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Cited by 258Eating Disorders and BehaviorsHypothalamic control of reproductive hormonesSports Performance and Training

Energy Availability in Athletics: Health, Performance, and Physique

Open access
Melin, Anna K., Heikura, Ida A., Tenforde, Adam, Mountjoy, Margo·2019·International Journal of Sport Nutrition and Exercise Metabolism
DOI 10.1123/ijsnem.2018-0201
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Abstract

The reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events. In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters. Health concerns with functional hypothalamic amenorrhea include impaired bone health, elevated risk for bone stress injury, and cardiovascular disease. Furthermore, LEA negatively affects recovery, muscle mass, neuromuscular function, and increases the risk of injuries and illness that may affect performance negatively. LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior. Long-term LEA causes metabolic and physiological adaptations to prevent further weight loss, and athletes may therefore be weight stable yet have impaired physiological function secondary to LEA. Achieving or maintaining a lower body mass or fat levels through long-term LEA may therefore result in impaired health and performance as proposed in the Relative Energy Deficiency in Sport model. Preventive educational programs and screening to identify athletes with LEA are important for early intervention to prevent long-term secondary health consequences. Treatment for athletes is primarily to increase energy availability and often requires a team approach including a sport physician, sports dietitian, physiologist, and psychologist.

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  • The known consequences of LEA cause a myriad of complications, including reproductive dysfunction and impairments to skeletal, cardiovascular, gastrointestinal, endocrine, and neurological function.

    “Briefly, the known consequences of LEA cause a myriad of complications, which include reproductive dysfunction and impairments to skeletal, cardiovascular, gastrointestinal, endocrine, and neurological function [113,115,127,128].”

    From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [128]

    The Reproductive Dysfunction, Impaired Skeletal Health and BSI, and Metabolic Alterations sections describe reproductive, bone, and hormonal consequences of LEA. Metabolic Alterations reports cardiovascular findings in runners with functional hypothalamic amenorrhea and an association with gastrointestinal problems, while Performance reports reduced neuromuscular performance. These passages do not establish neurological dysfunction broadly, and the cardiovascular and gastrointestinal evidence is more qualified than the claim suggests. Page numbers were not available in our copy. (LLM, conf=0.86)

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  • Problems associated with chronic or severe low energy availability, known as relative energy deficiency in sports, are well known.

    “Problems associated with chronic or severe low energy availability, known as relative energy deficiency in sports, are well known (Mountjoy et al., 2018); specific issues in relation to Athletics are covered by Melin et al. (2019).”

    From Contemporary Nutrition Strategies to Optimize Performance in Distance Runners and Race Walkers (2019) · cites this paper as Melin et al., 2019

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Research works printed but not linked: 2

  1. [41]41. Martinsen, M., Bahr, R., Børresen, R., Holme, I., Pensgaard, A.M., & Sundgor-Borgen, J. (2014a). Preventing eating disorders among young elite athletes. Medicine & Science in Sports & Exercise, 46(3), 435-447. PubMed ID: 24549033 doi:10.1249/MSS. · DOI
  2. [61]61. Stellingwerff, T., Whitfield, J., & Bovim, I. (2019). IAAF nutrition consensus: Nutrition for middle distance athletes. International Journal of Sport Nutrition and Exercise Metabolism,29(2). doi:10 .1123/ijsnem.2018-0241

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Authors
Melin, A. K., Heikura, I. A., Tenforde, A., & Mountjoy, M.
Affiliations
  • University of Copenhagen (DK)
  • Australian Catholic University (AU)
  • Spaulding Rehabilitation Hospital (US)
  • International Olympic Committee (CH)
ORCID
Venue
International Journal of Sport Nutrition and Exercise Metabolism
Publisher
Human Kinetics
Published
2019-03-01
Volume
29
Issue
2
Pages
152-164
ISSN
  • 1526-484X (ISSN-L)
  • 1543-2742
DOI
10.1123/ijsnem.2018-0201
OpenAlex
W2908767208
Cited by
258
References
84
Citations by year
2026: 39 · 2025: 32 · 2024: 37 · 2023: 41 · 2022: 39 · 2021: 32 · 2020: 26 · 2019: 10 · 2018: 1
FWCI
4.21
Type
journal article
Language
en
Open access
Locations
  • International Journal of Sport Nutrition and Exercise Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
Keywords
low energy availability, track and field athletes, functional hypothalamic amenorrhea, relative energy deficiency in sport, bone health, bone stress injuries, cardiovascular risk, disordered eating, body mass reduction, testosterone, athletic performance, injury risk, screening and prevention, multidisciplinary treatment
MeSH terms
Feeding and Eating Disorders, Body Composition, Body Weight, Energy Intake, Energy Metabolism, Humans, Nutritional Requirements, Athletic Performance, Athletes, Reproductive Health, Sports Nutritional Physiological Phenomena

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