Evidence of negative energy balance using doubly labelled water in elite Kenyan endurance runners prior to competition
Open accessAbstract
Previous studies have found Kenyan endurance runners to be in negative energy balance during training and prior to competition. The aim of the present study was to assess energy balance in nine elite Kenyan endurance runners during heavy training. Energy intake and expenditure were determined over 7 d using weighed dietary intake and doubly labelled water, respectively. Athletes were on average in negative energy balance (mean energy intake 13 241 (SD 1330) kJ/d v. mean energy expenditure 14 611 (SD 1043) kJ/d; P=0.046), although there was no loss in body mass (mean 56.0 (SD 3.4) kg v. 55.7 (SD 3.6) kg; P=0.285). The calculation of underreporting was 13 % (range -24 to +9 %) and almost entirely accounted for by undereating (9 % (range -55 to +39 %)) as opposed to a lack of significant underrecording (i.e. total water intake was no different from water loss (mean 4.2 (SD 0.6) l/d v. 4.5 (SD 0.8) l/d; P=0.496)). Fluid intake was modest and consisted mainly of water (0.9 (SD 0.5) l/d) and milky tea (0.9 (SD 0.3) l/d). The diet was high in carbohydrate (67.3 (SD 7.8) %) and sufficient in protein (15.3 (SD 4.0) %) and fat (17.4 (SD 3.9) %). These results confirm previous observations that Kenyan runners are in negative energy balance during periods of intense training. A negative energy balance would result in a reduction in body mass, which, when combined with a high carbohydrate diet, would have the potential in the short term to enhance endurance running performance by reducing the energy cost of running.
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There are consistent reports of low energy intakes relative to calculated or expected exercise energy expenditures in various groups of East African middle- and long-distance athletes.
“there are consistent reports of low energy intakes relative to calculated or expected exercise energy expenditures in various groups of East African middle-and long-distance athletes (Fudge et al., 2006(Fudge et al., , 2008;;Onywera et al., 2004).”
From Contemporary Nutrition Strategies to Optimize Performance in Distance Runners and Race Walkers (2019) · cites this paper as Fudge et al., 2006
Dietary surveys of Kenyan and Ethiopian runners have been limited to their home environments and training camps.
“Although dietary surveys of Kenyan and Ethiopian runners have been limited to their home environments and training camps (Beis et al., 2011;Christensen et al., 2002;Fudge et al., 2006Fudge et al., , 2008;;Onywera et al., 2004)”
From Contemporary Nutrition Strategies to Optimize Performance in Distance Runners and Race Walkers (2019) · cites this paper as Fudge et al., 2006
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Beis, L. Y., Willkomm, L., Ross, R., Bekele, Z., Wolde, B., Fudge, B., & Pitsiladis, Y. P. (2011) · Journal of the International Society of Sports Nutrition · doi:10.1186/1550-2783-8-7 · Cited by 62 · see citing works
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BackgroundPostexercise High-Fat Feeding Suppresses p70S6K1 Activity in Human Skeletal Muscle
HAMMOND, K. M., IMPEY, S. G., CURRELL, K., MITCHELL, N., SHEPHERD, S. O., JEROMSON, S., HAWLEY, J. A., CLOSE, G. L., HAMILTON, L. D., SHARPLES, A. P., et al. (2016) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001009 · Cited by 30 · see citing works
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BackgroundUltra-Endurance Participation and Acute Kidney Injury: A Narrative Review
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“Kenyan runners are an interesting cohort of athletes to study due to their dominance of international running events (Tucker, Onywera, & Santos-Concejero, 2015), and have been shown to be at high risk of reduced energy availability (Fudge et al., 2006; Muia, Wright, Onywera, & Kuria, 2016; Onywera, Kiplamai, Boit, & P…”
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“Yet systematic reviews (18), prospective observational studies (22), and case studies (20) of changes in energy expenditure, EI, and body composition in highly trained endurance athletes document self-imposed fluctuations across the training season and sporting career to achieve an optimal physique…”
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Physical activity, nutrition, and bone health
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“As an example, elite runners need 6 kcal · kg LbM · d [88], while triathletes require 24–33 kcal · kg LbM · d [89].”
BackgroundLower Leg Length is Associated with Running Economy in High Level Caucasian Distance Runners
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“Previous studies reported that male endurance athletes, including long distance runners, were in negative energy balance (EB) (Fudge et al., 2006; Torstviet et al., 2018).”
BackgroundPhysical performance during energy deficiency in humans: An evolutionary perspective.
Areta, J. (2023) · Comparative biochemistry and physiology. Part A, Molecular & integrative physiology · doi:10.1016/j.cbpa.2023.111473 · Cited by 15 · see citing works
24-h Fluid Kinetics and Perception of Sweat Losses Following a 1-h Run in a Temperate Environment
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“[10] provide data concerning day-to-day fluid intake and hydration status indicator references for free living men, and several investigations have documented hydration status changes over multiple days in elite Kenyan runners [11–13].”
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The race within a race: Together on the marathon starting line but miles apart in the experience
Burke, L. M., Whitfield, J., & Hawley, J. A. (2024) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2024.10.277 · Cited by 16 · see citing works
Oxfeldt, M., Marsi, D., Christensen, P. M., Andersen, O. E., Johansen, F. T., Bangshaab, M., Risikesan, J., Jeppesen, J. S., Hellsten, Y., Phillips, S. M., et al. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003370 · Cited by 14 · see citing works
“Some case studies (19) and prospective studies (38) in elite endurance athletes demonstrate that weight cycling may be undertaken successfully to achieve an optimal physique for race performance.”
BackgroundConsumo alimentar e perfil antropométrico de tenistas amadores e profissionais
Gomes, R. V., Ribeiro, S. M. L., Veibig, R. F., & Aoki, M. S. (2009) · Revista Brasileira de Medicina do Esporte · doi:10.1590/s1517-86922009000700007 · Cited by 14 · see citing works
Xavier, R., Sanchez, C. A., Paulucio, D., da Silva, I. M., Velasque, R., Nogueira, F. S., Ferrini, L. S. G., Dornelas-Ribeiro, M., Serrato, M., Alvarenga, R., et al. (2019) · Military Medicine · doi:10.1093/milmed/usz003 · Cited by 13 · see citing works
Halsey, L. G., & Bryce, C. M. (2020) · Experimental Physiology · doi:10.1113/ep088502 · Cited by 13 · see citing works
Bargoria, V., Timpka, T., Jacobsson, J., Halje, K., Andersson, C., Andersson, G., & Bermon, S. (2020) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2020.01.008 · Cited by 13 · see citing works
Koivisto, A., Paur, I., Paulsen, G., Garthe, I., Raastad, T., Bastani, N. E., Blomhoff, R., & Bøhn, S. K. (2020) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2020.00106 · Cited by 12 · see citing works
“Other studies have also reported reduced energy intake (Westerterp et al., 2000; Fudge et al., 2006), compromised appetite (Karl et al.”
BackgroundResultInfluentialHow much exercise should be promoted to raise total daily energy expenditure and improve health?
Byrne, N. M., & Hills, A. P. (2018) · Obesity Reviews · doi:10.1111/obr.12788 · Cited by 11 · see citing works
“(37) used a 7-day DLW protocol in nine elite Kenyan endurance runners”
MethodÕnnik, L., Mooses, M., Suvi, S., Haile, D. W., Ojiambo, R. M., Lane, A. R., & Hackney, A. C. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-021-04827-w · Cited by 10 · see citing works
Wilson, G., Lucas, D., Hambly, C., Speakman, J. R., Morton, J. P., & Close, G. L. (2017) · European Journal of Sport Science · doi:10.1080/17461391.2017.1406996 · Cited by 9 · see citing works
“…data suggest, that contrary to previous assertions (Dolan et al., 2011) the TEE of professional jockeys is not high in absolute terms when compared with other athletes of a similar mass (Fudge et al., 2006) (~11 versus 14.6 MJ), or team sport athletes (Anderson et al., 2017) (~11 versus 14.9 MJ).”
InfluentialCaldwell, H. G., Jeppesen, J. S., Lossius, L. O., Atti, J. P., Durrer, C., Oxfeldt, M., Melin, A. K., Hansen, M., Bangsbo, J., Gliemann, L., et al. (2024) · The FASEB Journal · doi:10.1096/fj.202401780r · Cited by 5 · see citing works
Running economy and body composition between competitive and recreational level distance runners
Mooses, M., Jürimäe, J., Mäestu, J., Mooses, K., Purge, P., & Jürimäe, T. (2013) · Acta Physiologica Hungarica · doi:10.1556/aphysiol.100.2013.3.10 · Cited by 16 · see citing works
Salagaras, B. S., MacKenzie‐Shalders, K. L., Slater, G., McLellan, C., & Coffey, V. G. (2021) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2021-0316 · Cited by 7 · see citing works
Frączek, B., Grzelak, A., & Klimek, A. (2019) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.01300 · Cited by 7 · see citing works
Suzuki, D., & Suzuki, Y. (2024) · Nutrients · doi:10.3390/nu16142273 · Cited by 5 · see citing works
“Elite and world-class athletes with acute and chronic energy deficits achieved aerobic capacity and performance commensurate with their requirements [42–47].”
BackgroundWhy the dominance of East Africans in distance running? A narrative review
Grivas, G. V., Onywera, V. O., Marco-Contreras, L. A., Sutehall, S., & Muñiz-Pardos, B. (2024) · Translational Exercise Biomedicine · doi:10.1515/teb-2024-0018 · Cited by 6 · see citing works
“East African athletes also tend to consume hypocaloric diets especially in the buildup to competition thus allowing for signi fi cant weight loss [61], which is bene fi cial to endurance performance as long as there are no symptoms of relative energy de fi ciency in sport (RED-S), as witnessed in…”
Jesus, F., Costello, N. B., Kondo, E., Francisco, R., Nunes, C. L., Matu, J., Sardinha, L. B., Murphy‐Alford, A. J., Luke, A. H., Pontzer, H., et al. (2025) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2024-0225 · Cited by 6 · see citing works
Performance of Kenyan athletes in mountain versus flat marathon running - An example in Switzerland
Harm, C., Knechtle, B., Rüst, C. A., Rosemann, T. J., Lepers, R., & Onywera, V. O. (2013) · Journal of Human Sport and Exercise · doi:10.4100/jhse.2013.84.01 · Cited by 5 · see citing works
“…a great part of Kenyan children have to run to school for several kilometres (Onywera et al., 2006), the diet during training (Beis et al., 2011; Fudge et al., 2006; Onywera et al., 2004), the environmental background and especially the motivation (Onywera et al., 2006; Wilber & Pitsiladis,…”
BackgroundUCI Sports Nutrition Project: Special Environments
Cheung, S. S., Stellingwerff, T., Stanley, J., Mujika, I., Nybo, L., & Girard, O. (2025) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2025-0101 · Cited by 4 · see citing works
[Body composition related with health in veteran athletes].
Román, P. Á. L., Sánchez, J. S., & Soto-Hermoso, V. M. (2012) · PubMed · doi:10.3305/nh.2012.27.4.5743 · Cited by 4 · see citing works
Manevitz, Z., Leshem, M., Heled, Y., Epstein, Y., Gershon, B., & Kodesh, E. (2021) · Appetite · doi:10.1016/j.appet.2021.105181 · Cited by 4 · see citing works
Profile of the female athlete triad among elite Kenyan endurance athletes and non-athletes
Goodwin, Y., Monyeki, Boit, M. K., de Ridder, J. H., & Toriola, A. L. (2014) · Boloka Institutional Repository (North-west University) · Cited by 4 · see citing works
Kwon, H.-T., & Kim, D. (2025) · Applied Sciences · doi:10.3390/app15073836 · Cited by 3 · see citing works
The Prevalence of Low Energy Availability in Cross-Country Skiers during the Annual Cycle
Андреевна, Б. Е., Lyudinina, A. Y., & Bojko, E. R. (2024) · Nutrients · doi:10.3390/nu16142279 · Cited by 3 · see citing works
“TEE was estimated with an equation rather than determined with the reference method (i.e., doubly-labeled water), which probably led to an overestimation of TEE in this study.”
MethodAssociation between Energy Availability and Menstrual Function in Elite Kenyan Runners
Goodwin, Y., Monyeki, M. A., Boit, M. K., de Ridder, J. H., Toriola, A. L., Mwangi, F., & Wachira, J. L. (2014) · Boloka Institutional Repository (North-west University) · doi:10.10520/ejc155191 · Cited by 3 · see citing works
Uchizawa, A., Osumi, H., Zhang, S., Yajima, K., Funayama, A., Kondo, E., Suzuki, Y., Tanaka, Y., Park, I., Enomoto, Y., et al. (2025) · iScience · doi:10.1016/j.isci.2024.111717 · Cited by 2 · see citing works
To drink or not to drink to drink recommendations: the evidence
Pitsiladis, Y. P., & Beis, L. Y. (2012) · BMJ · doi:10.1136/bmj.e4868 · Cited by 3 · see citing works
Energy metabolism and body composition in athletes
Sagayama, H. (2018) · 体力科學 · doi:10.7600/jspfsm.67.357 · Cited by 2 · see citing works
Recent Nutritional Guidelines for Endurance Athletes
Carlsohn, A. (2016) · Cited by 2 · see citing works
Energy deficiency and nutrition in endurance sports – focus on rowing
Koehler, K. (2020) · German Journal of Sports Medicine · doi:10.5960/dzsm.2019.409 · Cited by 2 · see citing works
Characteristics of Error Estimation in Food Weight Using Dietary Records of Male Endurance Athletes
Okamoto, K., Murata, H., Nishiyama, H., & Taguchi, M. (2019) · The Japanese Journal of Nutrition and Dietetics · doi:10.5264/eiyogakuzashi.77.154 · Cited by 2 · see citing works
Nutrition for Marathon Running
Koehler, K. (2016) · Springer eBooks · doi:10.1007/978-3-319-29728-6_3 · Cited by 2 · see citing works
Introduction to Sports Nutrition
Braun, B., & Miller, B. F. (2007) · Nutrition in exercise and sport · doi:10.1201/9780849379512.ch1 · Cited by 2 · see citing works
A Resource-Based View of Elite Kenyan Running Successes
Omondi-Ochieng, P. (2017) · Victoria University Research Repository (Victoria University) · Cited by 2 · see citing works
Mooses, M., Mooses, K., Haile, D. W., Durussel, J., Kaasik, P., & Pitsiladis, Y. P. (2015) · Journal of Sports Sciences · doi:10.1080/02640414.2015.1045927 · Cited by 2 · see citing works
“…or indeed the half-marathon/marathon but typically run distances that are dictated by competition and the needs of the manager or race organisers (Fudge et al., 2006; Mooses et al., 2014; Onywera, Kiplamai, Boit, & Pitsiladis, 2004; Onywera, Scott, Boit, & Pitsiladis, 2006; Pitsiladis, Onywera,…”
BackgroundLeogrande, P., Jardines, D., Brito, D. M., de la Torre, X., Botrè, F., Luch, A., Diel, P., & Parr, M. K. (2024) · Journal of Chemometrics · doi:10.1002/cem.3594 · Cited by 1 · see citing works
“In the context of sports and exercise science, MS has also been widely used in combination with stable isotope tracers to assess the substrate used during exercise and to evaluate the total energy expenditure of elite athletes [6].”
Stupin, A., Perić, L., Jukić, I., Boris, A., Stanojević, L., & Drenjančević, I. (2025) · Life · doi:10.3390/life15030458 · Cited by 1 · see citing works
“Previous studies have reported negative energy balances during the preparation phase in male cross-country skiers [24], and male runners [25], averaging 304 kcal/day for men athletes [26].”
Field Assessment of Physical Activity and Energy Expenditure among Athletes
Byrne, N. M., Shultz, S. P., & Hills, A. P. (2010) · CRC Press eBooks · doi:10.1201/b10203-10 · Cited by 1 · see citing works
Coleman, E. (2009) · CRC Press eBooks · doi:10.1201/9781420068160.ch8 · Cited by 1 · see citing works
The energetic cost of physical activity and the regulation of reproduction
Dufour, D. L. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511973642.005 · Cited by 1 · see citing works
dos Santos, J. A. R. (2017) · Revista Portuguesa de Ciências do Desporto · doi:10.5628/rpcd.17.01.75 · Cited by 1 · see citing works
Udnæseth, M. (2009) · NORA - Norwegian Open Research Archives · Cited by 1 · see citing works
Tapering strategies for elite endurance running performance
Spilsbury, K. L. (2016) · Loughborough University Institutional Repository (Loughborough University) · Cited by 1 · see citing works
Ingestão nutricional de corredores de meio-fundo
dos Santos, J. A. R., da Silva, D. J. L., & Gadelho, S. F. N. A. (2012) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas)
Field Assessment of Physical Activity and Energy Expenditure among Athletes
Driskell, J. A., & Wolinsky, I. (2002) · CRC Press eBooks · doi:10.1201/9781420041323-16
Beis, L. Y. (2012) · Enlighten: Theses (The University of Glasgow)
Influence of Physical Ability Fast Recovery of Athletes Based on Movement Food Nutrition
Zhang, Z. (2015) · The Open Cybernetics & Systemics Journal · doi:10.2174/1874110x01509011756
Energy Needs of Master Athletes
Byrne, N., & Hills, A. P. (2014) · eCite Digital Repository (University of Tasmania)
The physiology and pathology of heat and cold
Milledge, J. S., West, J., & Schoene, R. (2007) · CRC Press eBooks · doi:10.1201/b13371-28
Energetics Among Collegiate Cross-Country Runners
Briddell, K. M. (2018) · Scholars Archive - University at Albany (University at Albany, State University of New York) · doi:10.54014/1h83-0bm2
Stellingwerff, T. (2013) · Wiley eBooks · doi:10.1002/9781118692318.ch47
Editorial: Desporto e Política
dos Santos, J. A. R. (2017) · Revista Portuguesa de Ciências do Desporto · doi:10.5628/rpcd.17.01.09
Análise das diferenças entre corredores africanos e caucasianos de meio-fundo e fundo
dos Santos, J. A. R. (2019) · Revista Brasileira de Fisiologia do Exercício · doi:10.33233/rbfe.v11i3.3401
Bone health and high-performace athletes
Stewart, K. L. (2020) · Queensland University of Technology · doi:10.5204/thesis.eprints.203100
dos Santos, C. G. M., Filho, N. G. R., Domingues, C. A., Dornelas-Ribeiro, M., King, J. L., Budowle, B., Moura-Neto, R. S., & Silva, R. (2021) · Brazilian Journal of Medical and Biological Research · doi:10.1590/1414-431x202010317
The effect of endurance exercise on energy and protein balance
Rolleston, A. K. (2009) · ResearchSpace (University of Auckland)
- Authors
- Fudge, B. W., Westerterp, K. R., Kiplamai, F. K., Onywera, V. O., Boit, M. K., Kayser, B., & Pitsiladis, Y. P.
- Affiliations
- University of Glasgow (GB)
- Maastricht University (NL)
- Kenyatta University (KE)
- University of Geneva (CH)
- Corresponding author
- Pitsiladis, Yannis P.
- Venue
- British Journal Of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2006-01
- Volume
- 95
- Issue
- 1
- Pages
- 59-66
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- OpenAlex
- W2142836014
- Cited by
- 114
- References
- 33
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 8 · 2023: 5 · 2022: 2 · 2021: 5 · 2020: 8 · 2019: 7 · 2018: 8 · 2017: 10 · 2016: 6 · 2015: 2 · 2014: 8 · 2013: 9 · 2012: 6
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Kenyatta University Institutional Repository (Kenyatta University) (submittedVersion)
- University of Brighton Repository (University of Brighton) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Keywords
- negative energy balance, endurance runners, energy intake, energy expenditure, fluid intake, dietary carbohydrates, body mass, Kenyan athletes, training duration, endurance running performance
- MeSH terms
- Adult, Altitude, Energy Intake, Dietary Carbohydrates, Dietary Fats, Dietary Proteins, Drinking, Eating, Energy Metabolism, Humans, Kenya, Physical Endurance, Running, Body Mass Index
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