Publication Date



School of Health Sciences


Biology: Biomedical Sciences


Low energy availability, relative energy deficiency in sport, female athlete triad, energy balance, exercise, nutrition


Biochemical Phenomena, Metabolism, and Nutrition | Dietetics and Clinical Nutrition | Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Medical Nutrition | Nutritional and Metabolic Diseases | Sports Medicine | Sports Sciences


Low energy availability (LEA) is a state in which energy intake is insufficient to support energy expenditure while maintaining energy balance, which has been shown to result in gastrointestinal distress, immunosuppression, reduced metabolic rate, menstrual dysfunction, diminished bone health, and impaired cardiovascular function in females. Alterations to the microbiome and mucosal lining may propagate gastrointestinal complaints and compromised immune function associated with LEA. The pathophysiology of LEA is otherwise largely driven by hormonal adaptations. Diminished production of thyroid hormones is known to contribute to reduced metabolic rate. Decreases in leptin and insulin and increases in ghrelin disrupt reproductive function through modulation of anorexigenic and orexigenic factors, and the resulting hypoestrogenism can impair bone health and cardiovascular function.