Awareness and Knowledge of Low Energy Availability, the Female Athlete Triad and Relative Energy Deficiency in Sport amongst New Zealand Healthcare Professionals

Abstract

Background: Low Energy Availability (LEA) is a term used to describe the insufficient energy available for normal physiological processes due to exercise energy expenditure not being appropriately replaced. LEA is the underlying cause for both the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-s), and is becoming increasingly recognised in literature as being harmful to the health and overall performance of female athletes. Despite this, international research suggests that healthcare professionals are largely unaware and lack understanding of these terms. The knowledge and understanding of LEA, RED-s and the Triad among New Zealand (NZ) healthcare professionals is unknown. Objective: The primary objective of this study was to investigate the knowledge and awareness of LEA, RED-s and the Triad amongst NZ healthcare professionals. Design: A 99 item, expert reviewed, and pre-tested, online questionnaire designed to assess the awareness and knowledge of the nutritional needs of female athletes was used to investigate the knowledge and awareness of LEA, RED-s and the Triad amongst healthcare professionals in NZ. Dietitians, physiotherapists, nutritionists, physicians, and personal trainers from across NZ were recruited via personal communications, social media, and posters. Additionally, the contact details of healthcare clinics were obtained from online directories where emails containing study information and a link to the questionnaire were sent. Results: Of the 95 healthcare professionals that completed this questionnaire 55%, 23% and 21% were aware of the Triad, LEA and RED-s respectively. Of those aware of the Triad 65% had good knowledge and were able to correctly identify all three components. Additionally, of those healthcare professionals aware of LEA and RED-s 41% and 60% respectively were considered to have a good understanding of these terms. However, 46% of healthcare professionals who were aware of LEA were unable to distinguish the difference between LEA and negative energy balance. Meanwhile, greater than 80% of respondents correctly answered the knowledge questions assessing disordered eating (DE), menstruation, bone mineral density (BMD) and the health and performance consequences associated with LEA/inadequate energy intake. Conclusion: Overall NZ healthcare professionals are generally unaware of the terms LEA, the Triad and RED-s. Despite this, NZ healthcare professionals have good knowledge about DE, menstruation, BMD, and the health and performance consequences associated with LEA/inadequate energy intake. However, knowledge gaps still exist regarding the signs and symptoms of LEA, peak BMD, LEA definition, and the association between menstruation and bone health. Increased awareness and educational strategies addressing these knowledge gaps is required for the recognition and treatment of LEA, RED-s and the Triad.