energy availability (EA) in elite female rowers, determine its association with bone mineral density (BMD), and examine the ability of the low energy availability in females-questionnaire (LEAF-Q) and brief eating disorder in athletes-questionnaire (BEDA-Q) to distinguish between low and normal EA. DESIGN Observational cross-sectional study. METHODS Twenty-five elite female rowers participated in the study. EA was calculated by means of a 4-day food intake diary and analysis of training load. Low energy availability (LEA) was defined as EA <30 kCal * kg-1 * FFM-1 * day-1. Dual-energy X-ray absorptiometry (DXA) was used to assess fat free mass (FFM) and BMD Z-scores. LEA risk was assessed using the LEAF-Q and BEDA-Q. RESULTS The mean EA was 23.2 ± 12.2 kCal * kg-1 * FFM-1 * day-1. Prevalence of LEA was 64 %. The mean BMD Z-score was 1.6 ± 0.6 (range: 0.7 to 2.9). Athletes with LEA had a significantly higher BEDA-Q score than the group with normal EA (mean 0.30 ± 0.17 vs. 0.09 ± 0.11, P < 0.05), but LEAF-Q score was not different between groups (mean 10.4 ± 4.6, 8.2 ± 4.5, P = 0.29). CONCLUSION Low energy availability is common amongst elite female rowers in New Zealand and is positively correlated with higher scores on the BEDA-Q. Bone mineral density was normal irrespective of EA status.
Collapse
Affiliation(s)
| | | | - Stuart Armstrong
- Rowing New Zealand/High Performance Sport New Zealand, New Zealand
| | | | - Andrew E Kilding
- Sport Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology/High Performance Sport New Zealand, New Zealand
| |
Collapse
|
25
|
Kettunen O, Mikkonen R, Linnamo V, Mursu J, Kyröläinen H, Ihalainen JK. Nutritional intake and anthropometric characteristics are associated with endurance performance and markers of low energy availability in young female cross-country skiers. J Int Soc Sports Nutr 2023; 20:2226639. [PMID: 37342913 DOI: 10.1080/15502783.2023.2226639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Low energy availability (LEA) can have negative performance consequences, but the relationships between LEA and performance are poorly understood especially in field conditions. In addition, little is known about the contribution of macronutrients to long-term performance. Therefore, the aim of this study was to evaluate if energy availability (EA) and macronutrient intake in a field-based situation were associated with laboratory-measured performance, anthropometric characteristics, blood markers, training volume, and/or questionnaire-assessed risk of LEA in young female cross-country (XC) skiers. In addition, the study aimed to clarify which factors explained performance. METHODS During a one-year observational study, 23 highly trained female XC skiers and biathletes (age 17.1 ± 1.0 years) completed 3-day food and training logs on four occasions (September-October, February-March, April-May, July-August). Mean (±SD) EA and macronutrient intake from these 12 days were calculated to describe yearly overall practices. Laboratory measurements (body composition with bioimpedance, blood hormone concentrations, maximal oxygen uptake (VO2max), oxygen uptake (VO2) at 4 mmol·L-1 lactate threshold (OBLA), double poling (DP) performance (time to exhaustion), counter movement jump (height) and the Low Energy Availability in Females Questionnaire (LEAF-Q)) were completed at the beginning (August 2020, M1) and end of the study (August 2021, M2). Annual training volume between measurements was recorded using an online training diary. RESULTS The 12-day mean EA (37.4 ± 9.1 kcal·kg FFM-1·d-1) and carbohydrate (CHO) intake (4.8 ± 0.8 g·kg-1·d-1) were suboptimal while intake of protein (1.8 ± 0.3 g·kg-1·d-1) and fat (31 ± 4 E%) were within recommended ranges. Lower EA and CHO intake were associated with a higher LEAF-Q score (r = 0.44, p = 0.042; r = 0.47, p = 0.026). Higher CHO and protein intake were associated with higher VO2max (r = 0.61, p = 0.005; r = 0.54, p = 0.014), VO2 at OBLA (r = 0.63, p = 0.003; r = 0.62, p = 0.003), and DP performance at M2 (r = 0.42, p = 0.051; r = 0.44, p = 0.039). Body fat percentage (F%) was negatively associated with CHO and protein intake (r = -0.50, p = 0.017; r = -0.66, p = 0.001). Better DP performance at M2 was explained by higher training volume (R2 = 0.24, p = 0.033) and higher relative VO2max and VO2 at OBLA at M2 by lower F% (R2 = 0.44, p = 0.004; R2 = 0.47, p = 0.003). Increase from M1 to M2 in DP performance was explained by a decrease in F% (R2 = 0.25, p = 0.029). CONCLUSIONS F%, and training volume were the most important factors explaining performance in young female XC skiers. Notably, lower F% was associated with higher macronutrient intake, suggesting that restricting nutritional intake may not be a good strategy to modify body composition in young female athletes. In addition, lower overall CHO intake and EA increased risk of LEA determined by LEAF-Q. These findings highlight the importance of adequate nutritional intake to support performance and overall health.
Collapse
Affiliation(s)
- Oona Kettunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Ritva Mikkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Vesa Linnamo
- Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Jaakko Mursu
- Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Heikki Kyröläinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Johanna K Ihalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| |
Collapse
|
26
|
Dallman J, Herda A, Cleary CJ, Morey T, Diederich A, Vopat BG, Vopat LM. A Brief Review of the Literature for Published Dual-Energy X-Ray Absorptiometry Protocols for Athletes. Sports Health 2023:19417381231208204. [PMID: 37953634 DOI: 10.1177/19417381231208204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
CONTEXT Dual-energy x-ray absorptiometry (DXA) is widely known for its utility in diagnosing a patient with osteopenia or osteoporosis; however, its utility in evaluation of body composition and potential athletic performance was previously routinely overlooked. In recent years, athletic programs have begun employing this equipment during athlete screening. However, it is currently unknown how athletic programs are utilizing this information to guide an athlete's training and health. OBJECTIVE To explore the literature to identify what is known regarding sports performance and athlete health based on body composition recordings. DATA SOURCES PubMed and Google Scholar databases were searched for this brief review. STUDY SELECTION A focus was placed on articles within the past 10 years that discussed DXA protocols within athletic populations; 14 articles were included in this brief literature review. STUDY DESIGN Brief literature review. LEVEL OF EVIDENCE Level 5. DATA EXTRACTION One member of the research team searched the literature and retrieved articles with the purpose of analyzing and/or explaining DXA imaging in body composition analysis of active persons (primarily athletes). RESULTS Quality assurance scans with a phantom calibration block as well as athlete prescreening condition and activity standardization was routinely recommended. However, only 1 study reported a specific DXA protocol for athletes, and only 1 study described guidelines for how to report DXA results in athletic populations, suggesting it is plausible yet difficult due to the small changes detectable. CONCLUSION Due to the limited literature as well as a lack of reference values for specific athletic populations, the authors of this review recommend using the current Nana et al (Int J Sport Nutr Exerc Metab 2015;25:198-215) DXA protocol for performing DXA scans in the athletic population as well as current Hind et al (J Clin Densitom 2018;21:429-443) guidelines for distributing the information.
Collapse
Affiliation(s)
| | - Ashley Herda
- University of Kansas Exercise and Human Performance Laboratory, Department of Health, Sport, and Exercise Sciences, Lawrence, Kansas
| | - Christopher J Cleary
- University of Kansas Exercise and Human Performance Laboratory, Department of Health, Sport, and Exercise Sciences, Lawrence, Kansas
| | - Tucker Morey
- University of Kansas Medical Center Department of Orthopedic Surgery, Kansas City, Kansas
| | - Andrew Diederich
- University of Kansas Medical Center Department of Orthopedic Surgery, Kansas City, Kansas
| | - Bryan G Vopat
- University of Kansas Medical Center Department of Orthopedic Surgery, Kansas City, Kansas
| | - Lisa M Vopat
- University of Kansas Medical Center Department of Orthopedic Surgery, Kansas City, Kansas
| |
Collapse
|
27
|
Norton KM, Davies RS, LeCheminant JD, Fullmer S. Educational Preparation and Course Approach of Undergraduate Sports Nutrition instructors in Large U.S. Institutions. Sports (Basel) 2023; 11:176. [PMID: 37755853 PMCID: PMC10536551 DOI: 10.3390/sports11090176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
College courses are often offered from various disciplines, and depending on which department offers the class, the course could be taught by faculty with different educational preparation or training. This could result in significant differences in the approach and content of the course (i.e., theoretical or applied) or a difference in the instructors' perceived importance and, therefore, the depth and time spent on various topics. We evaluated potential differences in the sports nutrition curriculum because it is a course that is usually taught by either nutritionists or exercise physiologists. A cross-sectional survey was sent to sports nutrition instructors at accredited large U.S. institutions. Descriptive statistics were analyzed via an ANOVA and Χ2 using Crosstabs in Qualtrics. Alpha was set at p < 0.001. Additionally, short interviews with some participants were recorded and transcribed verbatim. The findings of this study indicated that regardless of the instructor's educational preparation and discipline, the majority of sports nutrition topics received similar time and depth and were rated as similarly important (p > 0.001). Out of 10 current textbooks, the majority of instructors preferred only 1 of 4 of them. From the short interviews, instructors reported that their courses were more applied than theoretical or balanced between the two. Most instructors designed their courses with a focus on achieving applied outcomes.
Collapse
Affiliation(s)
- Kayla Marie Norton
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT 84602, USA
| | - Randall Spencer Davies
- Department of Instructional Psychology and Technology, Brigham Young University, Provo, UT 84602, USA
| | - James Derek LeCheminant
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT 84602, USA
| | - Susan Fullmer
- Department of Nutrition, Dietetics and Food Science, Brigham Young University, Provo, UT 84602, USA
| |
Collapse
|
28
|
Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023; 57:1073-1097. [PMID: 37752011 DOI: 10.1136/bjsports-2023-106994] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
Collapse
Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Naama Constantini
- Sports Medicine Center, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ida Aliisa Heikura
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anna Melin
- Department of Sport Science - Swedish Olympic Committee Research Fellow, Linnaeus University, Kalmar, Sweden
| | - Anne Marte Pensgaard
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trent Stellingwerff
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
- World Archery, Lausanne, Switzerland
| |
Collapse
|
29
|
Mathisen TF, Ackland T, Burke LM, Constantini N, Haudum J, Macnaughton LS, Meyer NL, Mountjoy M, Slater G, Sundgot-Borgen J. Best practice recommendations for body composition considerations in sport to reduce health and performance risks: a critical review, original survey and expert opinion by a subgroup of the IOC consensus on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023; 57:1148-1158. [PMID: 37752006 DOI: 10.1136/bjsports-2023-106812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND The assessment of body composition (BC) in sport raises concern for athlete health, especially where an overfocus on being lighter or leaner increases the risk of Relative Energy Deficiency in Sport (REDs) and disordered eating. METHODS We undertook a critical review of the effect of BC on performance (29 longitudinal, prospective or intervention studies) and explored current practice related to BC considerations via a follow-up to a 2013 internationally distributed survey. RESULTS The review found that a higher level of body fat was negatively associated with endurance performance, while a gain in muscle mass resulted in performance benefits across sports. BC did not contribute to early talent identification, and no unique cut-off to signify a performance advantage for BC was identified. BC appears to be one of an array of variables impacting performance, and its influence should not be overstated. The survey (125 practitioners, 61 sports and 26 countries) showed subtle changes in BC considerations over time, such as an increased role for sport dietitian/nutrition practitioners as BC measurers (2013: 54%, 2022: 78%); less emphasis on reporting of body fat percentage (2013: 68%, 2022: 46%) and reduced frequency of BC assessment if ≥every fourth week (2013: 18%, 2022: 5%). Respondents remained concerned about a problematic focus on BC (2013: 69%, 2022: 78%). To address these findings, we provide detailed recommendations for BC considerations, including an overview of preferable BC methodology. CONCLUSIONS The 'best practice' guidelines stress the importance of a multidisciplinary athlete health and performance team, and the treatment of BC data as confidential medical information. The guidelines provide a health focus around BC, aiming to reduce the associated burden of disordered eating, problematic low energy availability and REDs.
Collapse
Affiliation(s)
| | - Timothy Ackland
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise M Burke
- Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Naama Constantini
- Sport Medicine, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Judith Haudum
- Department of Sport and Exercise Science, University of Salzburg, Hallein-Rif, Salzburg, Austria
| | | | - Nanna L Meyer
- Department of Human Physiology and Nutrition, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- REDs Consensus Writing Group, International Olympic Committee, Lausanne, Switzerland
| | - Gary Slater
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | | |
Collapse
|
30
|
Burke LM, Ackerman KE, Heikura IA, Hackney AC, Stellingwerff T. Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs. Br J Sports Med 2023; 57:1098-1108. [PMID: 37752007 DOI: 10.1136/bjsports-2023-107335] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
The 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) notes that exposure to low energy availability (LEA) exists on a continuum between adaptable and problematic LEA, with a range of potential effects on both health and performance. However, there is variability in the outcomes of LEA exposure between and among individuals as well as the specific manifestations of REDs. We outline a framework for a 'systems biology' examination of the effect of LEA on individual body systems, with the eventual goal of creating an integrated map of body system interactions. We provide a template that systematically identifies characteristics of LEA exposure (eg, magnitude, duration, origin) and a variety of moderating factors (eg, medical history, diet and training characteristics) that could exacerbate or attenuate the type and severity of impairments to health and performance faced by an individual athlete. The REDs Physiological Model may assist the diagnosis of underlying causes of problems associated with LEA, with a personalised and nuanced treatment plan promoting compliance and treatment efficacy. It could also be used in the strategic prevention of REDs by drawing attention to scenarios of LEA in which impairments of health and performance are most likely, based on knowledge of the characteristics of the LEA exposure or moderating factors that may increase the risk of harmful outcomes. We challenge researchers and practitioners to create a unifying and dynamic physiological model for each body system that can be continuously updated and mapped as knowledge is gained.
Collapse
Affiliation(s)
- Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ida A Heikura
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Trent Stellingwerff
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
31
|
Ackerman KE, Rogers MA, Heikura IA, Burke LM, Stellingwerff T, Hackney AC, Verhagen E, Schley S, Saville GH, Mountjoy M, Holtzman B. Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs. Br J Sports Med 2023; 57:1136-1147. [PMID: 37752010 DOI: 10.1136/bjsports-2023-107359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/28/2023]
Abstract
In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent or young adult, female athletes. Much of the existing physiology and concepts, however, are either based on or extrapolated from limited studies, and the comparison of studies is hindered by the lack of standardised protocols. In this review, we have evaluated and outlined current best practice methodologies to study REDs in an attempt to guide future research.This includes an agreement on the definition of key terms, a summary of study designs with appropriate applications, descriptions of best practices for blood collection and assessment and a description of methods used to assess specific REDs sequelae, stratified as either Preferred, Used and Recommended or Potential Researchers can use the compiled information herein when planning studies to more consistently select the proper tools to investigate their domain of interest. Thus, the goal of this review is to standardise REDs research methods to strengthen future studies and improve REDs prevention, diagnosis and care.
Collapse
Affiliation(s)
- Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margot Anne Rogers
- Australian Institute of Sport, Bruce, South Australia, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia
| | - Ida A Heikura
- Canadian Sport Institute-Pacific, Victoria, British Columbia, Canada
- Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Louise M Burke
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Victoria, British Columbia, Canada
- Department of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports and Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Stacey Schley
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Grace H Saville
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Mass General for Children, Boston, Massachusetts, USA
| |
Collapse
|
32
|
Torstveit MK, Ackerman KE, Constantini N, Holtzman B, Koehler K, Mountjoy ML, Sundgot-Borgen J, Melin A. Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med 2023; 57:1119-1126. [PMID: 37752004 DOI: 10.1136/bjsports-2023-106932] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.
Collapse
Affiliation(s)
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naama Constantini
- Sport Medicine, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Anna Melin
- Department of Sport Science, Linnaeus University, Vaxjo/Kalmar, Sweden
| |
Collapse
|
33
|
Gogojewicz A, Straburzyńska-Lupa A, Podgórski T, Frajtag P, Bibrowicz K, Śliwicka E. Assessment of the Dietary Intake and Nutritional Status of Polish Professional Futsal Players: A Descriptive Study-Do Futsal Players Require Nutritional Education? Nutrients 2023; 15:3720. [PMID: 37686752 PMCID: PMC10490003 DOI: 10.3390/nu15173720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Futsal is a discipline with high training and nutritional requirements. Despite growing research interest in athletes' diet and nutritional status, no studies have examined Polish male futsal players. Therefore, the aim of this descriptive study was an assessment of the dietary intake and nutritional status in a selected group of futsal players. The study comprised 11 members of a top Polish futsal team (aged 26 ± 3.62 years). Dietary intake was assessed using a standardized 3-day food record. Body composition, total energy expenditure, physical fitness level, and concentrations of the biochemical indices of each participant were estimated. The energy availability in the diet was lower than recommended. Moreover, low consumption of carbohydrates was stated, as well as an inadequate intake of Vitamins E and D. Higher protein and cholesterol intake than recommended were also observed. To conclude, our results point to the need for educating athletes and coaches, particularly teaching about proper food choices, promoting quality foods, and, in some cases, using individual dietary plans to meet energy and nutrient needs. Nutrition education would help to improve their dietary and health habits and optimize their performance in sports training.
Collapse
Affiliation(s)
- Anna Gogojewicz
- Department of Food and Nutrition, Poznan University of Physical Education, 61-871 Poznań, Poland;
| | - Anna Straburzyńska-Lupa
- Department of Physical Therapy and Sports Recovery, Poznan University of Physical Education, 61-871 Poznań, Poland; (A.S.-L.); (P.F.)
| | - Tomasz Podgórski
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-871 Poznań, Poland;
| | - Paulina Frajtag
- Department of Physical Therapy and Sports Recovery, Poznan University of Physical Education, 61-871 Poznań, Poland; (A.S.-L.); (P.F.)
| | - Karol Bibrowicz
- Department Science and Research Center of Body Posture, Kazimiera Milanowska College of Education and Therapy, 61-473 Poznań, Poland;
| | - Ewa Śliwicka
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-871 Poznań, Poland;
| |
Collapse
|
34
|
Siedler MR, De Souza MJ, Albracht-Schulte K, Sekiguchi Y, Tinsley GM. The Influence of Energy Balance and Availability on Resting Metabolic Rate: Implications for Assessment and Future Research Directions. Sports Med 2023; 53:1507-1526. [PMID: 37213050 DOI: 10.1007/s40279-023-01856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
Resting metabolic rate (RMR) is a significant contributor to an individual's total energy expenditure. As such, RMR plays an important role in body weight regulation across populations ranging from inactive individuals to athletes. In addition, RMR may also be used to screen for low energy availability and energy deficiency in athletes, and thus may be useful in identifying individuals at risk for the deleterious consequences of chronic energy deficiency. Given its importance in both clinical and research settings within the fields of exercise physiology, dietetics, and sports medicine, the valid assessment of RMR is critical. However, factors including varying states of energy balance (both short- and long-term energy deficit or surplus), energy availability, and prior food intake or exercise may influence resulting RMR measures, potentially introducing error into observed values. The purpose of this review is to summarize the relationships between short- and long-term changes in energetic status and resulting RMR measures, consider these findings in the context of relevant recommendations for RMR assessment, and provide suggestions for future research.
Collapse
Affiliation(s)
- Madelin R Siedler
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Mary Jane De Souza
- Departments of Kinesiology and Physiology, Pennsylvania State University, University Park, PA, USA
| | | | - Yasuki Sekiguchi
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA.
| |
Collapse
|
35
|
BURKE LOUISEM, WHITFIELD JAMIE, ROSS MEGANLR, TEE NICOLIN, SHARMA AVISHP, KING ANDYJ, HEIKURA IDAA, MORABITO AIMEE, MCKAY ALANNAHKA. Short Severe Energy Restriction with Refueling Reduces Body Mass without Altering Training-Associated Performance Improvement. Med Sci Sports Exerc 2023; 55:1487-1498. [PMID: 36940222 PMCID: PMC10348613 DOI: 10.1249/mss.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE We investigated short-term (9 d) exposure to low energy availability (LEA) in elite endurance athletes during a block of intensified training on self-reported well-being, body composition, and performance. METHODS Twenty-three highly trained race walkers undertook an ~3-wk research-embedded training camp during which they undertook baseline testing and 6 d of high energy/carbohydrate (HCHO) availability (40 kcal·kg FFM -1 ·d -1 ) before being allocated to 9 d continuation of this diet ( n = 10 M, 2 F) or a significant decrease in energy availability to 15 kcal·kg FFM -1 ·d -1 (LEA: n = 10 M, 1 F). A real-world 10,000-m race walking event was undertaken before (baseline) and after (adaptation) these phases, with races being preceded by standardized carbohydrate fueling (8 g·kg body mass [BM] -1 for 24 h and 2 g·kg BM -1 prerace meal). RESULTS Dual-energy x-ray absorptiometry-assessed body composition showed BM loss (2.0 kg, P < 0.001), primarily due to a 1.6-kg fat mass reduction ( P < 0.001) in LEA, with smaller losses (BM = 0.9 kg, P = 0.008; fat mass = 0.9 kg, P < 0.001) in HCHO. The 76-item Recovery-Stress Questionnaire for Athletes, undertaken at the end of each dietary phase, showed significant diet-trial effects for overall stress ( P = 0.021), overall recovery ( P = 0.024), sport-specific stress ( P = 0.003), and sport-specific recovery ( P = 0.012). However, improvements in race performance were similar: 4.5% ± 4.1% and 3.5% ± 1.8% for HCHO and LEA, respectively ( P < 0.001). The relationship between changes in performance and prerace BM was not significant ( r = -0.08 [-0.49 to 0.35], P = 0.717). CONCLUSIONS A series of strategically timed but brief phases of substantially restricted energy availability might achieve ideal race weight as part of a long-term periodization of physique by high-performance athletes, but the relationship between BM, training quality, and performance in weight-dependent endurance sports is complicated.
Collapse
Affiliation(s)
- LOUISE M. BURKE
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - JAMIE WHITFIELD
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - MEGAN L. R. ROSS
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - NICOLIN TEE
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | | | - ANDY J. KING
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - IDA A. HEIKURA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
- Canadian Sport Institute–Pacific, Victoria, British Columbia, CANADA
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, CANADA
| | - AIMEE MORABITO
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - ALANNAH K. A. MCKAY
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| |
Collapse
|
36
|
Mey JT, Karpinski CA, Yang S, Madere JD, Piattoly T, Harper R, Kirwan JP. Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions. JMIR Form Res 2023; 7:e45098. [PMID: 37494083 PMCID: PMC10413240 DOI: 10.2196/45098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/29/2023] [Accepted: 06/16/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). OBJECTIVE The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes' and sport professionals' perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. METHODS An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. RESULTS Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. "Health" and "sports performance" were the highest scoring motivators, while the highest scoring barriers were "cost of food," "easy access to unhealthy food," and "time to cook or prepare food." Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. CONCLUSIONS The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance.
Collapse
Affiliation(s)
- Jacob T Mey
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | | | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Joseph D Madere
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Tavis Piattoly
- My Sports Dietitian, LLC, Baton Rouge, LA, United States
| | - Ronnie Harper
- My Sports Dietitian, LLC, Baton Rouge, LA, United States
| | - John P Kirwan
- Pennington Biomedical Research Center, Baton Rouge, LA, United States
| |
Collapse
|
37
|
Curtis C, Arjomandkhah N, Cooke C, Ranchordas MK, Russell M. Estimated Energy Expenditures and Energy Intakes of International Female Rugby Sevens Players in Five Days of a Training Camp and Competition Preparation. Nutrients 2023; 15:3192. [PMID: 37513610 PMCID: PMC10383934 DOI: 10.3390/nu15143192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
To understand the energy balance of international female rugby sevens (R7s) players in applied environments, this study estimated the energy intakes (EI) and total daily estimated energy expenditures (TDEE) during a five-day training camp (TRAIN) and phase of competition preparation (COMP) of equal duration. Tri-axial accelerometer devices were worn throughout both scenarios to estimate TDEE, whereas EI was estimated via self-reported food diaries. Energy deficits of -47% (TDEETRAIN: 14.6 ± 1.6 MJ·day-1, EITRAIN: 7.7 ± 0.9 MJ·day-1, p ≤ 0.001, d = 5.1) and -50% (TDEECOMP: 15.5 ± 1.6 MJ·day-1, EICOMP: 7.7 ± 1.0 MJ·day-1, p ≤ 0.001, d = 5.7) were observed throughout TRAIN (n = 11; age: 25 ± 4 years, height: 170 ± 6 cm, weight: 71 ± 7 kg) and COMP (n = 8; age: 25 ± 3 years, height: 172 ± 5 cm, weight: 72 ± 6 kg), respectively. Carbohydrate intakes were below the lower range of sports nutrition recommendations in both TRAIN (-62%; 2.3 ± 0.3 g·kg-1 BM, p ≤ 0.001) and COMP (-60%; 2.4 ± 0.5 g·kg-1 BM, p ≤ 0.001). For protein (TRAIN: 1.7 ± 0.4 g·kg-1 BM, COMP: 1.5 ± 0.1 g·kg-1 BM), intakes met the lower range of recommendations. Fat intake exceeded recommendations of the percentage of total EI (COMP: 39 ± 5%). Accordingly, the dietary strategies of international female R7s players may warrant optimization, as carbohydrate and fat intakes were less than optimal when compared to current performance-based sports nutrition guidelines.
Collapse
Affiliation(s)
- Christopher Curtis
- School of Social and Health Sciences, Leeds Trinity University, Leeds LS18 5HD, UK
- School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain
| | - Nicola Arjomandkhah
- School of Social and Health Sciences, Leeds Trinity University, Leeds LS18 5HD, UK
| | - Carlton Cooke
- Carnegie School of Sport, Leeds Beckett University, Headingley Campus, Leeds LS6 3QS, UK
| | - Mayur K Ranchordas
- Academy of Sport and Physical Activity, Health Research Institute and Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK
| | - Mark Russell
- School of Social and Health Sciences, Leeds Trinity University, Leeds LS18 5HD, UK
| |
Collapse
|
38
|
Dasa MS, Friborg O, Kristoffersen M, Pettersen G, Sagen JV, Sundgot-Borgen J, Rosenvinge JH. Evaluating the Suitability of the Low Energy Availability in Females Questionnaire (LEAF-Q) for Female Football Players. SPORTS MEDICINE - OPEN 2023; 9:54. [PMID: 37439966 DOI: 10.1186/s40798-023-00605-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The Low Energy Availability in Females Questionnaire (LEAF-Q) is a screening tool developed to detect endurance athletes and dancers at risk for development of persistent low energy availability (LEA) and the female athlete triad (Triad). This study investigated the applicability of the LEAF-Q in a cohort of sixty professional female football players. METHODS The participants were classified as at risk (≥ 8) or not at risk (< 8) for persistent LEA and the Triad according to their LEAF-Q score, before being compared. Receiver operating curves were then conducted to examine the ability of the overall LEAF-Q and subcategories to correctly determine the presence of clinically defined markers of the Triad. Additionally, Youden's index was calculated to determine the best fitting cut-off values. RESULTS Thirty-two percent of participants were classified as at risk by the LEAF-Q. We found no statistically significant differences between the two groups for any markers associated with persistent LEA. Except for acceptable accuracy in determining menstrual status, all other LEAF-Q components exhibited poor accuracy and predictive values. Youden's index scores imply that increasing the overall and injury cut-off values to ≥ 10 and ≥ 5 respectively, would yield increased performance. CONCLUSIONS Our findings do not support the use of the LEAF-Q for the purpose of detecting LEA and Triad conditions among female football players.
Collapse
Affiliation(s)
- Marcus S Dasa
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Oddgeir Friborg
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Morten Kristoffersen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Jørn V Sagen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | | | - Jan H Rosenvinge
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
39
|
Garron T, Klein DJ. Male Army ROTC Cadets Fail to Meet Military Dietary Reference Intakes and Exhibit a High Prevalence of Low Energy Availability and Poor Sleep Quality. J Funct Morphol Kinesiol 2023; 8:95. [PMID: 37489308 PMCID: PMC10366743 DOI: 10.3390/jfmk8030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
The purpose of this study was to assess the dietary habits, prevalence of low energy availability (EA), and sleep quality in a cohort of male army Reserve Officer Training Corps (ROTC) cadets, and to investigate the relationship between EA and sleep quality as well as EA and various body composition variables that are important for tactical readiness. Thirteen male army ROTC cadets (22.2 ± 4.1 yrs; BMI: 26.1 ± 2.3) had their EA and body composition assessed using diet and exercise records alongside bioelectrical impedance analysis. Cadets also completed a validated sleep questionnaire. Sixty-two percent of participants presented with clinically low EA (<30 kcal/kg fat-free mass [FFM]) and none met the optimum EA threshold (≥45 kcal/kg FFM). Dietary analysis indicated that 15%, 23%, 46%, 23%, and 7% of cadets met the Military Dietary Reference Intakes (MDRI) for calories, carbohydrates, protein, fat, and fiber, respectively. Additionally, 85% of cadets exhibited poor sleep quality. Significant associations between EA and fat mass/percent body fat were shown (p < 0.05). There was, however, no statistically significant correlation between EA and sleep quality. The present study found a high prevalence of low EA and sleep disturbance among male army ROTC cadets and that many were unable to meet the MDRIs for energy and macronutrient intake. Further, low EA was associated with higher percent body fat and fat mass but not sleep quality.
Collapse
Affiliation(s)
- Taylor Garron
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
| | - Dylan J Klein
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
| |
Collapse
|
40
|
Klein DJ, McClain P, Montemorano V, Santacroce A. Pre-Season Nutritional Intake and Prevalence of Low Energy Availability in NCAA Division III Collegiate Swimmers. Nutrients 2023; 15:2827. [PMID: 37447154 DOI: 10.3390/nu15132827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
There is limited information regarding the dietary habits and energy availability (EA) of collegiate athletes. Therefore, the purpose of the present study is to assess the nutrient intakes, dietary habits, and prevalence of low EA (<30 kcals/kg FFM) in a group of National Collegiate Athletic Association (NCAA) Division III male and female swimmers. Energy and nutrient intake, body composition, and exercise energy expenditure was assessed in 30 (n = 15 males, n = 15 females) NCAA Division III swimmers during pre-season using three-day diet and seven-day activity records alongside multi-frequency, bioelectric impedance analysis. A validated screening tool was used to assess for low EA in the female swimmers. Mean EA in male and female athletes was 32.7 ± 12 and 34.9 ± 13.7 kcals/kg FFM, respectively, and was not significantly different between the sexes (p = 0.65). Twenty percent of swimmers (n = 3 males, n = 3 females) presented with optimal EA, 37% (n = 5 males, n = 6 females) presented with sub-optimal EA, and 43% (n = 7 males, n = 6 females) presented with low EA. Swimmers who presented with a low EA consumed significantly less calories, carbohydrates, and proteins than non-low EA swimmers (p < 0.02). The validated screening tool failed to classify 50% of female swimmers who presented with low EA. Only eight athletes achieved the USDA MyPlate recommendation for fruits, whereas three athletes achieved the recommendation for vegetables, with no differences between the sexes (p > 0.05). The present findings show that there was a high prevalence of low EA during the pre-season among male and female collegiate swimmers that was not fully captured using a validated screening tool for females. Low EA occurred alongside lower intakes of calories, carbohydrates, and proteins, and the majority of swimmers did not meet the United States Department of Agriculture recommendations for fruit and vegetable intake. These data stress the need for improved dietary intakes in NCAA Division III collegiate swimmers.
Collapse
Affiliation(s)
- Dylan J Klein
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
| | - Patrick McClain
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
| | - Victoria Montemorano
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
| | - Alaina Santacroce
- Department of Health and Exercise Science, Rowan University, Glassboro, NJ 08028, USA
| |
Collapse
|
41
|
Baceviciene M, Jankauskiene R, Rutkauskaite R. The Comparison of Disordered Eating, Body Image, Sociocultural and Coach-Related Pressures in Athletes across Age Groups and Groups of Different Weight Sensitivity in Sports. Nutrients 2023; 15:2724. [PMID: 37375628 DOI: 10.3390/nu15122724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of the present study was to compare disordered eating (DE), body image, and sociocultural and coach-related pressures between athletes of different age groups (adolescents and adults) and between athletes participating in weight-sensitive (WS) and less WS groups. A total of 1003 athletes participated in this study. The age range of the sample was 15 to 44 years, and the mean age was 18.9 ± 5.8 years (51.3% were female). Athletes who voluntarily agreed to participate in the study were provided with the study measures on DE, body image and sociocultural attitudes towards appearance. Vomiting, laxative misuse and excessive exercise were more prevalent in adolescent female athletes than adults, while dietary restraint was more common in adult male athletes than adolescents. Adolescent female athletes experienced higher sociocultural (family, peers) and sport-related (coach) pressures and a less positive body image compared with adult female athletes. Adult male athletes experienced higher overweight preoccupation, more DE and unhealthy eating habits, and engaged in more frequent self-weighing behaviour compared with adolescent males. When the effect of weight sensitivity in sports was tested, a higher prevalence of DE and overweight preoccupation, more frequent self-weighing, and higher body-image-related pressure from coaches were observed in female athletes participating in aesthetic weight-sensitive (WS) sports as compared with those participating in less WS sports. No differences in positive body image were observed in female WS and less WS sports. Special DE prevention and positive body image promotion programs are necessary for female competitive athletes and parents of adolescent female athletes, especially those participating in aesthetic ones. For adult male athletes, special programs aiming to promote healthy eating should be implemented to prevent DE and body image concerns. Special education about DE prevention is compulsory for coaches who train female athletes.
Collapse
Affiliation(s)
- Migle Baceviciene
- Department of Physical and Social Education, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Rasa Jankauskiene
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Renata Rutkauskaite
- Department of Physical and Social Education, Lithuanian Sports University, 44221 Kaunas, Lithuania
| |
Collapse
|
42
|
Abstract
Females are often underrepresented in the scientific literature, but awareness of the need for female-specific research is increasing. Review articles have been published on the effects of the menstrual cycle on aspects of exercise performance and physiology, yet to date no research has reviewed the effect of menstrual cycle phase on dietary energy intake. Fluctuations in endogenous sex hormones across the menstrual cycle influence a range of physiological processes, including those involved in nutritional status. Observational research typically quantifies female athletes' nutritional intakes at a single time point; however, this may provide inaccurate information if dietary intake fluctuates across the menstrual cycle. Similarly, this may have implications for interventional research, where dietary intake is often poorly controlled or monitored. This review aimed to synthesize the published literature on dietary energy intakes of naturally menstruating females in various phases of the menstrual cycle. The review critiques the relevant literature in light of recent publications on good practice for female research, explores the impact of the menstrual cycle on energy intake, identifies gaps within the evidence base, and informs future research. Overall, energy intake appears to be lower in the follicular phase compared with the luteal phase, with a particular decrease in the days leading up to and including ovulation. The magnitude of these fluctuations is not yet clearly quantifiable and most likely varies, both between individuals, and from cycle to cycle. This review notes the lack of high-quality research investigating the energy intakes of females across the menstrual cycle, and the very limited data available for female athletes and others who undertake large amounts of physical activity. It also highlights the need for researchers to take into consideration anovulatory cycles and the potential effects of premenstrual disorders on dietary intake.
Collapse
Affiliation(s)
- Michaela M Rogan
- are with the Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Katherine E Black
- K.E. Black, Department of Human Nutrition, University of Otago, PO Box 54, Dunedin, Otago, New Zealand. E-mail:
| |
Collapse
|
43
|
Hertig-Godeschalk A, Ruettimann B, Valido E, Glisic M, Stoyanov J, Flueck JL. Energy Availability and Nutritional Intake during Different Training Phases of Wheelchair Athletes. Nutrients 2023; 15:nu15112578. [PMID: 37299541 DOI: 10.3390/nu15112578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Optimizing nutritional intake and timing helps athletes to improve performance and long-term health. Different training phases can require varying nutritional needs. In this study, we conducted a descriptive assessment of dietary intake, energy availability (EA), and blood biochemical parameters in elite wheelchair athletes during distinct training phases. Data analyzed in this study were collected as part of a randomized controlled crossover trial exploring the feasibility of probiotics and prebiotic supplementation. Data were obtained from consecutive three-day diaries and blood samples, both collected at four different time points across four consecutive months. We included 14 athletes (mean (standard deviation) age 34 (9) years, eight females, and six males) active in different wheelchair sports. The mean daily nutritional intake (g/kg body mass) for females and males was 2.7 (0.9) and 4.0 (0.7) for carbohydrates, 1.1 (0.3) and 1.5 (0.3) for protein, and 0.8 (0.3) and 1.4 (0.2) for fat. EA did not change across the four time points in either female (p = 0.30) or male (p = 0.05) athletes. The mean EA was lower in female athletes compared to male athletes (p = 0.03). Low EA (≤30 kcal/ kg fat-free mass/day) was observed in female (58 (29) % of days) and male (34 (23) % of days) athletes. Iron deficiency with anemia was observed in two female athletes. Mean vitamin D levels were insufficient (<75 nmol/L). Macronutrient intake, EA, and blood biochemical parameters were suboptimal in this cohort of elite wheelchair athletes, especially in female athletes.
Collapse
Affiliation(s)
- Anneke Hertig-Godeschalk
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207 Nottwil, Switzerland
| | - Belinda Ruettimann
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207 Nottwil, Switzerland
| | - Ezra Valido
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences, University of Lucerne, 6002 Lucerne, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, 3012 Bern, Switzerland
| | - Joelle L Flueck
- Institute of Sports Medicine, Swiss Paraplegic Centre Nottwil, 6207 Nottwil, Switzerland
| |
Collapse
|
44
|
Barrack MT, Domino S, Gray VB, Cotter JA, Rauh MJ, Nichols JF. Support for inadvertent undereating in female adolescent athletes with clinical indicators of low energy availability. J Sci Med Sport 2023:S1440-2440(23)00072-5. [PMID: 37248163 DOI: 10.1016/j.jsams.2023.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVES This study evaluated pathways to low energy availability in a sample of female adolescent athletes (n = 464). DESIGN Cross-sectional. METHODS Participants (age 13-18 y) underwent assessments for height, weight, eating attitudes and behaviors, and menstrual function. Bone mineral density and body composition were evaluated by dual-energy x-ray absorptiometry in a subset of participants (n = 209). Athletes were classified with clinical indicators of low energy availability if they met criteria for 1) primary or secondary amenorrhea or 2) clinical underweight status (body mass index-for-age < 5th percentile). Disordered eating was assessed using the Eating Disorder Examination Questionnaire. RESULTS Thirty (6.5%) athletes exhibited clinical indicators of low energy availability, with higher estimates in leanness than non-leanness sports (10.9% vs. 2.1%, p < 0.005). Among athletes with clinical indicators of low energy availability, 80% (n = 24) did not meet criteria for disordered eating, eating disorder, or report the desire to lose weight. Athletes with (vs. without) clinical indicators of low energy availability exhibited lower lumbar spine (-1.30 ± 1.38 vs. -0.07 ± 1.21, p < 0.001) and total body (-0.30 ± 0.98 vs. 0.53 ± 0.97, p < 0.006) bone mineral density Z-scores. CONCLUSIONS A majority of female adolescent athletes with clinical indicators of low energy availability did not exhibit characteristics consistent with intentional dietary restriction, supporting the significance of the inadvertent pathway to low energy availability and need for increased nutrition education in this population.
Collapse
Affiliation(s)
- Michelle T Barrack
- Department of Family and Consumer Sciences, California State University Long Beach, United States of America.
| | - Sarah Domino
- Department of Family and Consumer Sciences, California State University Long Beach, United States of America
| | - Virginia B Gray
- Department of Family and Consumer Sciences, California State University Long Beach, United States of America
| | - Joshua A Cotter
- Department of Kinesiology, California State University Long Beach, United States of America
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, United States of America
| | - Jeanne F Nichols
- Herbert Wertheim School of Public Health, University of California San Diego, United States of America; School of Exercise and Nutritional Sciences, San Diego State University, United States of America
| |
Collapse
|
45
|
Maekawa M, Miyamoto A, Ariyoshi H, Miura K. A Survey of the Menstrual Status of Female College Students. Healthcare (Basel) 2023; 11:healthcare11081108. [PMID: 37107942 PMCID: PMC10137779 DOI: 10.3390/healthcare11081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Education about menstruation is a sensitive topic for young female students; providing appropriate knowledge is essential for maintaining and improving their health. The present study was conducted to collect data corresponding to different factors affecting health among young individuals; the menstrual status, exercise habits, sleep status, and body composition of these individuals as well as the relationships among these factors, were evaluated. Altogether, 200 female students responded to the survey; 129 completed all the physical measurement items. As a case study, face-to-face interviews regarding menstrual symptoms were conducted. Results showed that 49/200 (25%) and 120/200 (60%) participants experienced moderate or severe pain before and during menstruation, respectively. The degree of pain one week before menstruation and during menstruation were significantly positively correlated (r = 0.573, p < 0.01). When analyzed as group data, it was difficult to identify the relationship between menstrual status, exercise habits, and sleep status; these were found to be intricately associated with various factors. The case study analysis confirmed that some individuals experienced physical and psychological symptoms, such as irregular menstrual cycles, premenstrual syndrome, and severe menstrual cramps.
Collapse
Affiliation(s)
- Maki Maekawa
- Department of Physical Education, International Pacific University, 721 Kanonji, Seto-cho, Higashi-ku, Okayama 709-0863, Japan
| | - Aya Miyamoto
- Department of Physical Education, International Pacific University, 721 Kanonji, Seto-cho, Higashi-ku, Okayama 709-0863, Japan
| | - Hiromi Ariyoshi
- Ariyoshi Occupational Health Consultant Office, Fukuoka 815-0038, Japan
| | - Koji Miura
- Department of Physical Education, International Pacific University, 721 Kanonji, Seto-cho, Higashi-ku, Okayama 709-0863, Japan
| |
Collapse
|
46
|
Hamstra-Wright KL, Bliven KCH, Coumbe-Lilley JE, Djelovic E, Patel J. The Relationship Between Eating Disorders, Disordered Eating, and Injury in Athletes: A Critically Appraised Topic. J Sport Rehabil 2023; 32:474-481. [PMID: 37030667 DOI: 10.1123/jsr.2022-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/14/2023] [Accepted: 02/02/2023] [Indexed: 04/10/2023]
Abstract
CLINICAL SCENARIO Eating disorders (EDs) and disordered eating (DE) result in numerous physical and psychological complications for female and male athletes. Besides bone-related injury, little research exists investigating what injuries EDs and/or DE contribute to. CLINICAL QUESTION Are EDs and/or DE a risk factor for injury incidence in athletes? SUMMARY OF KEY FINDINGS We searched for prospective studies assessing EDs or DE as a risk factor for injury in female or male athletes high school age and older. Our search returned 5 studies. One study found Eds, or DE were not a risk for any type of injury in female cross-country and track-and-field athletes. Two studies found a possible relationship between EDs or DE, as one contributing factor of others, in the incidence of bone stress injuries (BSIs) in female athletes who compete in various sports. One study found female, but not male, cross-country and track-and-field athletes with a history of EDs were more at risk for stress fractures than those without a history. One study found Eds, or DE were not a risk for BSI in female runners and triathletes. CLINICAL BOTTOM LINE Large and important gaps in the literature exist investigating injuries related to EDs or DE outside of BSIs. There is low-moderate evidence that EDs and/or DE are either a sole, or contributing, risk factor for BSIs in female athletes. STRENGTH OF RECOMMENDATION Grade B evidence exists to support the idea that EDs and/or DE are a risk factor for a specific type of injury (BSI) in female athletes only.
Collapse
Affiliation(s)
- Karrie L Hamstra-Wright
- Department of Kinesiology and Nutrition, Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, University of Illinois at Chicago, Chicago, IL,USA
| | - Kellie C Huxel Bliven
- Department of Interdisciplinary Health Studies, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ,USA
| | - John E Coumbe-Lilley
- Department of Kinesiology and Nutrition, Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, University of Illinois at Chicago, Chicago, IL,USA
| | - Eddin Djelovic
- Department of Kinesiology and Nutrition, Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, University of Illinois at Chicago, Chicago, IL,USA
| | - Jahnvi Patel
- Department of Kinesiology and Nutrition, Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, University of Illinois at Chicago, Chicago, IL,USA
| |
Collapse
|
47
|
Purdom T, Cook M, Colleran H, Stewart P, San Diego L. Low Energy Availability (LEA) and Hypertension in Black Division I Collegiate Athletes: A Novel Pilot Study. Sports (Basel) 2023; 11:sports11040081. [PMID: 37104155 PMCID: PMC10143550 DOI: 10.3390/sports11040081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023] Open
Abstract
The purpose of this study was to investigate the relationship between low energy availability (LEA) and nutritional content with high blood pressure (HBP) in African American Division I athletes. Twenty-three D1 African American pre-season athletes were recruited to participate. HBP was defined as >120 systolic blood pressure (BP) and <80 diastolic BP. Athletes self-reported nutritional intake using a non-consecutive 3-day food recall which was then reviewed by a sports dietitian. LEA was evaluated as total energy intake-total daily energy expenditure (TDEE), which was predicted. Additionally, micronutrients were evaluated. A statistical analysis relied on Spearman correlation (R), standardized mean difference with 95% confidence interval, mean ± SD, and odds ratios (OR). Correlation values were categorized: 0.20-0.39 = low; 0.40-0.69 = moderate; 0.70-1.0 = strong. A moderate relationship was observed between HBP and LEA (R = 0.56) with 14/23 having HBP. Of the 14 athletes observed with HBP, 78.5% (11/14) were calorically deficient (-529 ± 695 kcal) with an OR of 7.2. Micronutrient intake deficiencies were ubiquitous among the 23 HBP athletes: poly-unsaturated fatty acid -29.6%; omega-3 -26.0%; iron -46.0%; calcium -25.1%; and sodium -14.2%, amongst others. LEA and micronutrient deficiencies may contribute to HBP in Black D1 athletes, which has been shown to be the most common modifiable risk factor to decrease the risk of sudden cardiac death.
Collapse
Affiliation(s)
- Troy Purdom
- Department of Kinesiology, North Carolina Agricultural and Technical State University, Greensboro, NC 27401, USA
| | - Marc Cook
- Department of Kinesiology, North Carolina Agricultural and Technical State University, Greensboro, NC 27401, USA
| | - Heather Colleran
- Department of Family and Consumer Sciences, North Carolina Agricultural and Technical State University, Greensboro, NC 27401, USA
| | - Paul Stewart
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lauren San Diego
- Department of Family and Consumer Sciences, North Carolina Agricultural and Technical State University, Greensboro, NC 27401, USA
| |
Collapse
|
48
|
Marzuki MIH, Mohamad MI, Chai WJ, Farah NMF, Safii NS, Jasme JK, Jamil NA. Prevalence of Relative Energy Deficiency in Sport (RED-S) among National Athletes in Malaysia. Nutrients 2023; 15:nu15071697. [PMID: 37049534 PMCID: PMC10096906 DOI: 10.3390/nu15071697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Relative energy deficiency in sport (RED-S), which underpins the concept of low energy availability (LEA), can negatively affect athletes’ health and performance. This study aims to investigate the prevalence of RED-S among national athletes in Malaysia. A total of 192 national athletes (97 males, 18–39 years old) responded to an online survey regarding the RED-S risk. Most athletes (67.2%) were classified as having a medium/high RED-S risk. Female (41.2%), weight-class (23.9%), and intermittent sports (20.3%) had the highest prevalence of medium/high RED-S risk. Overall, most athletes spent 2–5 h daily (55.2%) and 6–7 days weekly (53.6%) practicing or playing their sport, and 47.9% reported feeling tired recently. The athletes were also terrified of being overweight (61.5%), worried about what they eat (64.7%), concerned about having fat on their bodies (62.6%), and thinking about burning calories while exercising (69.3%). Only 16.7% of the athletes had a prior history of stress fractures, and 40.6% continued to participate in activities 6–7 days per week while injured. The majority of female athletes (88.3%) had regular menstrual cycles. These findings support the notion that RED-S screening should be addressed in the athletic community. Future research is needed to clinically assess these athletes and investigate the impacts of RED-S on their health and sports performance.
Collapse
Affiliation(s)
- Muhammad Irfan Haiqal Marzuki
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Mohd Izham Mohamad
- Sports Nutrition Centre, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Wen Jin Chai
- Sports Nutrition Centre, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Nor M. F. Farah
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Nik Shanita Safii
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Jasmiza Khuzairi Jasme
- Sports Medicine Centre, National Sports Institute of Malaysia, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Nor Aini Jamil
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
- Correspondence:
| |
Collapse
|
49
|
Ellis DG, Speakman J, Hambly C, Morton JP, Close GL, Donovan TF. An Observational Case Series Measuring the Energy Expenditure of Elite Tennis Players During Competition and Training by Using Doubly Labeled Water. Int J Sports Physiol Perform 2023; 18:547-552. [PMID: 36965488 DOI: 10.1123/ijspp.2022-0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE An understanding of an athlete's total daily energy expenditure (TEE) is necessary to inform nutritional strategies, particularly where daily training and competitive demands are highly variable. This observational case series assessed the TEE of elite tennis players during high-level competition. METHODS Senior female singles participants (FS: n = 3; 21 [1] y; ranked Women's Tennis Association [WTA] top 125-375), an FS junior (n = 1; 16 y; ranked WTA top 350), and a men's doubles player (n = 1; 26 y; ranked Association of Tennis Professionals [ATP] top 5) were assessed for TEE (using the doubly labeled water method) during a 9- to 14-day period, which included training, Wimbledon Championships, WTA/ATP International Tournaments, Junior/Senior International Tennis Federation, and Wimbledon Junior Championships. One female (FS3) did not exercise from day 4 following injury. RESULTS TEE for men's doubles was 4586 kcal·d-1 (67 kcal·kg-1 fat-free mass [FFM]; daily activity 98 [74] min). Noninjured adult female participants' TEEs were 3396 and 3948 kcal·d-1 (66 and 81 kcal·kg-1 FFM; daily activity durations were 139 [84] min and 150 [66] min, respectively), while TEE for the injured athlete was 2583 kcal·d-1 (45.7 kcal·kg-1; daily nonexercise activity duration was <45 min). The junior player TEE was 3988 kcal·d-1 (78.2 kcal·kg-1 FFM; daily activity of 131 [66] min). CONCLUSION This observational case series positions tennis as a highly energetically demanding sport with variability evident between individuals (ie, TEE between 60 and 90 kcal·kg-1 FFM). Accordingly, nutritional strategies that promote sufficient energy availability should be emphasized with individual variability suitably assessed prior to prescription.
Collapse
Affiliation(s)
- Daniel G Ellis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool,United Kingdom
- Lawn Tennis Association, London,United Kingdom
| | - John Speakman
- School of Biological Sciences, University of Aberdeen, Aberdeen,United Kingdom
| | - Catherine Hambly
- School of Biological Sciences, University of Aberdeen, Aberdeen,United Kingdom
| | - James P Morton
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool,United Kingdom
| | - Graeme L Close
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool,United Kingdom
| | - Tim F Donovan
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool,United Kingdom
| |
Collapse
|
50
|
Magee MK, Jones MT, Fields JB, Kresta J, Khurelbaatar C, Dodge C, Merfeld B, Ambrosius A, Carpenter M, Jagim AR. Body Composition, Energy Availability, Risk of Eating Disorder, and Sport Nutrition Knowledge in Young Athletes. Nutrients 2023; 15:nu15061502. [PMID: 36986231 PMCID: PMC10052043 DOI: 10.3390/nu15061502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Young athletes may be at risk for low energy availability (LEA) or dietary habits that are indicative of eating disorders. Thus, the purpose of the current study was to investigate the prevalence of LEA among high school athletes and examine those at risk for eating disorders. A secondary aim was to examine relationships between sport nutrition knowledge, body composition, and LEA. METHODS 94 male (n = 42) and female (n = 52) mean ± SD age: 18.09 ± 2.44 y; height: 172.6 ± 9.8 cm; body mass: 68.7 ± 14.5 kg; BMI: 22.91 ± 3.3 kg·m-2) athletes completed a body composition assessment and electronic versions of the abridged sports nutrition knowledge questionnaire (ASNK-Q), brief eating disorder in athletes questionnaire (BEDA-Q), and the low energy availability for females questionnaire (LEAF-Q; females only). RESULTS 52.1% of female athletes were classified as being at risk for LEA. Moderate inverse relationships existed for computed LEAF-Q scores and BMI (r = -0.394; p < 0.01). A total of 42.9% of males (n = 18) and 68.6% of females (n = 35) were at risk for eating disorders, with females being at greater risk (p < 0.01). Body fat percentage was a predictor (β = -0.095; p = -0.01) for eating disorder risk status. For every 1 unit increase in body fat percentage, athletes were 0.909 (95% CI: 0.845-0.977) times less likely to be classified as at risk for an eating disorder. Male (46.5 ± 13.9) and female (46.9 ± 11.4) athletes scored poorly on the ASNK-Q, with no differences between sex (p = 0.895). CONCLUSIONS Female athletes were at a greater risk for eating disorders. No relationships existed between sport nutrition knowledge and %BF. Female athletes with a higher %BF had a lower risk for an eating disorder and risk for LEA.
Collapse
Affiliation(s)
- Meghan K Magee
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA
- Kinesiology, School of Sport Recreation and Tourism Management, George Mason University, Manassas, VA 22030, USA
| | - Margaret T Jones
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA
- Kinesiology, School of Sport Recreation and Tourism Management, George Mason University, Manassas, VA 22030, USA
- Sport, Recreation, and Tourism Management, George Mason University, Fairfax, VA 22030, USA
| | - Jennifer B Fields
- Exercise Science and Athletic Training, Springfield College, Springfield, MA 01109, USA
| | - Julie Kresta
- Exercise Physiology and Human Performance, Texas A&M University-Central Texas, Killeen, TX 76549, USA
| | - Chinguun Khurelbaatar
- Exercise & Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Christopher Dodge
- Exercise & Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Brandon Merfeld
- Exercise & Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Abby Ambrosius
- Exercise & Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Makenna Carpenter
- Exercise & Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
| | - Andrew R Jagim
- Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA 22030, USA
- Exercise & Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI 54601, USA
| |
Collapse
|