INTRODUCTION: Endurance athletes with high training loads and weight focus have increased risk of low energy and carbohydrate (CHO) availability. Sufficient CHO availability throughout the day is needed to provide substrate to e.g., muscles and hypothalamic-pituitary hormone production. The aim of this study was to investigate the dietary intake with special focus on timing of CHO intake in relation to training load in athletes with symptoms of Relative Energy Deficiency in Sport (RED-S). METHODS: Female endurance athletes (n=12) [26 ± 4 years, BMI: 21 ± 2 kg/m2, training: 13 ± 4 hours/week], with symptoms of RED-S (Low Energy Availability in Females Questionnaire total score = 8), and without disordered eating behavior were included. Athletes recorded their dietary intake (prospective weighed food records) and training for seven consecutive days. The type of activity and time spent in each intensity (I) zone (1-5) were recorded for each training session. I1 was defined as a workload of 60-72% of max heart rate (HR) (individual performance test), I2 as 72-82% of max HR, I3 as 82-87% of max HR, I4 as 87-92% of max HR and I5 as > 92% of max HR. The nutrient analysis program DietistNet, Sweden was used to assess dietary intake. CHO intake was furthermore analyzed for; key training sessions (high intensity, in the present study starting from I3)/=120 min) and easy training sessions (all other sessions >30<120 min) as well as for training days; hard training days (= 1 key session) and light training days (all other days). Mean difference, 95% confidence intervals (CI) not including 0, and a paired student`s t-test were used to determine differences between participants dietary and CHO intake and international sport nutrition recommendations. RESULTS: The mean daily energy intake was 2821 ± 529 kcal. None of the participants met the recommended daily CHO intake based on individual training load [CI -1.7 (-2.4 to -0.9)], or CHO intake immediate after (1 g/kg) [CI -0.7 (-0.9 to -0.5)] or between (1 g/kg/h) [CI-1.2 (-2.0 to -0.4)] key training sessions. Only 27% fulfilled the CHO intake during (30-60 g/h) key training sessions [CI -15.2 (-29.1 to -1.3)] even though the minimum CHO recommendation of 30 g/h was used in the analyze. The daily CHO recommendations were more difficult to fulfill during hard compared to light training days (p=0.014). All participants met the international sport nutrition recommendations for protein (2.1 ± 0.6 g/kg/day vs. 1.2-2.0 g/kg/day) and fat (36.5 ± 7.2 E% vs. 25-35 E%). CONCLUSION: In the present study, female endurance athletes with symptoms of RED-S did not match their total or timing of CHO intake in relation to training load according to international sport nutrition recommendations, while protein and fat intake was sufficient. Hence, these results indicate that focus on optimizing CHO intake is needed to prevent and treat RED-S.
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