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Durham University

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Publication details for Dr Karen Hind

Keay, N., Francis, G. & Hind, K. (2018). Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists. BMJ Open Sport and Exercise Medicine 4(1): e000424.

Author(s) from Durham


Objectives To evaluate the efficacy of a sport-specific energy availability (EA) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S). Methods Fifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed by a newly developed sport-specific questionnaire and clinical interview (SEAQ-I) and received dual energy X-ray absorptiometry (DXA) bone mineral density (BMD) and body composition scans and blood tests for endocrine markers. Results Low EA as assessed using the SEAQ-I, was observed in 28% of cyclists. Low lumbar spine BMD (Z-score<−1.0) was found in 44% of cyclists. EA was the most significant determinant of lumbar spine BMD Z-score (p<0.001). Among low EA cyclists, lack of previous load-bearing sport was associated with the lowest BMD (p=0.013). Low EA was associated with reduced total percentage fat (p<0.019). The 10 cyclists with chronic low EA had lower levels of testosterone compared with those having adequate EA (p=0.024). Mean vitamin D concentration was below the level recommended for athletes (90  nmol/L). Training loads were positively associated with power-to-weight ratios, assessed as 60  min functional threshold power (FTP) per kg (p<0.001). Percentage body fat was not significantly linked to cycling performance. Conclusions This study demonstrates that a SEAQ-I is effective for identifying male road cyclists with acute intermittent and chronic sustained low EA. Cyclists with low EA, particularly in the long-term, displayed adverse quantifiable measures of bone, endocrinology and performance consequences of RED-S.


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BASEM funded study