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Cited by 45Eating Disorders and BehaviorsNutrition, Health and Food BehaviorLower Extremity Biomechanics and Pathologies

Risk of Low Energy Availability among Female and Male Elite Runners Competing at the 26th European Cross-Country Championships

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Jesus, Filipe, Castela, Inês, Silva, Analiza M, Branco, Pedro A., Sousa, Mónica·2021·Nutrients
DOI 10.3390/nu13030873PMC PMC8000897
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Abstract

Low energy availability (LEA) causes impaired physiological functioning. Cross-country running is a weight-sensitive sport, making athletes more prone to LEA. We aimed to estimate the prevalence of elite European cross-country athletes at risk of LEA using the LEA in Females Questionnaire (LEAF-Q) and to analyze demographic and physical characteristics that are associated with LEA. Athletes ≥ 18 years competing at the 26th European Cross-Country Championships (n = 602) were invited to complete a questionnaire (sociodemographic, training, anthropometric characteristics, and LEAF-Q). A total of 207 valid surveys were collected (83 females, 22.1 (4.0) years, and 124 males, 22.3 (4.1) years), and 16 surveys were excluded. A high prevalence of athletes at risk of LEA (64.3%) was observed, being higher in females than in males (79.5 and 54.0% respectively, p < 0.001). More than half of athletes (54.1%, n = 112) reported bowel movements once a week or more rarely, while 33 female athletes (41.3%) did not report normal menstruation. Overall, cross-country athletes are at high risk of LEA. Moreover, a high prevalence of gastrointestinal and menstrual impairments was reported. Hence, athletes should be followed by multidisciplinary teams to inform, prevent, and treat LEA and its effects.

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  • Jesus et al. found 10/133 (7.5%) elite cross-country runners with LEA had a stress fracture in the past year, compared to 0/90 athletes without LEA.

    “Jesus et al. [58] Elite cross-country runners (n = 223), 133 (64.3%) of whom were at risk for LEA 10/133 (7.5%) athletes with LEA had a stress fracture in the past year, compared to 0/90 athletes without LEA.”

    From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [58]

    The Discussion (§4.3; page unavailable) reports 10 stress fractures, all among athletes identified as at risk of LEA, supporting 10/133 and none in the group not at risk. But the Abstract and Discussion report 207 valid surveys and 133 athletes at risk, leaving 74—not 90—without identified risk. The paper identifies risk of LEA rather than confirming that those athletes had LEA. (LLM, conf=0.92)

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References 44 · Cited by 45

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Authors
Jesus, F., Castela, I., Silva, A. M., Branco, P. A., & Sousa, M.
Affiliations
  • University of Lisbon (PT)
  • Universidade Nova de Lisboa (PT)
  • Medical &amp; Anti-Doping Commission, European Athletics, CH-1003 Lausanne, Switzerland
Corresponding author
Sousa, Mónica
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2021-03-07
Volume
13
Issue
3
Pages
873
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu13030873
PMC
PMC8000897
OpenAlex
W3135186660
Cited by
45
References
44
Citations by year
2026: 10 · 2025: 9 · 2024: 10 · 2023: 9 · 2022: 4 · 2021: 3
FWCI
4.43
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
European Athletics (N/a.)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords
low energy availability, cross country running, elite athletes, sex differences, LEAF-Q, gastrointestinal symptoms, menstrual disorders, prevalence, multidisciplinary team
MeSH terms
Adult, Energy Metabolism, Europe, Female, Gastrointestinal Diseases, Humans, Male, Menstruation Disturbances, Protein-Energy Malnutrition, Surveys and Questionnaires, Risk Factors, Running, Sex Factors, Prevalence, Young Adult, Athletes, Sports Nutritional Physiological Phenomena

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