Low energy availability a pervasive condition among Singaporean athletes

About one-third of amateur and recreational athletes in Singapore are at potential risk of low energy availability (LEA), as reported in a local study. The prevalence does not differ by athlete type, sport type, or whether the athletes train with a coach, demonstrating a high pervasiveness of LEA in this population.

“A state of LEA occurs when an individual has insufficient energy to support normal physiological functions after deducting the cost of exercise energy expenditure,” so an adequate diet is critical for athletes to meet the energy needs for optimum health and performance, according to the investigators. [Appetite 2007;48:359-367; Br J Sports Med 2014;48:491-497]

LEA involves a low energy intake with or without disordered eating. Other factors that may contribute to the condition include compulsive exercise behaviours, higher bone injury risk, psychological consequences, and low awareness and incorrect perceptions on aspects like body weight, body fat, and leanness. [J Sports Sci 2011;29:S7-S15; Br J Sports Med 2014;48:491-497]

In the study, 318 amateur or recreational athletes from Singapore aged 21–35 years old (61 percent female) completed a 52-item online questionnaire used to determine potential LEA risk. The primary measures of this risk were a mean score of ≥4.0 on any of the Eating Disorder Examination Questionnaire (EDE-Q) subscale, and/or a global score of ≥4.0, and/or body mass index (BMI) <18.5 kg/m².

A total of 109 athletes (34.3 percent) were at potential risk of LEA, with the risk being higher among women than men (44.3 percent vs 18.5 percent; p<0.001). In general, at-potential-risk athletes were more likely to be underweight (BMI <18.5 kg/m²) and/or have a score of ≥4.0 on one or more subscales and/or the global score of the EDE-Q compared with those who were not at risk. [Phys Act Health 2021;5:166-177]

“In addition, the athletes presented pathogenic eating behaviours and excessive exercising, [implying] that potential LEA risk prevalence could be eminent and may be a possible public health concern in Singapore,” according to the investigators.

LEA can lead to Relative Energy Deficiency in Sport (RED-S) for both male and female athletes. Individuals affected with RED-S exhibit impaired physiological functions including metabolic rate, bone health, immunity, protein synthesis, and cardiovascular health. The current body of evidence on LEA mainly focuses on competitive female athlete populations, whereas the current study provides support for the existence of potential LEA risk in male and noncompetitive athlete populations. [Scand J Med Sci Sports 2015;25:610-622; J Sports Sci 2016;34:598-606]

“Despite increasing sports participation rates in Asia, including Singapore, there is a lack of studies on energy intake patterns and associated risks in Asian athlete populations. If the magnitude of LEA risk in a population remains undetermined, it may remain unaddressed and has the potential to escalate to RED-S, leading to longer-term adverse health and performance consequences,” the investigators said.

Various stakeholders such as athletes, coaches, parents, and sports governing bodies should be made aware of LEA, as well as its factors, risks, and outcomes, they added.

“Importantly, developing athlete and coach education strategies and programmes on primary prevention of LEA and, consequently, RED-S would be paramount to cultivate a healthy sporting culture amongst athletes,” according to the investigators.