Prevalence of Physiological and Perceptual Markers of Low Energy Availability in Male Academy Football Players: a Study Protocol for a Cross-sectional Study

Overview

Journal BMJ Open Sport Exerc Med

Specialty Orthopedics

Date 2024 Oct 9

PMID 39381413

Authors

Jamie Ashby

Thomas Mullen

Philip Smith

John P Rogers

Nick Dobbin

Affiliations

Soon will be listed here.

Abstract

Low energy availability (LEA) is a core feature of the female athlete triad and relative energy deficiency in sport (REDs). LEA underpins multiple adverse health and performance outcomes in various athletic populations, including weight category, endurance and aesthetic sports. Recent reports suggest LEA is highly prevalent in female football, volleyball and netball, with little known on male team-sport athletes. Therefore, the study aims to identify the prevalence of LEA among male academy football players (16-23 years), using surrogate markers that align with the International Olympic Committee REDs Clinical Assessment Tool-Version 2. A cross-sectional study design will be used with physiological and perceptual markers of LEA measured. The study will seek to recruit 355 players to complete several online questionnaires believed to be associated with LEA, measured using a 24-hour food and activity diary. Of the 355 players, a subsample (n=110) will complete an additional 3-day food and activity diary, provide a venous blood sample to measure levels of total testosterone and free triiodothyronine, and have resting metabolic rate (RMR) measured to determine RMR. The prevalence of LEA will be determined using the low (<30 kcal·kgFFM·day) domain of energy availability and divided by the total number of participants. Descriptive statistics will be used to summarise the whole group and difference status of energy availability (eg, low, reduced, optimal, high). A univariable and multivariable binary logistic regression analysis will be modelled to assess the association of various surrogate markers with the presence of LEA.

References

Keay N, Francis G, Entwistle I, Hind K . Clinical evaluation of education relating to nutrition and skeletal loading in competitive male road cyclists at risk of relative energy deficiency in sports (RED-S): 6-month randomised controlled trial. BMJ Open Sport Exerc Med. 2019; 5(1):e000523. PMC: 6539156. DOI: 10.1136/bmjsem-2019-000523. View

Grove J, Main L, Partridge K, Bishop D, Russell S, Shepherdson A . Training distress and performance readiness: laboratory and field validation of a brief self-report measure. Scand J Med Sci Sports. 2014; 24(6):e483-490. DOI: 10.1111/sms.12214. View

Torstveit M, Fahrenholtz I, Lichtenstein M, Stenqvist T, Melin A . Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes. BMJ Open Sport Exerc Med. 2019; 5(1):e000439. PMC: 6350749. DOI: 10.1136/bmjsem-2018-000439. View

Boer P . Estimated lean body mass as an index for normalization of body fluid volumes in humans. Am J Physiol. 1984; 247(4 Pt 2):F632-6. DOI: 10.1152/ajprenal.1984.247.4.F632. View

Mountjoy M, Ackerman K, Bailey D, Burke L, Constantini N, Hackney A . 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023; 57(17):1073-1097. DOI: 10.1136/bjsports-2023-106994. View

McGuire A, Warrington G, Doyle L . Prevalence of low energy availability and associations with seasonal changes in salivary hormones and IgA in elite male Gaelic footballers. Eur J Nutr. 2023; 62(4):1809-1820. PMC: 9968222. DOI: 10.1007/s00394-023-03112-0. View

Scheffer J, Dunshea-Mooij C, Armstrong S, MacManus C, Kilding A . Prevalence of low energy availability in 25 New Zealand elite female rowers - A cross sectional study. J Sci Med Sport. 2023; 26(12):640-645. DOI: 10.1016/j.jsams.2023.09.016. View

Pensgaard A, Sundgot-Borgen J, Edwards C, Jacobsen A, Mountjoy M . Intersection of mental health issues and Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med. 2023; 57(17):1127-1135. DOI: 10.1136/bjsports-2023-106867. View

Stevenson M . Sample Size Estimation in Veterinary Epidemiologic Research. Front Vet Sci. 2021; 7:539573. PMC: 7925405. DOI: 10.3389/fvets.2020.539573. View

10.

Martinsen M, Holme I, Pensgaard A, Torstveit M, Sundgot-Borgen J . The development of the brief eating disorder in athletes questionnaire. Med Sci Sports Exerc. 2014; 46(8):1666-75. DOI: 10.1249/MSS.0000000000000276. View

11.

Stenqvist T, Torstveit M, Faber J, Melin A . Impact of a 4-Week Intensified Endurance Training Intervention on Markers of Relative Energy Deficiency in Sport (RED-S) and Performance Among Well-Trained Male Cyclists. Front Endocrinol (Lausanne). 2020; 11:512365. PMC: 7545350. DOI: 10.3389/fendo.2020.512365. View

12.

Oxfeldt M, Marsi D, Christensen P, Andersen O, Johansen F, Bangshaab M . Low Energy Availability Followed by Optimal Energy Availability Does Not Benefit Performance in Trained Females. Med Sci Sports Exerc. 2024; 56(5):902-916. DOI: 10.1249/MSS.0000000000003370. View

13.

Heikura I, Stellingwerff T, Areta J . Low energy availability in female athletes: From the lab to the field. Eur J Sport Sci. 2021; 22(5):709-719. DOI: 10.1080/17461391.2021.1915391. View

14.

Lundy B, Torstveit M, Stenqvist T, Burke L, Garthe I, Slater G . Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q. Nutrients. 2022; 14(9). PMC: 9101736. DOI: 10.3390/nu14091873. View

15.

Langan-Evans C, Reale R, Sullivan J, Martin D . Nutritional Considerations for Female Athletes in Weight Category Sports. Eur J Sport Sci. 2021; 22(5):720-732. DOI: 10.1080/17461391.2021.1936655. View

16.

Herrmann S, Willis E, Ainsworth B, Barreira T, Hastert M, Kracht C . 2024 Adult Compendium of Physical Activities: A third update of the energy costs of human activities. J Sport Health Sci. 2024; 13(1):6-12. PMC: 10818145. DOI: 10.1016/j.jshs.2023.10.010. View

17.

Carter J, Lee D, Perrin C, Ranchordas M, Cole M . Significant Changes in Resting Metabolic Rate Over a Competitive Match Week Are Accompanied by an Absence of Nutritional Periodization in Male Professional Soccer Players. Int J Sport Nutr Exerc Metab. 2023; 33(6):349-359. DOI: 10.1123/ijsnem.2023-0069. View

18.

Sesbreno E, Blondin D, Dziedzic C, Sygo J, Haman F, Leclerc S . Signs of low energy availability in elite male volleyball athletes but no association with risk of bone stress injury and patellar tendinopathy. Eur J Sport Sci. 2022; 23(10):2067-2075. DOI: 10.1080/17461391.2022.2157336. View

19.

Stables R, Hannon M, Costello N, McHaffie S, Sodhi J, Close G . Acute fuelling and recovery practices of academy soccer players: implications for growth, maturation, and physical performance. Sci Med Footb. 2022; 8(1):37-51. DOI: 10.1080/24733938.2022.2146178. View

20.

Compher C, Frankenfield D, Keim N, Roth-Yousey L . Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006; 106(6):881-903. DOI: 10.1016/j.jada.2006.02.009. View