Disordered Eating in Athletes - REDS Part 2 PDF

Energy Availability, The Female Athlete Triad & RED-S Stella Dion, APD ‹#› 1/23 Energy Availability (EA) Appropriate energy (caloric) intake ⚬ Fundamental to successful athletic performance ⚬ Fundamental to good health Low energy availability (LEA) ⚬ Female A...

Energy Availability, The Female Athlete Triad & RED-S Stella Dion, APD ‹#› 1/23 Energy Availability (EA) Appropriate energy (caloric) intake ⚬ Fundamental to successful athletic performance ⚬ Fundamental to good health Low energy availability (LEA) ⚬ Female Athlete Triad ⚬ RED-S ‹#› 2/23  Energy Availability energy intake matched with energy not matched to energy demand excessive training load insufficient energy intake Energy demand for training load Energy demand for Energy demand for training load energy intake training load energy requirement for life processes Reduced energy Sufficient energy Reduced energy available for life available for life available for life processes processes processes ‹#› 2/23  The Female Athlete Triad Optimal EA Reduced EA (with/without DE) Eumenorrhea Optimal BMD LEA (with/without Subclinical menstrual an DE) disorders Low BMD EA = energy availability Functional LEA = low energy availabiltiy Hypothalamic Osteoporosis DE = disordered eating Amenorrhea BMD = bone mineral density ‹#› 4/23  Prevalence of Components of The Female Athlete Triad Disordered eating + Menstrual Female Athlete Triad Disordered eating + low bone mineral dysfunction + low (all three components) Menstrual dysfunction density bone mineral density Elite athletes 4.3% 26.9% 10.2% 5.4% (N = 186) (N = 8) (N = 50) (N = 19) (N = 10) Control group 3.4% 13.8% 15.2% 12.4% (N = 145) (N = 5) (N = 20) (N = 22) (N = 18) 5/23 Low Bone Mineral Density (BMD) ‹#› 6/23  Psychological Metabolic Relative Energy Immunological Endocrine Deficiency in Gastrointestinal RED-S Haematological Sport Growth & Cardiovascular Development The (‘female athlete’) Triad Bone Health Menstrual Function 7/23 Knowledge Check Q: What is energy availability? (A) When energy intake and energy expenditure is matched (B) Energy intake minus energy expended via life processes (C) Low bone mineral density (D) The energy remaining for life processes after subtracting the energy used in exercise from total energy intake 8/23 Knowledge Check Answer Q: What is energy availability? (A) When energy intake and energy expenditure is matched (B) Energy intake minus energy expended via life processes (C) Low bone mineral density (D) The energy remaining for life processes after subtracting the energy used in exercise from total energy intake 9/23  Hypothalamic Pituitary Gonadal Axis Series of hormonal pathways connecting the hypothalamus, pituitary gland & gonads Role in immune & reproductive function LEA = reproductive hormone production ‹#› 10/23  REDs Underlying Causal Factors Image adapted from: Melin A. et al., Energy Availability in Athletics: Health, Performance, and Physique. Int J Sport Nutr Exerc Metab. 2019; 29(2):152-164. ‹#› 11/23  Mary Cain’s Story https://youtu.be/qBwtCf2X5jw 12/23  RED-S Potential Negative Effects (1 of 2) Menstrual dysfunction due to hormonal abnormalities in females; reproductive function in males Impaired bone health and increased risk for stress fractures Psychological consequences Risk for disordered eating and progression to an ED Risk for developing iron-deficiency anemia and chronic fatigue Impaired immune system ‹#› 13/23  RED-S Potential Negative Effects (2 of 2) Reduced muscle protein synthesis Increased risk for cardiovascular disease due to unfavorable lipid profiles Impaired growth and development Gastrointestinal problems, especially if the athlete is fasting, vomiting, or using diuretics or laxatives ‹#› 14/23  EA: reference ranges and cut-off points? The early Female Athlete Triad literature suggested that the Hypothalamic Pituitary Gonadal Axis could be influenced within 5 days of low energy availability, when energy availability fell below 30 kCal (or 126kJ) /kg fat free mass. The following cut points have been suggested for interpreting energy availability: ‹#› 15/23 Monitoring & Screening Early Intervention is critical Athletes at risk should be closely monitored for key signs: ⚬ Specific eating patterns (e.g., vegetarians) ⚬ Recurrent injuries and/or ongoing fatigue Regular screening is essential for prevention, including: ⚬ Annual physical exams ⚬ Laboratory tests ⚬ DEXA scans for bone health ⚬ Blood counts 16/23  Screening & Prevention of REDs LEAF-Q & LEAM-Q The Female Athlete Triad Cumulative Risk Assessment Relative Energy Deficiency in Sport - Clinical Assessment Tool (RED-S CAT2) Limitations? ‹#› 17/23 Assessment of LEA & REDs in Athletes (AIS) 18/23 Treatment focus for RED-S Adequate energy intake - gradual increase Periodisation of nutritional intake Focus on bone-building nutrients Gut health-promoting nutrition Modification of training Ensure adequate sleep Address mental health Consider the medication(s) being taken ‹#› 19/23  Expected Improvements Once energy availability is restored, it is important to understand what to expect in terms of improvements in various markers of REDs. Whilst some markers like RMR can recover relatively quickly, others like bone density may take years, or possibly never fully recover. Expected recovery timeframe Resting Metabolic Rate: Within weeks Menstruation: Months Bone health: Longer, and may never reach optimal levels Blood biomarkers (medical): Unclear, requires further validation ‹#› 20/23  Activity The members of a female gymnastics team may all appear to have a lean, thin physique but may include both well-trained athletes without disordered eating behaviours and athletes who demonstrate disordered eating and exercise behaviours. How does a coach distinguish between these two groups of athletes to help those who may need treatment get it? ‹#› 21/23  Summary (1 of 2) Now that the lesson has ended, from both lectures you should have learned how to: Outline changes in eating and exercising patterns over time that may put athletes at risk for disordered eating and eating disorders. Describe the concepts of normal eating, disordered eating, and eating disorders. Compare and contrast anorexia nervosa, bulimia nervosa, binge eating disorder, and anorexia athletica. ‹#› 22/23  Summary (2 of 2) State the prevalence of disordered eating and eating disorders in male and female athletes, and explain the distinctions between athletes with eating disorders and those who are training intensely but do not have a disordered eating pattern. Explain the role of energy availability and the health and performance effects on the athlete if energy availability is low. Discuss the components of Female Athlete Triad. Explain how the concept of the Relative Energy Deficiency in Sport (RED-S) differs from the Female Athlete Triad. ‹#› 23/23