Athletes' and Coaches' Perceptions of Nutritional Advice: Eating More Food for Health and Performance.

BACKGROUND: Low energy availability results in physiological adaptations which contribute to unfavourable health outcomes. Little information exists on perceptions of nutritional advice to eat more food to maintain health and enhance performance. The aim of this study was to explore athletes' and coaches' perceptions towards advice to athletes to eat larger than their current quantities of food and to explore how nutritionists could deliver this advice. METHODS: Semi-structured interviews (~20 min in length) were conducted using online communication technology, audio-recorded, and transcribed verbatim. The interview explored perceptions of the nutritional advice provided, its role in health and performance, and the challenges to eating larger amounts of food. Data were analysed using NVIVO 1.2 using an inductive thematic approach. RESULTS: Nine elite athletes (female = 6; males = 3) and nine high-performance coaches (female = 3; male = 6) completed the semi-structured interviews. Athletes reported improved training consistency, fewer injuries and illnesses, and improved resilience when consuming adequate energy and nutrients to meet their needs. Lack of time and meal preparation difficulties were the main challenges faced to fuelling. CONCLUSIONS: Although education about under-fuelling is important, motivating, enabling, and supporting athletes to change behaviour is pivotal to increasing athlete self-awareness and to make long-term nutritional changes.

Self-reported reproductive health of athletic and recreationally active males in Ireland: potential health effects interfering with performance.

Introduction: The syndrome of Relative Energy Deficiency in Sport (RED-S) consensus statements recognise that male athletes might have impaired fertility in terms of the Exercise Hypogonodal Male Condition (ExHMC). Thus, the aims of this study were to (1) identify risk of ExHMC in active males in various sports and (2) determine if associations between risk of ExHMC and health problems interfering with training and competition exist. Methods: A questionnaire was distributed online (November 2018-January 2019) using questions derived from the "Androgen Deficiency in the Aging Male Questionnaire" (ADAM-Q) to assess risk of ExHMC. Additional questions were included to collect information on participant demographics, injury and illness history and dietary habits. Logistic regression analyses explored differences between groups. Results: Risk of ExHMC was identified in 23.3% (n = 185) of 794 questionnaire participants. Following multivariate analyses, risk of ExHMC was independently associated with a lower than normal sex drive rating within the last month (OR 7.62, 95%CI 4.99-11.63) and less than three morning erections per week within the last month (OR: 4.67, 95%CI 3.23-6.76). Risk of ExHMC was associated with 15-21 days absence from training or competition during the previous 6 months due to overload injuries in the univariate analysis (OR = 2.69, 95% CI = 1.24-5.84). Conclusion: Risk of ExHMC and associated symptoms in this heterogeneous sample may be indicative of RED-S. Confounding factors such as over-training, medication use, fatigue and psychological stress need to be considered. Identification of male athletes exhibiting physiological symptoms associated with RED-S requires more research.

Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance.

Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying "true" low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

Screening for risk of low energy availability in athletic and recreationally active females in Ireland.

INTRODUCTION: Low energy availability (LEA) results in physiological adaptations, which can contribute to unfavourable health outcomes. Little information exists on risk of LEA in active individuals competing in different sports or levels of competition. The aims of this study were to (1) identify risk of LEA in females competing at different levels of competition and (2) investigate associations between risk of LEA, illness and dietary habits. METHODS: The validated questionnaire, 'Low Energy Availability in Females Questionnaire' was distributed online (November 2016-February 2017) to assess risk of LEA. Twenty-nine additional questions collected information on demographics, illness history and dietary habits. Participants were considered at risk of LEA if they attained a score of ≥ 8 and were grouped into: (i) international; (ii) provincial/inter-county; (iii) competitive; and (iv) recreationally active. Chi-square and logistic regression analyses were used to explore differences between those at risk or not at risk of LEA. RESULTS: Risk of LEA was identified in 40% (n = 331) of 833 participants and was 1.7 and 1.8 times more likely in international and provincial/inter-county athletes compared to those who were recreationally active (International: odds ratios (OR) 1.68, 95% confidence intervals (95%CI) 1.12-2.54; Provincial/inter-county: OR 1.83, 95%CI 1.20-2.77). In participants at risk of LEA, missing >22 days of training during the previous year due to illness occurred 3 times more frequently (OR 3.01, 95%CI 1.81-5.02). CONCLUSION: Risk of LEA was widespread in this heterogeneous sample. Awareness of LEA and the development of appropriate energy management strategies to ensure athlete health across levels of competition are required.