Introduction: The Female Athlete Triad and the Relative Energy Deficiency Syndrome (RED-S) are similar syndromes caused by low energy availability (LEA), which can have negative consequences for the health and performance of athletes. For both syndromes, early detection of at-risk athletes is important to prevent long-term health consequences. For these purposes, a short validated Low-Energy Availability in Female athletes Questionnaire is used (LEAF-Q). Although there is more and more research on RED-S every year, this area is still poorly researched and much ambiguity remains, especially when it comes to research involving the triathlon population. That is why, in our research, we studied the topic of energy availability and relative energy deficit in the population of triathletes. We wanted to find out to what extent the LEAF-Q questionnaire recognizes RED-S in Slovenian triathletes and to examine the possible association of RED-S with the eating habits, knowledge of sports nutrition, and the incidence of injuries. Methods: 30 triathletes with an average age of 32.1 years participated in the study. Each performed a bioimpedance measurement of body composition, an indirect calorimetry measurement to determine the resting metabolic rate (mRMR) and answered four online questionnaires: (1) LEAF-Q, (2) NSKQ - nutrition knowledge questionnaire, (3) TFEQ - three-factor eating questionnaire and (4) injury questionnaire. Results: The average total score of the LEAF-Q questionnaire was 7, and 43% of triathletes were at risk for triad and RED-S based on the total score (≥ 8 points). Injury (LEAF-Q ≥ 2), gastrointestinal (LEAF-Q ≥ 2) and menstrual dysfunction problems (LEAF-Q ≥ 4) were reported by 47 %, 37 % and 33 % of triathletes, respectively. The questionnaire on nutrition knowledge showed that the knowledge of triathletes was average, as they achieved a result of 53%, with the worst knowledge in the field of sports nutrition and nutritional supplements. The TFEQ questionnaire shows that triathletes have the most problems with emotional eating factors. The measured resting metabolic rate (mRMR) was 5581 kJ / day (1333 kcal / day), and the predicted RMR using Cunnigham equation (pRMRc) was 6778 kJ / day (1619 kcal / day), the average ratio between the actual and predicted resting metabolic rate was 0.83. 73% of triathletes were at risk for RED-S according to the mRMR / pRMRc ratio criterion (<0.9). Injured triathletes had, on average, higher score on the LEAF-Q (8.94), which also means a higher risk for RED-S. We also found a borderline statistically significant negative association between NSKQ scores and LEAF-Q scores, meaning that those who showed poorer dietary knowledge were also more at risk for RED-S. Conclusion: Research has shown that RED-S is common in the selected sample of triathletes (43%), and that a large proportion (73%) also shows a disproportion between the measured and predicted energy consumption at rest. There should be concern about the lack of knowledge of triathletes in the field of sports nutrition. The results of our research indicate the need for close cooperation of triathletes with a dietitian or nutritionists, and further raising awareness of RED-S issues.
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