Risk of Low Energy Availability in National and International Level Paralympic Athletes: An Exploratory Investigation

• Main Authors: Kelly Pritchett, Alicia DiFolco, Savannah Glasgow, Robert Pritchett, Katy Williams, Trent Stellingwerff, Patricia Roney, Susannah Scaroni, Elizabeth Broad
• Format: Article
• Language: English
• Published: MDPI AG 2021-03-01
• Series: Nutrients
• Subjects: RED-S; energy availability; Paralympic; spinal cord injury; bone health; reproductive hormones
• Online Access: https://www.mdpi.com/2072-6643/13/3/979

(1) Background: The purpose of this study was to examine the symptoms of low energy availability (LEA) and risk of relative energy deficiency in sport (RED-S) symptoms in para-athletes using a multi-parameter approach. (2) Methods: National level para-athletes (<i>n</i> = 9 males, <i>n</i> = 9 females) completed 7-day food and activity logs to quantify energy availability (EA), the LEA in Females Questionnaire (LEAF-Q), dual energy X-ray absorptiometry (DXA) scans to assess bone mineral density (BMD), and hormonal blood spot testing. (3) Results: Based on EA calculations, no athlete was at risk for LEA (females < 30 kcal·kg⁻¹ FFM·day⁻¹; and males < 25 kcal·kg⁻¹ FFM·day⁻¹; thresholds for able-bodied (AB) subjects). Overall, 78% of females were “at risk” for LEA using the LEAF-Q, and 67% reported birth control use, with three of these participants reporting menstrual dysfunction. BMD was clinically low in the hip (<−2 z-score) for 56% of female and 25% of male athletes (4) Conclusions: Based on calculated EA, the risk for RED-S appears to be low, but hormonal outcomes suggest that RED-S risk is high in this para-athlete population. This considerable discrepancy in various EA and RED-S assessment tools suggests the need for further investigation to determine the true prevalence of RED-S in para-athlete populations.