This review updates and complements the review of energy balance and body composition in the Proceedings of the 2003 IOC Consensus Conference on Sports Nutrition. It argues that the concept of energy availability is more useful than the concept of energy balance for managing the diets of athletes. It then summarizes recent reports of the existence, aetiologies, and clinical consequences of low energy availability in athletes. This is followed by a review of recent research on the failure of appetite to increase ad libitum energy intake in compensation for exercise energy expenditure. The review closes by summarizing the implications of this research for managing the diets of athletes.

Little is known about the effects of combined micronutrient and sugar consumption on growth and cognition. In the present study, we investigated the effects of micronutrients and sugar, alone and in combination, in a beverage on growth and cognition in schoolchildren. In a 2 × 2 factorial design, children (n414, 6–11 years) were randomly allocated to consume beverages containing (1) micronutrients with sugar, (2) micronutrients with a non-nutritive sweetener, (3) no micronutrients with sugar or (4) no micronutrients with a non-nutritive sweetener for 8·5 months. Growth was assessed and cognition was tested using the Kaufman Assessment Battery for Children version II (KABC-II) subtests and the Hopkins Verbal Learning Test (HVLT). Micronutrients decreased the OR for Fe deficiency at the endpoint (OR 0·19; 95 % CI 0·07, 0·53). Micronutrients increased KABC Atlantis (intervention effect: 0·76; 95 % CI 0·10, 1·42) and HVLT Discrimination Index (1·00; 95 % CI 0·01, 2·00) scores. Sugar increased KABC Atlantis (0·71; 95 % CI 0·05, 1·37) and Rover (0·72; 95 % CI 0·08, 1·35) scores and HVLT Recall 3 (0·94; 95 % CI 0·15, 1·72). Significant micronutrient × sugar interaction effects on the Atlantis, Number recall, Rover and Discrimination Index scores indicated that micronutrients and sugar in combination attenuated the beneficial effects of micronutrients or sugar alone. Micronutrients or sugar alone had a lowering effect on weight-for-agez-scores relative to controls (micronutrients − 0·08; 95 % CI − 0·15, − 0·01; sugar − 0·07; 95 % CI − 0·14, − 0·002), but in combination, this effect was attenuated. The beverages with micronutrients or added sugar alone had a beneficial effect on cognition, which was attenuated when provided in combination.

Limited data are available on the female athlete triad (Triad) in athletes from minority groups. We explored subclinical and clinical Triad components amongst adolescent elite Kenyan athletes (n = 61) and non-athletes (n = 49). Participants completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Ultrasound assessed calcaneus bone mineral density (BMD). Eating Disorder Inventory subscales and the Three-Factor Eating Questionnaire’s cognitive dietary restraint subscale measured disordered eating (DE). EA was lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal ∙ kg FFM⁻¹ ∙ d⁻¹, P = 0.003). More athletes were identified with clinical low EA (17.9% vs. 2.2%, OR = 9.5, 95% CI 1.17–77, P = 0.021) and clinical menstrual dysfunction (32.7% vs. 18.3%, χ² = 7.1, P = 0.02). Subclinical (75.4% vs. 71.4%) and clinical DE (4.9% vs. 10.2%, P = 0.56) as well as BMD were similar between athletes and non-athletes. More athletes had two Triad components than non-athletes (8.9% vs. 0%, OR = 0.6, 95% CI 0.5–6.9, P = 0.05). Kenyan adolescent participants presented with one or more subclinical and/or clinical Triad component. It is essential that athletes and their entourage be educated on their energy needs including health and performance consequences of an energy deficiency.

The ergogenic effect of caffeine on endurance exercise is commonly accepted. We aimed to elucidate realistically the effect of caffeine on triathlon event performance using a field study design, while allowing investigation into potential mechanisms at play. A double-blind, randomized, crossover field trial was conducted. Twenty-six triathletes (14 males and 12 females; mean ± SD: age = 37.8 ± 10.6 years, habitual caffeine intake = 413 ± 505 mg/day, percentage body fat = 14.5 ± 7.2%, and training/week = 12.8 ± 4.5 hr) participated in this study. Microencapsulated caffeine (6 mg/kg body weight) was supplemented 60 min pretrial. Performance data included time to completion, rating of perceived exertion, and profile of mood states. Blood samples taken before, during, and postrace were analyzed for cortisol, testosterone, and full blood count. Capillary blood lactate concentrations were assessed prerace, during transitions, and 3, 6, 9, 12, and 15 min after triathlons. Caffeine supplementation resulted in a 3.7% reduction in swim time (33.5 ± 7.0 vs. 34.8 ± 8.1 min, p < .05) and a 1.3% reduction in time to completion (149.6 ± 19.8 vs. 151.5 ± 18.6 min, p < .05) for the whole group. Gender differences and individual responses are also presented. Caffeine did not alter the rating of perceived exertion significantly, but better performance after caffeine supplementation suggests a central effect resulting in greater overall exercise intensity at the same rating of perceived exertion. Caffeine supplementation was associated with higher postexercise cortisol levels (665 ± 200 vs. 543 ± 169 nmol/L, p < .0001) and facilitated greater peak blood lactate accumulation (analysis of variance main effect, p < .05). We recommend that triathlon athletes with relatively low habitual caffeine intake may ingest 6 mg/kg body weight caffeine, 45–60 min before the start of Olympic-distance triathlon to improve their performance.

Background: Modern culture has stereotyped the female body as one that is continually getting thinner. Internalization of the ‘thin’ ideal is partly attributable to the inner ideal to be successful combined with the external pressure imposed by media and others. Many individuals attempt to achieve these ideals by behavior modification that imposes health risks.Purpose: To investigate disordered eating (DE) behavior and energy status in female student dancers.Methods: Volunteer dancers (n = 26) aged 19.0 (18.0; 21.0) years, matched by controls (n = 26) aged 20.0 (19.0; 21.0) years were recruited. Eating Disorder Inventory-3 (EDI-3) subscales, Three-factor Eating Questionnaire (TFEQ) Cognitive Dietary Restraint (CDR) subscale, and EDI-3 Referral Form behavioral questions assessed DE behavior. Energy status was assessed with a food record and Actiheart monitor.Results: Dancers achieved significantly higher scores than controls in all questionnaires, namely: EDI-3 Drive for Thinness [12.0 (3.0; 19.0) vs. 4.5 (2.0; 9.0), p = .023], EDI-3 Body Dissatisfaction [16.0 (10.0; 25.0) vs. 6.5 (3.0; 14.0), p = .004], and TFEQ-CDR [9.0 (2.0; 15.0) vs. 3.0 (3.0; 7.0), p = .032]; dancers used excessive exercise to lose weight (19.2% vs. 0%, c² = 5.53, p = .019), and had lower energy availability (24% vs. 8%, p < .05) than controls. The average energy balance (EB) was negative for both groups [dancers: EB = -3896 (-5236; -1222) vs. controls: EB = -2639 (-4744; -789) kJ/day].Conclusions: Female dancers are at risk for DE behavior and many have suboptimal energy status which may be related to their quest to achieve a more desirable appearance; education on healthy weight management practices is needed.