Prevalence of Female Athlete Triad and Relative Energy Deficiency in Sport Health Conditions in Elite East African Distance Runners

Research Team Members: Martin Mooses, Anthony C. Hackney, Diresibachew H Wondimu, Amy R. Lane


Running economy test on best local track

Why did you do this study?

Low energy availability has been identified as a driving force behind the Female Athlete Triad (TRIAD) and more recently, Relative Energy Deficiency in Sport (RED-S) health conditions, which affects males too. Low energy availability (LEA) occurs when an individual’s energy intake minus the exercise energy expenditure is below a level that will ensure adequate energy for exercise as well as all physiological processes within the body. When LEA exists, systems within the body alter function to minimize energy demand resulting in hormonal, metabolic and bone disorders. These disorders can have detrimental effects in the short term on exercise performance, injury rate, as well as impact general health later in life. Endurance athletes are at increased risk for LEA due to the high volumes of exercise training they perform. The research conducted in this area so far has been done predominantly in Caucasian (US and European) populations. Very little is known about prevalence in East African endurance athletes, arguably the best runners in the world (e.g., in the last 60 years, Kenyan-Ethiopian male and female runners have won nearly 100 Olympic medals).

It has been suggested that their low body mass and BMI have benefitted their performance through a more advantageous running economy, but those same factors (body mass, BMI) could also put them at risk for the TRIAD or RED-S conditions, ultimately resulting in negative effects for competition and longevity in sport. Therefore, the focus of our study is to identify the prevalence and risk factors for the TRIAD and RED-S, respectively, in East African elite distance runners (females and males).


Blood lactate collection

What did you do and what did you find in this study?

The study is currently a work in progress. This fall, members of our international team from Ethiopia, Kenya and Estonia have been on-site in Kenya working with local contacts to begin collecting pilot data in a small group of the female athletes at a training camp. The UNC component of the team has been working remotely with the international members, but is to be on site in the coming weeks.

Several questionnaires to identify possible disordered eating behaviors have been piloted this fall. Exercise testing including maximal performance assessments to determine fitness and running economy have been developed. Body composition and bone health are measured with dual energy x-ray absorptiometry (DXA), and blood draws for hormonal analyses in this study. The logistics of where and how to do this in some of the rural areas of Kenya are being worked out by the team. Finally, dietary and training records are maintained for a week by each participant and the means to do this accurately are being developed in the camp setting.

The pilot work this fall included some of the exercise testing and running economy tests (picture 1) and blood lactate collection (picture 2) at the top track facilities in the area. The study location, provides some challenges with an old pool table as the “field lab” (picture 3). The preliminary work conducted this fall will permit the finalization for testing logistics and the commencement of major data collection in early 2017. Participants will include 30 female and 30 male elite East African endurance runners, with 30 female and 30 male adult non-athletes matched for age and ethnicity as controls. This study is funded on a 2 year grant through the International Athletics Foundation (project # 417).


Field lab

How do these findings impact the public?

The findings from this study will help build knowledge about the impact that LEA has on elite East African endurance athletes. Through the identification of prevalence rates, this work can contribute to development of future interventions to minimize the prevalence, prevent occurrence and improve recovery from TRIAD and/or RED-S. Additionally, bringing this research to Kenya may increase education about energy availability to a broader audience.