Energy availability in female athletes with disabilities: a narrative review
AbstractResearch on female athletes has increased, with the main focus on Low Energy Availability (LEA) and Female Athlete Triad (TRIAD), however there is a gap in knowledge about LEA and related conditions such as eating disorder, menstrual dysfunction and bone health in athletes with disabilities. The literature suggests that those athletes, depending on the type of disability, have a higher risk of developing LEA. In this way, the objective of this review is to describe the impact of LEA on health and performance of female athletes, with special focus on athletes with disabilities. A narrative review of the literature was conducted using as search terms LEA and TRIAD components - bone health and menstrual dysfunction - in female athletes. The narrative review yielded 24 studies on the subject, of those, 10 original studies, in which LEA was diagnosed in female athletes, only one referring to athletes with disabilities. Literature indicates the complexity in estimating EA, since the methods used to determine its components may present inaccuracies, especially for athletes with disabilities. Further researched is needed to assess EA in female athletes, especially with disabilities, as well as the improvement of EA's assessment and screening methods.
American College of Sports Medicine. (2007). The Female athlete triad. Med Sci Sports Exerc, 39(10), 1867â€“82. doi: 10.1249/mss.0b013e318149f111.
Blauwet, C.A. (2015). The paralympic female athletes. In: M. L. Mountjoy (Org). The female athlete. New Jersey: John Wiley & Sons. pp.120 â€“ 128.
Blauwet, C. A., Brook, E. M., Tenforde, A. S., Broad, E., Hu, C. H., Abdu-Glass, E., & Matzkin, E. G. (2017). Low energy availability, menstrual dysfunction, and low bone mineral density in individuals with a disability: implications for the para athlete population. Sport Med, 1â€“12. https://doi.org/doi:10.1007/s40279-017-0696-0.
Broad, E. & Burke, L. (2013). Principles of sport nutrition. In: E. Broad (Org). Sport nutrition of Paralympic athletes. Boca Raton: CRC Press. pp. 23-65.
Coelho, G. M., Farias, M. L., Mendonça, L. M., Mello, D. B., Lanzillotti, H. S., Ribeiro, B. G., & Soares, E. . (2013). The prevalence of disordered eating and possible health consequences in adolescent female tennis players from Rio de Janeiro, Brazil. Appetite, 64, 39â€“47. https://doi.org/doi: 10.1016/j.appet.2013.01.001.
Constantini, N.W. & Lebrun, C. M. (2015). Bone Health. In: M. L. Mountjoy (Org). The female athlete. New Jersey: John Wiley & Sons. pp.56 â€“ 66.
Dadgostar, H., Razi, M., Aleyasin, A., Alenabi, T., & Dahaghin, S. (2009). The relation between athletic sports and prevalence of amenorrhea and oligomenorrhea in Iranian female athletes. Sports Med Arthrosc Rehabil Ther Technol., 1(1), 1-16. doi: 10.1186/1758-2555-1-16.
Folscher, L., Grant, C. C., Fletcher, L., & Rensberg, D. C. (2015). Ultra-marathon athletes at risk for the Female Athlete Triad. Sport Med - Open, 1(1), 1â€“8. https://doi.org/doi: 10.1186/s40798-015-0027-7.
Hoch, A. Z., Pajewski, N. M., Moraski, L., Carrera, G. F., Wilson, C. R., Hoffmann, R. G., â€¦ Gutterman, D. D. (2009). Prevalence of the Female Athletes Triad in high school athletes and sedentary students. Clin J Sport Med, 19(5), 421â€“428. doi:10.1097/JSM.0b013e3181b8c136.
International Olympic Committee. (2017). Women in Sport. Available in: https://www.olympic.org/women-in-sport/background.
International Paralympic Committee. (2016). About Rio 2016. Available in: https://www.paralympic.org/rio-2016/about-us
International Society for Clinical Densitometry. (2015). 2015 ISCD Official Positions â€“ Adult. Retrieved March, 30, 2017, from http://www.iscd.org/official-positions/2015-iscd-official-positions-adult/.
Joaquim, D.P. (2016). Análise do gasto energético com exercÃcio e estimativa da energia disponÃvel de atletas ParalÃmpicos de atletismo. Dissertação de Mestrado, Instituto Saúde e Sociedade, Universidade Federal de São Paulo. Santos, SP, Brazil.
Koehler, K., Achtzehn, S., Braum, H., Mester, J., & Schaenzer, W. (2013). Comparison of self-reported energy availability and metabolic hormones to assess adequacy of dietary energy intake in young elite athletes. Appl Physiol Nutr Metab, 38(7), 725â€“733.
Matzkin, E., Curry, E.J. & Whitlock, K. (2015). Female athlete triad: past, present, and future. J Am Acad Orthop Surg, 23(7), 424â€“432. doi: 10.5435/JAAOS-D-14-00168.
Slater, J., Brown, R., McLay-Cooke, R., & Black, K. (2017). Low Energy Availability in Exercising Women Historical Perspectives and Future Directions. Sport Med, 47(2), 207â€“220.
Silva, M. R. G., & Paiva, T. (2015). Low energy availability and low body fat of female gymnasts before an international competition. Eur J Sport Sci, 15(7), 591â€“599.
Souza, M. J., Nattiv, A., Joy, E., Misra, M., Williams, N., Mallinson, R. J., â€¦ Panel, E. (2014). 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad. Br J Sports Med, 48(289), 1â€“20. doi:10.1136/bjsports-2013-093218.
Márquez, S., & Molinero, O. (2013). Energy availability, menstrual dysfunction and bone health in sports; an overwiew of the female athlete triad. Nutr Hosp, 28(4), 1010â€“1017.
Melin, A., Tornberg, A.B., Skouby, S., Moller, S.S., Sundgot-borgen, J., Faber, J., â€¦ Sjödin, A. (2015). Energy availability and the female athlete triad in elite endurance athletes. Scand J Med Sci Sports, 25(5), 610â€“622. doi: 10.1111/sms.12261
Melin, A., Tornberg, A. B., Skouby, S., Faber, J., Ritz, C., Sjödin, A., & Sundgot-Borgen, J. (2014). The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med, 48, 540â€“545.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., â€¦ Ljungqvist, A. (2014). The IOC consensus statement: beyond the Female Athlete Triad â€” Relative Energy Deficiency in Sport (RED-S). Br J Sports Med, 48(7), 491â€“497. https://doi.org/doi:10.1136/bjsports-2014-093502.
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., â€¦ Ljungqvist, A. (2015). Authorsâ€™ 2015 additions to the IOC consensus statement: Relative Energy Deficiency in Sport (RED-S). Br J Sports Med, 49(7), 417â€“420. https://doi.org/doi: 10.1136/bjsports-2014-094371.
Muia, E. N., Wright, H., Onywera, V. O., & Kuria, E. N. (2016). Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating. J sports Sci, 37(4), 598â€“606. https://doi.org/doi: 10.1080/02640414.2015.1065340.
Nazem, T. G., & Ackerman, K. (2012). The Female Athlete Triad. Sports Health, 4(4), 302â€“311.
Loucks, A.B, Kiens, B., & Wright, H. (2011). Energy availability in athletes. J Sport Sci, 29(S1), S7â€“S15. https://doi.org/doi: 10.1080/02640414.2011.588958.
Reed, J., Souza, M. J., & Williams, N. (2013). Changes in energy availability across the season in Division I female soccer players. J sports Sci, 31(3), 314â€“324.
Viner, R. T., Harris, M., Berning, J. R., & Meyer, N. L. (2015). Energy Availability and Dietary Patterns of Adult Male and Female Competitive Cyclists With Lower Than Expected Bone Mineral Density. Int J Sport Nutr Exerc Metab, 25, 594â€“602.