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Clinical Nutrition Open Science
Article . 2025 . Peer-reviewed
License: CC BY
Data sources: Crossref
image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
Clinical Nutrition Open Science
Article . 2025
Data sources: DOAJ
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Assessment of relative energy deficiency in sport and malnutrition prevalence in female endurance runners by energy availability questionnaire, bioelectrical impedance analysis and relationship with ovulation status

Authors: Samantha Sharp; Roni Mashiach-Fransis; Nicola Keay; Adrian Slee;

Assessment of relative energy deficiency in sport and malnutrition prevalence in female endurance runners by energy availability questionnaire, bioelectrical impedance analysis and relationship with ovulation status

Abstract

Summary: Background and Aims: Low energy availability (LEA) underpins Relative Energy Deficiency in Sport (REDs) - a multisystemic syndrome impacting athletic performance and overall health. Despite its prevalence, research examining clinical REDs indicators in female runners is limited. This study investigated the relationship between REDs screening, BIA assessment of malnutrition and ovulatory status in female endurance runners using an Energy Availability Questionnaire, Bioelectrical Impedance Assessment (BIA) and female reproductive sex hormone levels. Methods: 70 female runners from London, UK running clubs participated in this study. The median age of the participants was 32 years old (range 18–55 years old), with mean ± SD BMI 21.2±2.4 kg/m2. Participants ≥35 years were classified as master's athletes (MA), and those <35 years were classified as younger athletes (YA). All participants answered the Energy Availability Questionnaire, and a scoring system was used to assess REDs risk. 56 from this group underwent anthropometric measurements using multifrequency BIA, and 20 subsequently underwent finger prick capillary blood test to evaluate oestrogen, progesterone, follicle-stimulating hormone, luteinising hormone, and testosterone levels 7 days before their predicted period. Two-way t-test compared REDs-RS of different fat-free mass index (FFMI) percentiles. Linear regression examined associations between BIA anthropometric measurements, hormones, and REDs scores. One-tailed and two-tailed t-tests compared REDs scores and BIA metrics between ovulatory vs. anovulatory participants, respectively. Results: 64% of YA and 29% of MA were identified as being at significant risk of REDs (REDs-RS ≤ 0). BIA measurements indicated that 19% of YA and 50% of MA had FFMI below the ESPEN clinical malnutrition cut-off point of 15 kg/m2 with a mean FFMI of 15.5± 1.38 kg/m2 for YA and MA. Overall, 82% of the participants had FFMI below the suggested 20th percentile for female athletes in weight-sensitive sports. In YA, REDs risk was significantly increased in FFMI ≤5th percentile and associated with lower fat mass index (5.16±1.57 kg/m2). BIA phase angle (PA) was not significantly different between YA (6.4±0.6°) and MA (6.3±0.6°). Examination of ovulation status revealed that REDs-RS values were significantly greater, thus implicating lower REDs risk, in ovulatory (3.5 ± 3.9) vs anovulatory (-0.7 ± 5.1) participants. Conclusions: REDs is prevalent in female runners, regardless of age. BIA indicators of malnutrition, including FFMI, FMI, PA, may function as useful and novel clinical indicators of REDs in female runners. Low FFMI was highly prevalent in MA runners. REDs risk in female runners is closely related to ovulation status and may be quantified using the Dancers Energy Availability Questionnaire (DEAQ) framework, modified for use for female runners.

Keywords

Ovulatory state, Nutrition. Foods and food supply, Malnutrition, Relative energy deficiency in sport, Endurance athletes, Fat free mass, TX341-641, Body composition

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
gold