BJSM effects of low energy availability are likely to provide significant incentive to change damaging behaviours. Such studies should confirm under which situations these effects occur (figure 2). In addition, some athletes with disordered eating/ eating disorders practise extreme weight control methods (fasting, vomiting, diuretic and laxative abuse) that have possible health and performance consequences such as dehydration and electrolyte imbalances, and gastrointestinal problems, including esophagitis and oesophageal perforation from vomiting. Diuretics and some diet pills may contain WADA prohibited substances.58 Male athletes Although there is a dearth of prevalence studies in low EA in male athletes, Vogt et al59 severely reduced EA of 8 kcal/kg/FFM/day and Müller et al60 tional level ski jumpers. Although male athletes are at lower risk for developing DE/ED8,18,61 male athletes is high in cycling (50%),62 and weight class sports (18%).15 associated with low BMD.63 male endurance athletes in running37,64,65 bearing sports such as cycling,66–69 BMD. Low EA alters endocrine function11 showed that male cyclists had have reported high prevalence of underweight internathe prevalence in elite gravitational (24%) DE/EDs in male jockeys are Even in the absence of DE/EDs, and in non-weight are at high risk for low and direct and indirect impacts on bone may occur in male athletes.70 Athletes of non-caucasian ethnicity The prevalence of low EA has been studied mainly in females of Caucasian, European or European American descent. Whether race plays a role in the incidence and underlying aetiology of the RED-S remains speculative. Race is a significant variable for several of the individual Triad components in non-athletic women. For example, a lower risk of ED is shown in African-American than Caucasian women,71 even among adolescent athletes.72 Figure 1 Health Consequences of Relative Energy Deficiency in Sport (RED-S) showing an expanded concept of the Female Athlete Triad to acknowledge a wider range of outcomes and the application to male athletes (*Psychological consequences can either precede RED-S or be the result of RED-S). Adapted from Constantini.54 Whether the prevalence of menstrual disorders differs among racially diverse, athletic groups is currently unknown. In nonathletes, menarche occurs significantly earlier in AfricanAmerican than in Caucasian or European American women.73 The BMD of African-American non-athletic females is significantly greater than that of Caucasian women, with a lower risk of osteoporosis and fracture.74 In athletes, little is known about the differences in BMD among ethnic groups, especially in the presence of low EA, DE/EDs and hormonal and metabolic imbalances. Stress fractures in African-American military recruits are lower than in Caucasian recruits.75 Based on preliminary data of a multicentre study, African-American and African black athletes exhibit similar symptoms of low EA, with Caucasian athletes showing greater risk of DE/EDs and menstrual dysfunction76 and no advantage for BMD in African black athletes.77 There are no published scientific studies in Hispanic and limited evidence on Asian athletes.78 Figure 2 Potential Performance Effects of Relative Energy Deficiency in Sport (*Aerobic and anaerobic performance). Adapted from Constantini.54 18 Sport & Geneeskunde | september 2014 | nummer 4 Athletes with a disability At present there are no data available on low EA in athletes with disabilities. Individuals with spinal cord injuries, suffer from osteoporosis due to the lack of skeletal loading.79 While no data exist on EA or DE/ED patterns in athletes Pagina 17
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Sport & Geneeskunde nummer 4 | november 2014 Lees publicatie 43Home