Low Energy Availability Risk in Female Triathletes

Background: The highly complex syndromes of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S) are underpinned by low energy availability (LEA). LEA has been defined as the imbalance between dietary energy intake (EI) and exercise energy expenditure (EEE), leading to inadequate energy available to optimally support physiological function and health. Chronic LEA, with or without disordered eating (DE) or eating disorder (ED), has been associated with direct and indirect links to the development of menstrual disturbances and impaired bone health. It has also been proposed that chronic LEA may result in impairments to several other health (i.e., cardiovascular, endocrine) and performance (i.e., muscle strength, cognitive function), factors, however limited evidence exists to support these findings. Endurance sports athletes have been reported to be at an increased risk of developing LEA and the subsequent health and performance impairments due to high daily EEE. High daily EEE may arise from high training volumes and/or an increased risk of DE/ED, and/or an increased risk of exercise dependence (EXD). Although it has been accepted endurance athletes may be at an increased risk of developing LEA, to date limited data exists in female athletes particularly from multi-sport endurance athletes. Aim: The main purpose of this thesis was to investigate the prevalence of risk of LEA and associated risk factors (i.e., DE, ED, and EXD) in female triathletes