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Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance
Open accessAbstract
Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.
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“It is important to understand and identify LEA because it sets the stage for the Female Athlete Triad (FAT) and Relative Energy Deficiency in Sport (REDs) [5].”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [5]
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“The majority of body composition changes occur in the four to five years leading up to menopause (commonly defined as a period of time of 12 months of no menses), after which body composition changes are more age-related, rather than hormone-related [112].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [112]
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Metadata
- Authors
- Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S.-J. M., & Corish, C. A.
- Affiliations
- University College Dublin (IE)
- Sport Ireland Institute (IE)
- Linnaeus University (SE)
- Sport Ireland Institute, Sports Campus Ireland, Abbotstown, D15 PNON Dublin, Ireland
- Corresponding author
- Logue, Danielle M.
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2020-03-20
- Volume
- 12
- Issue
- 3
- Pages
- 835
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC7146210
- OpenAlex
- W3012153241
- Cited by
- 321
- References
- 66
- Citations by year
- 2026: 58 · 2025: 40 · 2024: 69 · 2023: 53 · 2022: 47 · 2021: 43 · 2020: 10
- FWCI
- 2.99
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
- Funders
- Irish Research Council (EPS-PG-2015-99)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- low energy availability, relative energy deficiency in sport, female athlete triad, menstrual disorders, athletic performance, energy balance, screening tool, LEAF-Q, nutritional strategies, bone health, prevalence, risk factors
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Feeding and Eating Disorders, Energy Intake, Energy Metabolism, Female, Humans, Male, Middle Aged, Nutritional Status, Prevalence, Malnutrition, Athletic Performance, Young Adult, Athletes, Sports Nutritional Physiological Phenomena
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