Objectives To evaluate the efficacy of a sport-specific energy availability (EA) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S).
Methods Fifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed by a newly developed sport-specific questionnaire and clinical interview (SEAQ-I) and received dual energy X-ray absorptiometry (DXA) bone mineral density (BMD) and body composition scans and blood tests for endocrine markers.
Results Low EA as assessed using the SEAQ-I, was observed in 28% of cyclists. Low lumbar spine BMD (Z-score<−1.0) was found in 44% of cyclists. EA was the most significant determinant of lumbar spine BMD Z-score (p<0.001). Among low EA cyclists, lack of previous load-bearing sport was associated with the lowest BMD (p=0.013). Low EA was associated with reduced total percentage fat (p<0.019). The 10 cyclists with chronic low EA had lower levels of testosterone compared with those having adequate EA (p=0.024). Mean vitamin D concentration was below the level recommended for athletes (90 nmol/L). Training loads were positively associated with power-to-weight ratios, assessed as 60 min functional threshold power (FTP) per kg (p<0.001). Percentage body fat was not significantly linked to cycling performance.
Conclusions This study demonstrates that a SEAQ-I is effective for identifying male road cyclists with acute intermittent and chronic sustained low EA. Cyclists with low EA, particularly in the long-term, displayed adverse quantifiable measures of bone, endocrinology and performance consequences of RED-S.
- energy availability
- male athletes
- bone health
- relative energy deficiency in sport
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Collaborators Ian Entwistle and Brian Oldroyd, Leeds Beckett University, Leeds, UK.
Contributors NK: conceptualisation of project, development of study design, research funding application, involvement of cyclists, their coaches and sports performance dieticians, conducting clinical sport specific interviews, drafting and revision of manuscript. GF: cycle specific advanced statistical analysis and revision of manuscript. KH: development of study design, research funding application, scanning of cyclists, drafting and revision of manuscript, IE and BO scanning of cyclists.
Funding Thank you to the British Association of Sport and Exercise Medicine (BASEM) for funding this study with a research bursary. Thanks also to SunVitD3 for funding the analysis of endocrine and metabolic markers.
Competing interests None declared.
Patient consent Not required.
Ethics approval Leeds Beckett University Research Ethics Board.
Provenance and peer review Not commissioned; externally peer reviewed.
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