Sarah Amorim de Morais Santos*

sarahamorims@hotmail.com

Karen Carolina Martins Julião**

karenmartinsj@gmail.com

Marcos Daniel Motta Drummond***

zangmarcos@gmail.com

*Graduada em Nutrição

Especialista em treinamento de Endurance

com ênfase em Nutrição Esportiva

Universidade Federal de Minas Gerais (UFMG)

**Especialista em Emagrecimento e Hipertrofia pela Coimbra Academy
Graduada em Nutrição

Universidade Federal de Minas Gerais (UFMG)

***Doutor em Ciências do Esporte

Mestre em Ciências do Esporte

Especialista em Fisiologia do Exercício

Graduado em Educação Física
Graduado em Nutrição, Professor da UFMG

Coordenador do Laboratório de Nutrição

e Treinamento Esportivo da UFMG (LAN-UFMG)

Universidade Federal de Minas Gerais (UFMG)

(Brasil)

Reception: 07/01/2024 - Acceptance: 03/17/2025

1st Review: 02/21/2025 - 2nd Review: 03/04/2025

Accessible document. Law N° 26.653. WCAG 2.0

Suggested reference: Santos, S.A. de M., Julião, K.C.M., & Drummond, M.D.M. (2025). Low Energy Availability and Risk of Relative Energy Deficiency in Sport (RED-s). A real problem among Women in Resistance Training? Lecturas: Educación Física y Deportes, 30(327), 85-97. https://doi.org/10.46642/efd.v30i327.7764

 

Abstract

    This study aimed to evaluate food consumption and the prevalence of Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-s) within a group of women practitioners of resistance training. The sample consisted of 23 women, with a mean age of 23 ± 4.73 years, average body mass of 59.6 ± 5.26 kg and average height of 163 ± 6.61 cm. They underwent anamnesis, a daily dietary record to assess caloric intake and a daily activity record, and with this information the total energy expenditure (TEE) was determined. Body composition was assessed using skinfolds. The Low Energy Availability in Females Questionnaire (LEAF-Q) was applied and the energy availability (EA) of each subject was calculated. The results showed that the average total caloric intake was 1757 ± 557 kcal (95% CI 1516 - 1998), while the TEE was 2064 ± 185 kcal (95% CI 1983 - 2144). The mean EA was 38.6 ± 11.8 kcal/kg FFM/day (95% CI 33.5 - 43.7). LEA was present in 21.74% of the sample. The average score obtained in the LEAF-Q questionnaire was 4.13 ± 2.52 (95% CI 2.82 - 5.0), with 8.7% of volunteers classified at risk of RED-s. It is concluded that LEA and high risk for RED-s are not prevalent among women practitioners of resistance training.

    Keywords: Energy intake. Female athlete triad syndrome. Fertile period. Nutrition in sport.

 

Resumo

    Este estudo teve como objetivo avaliar o consumo alimentar e identificar a prevalência da síndrome da baixa disponibilidade energética (BDE) e a Síndrome da Deficiência Energética Associada ao Esporte (Relative Energy Deficiency in Sport - RED-s) entre um grupo de mulheres praticantes de musculação. A amostra foi constituída por 23 mulheres, com idade média de 23 ± 4,73 anos, massa corporal média de 59,6 ± 5,26kg, altura média de 1,63 ± 6,61cm. Elas foram submetidas à aplicação de anamnese, recordatório alimentar habitual para avaliação da ingestão calórica e recordatório de atividades diárias e, a partir disso, o gasto energético total (GET) foi calculado. A composição corporal foi avaliada por meio de dobras cutâneas. Aplicou-se o questionário Low Energy Availability in Females Questionnaire (LEAF-Q) e calculou-se a disponibilidade energética (DE) de cada uma. Os resultados mostraram que o valor calórico ingerido total médio foi de 1757 ± 557 kcal (IC 95% 1516 - 1998), enquanto o GET foi de 2064 ± 185 kcal (IC 95% 1983 - 2144). A média da DE, foi de 38,6 ± 11,8 kcal/kg MLG/dia (IC 95% 33,5 - 43,7). A BDE esteve presente em 21,74% da amostra. A pontuação média obtida no questionário LEAF-Q foi de 4,13 ± 2,52 (IC 95% 2,82 - 5,0), sendo 8,7% das voluntárias classificadas em risco de RED-s. Conclui-se que a BDE e elevado risco para RED-s não são prevalentes entre mulheres praticantes de musculação. Mais estudos envolvendo BDE, risco de RED-s e esse grupo são necessários.

    Unitermos: Ingestão calórica. Tríade da mulher atleta. Período fértil. Nutrição no esporte.

 

Resumen

    Este estudio tuvo como objetivo evaluar el consumo de alimentos y la prevalencia de Baja Disponibilidad Energética (BDE) y Deficiencia Energética Relativa en el Deporte (Relative Energy Deficiency in Sport - RED-s) dentro de un grupo de mujeres practicantes de entrenamiento de resistencia. La muestra consistió en 23 mujeres, con una edad media de 23 ± 4,73 años, una masa corporal promedio de 59,6 ± 5,26 kg y una altura promedio de 163 ± 6,61 cm. Se les realizó anamnesis, un registro dietético diario para evaluar la ingesta calórica y un registro de actividad diaria, y con esta información se determinó el gasto energético total (GET). La composición corporal se evaluó mediante pliegues cutáneos. Se aplicó el Cuestionario de Baja Disponibilidad Energética en Mujeres (Low Energy Availability in Females Questionnaire, LEAF-Q) y se calculó la disponibilidad energética (DE) de cada sujeto. Los resultados mostraron que la ingesta calórica total promedio fue de 1757 ± 557 kcal (IC del 95%: 1516-1998), mientras que el GET fue de 2064 ± 185 kcal (IC del 95%: 1983-2144). La ingesta calórica media fue de 38,6 ± 11,8 kcal/kg de masa muscular libre/día (IC del 95%: 33,5-43,7). El 21,74% de la muestra presentó BDE. La puntuación media del cuestionario LEAF-Q fue de 4,13 ± 2,52 (IC del 95%: 2,82-5,0), con un 8,7% de las voluntarias clasificadas en riesgo de RED-s. Se concluye que la BDE y el alto riesgo de RED-s no son prevalentes entre las mujeres que practican entrenamiento de resistencia.

    Palabras clave: Ingesta energética. Síndrome de la tríada de la atleta femenina. Período fértil. Nutrición en el deporte.

 

Lecturas: Educación Física y Deportes, Vol. 30, Núm. 327, Ago. (2025)

---

 

Introduction 

 

    Energy availability (EA) is defined as the remaining energy available for maintaining all physiological functions after deducting exercise energy expenditure (Areta et al., 2021). Low energy availability is often associated with eating disorders, mismanaged efforts to achieve a certain aesthetic standard, and mismatches between dietary intake and training load. (McHaffie et al., 2023)

 

    Under controlled conditions, it is assumed that all physiological processes occur optimally when caloric intake, relative to fat-free mass (FFM), remains around 45 kcal/kg FFM/day (Areta et al., 2021; Loucks, & Thuma, 2003). Many of these processes are significantly disrupted when caloric intake falls below 30 kcal/kg FFM/day (Areta et al., 2021; Loucks. & Thuma, 2003). Generally, an EA of 30 kcal/kg FFM/day approximates to the basal metabolic rate (BMR), and this value is considered a threshold for maintaining hormonal functions and responses (Areta et al., 2021; Loucks, & Thuma, 2003). Below this threshold, the endocrine system undergoes alterations and imbalances for vital energy conservation (Areta et al., 2021). Many studies describe disruptions in the hypothalamic-pituitary-gonadal axis, thyroid, insulin production, appetite-regulating hormones, growth hormone resistance, and elevated cortisol⁷.

 

    Insufficient energy intake can be established with increased energy demands from sports and physical activities (Areta et al., 2021), thus determining low energy availability (LEA). Chronic and/or severe exposure to LEA leads to physiological and/or psychological dysfunctions, characterizing Relative Energy Deficiency in Sport (RED-S) (Areta et al., 2021). The syndrome results in decreased immunity, alterations in energy metabolism, glycogen synthesis, cardiovascular health, reproductive function, and increased risk of injuries and decreased athletic performance. (Areta et al., 2021)

 

    The causes of LEA may be related to eating disorders (Fahrenholtz et al., 2022). The syndrome can occur intentionally, associated with excessive emphasis on thinness and aesthetic components or pressure to improve performance (Melin et al., 2014). It can also occur involuntarily due to lack of knowledge or professional guidance (Logue et al., 2018). Regarding recreational female athletes, the concept of "drive for thinness" is well documented, considered a preliminary sign associated with eating disorders (De Souza et al., 2019). Initially conceived as a subscale of a psychological questionnaire titled Eating Disorder Inventory (EDI), the drive for thinness is characterized by profound dissatisfaction with body image, leading to obsessive-compulsive behavior changes (Sands, 2000). Individuals with a high drive for thinness are more likely to suffer from body dysmorphic disorder, depression, excessive exercise, low self-esteem, and extreme eating behaviors. (De Souza et al., 2019; Sands, 2000)

 

    LEA may be present, especially in sports modalities and physical exercise that emphasize thinness or low body weight, such as weight-classified sports (combat sports) or aesthetic sports (bodybuilding) and exercise (resistance training), which are usually subjected to a greater caloric restriction (Areta et al., 2021). However, LEA may be present in various sports modalities, such as swimming, cycling, running, synchronized swimming, and ballet. (Logue et al., 2018)

 

    As for the non-athlete physically active population, more scientific evidence is needed (Logue et al., 2018). The association between the pursuit of thinness and LEA in active women adopting severe caloric restriction dietary patterns has been observed (Sands, 2000). It is known that women are more prone to developing body image disturbances and eating disorders, and the increased use and influence of social media seem to exacerbate disordered behaviors (De Souza et al., 2019). Therefore, it is expected that this group is more vulnerable to LEA and consequently RED-S. Thus, research with this specific population is needed.

 

    In pursuit of aesthetic adaptation and better performance in general and sports activities, the practice of resistance training has increased, especially by women (Maria, & Juzwiak, 2021). Current research focuses on the possible effects of resistance training in women, with promising results regarding aesthetics and performance (Hagstrom et al., 2020). Nutrition directly influences the results, however, studies assessing dietary intake in this population have shown inadequacies in energy intake as well as in the intake of carbohydrates, proteins, lipids, and micronutrients.

 

    Therefore, dietary inadequacy is also present in the group of women practitioners of resistance training (Maria, & Juzwiak, 2021), indicating that LEA may be present in this population, leading to RED-S. Moreover, the group of resistance training practitioners for aesthetic and health purposes is larger than the group of professional athletes and seems to be impacted by eating disorders in the same proportion as high-performance athletes (De Souza et al., 2019). However, no studies were found investigating the prevalence of LEA and RED-S associated with physical effort in resistance training among women. Thus, the present study aimed to evaluate dietary intake and identify the prevalence of LEA and RED-S among a group of women resistance training practitioners. The hypothesis is that LEA and RED-S are prevalent in this population.

 

Methods 

 

    Study design 

 

    This was a cross-sectional and observational research study. Initially, the participants were characterized and the habitual dietary recall and habitual activity recall was performed. Subsequently, the translated, adapted, and validated Low Energy Availability in Females Questionnaire (LEAF-Q) developed by Maria and Juzwiak (2021) was answered by the volunteers. Finally, the sample underwent body composition assessment.

 

    Sample 

 

    The sample consisted of 23 women, with a mean age of 23 ± 4.73 years, who had been practicing resistance training for at least 12 months. Volunteers were recruited through social media and posters fixed in colleges, clubs, and gyms. The LEAF-Q is validated only for the female population, particularly active women of childbearing age (Melin et al., 2014), and therefore, the sample had to meet these inclusion criteria. The refusal to answer the questionnaires or to undergo physical evaluation was the exclusion criterion.

 

    Ethical considerations 

 

    Once all procedures were presented and explained to the volunteers, they signed the informed consent form (ICF), agreeing to participate in the study. This study adhered to all the standards established by the National Health Council (Resolution 466/2012).

 

Procedures 

 

    Total energy expenditure 

 

    The basal metabolic rate (BMR) was estimated using the Harris-Benedict equation. A recall of all routine activities was conducted to understand the physical activity level of each volunteer. The physical activity level of each volunteer was then determined based on the criteria established by the Institute of Medicine, which categorizes levels as sedentary, lightly active, active, and very active. The BMR was multiplied by the value corresponding to the physical activity level for each individual, resulting in the total energy expenditure (TEE). (Lamonte, & Ainsworth, 2001)

 

    Food recall 

 

    To investigate the dietary intake and consequently the energy intake of each volunteer, a habitual food recall was performed. The food recall is a descriptive and prospective questionnaire in which the volunteer reports all foods, beverages, supplements, and culinary preparations ingested throughout the day. Thus, the volunteers reported their daily meals, those they were most accustomed to consuming. Portions were established in weight or household measures, to be translated into milliliters or grams by the interviewers for statistical analysis purposes. All data obtained were analyzed qualitatively and quantitatively using Dietbox® Software (version 6.8.3, online, Brazil), using the following tables as a reference, in order of preference: Brazilian Food Composition Table (TACO) and Nutritional Composition Table of Foods Consumed in Brazil (IBGE). Foods not found were registered in the software according to the nutritional table provided by the manufacturer, obtained from the official website of each brand, aiming to obtain reliable data.

 

    Anthropometric and body composition evaluation 

 

    For anthropometric evaluation, a digital scale (FILIZOLA, Brazil) with a precision of 0.1 kg was used for measuring body weight, and a stadiometer with a precision of 0.5 cm (FILIZOLA, Brazil) was used for measuring height. For the evaluation of body composition, skinfold thickness measurements were taken, following the protocol described by Jackson, Pollock, and Ward for 7 skinfold sites using a scientific caliper from the brand CESCORF® with a reading range of 70 mm and a sensitivity of 0.1 mm. The 7 skinfold sites are: subscapular, thoracic, abdominal, triceps, midaxillary, thigh, and suprailiac. Measurements were taken on the right side of the body of the volunteers and were performed by only one evaluator to minimize differences in data.

 

    Energy availability (EA) 

 

    The EA for each volunteer was estimated by the mathematical equation proposed by Loucks et al. (2003) was used (equation 1):

 

EA = CI - GET/ FFM eq. 1.

 

    IC = caloric intake; GET = energy expenditure in exercise; and FFM= fat-free mass

 

    The result of the food recall was used to determine caloric intake. Additionally, the energy expenditure in exercise determined from the activity recall and the fat-free mass (MLG) measured in the anthropometric evaluation were considered.

 

    LEAF-Q questionnaire 

 

    To assess the risk of developing RED-S, the adapted, and validated LEAF-Q questionnaire by Maria and Juzwiak (2021) was conducted. Comprising 25 items, the questionnaire addresses factors relevant to identifying the risk of the Female Athlete Triad, such as menstrual status, occurrence and recurrence of injuries, gastrointestinal status, recurrent weight fluctuations, and training frequency. These factors are distributed into three main sections: musculoskeletal injuries, gastrointestinal function, and menstrual function. Each section has a specific cutoff point, and scoring characterization is provided at the end of the material, ranging from 0 to 4 points. The risk of the Triad is identified when the sum of the scores is ≥8.

 

    Statistical analysis 

 

    The data were analyzed both qualitatively and quantitatively. For statistical analysis, the data were recorded and analyzed using Jamovi software (version 2.3). Additionally, the numerical results of the LEAF-Q and energy availability were analyzed. The mean, standard deviation, confidence interval (95% CI), and the percentage frequency of occurrence of low energy availability (LEA) and RED-S were obtained.

 

Results 

 

    The anthropometric characterization of the volunteers was as follows: average body mass of 59.6 ± 5.26 kg, average height of 163 ± 6.61 cm, fat-free mass of 45.6 ± 4.03 kg, and body fat percentage of 23 ± 4.19%.

 

    Regarding the daily dietary intake of the volunteers, the average total caloric intake was 1757 ± 557 kcal (95% CI 1516 - 1998), while the TEE was 2064 ± 185 kcal (95% CI 1983 - 2144). Additionally, the average energy availability (EA) was 38.6 ± 11.8 kcal/kg FFM/day (95% CI 33.5 - 43.7). Low energy availability (LEA) was present in 21.74% of the sample. Therefore, five volunteers had LEA, and three of them were using contraceptive pills. Furthermore, of the 20 women in the sample who were eumenorrheic, 11 were using pills.

 

    The average score obtained on the LEAF-Q questionnaire was 4.13 ± 2.52 (95% CI 2.82 - 5.0), and 8.7% (n=2) reached the risk score for RED-S. In the LEAF-Q, the "Gastrointestinal Function" section was the most frequently scored, with 73.91% (n=17) of the volunteers scoring above 0 in any of the topics. In the "Injuries" section, only 13.04% (n=3) of the volunteers scored above 0 in any of the topics. The same occurred in the "Menstrual Function" section, where 13.04% (n=3) of the volunteers scored above 0 in any of the topics. Additionally, in this section, 47.83% (n=11) of the volunteers indicated that they use contraceptive pills—this question does not have scoring values. Furthermore, 86.96% (n=20) are eumenorrheic, meaning they scored 0 on this question. No volunteer simultaneously presented a risk for RED-S and LEA. Table 1 shows the average score for each section of the LEAF-Q.

 

Section	Avg	SD
Injuries	0.522	1.50
Gastrointestinal tract	2.261	1.86
Menstruation	1.348	2.06
Total	4.130	2.52

Source: Research data

 

Discussion 

 

    The aim of this study was to identify the prevalence of low energy availability (LEA) and the risk of Relative Energy Deficiency in Sport (RED-S) in a group of women practitioners of resistance training, based on the dietary intake and the LEAF-Q. The hypothesis was that both LEA and the risk of developing RED-S would be prevalent in this population. However, the results obtained showed the opposite, as there was a low prevalence of LEA and RED-S risk. Thus, the study's hypothesis was refuted.

 

    The average total caloric intake of the volunteers in the present study (1757 ± 557 kcal) was lower than that found in the study by McHaffie et al. (2023), which reported an average intake of 2053 ± 486 kcal. Similar results were found in other studies that evaluated dietary intake in soccer players (Moss et al., 2021). The difference in results between the studies may be due to the difference in sports modalities. It is also observed that the average total energy expenditure (TEE) of the studied population remained relatively low. Generally, resistance training does not generate a high energy cost, and therefore, does not offer a significant increase in energy expenditure. Athletes that engage in sports with higher energy demands tend to have a higher risk of RED-S. This may explain why only 21.74% of the sample presented LEA, as the determination of EA considers the previously described variables.

 

    Evaluating the responses from the LEAF-Q questionnaire, the low average score of the volunteers was noted, with only 8.7% reaching the required score to be classified as at risk of developing RED-S. Similar results, i.e., low prevalence of RED-S risk, were also found by Maria & Juzwiak (2021) in competitive-level athletes from various modalities. However, a study by Slater et al. (2016) assessed recreational athletes and found a higher number of athletes at risk of RED-S (45%). The study by Fahrenholtz et al. assessed athletes from different modalities at a competitive level and also found higher prevalence rates of RED-S risk (65%), similar to the 62.5% found by Melin et al. (2014) The difference between the results obtained in the present study and the others can be explained by the different training levels and types of modalities among the studied groups. Based on the results of the present study, it is possible that women practitioners of resistance training do not represent a high-risk group for RED-S. The reasons for this may include the energy demands of different resistance training protocols, varied routines, individual body composition, and potentially pre-existing nutritional knowledge or professional guidance, common in this population. There is also a lack of studies investigating EA and RED-S in women practitioners of resistance training. Thus, more specific studies on RED-S and resistance training are needed.

 

    Additionally, women who practice resistance training may have adequate nutritional knowledge and behavior, guided by professional advice or their training environment (Canhestro et al., 2025). This may reduce the risk of RED-S. Furthermore, the main training objective of women practicing resistance training may influence their nutritional behavior and energy availability. A weight loss objective often leads to a hypocaloric diet and, consequently, low energy availability, whereas a muscle hypertrophy objective promotes an iso- or hypercaloric diet, with higher energy intake (Canhestro et al., 2025). Therefore, the training objective should be taken into consideration in future LEAF and RED-S investigations involving women engaged in resistance training.

 

    Another factor to consider and investigate is the possibility that the LEAF-Q may not be a pertinent instrument for resistance training. In its original version, no population that engaged in this modality was included. The version validated for the Brazilian population also did not include women practitioners of resistance training. Both versions included high-level athletes who trained at least 5 times a week. There is also a study by Black et al. (2018) that used recreational athletes, where the requirement was at least 150 minutes of moderate-intensity physical activity per week. However, this criterion was not included in the present study. Thus, it is possible that the physical activity level of this population does not meet the criteria to be considered a high-risk group for the development of RED-S.

 

    In the present study, the questionnaire section related to gastrointestinal function was not only the most frequently scored but also the section that obtained the highest scores (average 2.26 - Table 1). This section addresses topics such as flatulence, non-menstrual-related bloating, stomach discomfort, and stool frequency and consistency. This section tends to be the most frequently scored in the questionnaire (Melin et al., 2014). When associated with chronic LEA, these symptoms result from atrophy of the mucosa and intestinal morphology (Melin et al., 2014). However, they can also be motivated by dietary patterns unrelated to LEA. It is known that a Western-style diet -low in fiber and high in fat, sugar, and sodium- has been associated with negative changes in the microbiota, leading to metabolic disturbances that affect the intestines and cause the types of symptoms reported. (Liu et al., 2019)

 

    Additionally, only a small portion of the sample scored in the "Menstrual Function" section, which is the most extensive and therefore prone to higher scores on the questionnaire. Witkos et al. (2024) reported that menstrual disorders are common in women with LEAF. Thus, in the present study, the low average score of the volunteers can be explained by the significant number of hormonal contraceptive pill users—almost half of the sample. The use of this contraceptive method relieves premenstrual and dysmenorrhea symptoms and reduces menstrual flow, which can mask symptoms reported by the volunteers, thereby influencing the questionnaire results and the identification of RED-S risk. This may also be considered a study limitation. The use of hormonal contraceptives is common among female athletes and should be considered in LEAF and RED-S investigations. (Fahrenholtz et al., 2022)

 

    The environment is also crucial for the development of RED-S, often involving a component of eating disorders (Melin et al., 2014). The volunteers in question were not subjected to the professional pressure for high sports performance and based on the satisfactory energy availability that most consume daily, there is no scenario of disordered eating. (Wasserfurth et al., 2020)

 

    However, the lack of studies associating LEA and resistance training poses a barrier to further hypotheses. This should be considered an area of interest, as low energy availability, even in the short term, disrupts muscle protein synthesis (Areta et al., 2021), an undesirable event for many exercise practitioners, which can lead to long-term risks such as muscle mass loss and strength loss (Melin et al., 2014). Another limitation of the study could be the nutritional assessment tools and the determination of TEE. Especially, the transcription of household measures to weight and the application of questionnaires tends to have a subjective aspect, although the evaluators were previously trained for this. The short time frame for dietary data collection may also be a limiting factor. While a 5-day period of LEA is sufficient for hormonal changes, the literature does not yet well describe the time required for the development of RED-S (Wasserfurth et al., 2020). It is possible that RED-S takes longer to be identified, and different responses could emerge if there were the possibility of analyses over months.

 

    Other limitations, in addition to those discussed throughout this study, should be taken into consideration. Specifically, the sample size is a limitation, as it was defined by convenience. Additionally, the nutritional assessment tools and instruments used to investigate the risk of RED-S have inherent limitations (Heikura et al., 2021). Heikura et al. (2021) suggest that physiological markers should also be employed to assess the risk of RED-S across different sports disciplines. Therefore, further studies are needed to investigate the energy availability of women engaged in resistance training, using larger samples and additional methods.

 

    The resistance training population has its particularities and does not seem to be covered by assessment instruments for RED-S risk. From the results obtained in this study, it can be concluded that low energy availability and a high risk of RED-S are not prevalent among women practitioners of resistance training.

 

References 

 

Areta, J.L., Taylor, H.L., & Koehler, K. (2021). Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. European Journal of Applied Physiology, 121(1), 1-21. https://doi.org/10.1007/s00421-020-04516-0

 

Black, K., Slater, J., Brown, R.C., & Cooke, R. (2018). Low energy availability, plasma lipids, and hormonal profiles of recreational athletes. The Journal of Strength & Conditioning Research, 32(10), 2816-2824. https://doi.org/10.1519/jsc.0000000000002540

 

Canhestro, J.P., Carvalhaes, A.L.D., Martins Júnior, F. de A.D., & Drummond, M.D.M. (2025). Influence of professional nutritional support on dietary profile of strength-trained women. Lecturas: Educación Física y Deportes, 29(321), 108-126. https://doi.org/10.46642/efd.v29i321.7864

 

De Souza, M.J., Koltun, K.J., & Williams, N.I. (2019). The role of energy availability in reproductive function in the female athlete triad and extension of its effects to men: an initial working model of a similar syndrome in male athletes. Sports Medicine, 49(Suppl 2), 125-137. https://doi.org/10.1007/s40279-019-01217-3

 

Fahrenholtz, IL, Melin, AK, Wasserfurth, P., Stenling, A., Logue, D., Garthe, I., Koehler, K., Gräfnings, M., Lichtenstein, MB, Madigan, S., & Torstveit, M. K. (2022). Risk of low energy availability, disordered eating, exercise addiction, and food Intolerances in female endurance athletes. Frontiers in sports and active living, 4, 869594. https://doi.org/10.3389/fspor.2022.869594

 

Hagstrom, A.D., Marshall, P.W., Halaki, M., & Hackett, D.A. (2020). The effect of resistance training in women on dynamic strength and muscular hypertrophy: a systematic review with meta-analysis. Sports Medicine, 50(6), 1075-1093. https://doi.org/10.1007/s40279-019-01247-x

 

Heikura, I.A., Stellingwerff, T., & Areta, J.L. (2021). Low energy availability in female athletes: from the lab to the field. European Journal of Sport Science, 22(5), 709-719. https://doi.org/10.1080/17461391.2021.1915391

 

Lamonte, M.J., & Ainsworth, B.E. (2001). Quantifying energy expenditure and physical activity in the context of dose response. Medicine and science in sports and exercise, 33(6 Suppl), S370-8. https://doi.org/10.1097/00005768-200106001-00006

 

Liu, Y., Ajami, NJ, El-Serag, HB, Hair, C., Graham, DY, White, DL, Chen, L., Wang, Z., Plew, S., Kramer, J., Cole, R., Hernaez, R., Hou, J., Husain, N., Jarbrink-Sehgal, ME, Kanwa, F., Ketwaroo, G., Natarajan, Y., Shah, R., Velez, M., Mallepally, N., Petrosino, JF, & Jiao, L. (2019). Dietary quality and the colonic mucosa–associated gut microbiome in humans. The American journal of clinical nutrition, 110(3), 701-712. https://doi.org/10.1093/ajcn/nqz139

 

Logue, D., Madigan, S.M., Delahunt, E., Heinen, M., Mc Donnell, S.J., & Corish, C.A. (2018). Low energy availability in athletes: a review of prevalence, dietary patterns, physiological health, and sports performance. Sports medicine, 48, 73-96. https://doi.org/10.1007/s40279-017-0790-3

 

Loucks, A.B., & Thuma, J.R. (2003). Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. The Journal of Clinical Endocrinology & Metabolism, 88(1), 297-311. https://doi.org/10.1210/jc.2002-020369

 

Maria, U.P. de, & Juzwiak, C.R. (2021). Cultural adaptation and validation of the low energy availability in females questionnaire (leaf-q). Revista Brasileira de Medicina do Esporte, 27(2), 184-188. https://doi.org/10.1590/1517-869220212702223889

 

McHaffie, SJ, Langan-Evans, C., Strauss, JA, Areta, JL, Rosimus, C., Evans, M., Waghorn, R., & Morton, JP (2023). Under-Fuelling for the work required? Assessment of dietary practices and physical loading of adolescent female soccer players during an intensive international training and game schedule. Nutrients, 15(21), 4508. https://doi.org/10.3390/nu15214508

 

Melin, A., Tornberg, Å.B., Skouby, S., Faber, J., Ritz, C., Sjödin, A., & Sundgot-Borgen, J. (2014). The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. British journal of sports medicine, 48(7), 540-545. https://doi.org/10.1136/bjsports-2013-093240

 

Moss, SL, Randell, RK, Burgess, D., Ridley, S., ÓCairealláin, C., Allison, R., & Rollo, I. (2021). Assessment of energy availability and associated risk factors in professional female soccer players. European Journal of Sport Science, 21(6), 861-870. https://doi.org/10.1080/17461391.2020.1788647

 

National Health Council (2012). Resolution No. 466, of December 12, 2012: Guidelines and regulatory standards for research involving human beings. Ministry of Health. http://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

 

Sands, R. (2000). Reconceptualization of body image and drive for thinness. International journal of eating disorders, 28(4), 397-407. https://doi.org/10.1002/1098-108x(200012)28:4%3C397::aid-eat7%3E3.0.co;2-u

 

Slater, J., McLay-Cooke, R., Brown, R., & Black, K. (2016). Female recreational exercisers at risk for low energy availability. International journal of sport nutrition and exercise metabolism, 26(5), 421-427. https://doi.org/10.1123/ijsnem.2015-0245

 

Wasserfurth, P., Palmowski, J., Hahn, A., & Krüger, K. (2020). Reasons for and consequences of low energy availability in female and male athletes: social environment, adaptations, and prevention. Sports medicine-open, 6(1), 44. https://doi.org/10.1186/s40798-020-00275-6

 

Witkos, J., Luberda, E., Błażejewski, G., Strój, E. (2024). Menstrual cycle disorders as an early symptom of energy deficiency among female physique athletes assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). PLoS One, 19(6), 1-17. https://doi.org/10.1371/journal.pone.0303703

Lecturas: Educación Física y Deportes, Vol. 30, Núm. 327, Ago. (2025)