Sports Dietitians' Methods of Assessing Energy Deficiency Among Free-Living Athletes

Persistent energy deficiency may negatively affect reproductive function, bone health, and other body systems; however, information regarding the methods of evaluating energy deficiency among sports dietitians working with free -living athletes is limited.

This cross-sectional study aimed to assess methods used by sports dietitians to evaluate energy deficiency and compare according to practice setting and level of experience in the field. Sports dietitian participants completed a 39-item survey addressing methods of evaluating energy intake, energy expenditure, anthropometric measures, eating attitudes and behaviors, and related biomarkers or clinical assessments. Chi-square tests evaluated differences in assessment methods according to practice setting and level of experience in the field.

Eighty-nine sports dietitians submitted a complete survey. Energy intake (100%), exercise energy expenditure (98.9%), disordered eating (93.2%), and body weight (84.3%) were most frequently assessed. Sixty-six percent of participants assessed energy balance (EB) and 41.6% assessed energy availability (EA); 31.5% (n = 28) evaluated EB and EA. Energy intake was evaluated most frequently with a diet history (48.3%) or food logs (30.3%); activity factor estimates (49.4%) or exercise logs (29.2%) were most often used to evaluate energy expenditure. Bioelectrical impedance analysis (15.7%) and air displacement plethysmography (14.6%) were most frequently used to measure body composition. A higher proportion of RDNs with ≥7 years vs. <7 years of experience reported measuring EA (59.5% vs. 28.8%, p = 0.005).

While most sports dietitians evaluated energy deficiency, the protocol and assessment methods varied widely and differed according to years of experience and practice setting.