The Risk Of Low Energy Availability In Female Aesthetic Sports Athletes

Background: It is essential for athletes to consume sufficient energy at the right times to sustain health and performance.Low energy availability(LEA)is a medical condition observed in athletes,with a higher prevalence in aesthetic sports.Long-term LEA status can negatively impact athletic healthy and performance.It has been established that athletes in Western countries and populations are at a higher risk of LEA,especially in aesthetic sports,however the prevalence of LEA in populations of Chinese athletes has not been established.This study was the first time to evaluate the relative LEA prevalence in female athletes form different competitive levels in aesthetic sports in China.Methods: Female athletes from 6 sports were recruited from elite athletes on Chinese national teams and collegiate athletes on Beijing Sport University.Participants selfcompleted 2 online questionnaires to assess LEA and eating disorder risks.These included the Low Energy Availability in Females Questionnaire(LEAF-Q)that provided information on injury history,gastrointestinal function and menstrual history,and the Eating Disorder Inventory-3 Referral Form(EDI-3 RF).Subjects classified as elite athletes had recently competed in a national or international championship event.For a sub-group of elite athletes(n=14),body composition,bone mineral density,and blood serum were also quantified.Data were analyzed using SPSS Statistics,version21.To determine differences between sport levels(elite athletes and collegiate athletes)and EA status(high-risk and low-risk),parametric data were analyzed using an independent sample t-test,and nonparametric data were analyzed using a MannWhitney U-Test.Chi-squared tests were used to determine whether there were differences in the prevalence of LEA,ED,injury,gastrointestinal dysfunction,and menstrual disturbance between groups.Pearson correlation coefficients were used to determine the presence of any significant relationships.Differences in body composition,BMD and blood measures between subgroups were analyzed using an independent sample t-test.The statistical significance level was set at α< 0.05.Results: 1)A total of 41.6%(n=69)of participants were classified as having a risk of LEA and 57.2%(n=95)of participants as eating disorder risk.2)Those at the risk of LEA had higher training volumes and higher risks for bone injuries(52.2% vs.7.2%;p<0.001),menstrual disturbances(79.7% vs.30.9%;p<0.001)and gastrointestinal dysfunction(69.6% vs.47.4%;p=0.05).3)Elite athletes had significantly higher prevalence of the risk of LEA(55.8% vs.35.1%;p=.012)and primary amenorrhea(53.8% vs.13.3%;p<0.001)than collegiate athletes.4)Elite athletes at the risk of LEA had significantly lower estradiol(p=.021)and wholebody BMD(p=.018).Pearson correlations indicated that the whole-body BMD(r=-0.667,p=0.009)correlated negatively with LEAF-Q score.Conclusions: These data show that female athletes in aesthetic sports are at LEA risk,with a significantly higher prevalence of LEA risk observed in elite athletes than in collegiate athletes participating in aesthetics sport in China.These findings suggest that coaches and sports medicine staff working with aesthetic sport female athletes should be aware of these risks,and that those working with elite female athletes should be knowledgeable of these high risks and develop strategies that can lower prevalence.