Low Energy Availability in Male Indian Athletes: A Cross-Sectional Study

Low energy availability (LEA) is a mismatch between dietary energy intake and training-related expenditure that can impair performance, recovery, endocrine function, bone health, and overall athlete well-being; it is most often expected in endurance, weight-category, and physique-sensitive sports but can occur across disciplines. In male athletes, LEA is under-recognized because symptoms are subtle and non-specific and are frequently attributed to training fatigue. Because abrupt workload fluctuations may further strain recovery, the acute to chronic workload ratio (ACWR) provides a practical field marker of recent load spikes and a rationale for examining workload alongside LEA screening.

To determine the occurrence of LEA in young Indian athletes with the LEAM-Q questionnaire and determine the association with Acute on Chronic Workload Ratio (ACWR).

This cross-sectional analysis included 30 male athletes (18-35 years) from boxing, judo, and weightlifting. LEAM-Q responses were screened using the validated sex drive criterion. ACWR was calculated as (7-day workload x weekly RPE)/([monthly workload/4] x monthly RPE). Descriptive statistics were reported as mean ± standard deviation or median (IQR), and between-group comparisons were performed using the chi-square test, Fisher's exact test, Mann-Whitney U test, and Spearman rank correlation as appropriate (p<0.05).

Twelve athletes (40.0%) screened positive for LEA. Screen positivity differed significantly by sport: boxing 3/14 (21.4%), judo 3/8 (37.5%), and weightlifting 6/8 (75.0%) (chi-square=6.12, p=0.047; Cramer's V=0.45). Weightlifting athletes had higher odds of screening positive than non-weightlifters (Fisher's exact OR 8.0, p=0.034). The median sex-drive score was 3 (IQR 2-4). Median ACWR was 0.89 (IQR 0.75-1.00); 9 athletes (30.0%) were below the normal range, 19 (63.3%) were within the normal range (0.8-1.3), and 2 (6.7%) were above the high-risk threshold (>1.3). ACWR did not differ between LEA screen-positive and screen-negative athletes (median 0.89 vs. 0.89; p=0.966) and showed no correlation with LEAM-Q score (Spearman rho=0.05, p=0.805).

LEAM-Q identified a substantial burden of low energy availability risk in this cohort of young Indian male athletes, with the strongest signal in weightlifting and the most consistent abnormalities in sex drive items. ACWR was largely within the normal range and did not differentiate screen-positive athletes in this sample. These findings support routine LEAM-Q-based screening in male athletes, especially in weight-sensitive sports, and reinforce the need for early nutritional and clinical evaluation when the screen is positive.