Energy availability and the female troid in elite endurance athletes

The female athlete triad (Triad), links low energy avail-ability (EA), with menstrual dysfunction (MD), andimpaired bone health. The aims of this study were toexamine associations between EA/MD and energymetabolism and the prevalence of Triad-associated con-ditions in endurance athletes. Forty women [26.2 ± 5.5years, body mass index (BMI) 20.6 ± 2.0 kg/m2, bodyfat 20.0 ± 3.0%], exercising 11.4 ± 4.5 h/week, wererecruited from national teams and competitive clubs. Pro-tocol included gynecological examination; assessment ofbone health; indirect respiratory calorimetry; diet andexercise measured 7 days to assess EA; eating disorder(ED) examination; blood analysis. Subjects with low/reduced EA (< 45 kcal/kg FFM/day), had lower restingmetabolic rate (RMR) compared with those with optimalEA [28.4 ± 2.0 kcal/kg fat-free mass (FFM)/day vs30.5 ± 2.2 kcal/kg FFM/day, P < 0.01], as did subjectswith MD compared with eumenorrheic subjects(28.6 ± 2.4 kcal/kg FFM/day vs 30.2 ± 1.8 kcal/kg FFM/day, P < 0.05). 63% had low/reduced EA, 25% ED, 60%MD, 45% impaired bone health, and 23% had all threeTriad conditions. 53% had low RMR, 25% hypercholes-terolemia, and 38% hypoglycemia. Conclusively, athleteswith low/reduced EA and/or MD had lowered RMR.Triad-associated conditions were common in this groupof athletes, despite a normal BMI range. The high preva-lence of ED, MD, and impaired bone health emphasizesthe importance of prevention, early detection, and treat-ment of energy deficiency.