Effects of Individualised Nutrition on Performance and Athlete Triad Risk
DOI:
https://doi.org/10.17309/tmfv.2026.2.17Keywords:
Female Athlete Triad, RED-S, energy availability, nutritional intervention, sports performanceAbstract
Background. The Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S) are multifactorial conditions primarily driven by low energy availability and associated with impaired physiological function and reduced athletic performance. Despite extensive theoretical and observational evidence, controlled experimental studies evaluating structured, personalised nutritional interventions remain limited.
Objectives. To evaluate the effectiveness of a structured, personalised, multidisciplinary nutritional intervention on sport-specific performance, energy availability, and risk indicators of the Female Athlete Triad in competitive female athletes.
Material and Methods. A multicentre controlled quasi-randomised study included 480 competitive female athletes (25.1 ± 4.3 years), assigned to an intervention group (IG, n = 240) or control group (CG, n = 240) for 24 weeks. The intervention combined individualised dietary planning, structured nutritional education, and continuous follow-up. Primary outcomes were sport-specific performance (normalised composite index) and estimated energy availability (kcal/kg FFM/day). Secondary outcomes included Triad risk (LEAF-Q ≥ 8), eating behaviour (EDE-Q), nutritional knowledge (NSKQ), and body composition (DXA). Mixed-effects and multivariate regression models were applied (p < 0.05).
Results. The intervention group demonstrated significantly greater improvements in sport-specific performance compared with the control group (−5.8% ± 3.1 vs −0.9% ± 2.8; β = −0.31; 95% CI −0.42 to −0.20; p < 0.001), with a large standardized effect size (Cohen’s d = 1.66). Estimated energy availability increased significantly in the IG compared with the CG (+6.3 ± 5.9 vs +0.8 ± 4.7 kcal/kg FFM/day; β = 0.28; 95% CI 0.19–0.37; p < 0.001; Cohen’s d = 1.03).
The prevalence of Triad risk (LEAF-Q ≥ 8) decreased from 30.4% to 18.0% in the IG compared with 29.2% to 27.9% in the CG (OR = 0.49; 95% CI 0.34–0.71; p < 0.001). Significant improvements were observed in eating behaviour (EDE-Q: β = −0.24; 95% CI −0.35 to −0.12; p = 0.002) and nutritional knowledge (NSKQ: β = 0.41; 95% CI 0.29–0.53; p < 0.001). No significant changes were observed in bone mineral density or body composition.
Conclusions. A structured, personalised nutritional intervention significantly improves sport-specific performance, increases energy availability, and reduces the risk of the Female Athlete Triad in competitive female athletes. These findings provide experimental evidence supporting the implementation of multidisciplinary, individualised nutritional programmes as an effective strategy for improving both health and performance in women’s sport.
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References
American College of Sports Medicine. (1997). The female athlete triad. Medicine & Science in Sports & Exercise, 29(5), i–ix. DOI: https://doi.org/10.1097/00005768-199712000-00020
Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J., & Warren, M.P. (2007). American College of Sports Medicine position stand: The Female Athlete Triad. Medicine & Science in Sports & Exercise, 39(10), 1867–1882. https://doi.org/10.1249/mss.0b013e318149f111 DOI: https://doi.org/10.1249/mss.0b013e318149f111
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., & Ljungqvist, A. (2014). The IOC consensus statement: Beyond the Female Athlete Triad-Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 48(7), 491–497. https://doi.org/10.1136/bjsports-2014-093502 DOI: https://doi.org/10.1136/bjsports-2014-093502
Mountjoy, M., Sundgot-Borgen, J.K., Burke, L.M., Ackerman, K.E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A.K., Meyer, N.L., Sherman, R.T., Tenforde, A.S., Klungland Torstveit, M., & Budgett, R. (2018). IOC consensus statement on Relative Energy Deficiency in Sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11), 687–697. https://doi.org/10.1136/bjsports-2018-099193 DOI: https://doi.org/10.1136/bjsports-2018-099193
De Souza, M.J., Nattiv, A., Joy, E., Misra, M., Williams, N.I., Mallinson, R.J., Gibbs, J.C., Olmsted, M., Goolsby, M., & Matheson, G. (2014). 2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the female athlete triad. British Journal of Sports Medicine, 48(4), 289. https://doi.org/10.1136/bjsports-2013-093218 DOI: https://doi.org/10.1136/bjsports-2013-093218
Trakman, G.L., Forsyth, A., Hoye, R., & Belski, R. (2018). Nutrition knowledge and attitudes of athletes and coaches: A systematic review. Sports Medicine, 48(1), 165–177. https://doi.org/10.1007/s40279-017-0794-4
Heaney, S., O’Connor, H., Michael, S., Gifford, J., & Naughton, G. (2011). Nutrition knowledge in athletes: A systematic review. International Journal of Sport Nutrition and Exercise Metabolism, 21(3), 248–261. https://doi.org/10.1123/ijsnem.21.3.248 DOI: https://doi.org/10.1123/ijsnem.21.3.248
Burke, L.M., Hawley, J.A., Wong, S.H. S., & Jeukendrup, A.E. (2019). Carbohydrates for training and competition. Journal of Sports Sciences, 37(1), 1–18. https://doi.org/10.1080/02640414.2018.1555906 DOI: https://doi.org/10.1080/02640414.2018.1555906
Alaunyte, I., Perry, J.L., & Aubrey, T. (2015). Nutritional knowledge and eating habits of athletes: A systematic review. Journal of Human Nutrition and Dietetics, 28(5), 491–498. https://doi.org/10.1111/jhn.12255 DOI: https://doi.org/10.1111/jhn.12255
Heikura, I.A., Stellingwerff, T., Mero, A.A., & Burke, L.M. (2017). A mismatch between athlete practice and current sports nutrition guidelines among elite female and male endurance athletes. International Journal of Sport Nutrition and Exercise Metabolism, 27(4), 334–344. https://doi.org/10.1123/ijsnem.2016-0311 DOI: https://doi.org/10.1123/ijsnem.2016-0316
Fairburn, C.G., & Beglin, S.J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363–370. https://pubmed.ncbi.nlm.nih.gov/7866415/ DOI: https://doi.org/10.1002/1098-108X(199412)16:4<363::AID-EAT2260160405>3.0.CO;2-#
Nana, A., Slater, G.J., Hopkins, W.G., & Burke, L.M. (2015). Techniques for undertaking dual-energy X-ray absorptiometry whole-body scans to estimate body composition in tall and/or broad subjects. European Journal of Clinical Nutrition, 69(7), 759–765. https://doi.org/10.1038/ejcn.2015.37 DOI: https://doi.org/10.1038/ejcn.2015.37
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa
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