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Low RMRratio as a Surrogate Marker for Energy Deficiency, the Choice of Predictive Equation Vital for Correctly Identifying Male and Female Ballet Dancers at Risk
Abstract
Ballet dancers are reported to have an increased risk for energy deficiency with or without disordered eating behavior. A low ratio between measured ( m ) and predicted ( p ) resting metabolic rate (RMR ratio p RMR and to explore associations with additional markers of energy deficiency. Female (n = 20) and male (n = 20) professional ballet dancers, 19-35 years of age, were enrolled. m RMR was assessed by respiratory calorimetry (ventilated open hood). p RMR was determined using the Cunningham and Harris-Benedict equations, and different tissue compartments derived from whole-body dual-energy X-ray absorptiometry assessment. The protocol further included assessment of body composition and bone mineral density, blood pressure, disordered eating (Eating Disorder Inventory-3), and for females, the Low Energy Availability in Females Questionnaire. The prevalence of suppressed RMR was generally high but also clearly dependent on the method used to calculate p RMR, ranging from 25% to 80% in males and 35% to 100% in females. Five percent had low bone mineral density, whereas 10% had disordered eating and 25% had hypotension. Forty percent of females had elevated Low Energy Availability in Females Questionnaire score and 50% were underweight. Suppressed RMR was associated with elevated Low Energy Availability in Females Questionnaire score in females and with higher training volume in males. In conclusion, professional ballet dancers are at risk for energy deficiency. The number of…
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“There is a wide range in the reported estimated prevalence of LEA/REDs indicators in female (23%-79.5% [7][8][9][10][11][12][13][14][15][16] ) and male (15%-70% [12][13][14][15][16][17][18][19][20] ) athletes across a variety of sports”
From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [9]
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Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678333
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678309
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678324
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678306
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678327
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678321
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678318
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678315
Leonkiewicz, M., & Wawrzyniak, A. (2022) · Figshare · doi:10.6084/m9.figshare.19581810
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678312
Ghazzawi, H. A., Nimer, L. S., Haddad, A. J., Alhaj, O. A., Amawi, A. T., Pandi-Perumal, S. R., Trabelsi, K., Seeman, M. V., & Jahrami, H. (2024) · Figshare · doi:10.6084/m9.figshare.26678303
Jagim, A. R., Dobbs, W. C., Magee, M. K., Fields, J. B., Sims, J. N. L., Saine, N. D., & Jones, M. T. (2026) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000004071
Liu, Z. Y., Lee, W. S., Sohi, S. K., Tan, X. R., & Huang, L. (2026) · Sports · doi:10.3390/sports14080319
Metadata
- Authors
- Staal, S., Sjödin, A., Fahrenholtz, I., Bonnesen, K., & Melin, A. K.
- Affiliations
- University of Copenhagen (DK)
- Venue
- International Journal of Sport Nutrition and Exercise Metabolism
- Publisher
- Human Kinetics
- Published
- 2018-07-01
- Volume
- 28
- Issue
- 4
- Pages
- 412-418
- ISSN
- 1526-484X (ISSN-L)
- 1543-2742
- OpenAlex
- W2786560297
- Cited by
- 101
- References
- 58
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 25 · 2023: 15 · 2022: 13 · 2021: 8 · 2020: 12 · 2019: 9 · 2018: 2
- FWCI
- 10.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Sport Nutrition and Exercise Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Social Sciences › Arts and Humanities › Visual Arts and Performing Arts › Diversity and Impact of Dance
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Physiology (medical) › Body Composition Measurement Techniques
- Keywords
- ballet dancers, energy deficiency, resting metabolic rate, disordered eating, low energy availability, prediction equations, Harris-Benedict equation, Cunningham equation, bone mineral density, hypotension, training volume, sex differences, underweight
- MeSH terms
- Adult, Feeding and Eating Disorders, Basal Metabolism, Blood Pressure, Body Composition, Energy Intake, Dancing, Female, Humans, Male, Surveys and Questionnaires, Thinness, Biomarkers, Absorptiometry, Photon, Bone Density, Prevalence, Malnutrition, Young Adult, Sports Nutritional Physiological Phenomena
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