The DOI matches its Crossref record; 6 of the 6 references it cites were found in a registry or an index.
Energy availability and the female athlete triad in elite endurance athletes
Open accessAbstract
The female athlete triad (T riad), links low energy availability (EA), with menstrual dysfunction (MD), and impaired bone health. The aims of this study were to examine associations between EA/MD and energy metabolism and the prevalence of T riad‐associated conditions in endurance athletes. Forty women [26.2 ± 5.5 years, body mass index (BMI) 20.6 ± 2.0 kg/m 2, body fat 20.0 ± 3.0%], exercising 11.4 ± 4.5 h/week, were recruited from national teams and competitive clubs. Protocol included gynecological examination; assessment of bone health; indirect respiratory calorimetry; diet and exercise measured 7 days to assess EA; eating disorder (ED) examination; blood analysis. Subjects with low/reduced EA (< 45 kcal/kg FFM/day), had lower resting metabolic rate (RMR) compared with those with optimal EA [28.4 ± 2.0 kcal/kg fat‐free mass (FFM)/day vs 30.5 ± 2.2 kcal/kg FFM/day, P < 0.01], as did subjects with MD compared with eumenorrheic subjects (28.6 ± 2.4 kcal/kg FFM/day vs 30.2 ± 1.8 kcal/kg FFM/day, P < 0.05). 63% had low/reduced EA, 25% ED, 60% MD, 45% impaired bone health, and 23% had all three Triad conditions. 53% had low RMR, 25% hypercholesterolemia, and 38% hypoglycemia. Conclusively, athletes with low/reduced EA and/or MD had lowered RMR. T riad‐associated conditions were common in this group of athletes, despite a normal BMI range. The high prevalence of ED, MD, and impaired bone health emphasizes the importance of prevention, early detection, and treatment of energy deficiency.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“they do occur, can impair growth and maturation, reduce bone mineral density, delay recovery, compromise immune function and increase injury risk [14,15,107–109].”
From Dietary intake, nutrition knowledge, and behavior in youth team sport athletes: a scoping review and call to advance research and practice (2026) · cites this paper as [109]
In the citing paper
“Notably, the researchers in a study on 40 Danish and Swedish female national teams and competitive clubs found an association between the reduced energy availability and higher LDL cholesterol [77].”
From Nutritional Status and Cardiovascular Health in Female Adolescent Elite-Level Artistic Gymnasts and Swimmers: A Cross-Sectional Study of 31 Athletes (2021) · cites this paper as [77]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318149f111 · Cited by 1,554
Self-citationMountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., et al. (2014) · British Journal of Sports Medicine · doi:10.1136/bjsports-2014-093502 · Cited by 1,469 · cited 4×
“The International Olympic Committee (IOC) has recently published a new Consensus Statement, introducing a new concept, Relative Energy Deficiency in Sports (RED-S; Mountjoy et al., 2014), that replaces the previous statement concerning the Triad (Drinkwater et al., 2005).”
BackgroundInfluentialSelf-citationLow energy availability, not stress of exercise, alters LH pulsatility in exercising women
Loucks, A. B., Verdun, M., Heath, E. M., & (With the Technical Assistance of T. Law, S. A. J. R. T. (1998) · Journal of Applied Physiology · doi:10.1152/jappl.1998.84.1.37 · Cited by 539 · cited 1×
“The subjects with MD had, furthermore, lower blood glucose compared with eumenorrheic subjects, and earlier research has suggested that GnRH neuron activity and LH pulsatility are regulated by brain glucose availability (Loucks et al., 1998; Loucks, 2006).”
ResultRedman, L. M., Heilbronn, L. K., Martin, C. K., de Jonge, L., Williamson, D. A., Delany, J. P., Ravussin, E., & for the Pennington CALERIE team (2009) · PLoS ONE · doi:10.1371/journal.pone.0004377 · Cited by 355
Goldsmith, R., Joanisse, D. R., Gallagher, D., Pavlovich, K., Shamoon, E., Leibel, R. L., & Rosenbaum, M. (2010) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00053.2009 · Cited by 171
Endocrine manifestations of eating disorders
Warren, M. P. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2304 · Cited by 134
Cited by
IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update
Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A. K., Meyer, N. L., et al. (2018) · British Journal of Sports Medicine · doi:10.1136/bjsports-2018-099193 · Cited by 883
Self-citationMountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106994 · Cited by 974
Self-citationMountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A., Meyer, N., et al. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0136 · Cited by 447
Self-citationHeikura, I. A., Uusitalo, A. L. T., Stellingwerff, T., Bergland, D., Mero, A. A., & Burke, L. M. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2017-0313 · Cited by 318
Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S.-J. M., & Corish, C. A. (2020) · Nutrients · doi:10.3390/nu12030835 · Cited by 321
Self-citationLogue, D., Madigan, S. M., Delahunt, E., Heinen, M., Mc Donnell, S.-J., & Corish, C. A. (2018) · Sports Medicine · doi:10.1007/s40279-017-0790-3 · Cited by 274
Energy Availability in Athletics: Health, Performance, and Physique
Melin, A. K., Heikura, I. A., Tenforde, A., & Mountjoy, M. (2019) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0201 · Cited by 258
Self-citationPitfalls of conducting and interpreting estimates of energy availability in free-living athletes
Burke, L. M., Lundy, B., Fahrenholtz, I. L., & Melin, A. K. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0142 · Cited by 244
Self-citationEndocrine Effects of Relative Energy Deficiency in Sport
Elliott-Sale, K. J., Tenforde, A. S., Parziale, A. L., Holtzman, B., & Ackerman, K. E. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0127 · Cited by 229
Areta, J. L., Taylor, H. L., & Koehler, K. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-020-04516-0 · Cited by 214
Wasserfurth, P., Palmowski, J., Hahn, A., & Krüger, K. (2020) · Sports Medicine - Open · doi:10.1186/s40798-020-00275-6 · Cited by 190
Heydenreich, J., Kayser, B., Schutz, Y., & Melzer, K. (2017) · Sports Medicine - Open · doi:10.1186/s40798-017-0076-1 · Cited by 177
Stellingwerff, T., Heikura, I. A., Meeusen, R., Bermon, S., Seiler, S., Mountjoy, M. L., & Burke, L. M. (2021) · Sports Medicine · doi:10.1007/s40279-021-01491-0 · Cited by 171
Stellingwerff, T., Mountjoy, M., McCluskey, W. T., Ackerman, K. E., Verhagen, E., & Heikura, I. A. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106914 · Cited by 119
Recommendations and Nutritional Considerations for Female Athletes: Health and Performance
Holtzman, B., & Ackerman, K. E. (2021) · Sports Medicine · doi:10.1007/s40279-021-01508-8 · Cited by 111
Within‐day energy deficiency and reproductive function in female endurance athletes
Fahrenholtz, I. L., Sjödin, A., Benardot, D., Tornberg, Å. B., Skouby, S., Faber, J., Sundgot‐Borgen, J. K., & Melin, A. K. (2018) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.13030 · Cited by 106
Self-citationStaal, S., Sjödin, A., Fahrenholtz, I., Bonnesen, K., & Melin, A. K. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2017-0327 · Cited by 101
Self-citationTorstveit, M. K., Ackerman, K. E., Constantini, N., Holtzman, B., Koehler, K., Mountjoy, M. L., Sundgot-Borgen, J., & Melin, A. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106932 · Cited by 100
Self-citationBrook, E. M., Tenforde, A. S., Broad, E. M., Matzkin, E. G., Yang, H. Y., Collins, J. E., & Blauwet, C. A. (2019) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.13385 · Cited by 98
The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review
Petkus, D. L., Murray-Kolb, L. E., & De Souza, M. J. (2017) · Sports Medicine · doi:10.1007/s40279-017-0706-2 · Cited by 92
International society of sports nutrition position stand: nutritional concerns of the female athlete
Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse de Jonge, X. A. K., Hirsch, K. R., Arent, S. M., Hewlings, S. J., Kleiner, S. M., Bustillo, E., Tartar, J. L., et al. (2023) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2023.2204066 · Cited by 129
“for dietary energy intake and physical activity energy expenditure [61,113].”
BackgroundRogers, M. A., Appaneal, R. N., Hughes, D., Vlahovich, N., Waddington, G., Burke, L. M., & Drew, M. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-101517 · Cited by 89
Low‐energy density and high fiber intake are dietary concerns in female endurance athletes
Melin, A., Tornberg, Å. B., Skouby, S., Møller, S. S., Faber, J., Sundgot‐Borgen, J., & Sjödin, A. (2016) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.12516 · Cited by 89
Self-citationLow energy availability in female athletes: from the lab to the field
Heikura, I. A., Stellingwerff, T., & Areta, J. L. (2022) · European Journal of Sport Science · doi:10.1080/17461391.2021.1915391 · Cited by 84
Gallant, T. L., Ong, L. F., Wong, L., Sparks, M., Wilson, E., Puglisi, J. L., & Gerriets, V. A. (2025) · Sports Medicine · doi:10.1007/s40279-024-02130-0 · Cited by 118
Screening for low energy availability in male athletes: attempted validation of LEAM-Q
Lundy, B., Torstveit, M. K., Stenqvist, T. B., Burke, L. M., Garthe, I., Slater, G. J., Ritz, C., & Melin, A. K. (2022) · Nutrients · doi:10.3390/nu14091873 · Cited by 70
Self-citationLangbein, R. K., Martin, D., Allen-Collinson, J., Crust, L., & Jackman, P. C. (2021) · Journal of Sports Sciences · doi:10.1080/02640414.2021.1883312 · Cited by 66
Hutson, M. J., O’Donnell, E., Brooke-Wavell, K., Sale, C., & Blagrove, R. C. (2021) · Sports Medicine · doi:10.1007/s40279-020-01396-4 · Cited by 64
Fuelling the female athlete: Carbohydrate and protein recommendations
Moore, D. R., Sygo, J., & Morton, J. P. (2022) · European Journal of Sport Science · doi:10.1080/17461391.2021.1922508 · Cited by 60
Prevalence of indicators of low energy availability in elite female sprinters
Sygo, J., Coates, A. M., Sesbreno, E., Mountjoy, M. L., & Burr, J. F. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2017-0397 · Cited by 60
Nutritional Intake and Energy Availability of Collegiate Distance Runners
Beermann, B. L., Lee, D. G., Almstedt, H. C., & McCormack, W. P. (2020) · Journal of the American College of Nutrition · doi:10.1080/07315724.2020.1735570 · Cited by 58
Logue, D. M., Madigan, S. M., Heinen, M., McDonnell, S., Delahunt, E., & Corish, C. A. (2019) · European Journal of Sport Science · doi:10.1080/17461391.2018.1526973 · Cited by 53
Kuikman, M. A., Mountjoy, M., & Burr, J. F. (2021) · Nutrients · doi:10.3390/nu13082601 · Cited by 50
Jesus, F., Castela, I., Silva, A. M., Branco, P. A., & Sousa, M. (2021) · Nutrients · doi:10.3390/nu13030873 · Cited by 45
Prevalence of low energy availability in competitively trained male endurance athletes
Lane, A. R., Hackney, A. C., Smith-Ryan, A., Kucera, K., Registar-Mihalik, J., & Ondrak, K. (2019) · Medicina · doi:10.3390/medicina55100665 · Cited by 45
Ackerman, K. E., Rogers, M. A., Heikura, I. A., Burke, L. M., Stellingwerff, T., Hackney, A. C., Verhagen, E., Schley, S., Saville, G. H., Mountjoy, M., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107359 · Cited by 43
Fahrenholtz, I. L., Melin, A. K., Garthe, I., Hollekim-Strand, S. M., Ivarsson, A., Koehler, K., Logue, D., Lundström, P., Madigan, S., Wasserfurth, P., et al. (2023) · Nutrients · doi:10.3390/nu15051082 · Cited by 40
Self-citationDe Souza, M. J., Strock, N. C. A., Ricker, E. A., Koltun, K. J., Barrack, M., Joy, E., Nattiv, A., Hutchinson, M., Misra, M., & Williams, N. I. (2022) · Sports Medicine · doi:10.1007/s40279-021-01568-w · Cited by 39
Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know
Charlton, B. T., Forsyth, S., & Clarke, D. C. (2022) · International Journal of Sports Science & Coaching · doi:10.1177/17479541211054458 · Cited by 36
Symptoms of eating disorders and low energy availability in recreational active female runners
Karlsson, E., Alricsson, M., & Melin, A. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001623 · Cited by 35
Self-citationEgger, T., & Flueck, J. L. (2020) · Nutrients · doi:10.3390/nu12113262 · Cited by 30
Stenqvist, T. B., Melin, A. K., Garthe, I., Slater, G., Paulsen, G., Iraki, J., Areta, J., & Torstveit, M. K. (2021) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2020-0368 · Cited by 30
Self-citationJeppesen, J. S., Hellsten, Y., Melin, A. K., & Hansen, M. (2025) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/sms.70089 · Cited by 22
Self-citationJakše, B., Jakše, B., Mis, N. F., Jug, B., Šajber, D., Godnov, U., & Čuk, I. (2021) · Journal of Nutrition and Metabolism · doi:10.1155/2021/8810548 · Cited by 21
Markers of low energy availability in overreached athletes: a systematic review and meta-analysis
Kuikman, M. A., Coates, A. M., & Burr, J. F. (2022) · Sports Medicine · doi:10.1007/s40279-022-01723-x · Cited by 18
Nutritional Needs of the Female Athlete: Risk and Prevention of Low Energy Availability
Black, K. E., Baker, D. F., & Sims, S. T. (2020) · Strength & Conditioning Journal · doi:10.1519/ssc.0000000000000464 · Cited by 15
Dasa, M. S., Friborg, O., Kristoffersen, M., Pettersen, G., Sagen, J. V., Torstveit, M. K., Sundgot‐Borgen, J., & Rosenvinge, J. H. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12129 · Cited by 15
Self-citationIkegami, N., Samukawa, M., Sakamaki-Sunaga, M., Sugawara, M., Torashima, S., Ishida, T., Kasahara, S., & Tohyama, H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095580 · Cited by 14
Þegar orkuna skortir–áhrif hlutfallslegs orkuskorts í íþróttum (RED-s) á heilsu og árangur
Faculty of Health promotion, S. A. L. S., Varðardóttir, B., Guðmundsdóttir, S. L., Faculty of Health promotion, S. A. L. S., Ólafsdóttir, A. S., & Faculty of Health promotion, S. A. L. S. (2020) · Læknablaðið · doi:10.17992/lbl.2020.09.596 · Cited by 10
Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes
Haines, M. S., Kaur, S., Scarff, G., Lauze, M., Gerweck, A., Slattery, M., Oreskovic, N. M., Ackerman, K. E., Tenforde, A. S., Popp, K. L., et al. (2023) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgad215 · Cited by 9
Irwin, N., Ó Catháin, C., Ward, C., & Kelly, D. T. (2026) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2026.2671431 · Cited by 4
Metadata
- Authors
- Melin, A., Tornberg, Å. B., Skouby, S., Møller, S. S., Sundgot‐Borgen, J., Faber, J., Sidelmann, J. J., Aziz, M., & Sjödin, A.
- Venue
- Scandinavian Journal of Medicine & Science in Sports
- Publisher
- Wiley
- Published
- 2014-05-30
- Volume
- 25
- Issue
- 5
- Pages
- 610-622
- ISSN
- 0905-7188 (ISSN-L)
- 1600-0838
- OpenAlex
- W1770799467
- Cited by
- 296
- References
- 6
- FWCI
- 10.13
- Type
- journal article
- Language
- en
- Open access
- bronze
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.