Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performa
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REVIEW ARTICLE
Low Energy Availability in Athletes: A Review of Prevalence, Dietary Patterns, Physiological Health, and Sports Performance Danielle Logue1,2 • Sharon M. Madigan2 • Eamonn Delahunt1 • Mirjam Heinen1 Sarah-Jane Mc Donnell2 • Clare A. Corish1
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Ó Springer International Publishing AG 2017
Abstract In a high-performance sports environment, athletes can present with low energy availability (LEA) for a variety of reasons, ranging from not consuming enough food for their specific energy requirements to disordered eating behaviors. Both male and female high-performance athletes are at risk of LEA. Longstanding LEA can cause unfavorable physiological and psychological outcomes which have the potential to impair an athlete’s health and sports performance. This narrative review summarizes the prevalence of LEA and its associations with athlete health and sports performance. It is evident in the published scientific literature that the methods used to determine LEA and its associated health outcomes vary. This contributes to poor recognition of the condition and its sequelae. This review also identifies interventions designed to improve health outcomes in athletes with LEA and indicates areas which warrant further investigation. While return-to-play guidelines have been developed for healthcare professionals to manage LEA in athletes, behavioral interventions to prevent the condition and manage its associated negative health and performance outcomes are required.
& Danielle Logue [email protected] 1
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland
2
Sport Ireland Institute, National Sports Campus, Abbotstown, Dublin 15, Ireland
Key Points Advancements in research have revealed low energy availability (LEA) as an unfavorable factor involved in the disruption of physiological processes that may affect health and sports performance. Research is required to establish a standardized method to measure energy availability and the identification of LEA cut-offs is warranted for both male and females athletes. Investigations into health outcomes, injury, and illness in athletes with relative energy deficiency/ LEA are needed to define potential negative effects and ensure optimal health and sports performance.
1 Introduction Over the last 30 years, considerable research has been undertaken to understand the cause(s) of menstrual dysfunction and low bone mineral density (BMD), both of which are frequently observed amongst high-performance female athletes. It is widely acknowledged that low energy availability (LEA) is the main factor underpinning these unfavorable health outcomes. LEA occurs when an individual has insufficient energy to support normal physiological function after the cost of energy expended during exercise has been removed. This may occur with/without an eating disorder (ED) or disordered eating (DE) behavior and can have a negative effect on an athlete’s health [1, 2]. The female athlete triad (TRIAD) [3] demonstrates t
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