Journal of the American College of Nutrition

ISSN: 0731-5724 (Print) 1541-1087 (Online) Journal homepage: https://www.tandfonline.com/loi/uacn20

Nutritional Intake and Energy Availability of

Collegiate Distance Runners

Brooke L. Beermann, Deborah G. Lee, Hawley C. Almstedt & William P.

McCormack

To cite this article: Brooke L. Beermann, Deborah G. Lee, Hawley C. Almstedt & William P.
McCormack (2020): Nutritional Intake and Energy Availability of Collegiate Distance Runners,
Journal of the American College of Nutrition, DOI: 10.1080/07315724.2020.1735570

To link to this article: https://doi.org/10.1080/07315724.2020.1735570

Published online: 19 Mar 2020.

Submit your article to this journal

Article views: 3

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=uacn20
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION
https://doi.org/10.1080/07315724.2020.1735570

Nutritional Intake and Energy Availability of Collegiate Distance Runners

Brooke L. Beermann, Deborah G. Lee, Hawley C. Almstedt and William P. McCormack
Department of Health and Human Sciences, Loyola Marymount University, Los Angeles, California, USA

ABSTRACT ARTICLE HISTORY

Objective: Research investigating the dietary habits of distance runners has presented varying Received 25 September 2019
results. Proper dietary intake appears to enhance distance running performance and low dietary Accepted 24 February 2020
intake may impact health. The purpose of this investigation was to perform a comprehensive
KEYWORDS
evaluation of nutrient intake of collegiate distance runners with comparison to recommendations
Carbohydrate intake; bone-
for athletes. free lean mass; fat free
Methods: Twenty-one men (Age: 19.6 ± 1.2 years; height: 177.1 ± 5.7 cm; body mass: 65.7 ± 4.6 kg; mass; protein intake;
body fat: 15.5 ± 2.2%) and 20 women (Age: 20.2 ± 1.7 years; height: 162.9 ± 6.6 cm; body mass: macronutrients;
53.7 ± 6.5 kg; body fat: 23.3 ± 3.6%) volunteered to participate in the investigation. Energy intake micronutrients
was derived from the Block Food Frequency Questionnaire. Energy availability was calculated by
subtracting exercising energy expenditure from daily energy intake, divided by bone free lean
mass and fat-free mass. Macronutrient and micronutrient consumption were compared with the
appropriate dietary reference intake values, U.S. Dietary Guidelines, or standards recommended for
endurance athletes.
Results: Dietary intake for the men was 2,741.0 ± 815.2kilocalories and for the women was
1,927.7 ± 638.2kilocalories. A majority of the runners (73%) consumed less than recommended lev-
els of carbohydrates. All men and 75% of women met or exceeded the recommended daily pro-
tein intake. Fifty percent of women and 24% of men did not meet the recommended daily
allowance for calcium. Ninety-five percent of the runners did not meet the RDA for vitamin D. All
the men and 75% of the women met the RDA for iron intake, with 24 of the runners taking an
iron supplement. Eight men and 10 women did not meet the recommended intake for potassium.
Conclusion: The dietary intake in this group of distance runners is below that necessary for the
level of energy expended in their training. Carbohydrate intake is below the recommended
amount for endurance athletes, and the calcium and vitamin D intake may not be favorable for
bone health in this group of distance runners.

Abbreviations: AMDR: acceptable macronutrient distribution range; BFLM: bone-free lean mass;
BMI: body mass index; BW: body weight; CHO: carbohydrate; DRI: dietary reference intake; DXA:
dual-energy x-ray absorptiometry; EA: energy availability; EEE: exercising energy expenditure; EI:
energy intake; FFQ: food frequency questionnaire; FFM: fat-free mass; Kcals: kilocalories; LBM: lean
body mass; MET: metabolic equivalent; PRO: protein; REDS: relative energy deficiency in sport;
RMR: resting metabolic rate; SD: standard deviation; Vit: vitamin

Introduction metabolic pathways that require micronutrients, and exercise

Collegiate-level student-athletes often have a difficult time
meeting nutritional requirements due to frequent travel,
demanding schedules, limited food availability, and changing
environments. In sports that favor a lean build, such as dis-
tance running, there is pressure for the athlete to eat a
nutrient dense diet in order to enhance performance, yet
many athletes may restrict dietary intake in order to main-
tain or achieve a lean body composition in effort to enhance
performance. Nutrient requirements for athletes are higher,
as aerobic athletes need more carbohydrate than non-ath-
letes to fuel exercise and replace glycogen (1). In addition,
protein needs for athletes are greater due to degradation and
use of amino acids as an energy source during prolonged
endurance exercise (2). High-intensity training stresses
may result in muscular changes that escalate needs for some
vitamins and minerals (3). Proper nutrition can help to
counteract the damaging effects of high-intensity training
including suppression of the immune system, increased
inflammation, and increased risk for infection. In particular,
previous research has identified iron, zinc, vitamin A and D
as important micronutrients for immune health in athletes
(4). Iron intake is particularly important for distance run-
ners who often exhibit compromised iron status due to
hemolysis, alterations in hormones that regulate iron, insuf-
ficient iron consumption, and menstrual blood losses for
female athletes (5). These factors together can foster a diet
at risk for a number of nutritional deficiencies, specifically
in carbohydrates, vitamin D, iron, calcium, and zinc (6).

CONTACT William P. McCormack william.mccormack@lmu.edu Department of Health and Human Sciences, Loyola Marymount University, 1 LMU Dr. MS
8888, Los Angeles, CA 90045, USA.
ß 2020 American College of Nutrition
2 B. L. BEERMANN ET AL.
Diets lacking in macronutrients and micronutrients may
negatively affect performance and increase the risk for injury
and illness (5).
Previous research examining nutrient intake among non-
collegiate distance runners or endurance athletes in general is
equivocal. It appears that multisport and endurance athletes
may not be meeting recommendations for energy and
carbohydrate intake (7–9), however, Japanese endurance
athletes (10) and one study of distance runners (11) reported
achievement of carbohydrate and protein needs. Examination
of elite distance runners from Kenya, reported 75% of energy
intake from carbohydrates with an average consumption
of more than 10 g of carbohydrate relative to kg of body
weight (12). A number of studies have reported dietary intake
of distance runners or endurance athletes ranging in age
from 18 to 40 years with the purpose of assessing the influ-
ence of nutrition on risk for stress fractures (13–15), report-
ing that nutrients such as calcium, vitamin D, and protein
may influence risk for stress fracture among runners (14, 15).
When narrowing the research to focus on collegiate
athletes in particular, including distance runners, previous
investigations show energy, carbohydrate, protein, and
calcium intake to be under recommendations while some
male athletes overconsumed fat (16–19). Only a few studies
have examined the nutritional habits specifically of collegiate
distance runners (20–22). The results of these studies show
that male collegiate runners, but not females, tend to meet
total energy needs while calcium and vitamin D intake
are lower than recommendations. In general, the research
literature among collegiate distance runners is incomplete,
lacking examination of macro and micronutrients (21),
inclusion of both male and female athletes (20), and com-
parisons to standards or recommendation for athletes (22).
With high training loads and increased nutritional needs,
suboptimal eating habits among athletes can lead to low
energy availability (EA) and subsequent health consequences
(23). Rather than evaluating energy balance, EA associates
energy intake with ideal health and physical performance
(3). EA, defined as total energy intake minus energy
expenditure due to exercise, relative to fat free mass, is
an important foundation for health and success of sport
nutrition strategies (23, 24). Low EA may be caused by
disordered eating, restrictive eating, poor nutritional
knowledge, sudden increases in training intensity or volume
without diet alterations, or simply unintentional failure to
consume sufficient calories. EA is an underlying feature
of the female athlete triad, a syndrome of clinical issues
including disordered eating, menstrual dysfunction, and
poor skeletal health (24). Recently researchers have proposed
Relative Energy Deficiency in Sport (REDS) as a cluster of
physiological complications observed in athletes of both
sexes when EA is below needs (23, 25). REDS affects endo-
crine, hematological, metabolic, cardiovascular, and immune
systems while also impairing performance and increasing
risk for injury (5).
EA has been investigated in a number of sports, mainly
in female endurance athletes, although there is a growing
interest investigating this issue among male endurance
athletes (26, 27). In a review, Loucks (2007) reported that
female athletes may consume approximately 30% less energy,
especially carbohydrates, than their male counterparts (28).
Across many studies, there is a trend of low EA among
female athletes (24, 29, 30). Most of the research on EA has
examined endurance sports (31–33) although Woodruff and
Meloche (2013) reported EA in collegiate volleyball players
(34). Several investigations have examined EA in male athletes,
including older endurance athletes (35), recreationally active
men (36), however more research is needed among collegiate
distance runners, especially males. EA is difficult to assess
accurately as there are many variables involved and measuring
energy intake relies on self-reported data from athletes (37, 38).
Some research indicates EA should be reported relative to fat-
free mass (FFM) (3, 24, 28), while others use the term lean
body mass (LBM) (39, 40), and still further literature uses the
terms interchangeably (37). If researchers use dual-energy x-ray
absorptiometry (DXA) to measure body composition, as is rec-
ommended (37) due to its high precision (3), then reports are
able to be more specific about whether bone mass is included
in the denominator of the EA equation. Unlike other methods
of body composition assessment, like underwater weighing and
skinfold measurement, DXA uses a three-component model,
reporting fat mass, bone mass, and other fat-free soft tissue
which sum to total body mass (41).
In effort to provide clarity in calculations, we aimed to
analyze EA using only lean mass in comparison to lean
mass with bone mass. With a limited number of studies on
the dietary intake and EA of male and female collegiate dis-
tance runners, the purpose of this investigation was to per-
form a comprehensive evaluation of nutrient intake of
collegiate distance runners with comparison to recommen-
dations for athletes.
Materials and methods
Participants
Twenty-one men and 20 women from a National Collegiate
Athletic Association Division I cross-country team volun-
teered to participate in this study. Data collection occurred
during the competitive season for collegiate cross-country
runners. At the time of dietary assessment, the runners were
training in excess of 100 km weekly, including two high-
intensity workouts per week (interval, hill repeats, or race
day) and one long run of 20–25 km. In addition, the runners
performed four weekly cross-training sessions; two 1-hour
resistance training sessions, and two 1-hour aerobic training
sessions either “running” with a floated vest in the pool or
riding a cycle ergometer. The investigation was approved by
the Loyola Marymount University Institutional Review
Board for Human Subjects. All participants provided written
informed consent prior to initiating the study.
Nutrient intake
Participants completed the Block 2014 Food Frequency
Questionnaire (FFQ) via online survey, at their leisure. The

Table 1. Demographic and body composition variables for male and female
collegiate distance runners.
Males (n ¼ 21) Females (n ¼ 20)
Variable
Age (yrs) 19.6 ± 1.2 20.2 ± 1.7
Height (cm) 177.1 ± 5.7 162.9 ± 6.6
Weight (kg) 65.7 ± 4.6 53.7 ± 6.5
BMI (kg
m2) 21.0 ± 1.3 20.2 ± 1.6
% body fat 15.5 ± 2.2 23.3 ± 3.6
BFLM (kg) 53.3 ± 4.2 39.4 ± 4.5
FFM (kg) 55.7 ± 4.3 41.3 ± 4.7
Note. Data are presented as means ± SD. BFLM ¼ bone-free lean mass
determined by dual energy x-ray absorptiometry; FFM ¼ sum of soft-tissue
lean mass and bone mass determined by dual energy x-ray absorptiometry.

Males and Females were significantly different, p < 0.001.
questionnaire includes 127 beverage and food items,
with additional questions to modify for consumption of
carbohydrates, fats, protein, simple sugars and foods made
from whole grains. The survey incorporates questions
to assess supplemental, fortified, and enriched food sources
of nutrients. The food list of the FFQ is based on the
United States Department of Agriculture Food and Nutrient
Database, which was derived from data collection of the
National Health and Nutrition Examination Survey. FFQ
prompts inquire about portion sizes and frequency of con-
sumption on a monthly, weekly, and daily basis. Visuals assist
in estimating the accurate portion sizes. The Block FFQ is
recognized as a valid (42) and reliable (43) measure of nutri-
tional intake over the preceding 12 months (44). Results for
micronutrients are reported as dietary intake from food and
beverages and total intake, which includes supplemental sour-
ces. This analysis focused on micronutrients of particular
importance to athletes and those that are often problematic
for Americans (5, 45). The mean intake for macronutrients
and micronutrients were calculated for men and women and
compared to recommended values for athletes (3) and the
Dietary Reference Intakes (46–51).
Body composition
Dual-energy x-ray absorptiometry (DXA; Hologic Discovery
A, Waltham, MA) of the whole body was used to measure
bone-free lean mass (BFLM), fat-free mass (FFM), and per-
cent body fat. For the purpose of this research, BFLM is the
total mass of the body derived by DXA without bone mass or
fat mass. The term FFM used in this paper refers to the total
mass of the body derived by whole body DXA scan, exclud-
ing fat mass, and therefore includes soft-tissue lean mass and
bone mass. Whole body scans were performed and analyzed
by one technician after daily calibration. Body mass index
(BMI) was calculated from the height and weight measure-
ments taken without shoes while wearing light clothing.
Energy availability
EA was determined by subtracting exercising energy expend-
iture (EEE) from daily energy intake (EI) and dividing by
BFLM or FFM, derived from DXA. The Block FFQ provided
EI as total daily kilocalorie consumption. Training logs were
used to collect information about intensity and duration of
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 3
regular exercise over the previous three months.
Training records were scored using metabolic equivalents
(MET-hours
week1) from the compendium of physical
activity (52) to integrate energy expenditure at a variety of
intensities and for the reported lengths of time. To avoid
overestimating energy expended during exercise, we
incorporated activities with an intensity greater than 4.0
METs (33, 53). EEE was the total of all exercise (>4.0
METs) multiplied by the hours of activity and BFLM or
FFM. Additional modifications to EEE eliminated the
number of kilocalories contributed by resting metabolic rate
(RMR) during the hours of exercise (33, 38). Estimation of
RMR was calculated using the Cunningham equation (54).
In summary, adjusted EEE was the raw EEE minus RMR
per hour, multiplied by the number of hours of exercise at
4.0 METs or greater. The adjusted EEE was then subtracted
from EI and divided by BFLM or FFM to calculate EA.
For this investigation, EA has been categorized as optimal
for weight maintenance when it was 45 kcal
kg1, sub-
optimal when it is between 30–44 kcal
kg1, and clinically
low when it was <30 kcal
kg1 (24, 55). The number of
runners with EA in each of these categories was determined.
For comparison purposes, calculations were performed using
BFLM and FFM (including bone mass) as the denominator
to analyze this influence on average EA of runners and
categorization of EA as optimal, suboptimal, or clinically low.
Statistical analysis
Descriptive statistics are presented with means, standard
deviations, and range from low to high. Values were
compared to current Dietary Reference Intakes (46–51), U.S.
Dietary Guidelines (45), or standards established as appro-
priate for endurance athletes (3). Analysis of variance was
used to compare mean values of macro and micronutrients
between the sexes. All analyses were performed using SPSS
Version 22 (IBM Corp.; Armonk, NY) and a significance
level of less than 0.05 was applied throughout.
Results
Participants
Participant characteristics are presented in Table 1. Volunteers
had a reported mean running history of 7.3 ± 2.2 years and
identified themselves as White (64%), Hispanic (29%),
and Asian (7%). Male and female athletes were similar in age
and BMI, however men were significantly taller, heavier, and
had a lower percent body fat than female athletes.
Macronutrients
Mean daily consumption macronutrients and recommended
intakes are presented in Table 2. In comparison to female
athletes, male athletes consumed significantly more energy,
grams of protein relative to body weight (BW), percent
of kcals from protein, and grams of dietary fat (p < 0.05).
A majority (73%) of the athletes consumed less than the
4 B. L. BEERMANN ET AL.

Table 2. Macronutrient intake among male and female collegiate distance athletes.
Males Females
Mean ± SD Not meeting recommendations Mean ± SD Not meeting recommendations Recommended
(n ¼ 21) N, % (n ¼ 20) N, % Intakea,b,c
Total energy intake (kcals) 2,741.8 ± 815.2 NA 1,927.7 ± 638.2 NA NA
(1,404–4,314) (1,076–3,589)
Dietary CHO (gkgBW1) 5.3 ± 1.7 13, 62% 4.7 ± 1.9 17 (85%) 6–10a
(2.66–8.70) (2.32–10.4)
% kcals from CHO 50.7 ± 5.9 4, 19% 51.0 ± 6.2 5, 25% 45–65%b
(35.8–61.3) (41.6–66.7)
Dietary PRO (gkgBW1) 1.8 ± .5 6, 29% 1.4 ± 0.6 7, 35% 1.2–2.0a
(1.07–2.79) (0.72–3.1)
% kcals from PRO 17.1 ± 2.0 0 15.2 ± 1.8 0 10–35%b
(13.3–22.3) (11.4–18.3)
Dietary fat (g) 104.1 ± 38.8 NA 75.8 ± 28.5 NA NA
(47.3–191.2) (34.5–147.8)
% kcals from fat 33.7 ± 5.0 9, 43% 35.2 ± 4.7 11, 55% 20–35%b
(24.1–45.6) (23.1–41.8)
% kcals from SFA 10.9 ± 2.3 13, 62% 11.1 ± 2.1 13, 65% <10%c
(6.3–15.9) (8.7–16.8)
Range presented in parentheses; the number (N) and percent of participants not meeting recommended values are displayed; kcals ¼ kilocalories; BW ¼ body
weight; CHO ¼ carbohydrates; PRO ¼ protein; SFA ¼ saturated fatty acids.
a
Thomas et al., 2016.
b
Acceptable Macronutrient Distribution Range.
c

Dietary Guidelines for Americans, 2015–2020.
Signifies the mean values between men and women are significantly different (p < 0.05).

Table 3. Energy availability in male and female collegiate distance runners. whether calculated using BFLM or FFM. Paired t-tests
Energy availability Males (n ¼ 20) Females (n ¼ 17) showed that calculating EA using FFM, which included
kcals
BFLM1 (M ± SD) 35.2 ± 15.1 35.2 ± 17.1 2 kg of bone mass measured via DXA, results in signifi-
(8.8–65.8) (12.2–69.0) cantly lower values than EA calculated using BFLM
45 kcals
BFLM1 5, 25% 4, 24%
30–44 kcals
BFLM1 6, 30% 6, 35% (p < 0.001). When categorizing the EA of athletes according
<30 kcals
BFLM1 9, 45% 7, 41% to thresholds established in the literature, 43% had clinically
kcals
FFM1 (M ± SD) 33.1 ± 15.0 32.8 ± 16.1
(7.5–61.5) (11.0–64.7)
low EA, while 32% or 38% had subclinical low EA when
45 kcals
FFM1 4, 20% 3, 18% using BFLM and FFM, respectively. Relatively few, 19–24%,
30–44 kcals
FFM1 7, 35% 7, 41% met EA needs for weight maintenance, optimal endocrine
<30 kcals
FFM1 9, 45% 7, 41%
function, and healthy bone metabolism.
Note. Data are reported as mean (M) ± standard deviation (SD) with the
range in parentheses; the number (N) and percent of participants below the
recommended 45 kcals
BFLM1 or FFM1 are displayed; BFLM ¼ bone-free
lean mass determined by dual energy x-ray absorptiometry; FFM ¼ soft-tissue Micronutrients

lean mass and bone mass determined by dual energy x-ray absorptiometry.
Significantly lower than kcals
BFLM1, p < 0.001. Data for micronutrient intake is presented in Table 4. Male
athletes consumed significantly greater amounts of calcium,
recommended 6–10 g
kg1BW of carbohydrates for dietary iron, zinc, vitamin B12, dietary vitamin C, and vita-
high-intensity endurance sports such as collegiate distance min D than female athletes. Supplement use by female ath-
running. Only one female runner consumed more than the letes allowed total iron and vitamin C intake to be similar
recommended 10 g
kg1BW. Five female (25%) and 4 male among the sexes while dietary intake alone differed. Average
(19%) athletes fell under the acceptable macronutrient total calcium intake for men and women were both above
distribution range (AMDR) for CHO, while one female the RDA for adults ages 19 years and older, however, 50% of
athlete reported carbohydrate consumption above the AMDR the women and 24% of the men were below the recom-
at 67%. Mean protein intake for the men and women were mended calcium intake for their age. Mean iron intake was
both within the AMDR, however five women (25%) were well above the RDA, though individually five of the female
below recommended protein intake for athletes when control- athletes (25%) consumed below the recommended threshold.
ling for body weight. Eight of the athletes (6 men and 2 Twenty-four of the runners reported taking a dietary supple-
women) ate more than 2 g
kg1BW of protein. All athletes ment for iron, which was a contributing factor for the seven
consumed at least 20% of kcals from fat, however 49% males (33%) and eight females (40%) who consumed more
of the athletes consumed more than 35% of kcals from fat. than the upper limit for iron. While average potassium
When examining types of fatty acids consumed, over half of intake met the expected adequate intake levels, eight men
the athletes ate more than 10% of kcals from saturated fats. (38%) and 10 women (50%) fell short. All of the men and
65% of the women met the RDA for zinc, while one male
athlete consumed more than the upper limit. Three men
Energy availability
(14%) and seven women (35%) fell short of the RDA for
Results for EA calculations are presented in Table 3. Male vitamin A, while two females consumed more than the
and female distance runners had similar EA to each other upper limit. Vitamin B12 and vitamin C intake met the RDA
 JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 5

Table 4. Consumption of selected vitamins and minerals among male and female collegiate distance runners.
Males Females
Micronutrient Mean ± SD (n ¼ 21) Below DRI N, % Mean ± SD (n ¼ 20) Below DRI N, % Recommended intake
Dietary calcium (mg
day1) 1,357.5 ± 352.0 965.0 ± 398.8
Total calcium (mg
day1) 1,468.5 ± 397.2 5, 24% 1,154.7 ± 552.5 10, 50% 18 yrs: 1,300
19 yrs: 1,000
(888.5–2,569.3) (497.9–1,849.4)
Dietary iron (mg
day1) 23.3 ± 6.3 15.2 ± 4.9
Total iron (mg
day1) 43.6 ± 27.2 0 44.0 ± 25.6 5, 25% 18 yrs M: 11, F: 15
19 yrs M: 8, F: 18
(16.9–96.3) (6.5–80.5)
Total potassium (mg
day1) 3,614.4 ± 977.8 8, 38% 2,806.5 ± 1,120.1 10, 50% 18 yrs M: 3,000, F: 2,300a
19 yrs M: 3,400, F: 2,600a
(1,742.0–5,388.1) (1,259.5–5,685.0)
Total sodium (mg
day1) 4485.2 ± 1609.0 0 2912.0 ± 935.2 0 1500a
(2152.7–7999.0) (1656.0–5,410.3)
Dietary zinc (mg
day1) 18.8 ± 5.0 11.8 ± 3.9
Total zinc 23.1 ± 11.5 0 14.9 ± 7.3 4, 20% M:11
F 18 yrs: 9; F 19 yrs: 8
(11.0–65.1) (6.3–34.2)
Dietary Vit A (mg
day1) 1,123.8 ± 330.9 927.0 ± 502.0
Total Vit A (mg
day1) 1,309.3 ± 471.6 3, 14% 1,313.4 ± 934.5 7, 35% M: 900, F: 700
(615.4–2,727.1) (338.8–3,708.7)
Dietary Vit B12 (mg
day1) 9.3 ± 2.6 5.2 ± 2.3
Total Vit B12 (mg
day1) 10.8 ± 3.2 0 6.5 ± 3.2 0 2.4
(6.9–18.7) (2.5–12.0)
Dietary Vit C (mg
day1) 162.8 ± 63.1 123.2 ± 51.8
Total Vit C (mg
day1) 275.6 ± 263.9 0 185.9 ± 134.2 2, 10% 18 yrs M: 75, F: 65
19 yrs M: 90, F: 75
(84.4–1214.8) (39.8–639.5)
Dietary Vit D (IU
day1) 277.7 ± 109.8 122.3 ± 86.0
Total Vit D (IU
day1) 336.2 ± 179.0 20, 95% 213.8 ± 180.2 19, 95% 600
(63.6–892.9) (54.8–680.7)
Note. Range of data is presented in parentheses; the number (N) and percent of participants not meeting recommended values are displayed; Total intake
includes supplemental sources, while dietary intake is from food and beverages alone; DRI ¼ Dietary Reference Intake; Vit ¼ vitamin; M ¼ males; F ¼ females.
a

indicates reference standard is an Adequate Intake, all other micronutrient reference values are Recommended Dietary Allowances.
Males and females are significantly different, p < 0.05.

for most athletes, with two females (10%) consuming
less than the recommendation for vitamin C. A majority
of athletes (95%) did not consumed the RDA for vitamin D.
All of the athletes who consumed more than the RDA
for any micronutrient were using dietary supplements.
Discussion
The main finding of this investigation is the low
energy intake and EA for both the men and women in this
sample of collegiate distance runners. In particular, athletes
consumed too little carbohydrate in comparison to recom-
mendations for high-intensity, endurance athletes (3). Low
carbohydrate intake may impair performance and recovery
(5) while also lowering immune function (4). Previous
research among collegiate athletes (17, 19), endurance
athletes (7, 8) and specifically collegiate distance runners
(20, 21) also report poor carbohydrate intake.
Unlike data reported in this paper, Masson & Lamarche
(2016) found no difference in relative protein intake
between male and female athletes (8). As a group, the men
in this study were eating significantly more protein while
some of the female athletes were not consuming enough.
Athletes need more protein than the RDA, which is set
for the general adult population, however research suggests
several different targets for protein intake among athletes.
Protein needs for weight maintenance among track and field
athletes is 1.3–1.7 g/kg, athletes working to lose weight
should consume 1.6–2.4 g/kg, and endurance-trained athletes
who consume protein at the upper end of the 1.2–2.0 g/kg
(1.83 g/kg) recommendation may have metabolic and
performance advantages (5, 56). Protein intake may become
more important when CHO intake is limited or when EA is
low, as is the case for these collegiate distance runners (3).
We report an elevated proportion of energy derived from
dietary fat in male and female collegiate distance runners.
Recommendations for athletes suggest dietary fat intake
should meet public health guidelines (3). The findings
reported here are similar to Hinton et al. who also found
elevated fat and SFA intake, especially among male athletes
(17). On a positive note, none of the athletes in this study
showed a chronic intake of lipids below 20% of total energy,
which is important to ensure sufficient fat-soluble vitamins,
essential fatty acids, and omega-3 fatty acids (3).
Suboptimal EA was found in 75–80% of the athletes,
while over 40% of both male and female cross-country
runners met criteria for clinically low EA. Similar to reports
in published research (27, 57), EA was not significantly
different between male and female distance runners.
Previous research among female endurance/track athletes
report as low as 20% (31) but as high as 52% (58) of athletes
to have clinically low EA. Of the few studies exploring EA
in male athletes, prevalence of clinically low EA for endurance
sports ranges from 42 to 58% (27, 57). Much of the research
on the triad and REDS has focused on female athletes thus far,
however these findings suggest male distance runners exhibit
6 B. L. BEERMANN ET AL.
similar prevalence of suboptimal and clinically low EA
as female distance runners (35, 59). Without alteration,
chronically low EA will lead to injury, illness, and alterations
in endocrine, reproductive, metabolic, and cardiovascular
health (23, 38, 60, 61).
Some of the differences in EA reported in the literature
may be due to the variety of measurement methods and
challenges in accurately measuring the many components of
EA (37, 38). One component of EA fraught with error is
assessment of energy intake, which often relies on self-
report. We measured calorie intake with a validated and
reliable FFQ developed to assess routine consumption (42,
43), however no measure of dietary intake is without error.
Our measurement of EA is strengthened by use of DXA, the
recommended method (37) of body composition assessment
due to its low standard error of estimate, however some
research reports DXA to be less reliable in accurately
measuring fat mass of very lean athletes (41). We report
6.3–7.3% lower EA when using FFM in the calculation
versus BFLM because when measured via DXA use of FFM
includes 2 kg of bone mass. Despite significant differences
in EA depending on use of FFM versus BFLM, the two
methods of calculation did not significantly alter classifica-
tion of athletes into categories of optimal, suboptimal, or
clinically low EA. When considering all of the variables
involved with calculating EA, it is possible that differences
in measurement of FFM versus the more precise BFLM
contribute a relatively small discrepancy to estimates of EA
compared with measurements of other components of the
EA calculation (37), however even this small change has the
ability to improve the accuracy of EA assessment.
One of most important ways for distance runners to
lower risk for bone injuries and stress fractures is to achieve
and maintain adequate EA, attain adequate vitamin D status,
while also consuming sufficient levels of calcium (14, 62).
Similar to previous research (17, 22), the average calcium
intake for participants in this study met the RDA, however
half of the female runners and 25% of male runners did not
meet the recommended calcium intake. As reported else-
where (16), male runners consumed significantly more cal-
cium than female counterparts. The vitamin D intake with
this group was well below the RDA and the two athletes
who met the RDA or vitamin D were both taking dietary
supplements. One limitation of this study is that blood levels
of vitamin D were not assessed. This group is training out-
doors most of the year in Southern California where there is
ample sunshine, which may foster in vivo synthesis of vita-
min D. As reported elsewhere among female distance run-
ners (63), it is possible that serum levels of vitamin D are
adequate due to skin exposure to UVB light, even though
dietary intake of the micronutrient is low. Vitamin D is cru-
cial for optimal skeletal health, but is also particularly
important for athletes due to its role in muscular function
(64), injury prevention (65), reduced inflammation, and a
strong immune system (66). Previous research shows that
low vitamin D status may affect strength and power in col-
lege athletes (67). It is also important to note that athletes
with low EA and/or menstrual dysfunction may need up to
1,500 mg of calcium per day along with 2,000 IU of vitamin
D to optimize bone health (3).
All of the male runners and most (75%) of the female
runners were consuming at or above the RDA for iron.
Consumption of this trace mineral is particularly important
for distance runners who are at greater risk of poor iron
status due to foot-strike hemolysis and typically low
consumption of heme containing foods (3). Female distance
runners are especially prone to poor iron status because men-
strual blood loss, greater gastrointestinal losses of the mineral,
and elevated hepcidin after exercise (68). Therefore, iron
needs for female athletes may be 70% more than estimated
average requirement for iron (69). The athletes in this study
seemed to be well informed about the importance of iron
intake in running performance because more than half were
taking dietary supplements of this mineral. A recent review of
iron supplementation among marathon runners concluded
that supplementation of the trace mineral should be used to
correct low ferritin concentrations in athletes, may be used
to prevent iron deficiency, while also possibly improving
performance (68). Surprisingly, more than 37% of participants
in this study were consuming more than the upper limit
for iron. Data collection did not inquire whether any of the
athletes were working to treat or prevent iron deficiency. It is
possible that some of these athletes were under guidance
from a health professional to take high doses of iron. Serum
assessment of iron status would improve this research. None
of the athletes in this study reported to be vegetarians.
Most athletes were consuming adequate amounts of zinc,
vitamin B12, and vitamin C. Even though male athletes were
consuming more zinc, vitamin B12, and vitamin C than
female athletes, the average intake for both sexes was above
the RDA. Potassium serves as an intracellular electrolyte
and is therefore an important nutrient for high-intensity
endurance athletes, especially in a hot environment when
sweat loss of the mineral is substantial. Potassium consump-
tion was below the recommended AI for 44% of the athletes
(38% of the men and 50% percent of the women). More
information is needed on dietary potassium requirements.
Vitamin A, an essential micronutrient for its antioxidant
properties and role in growth and repair, was below
recommendations for 24% of athletes (3 men and 7 women).
Strengths of this study include analysis of male and
female athletes, with specific focus on a homogenous group
of collegiate athletes within a narrow age range. Further,
comparison to current dietary standards and needs
established for athletes contributes valuable information to
the literature in the field of sports nutrition. There was an
attempt to increase accuracy of EA calculation by analyzing
results with BFLM and FFM. A major limitation of this
research is the error associated with self-reported dietary
intake. Self-reported data may convey lower than actual
caloric intake, which would directly influence the macro-
and micronutrient intake. Research in sports nutrition of
collegiate distance runners could be improved by examining
timing of nutrient intake throughout the day and in relation
to intensity of training and length of workouts. Further
improvements in this work, would assess whether athletes

were trying to, or needed to, make changes in dietary intake
to alter body composition and thereby improve performance.
Conclusions
In this group of collegiate distance runners, it appears that
most athletes have low energy availability. Additionally,
there is need for further education among athletes because
carbohydrate intake was insufficient for optimal perform-
ance. Measurement of EA decreases significantly when FFM
is used in the equation versus BFLM. To improve the accur-
acy of EA assessment, we propose for future research to use
DXA to measure BFLM and express EA kcals available per
kg of BFLM, as bone tissue is less metabolically active dur-
ing exercise than muscle tissue. In general, dietary intake
could be improved by reducing the proportion of energy
derived from fat, especially working to lower consumption
of saturated fatty acids, while replacing these kcals with
nutrient-dense complex carbohydrates. Increased consump-
tion of calcium, vitamin D, and potassium are also needed,
however protein and iron intake were mostly adequate in
this population of collegiate distance runners.
Acknowledgements
We are grateful to Coaches Scott Guerrero, Jason Zarb-Cousin, and
Caitlin Jennings, and all of the research participants who volunteered
for and supported this research investigation. Thank you to Makenzie
Cook, Lily Bramble, and Rowena Feng for their assistance with data
analysis and management.
Funding
This research was supported by the Loyola Marymount University
Rains Research Assistant Program.
ORCID
William P. McCormack http://orcid.org/0000-0002-8634-2305
References
1. Costill DL, Sherman WM, Fink WJ, Maresh C, Witten M, Miller
JM. The role of dietary carbohydrates in muscle glycogen resyn-
thesis after strenuous running. Am J Clin Nutr. 1981;34(9):
1831–1836. doi:10.1093/ajcn/34.9.1831.
2. Lemon PW. Is increased dietary protein necessary or beneficial
for individuals with a physically active lifestyle? Nutr Rev. 2009;
54(4):S169–S175. doi:10.1111/j.1753-4887.1996.tb03913.x.
3. Thomas DT, Erdman KA, Burke LM. Position of the academy of
nutrition and dietetics, dietitians of canada, and the american col-
lege of sports medicine: Nutrition and athletic performance. J Acad
Nutr Diet. 2016;116(3):501–528. doi:10.1016/j.jand.2015.12.006.
4. Castell LM, Nieman DC, Bermon S, Peeling P. Exercise-induced
illness and inflammation: Can immunonutrition and iron help?
Int J Sport Nutr Exerc Metab. 2019;29(2):181–188. doi:10.1123/
ijsnem.2018-0288.
5. Burke LM, Castell LM, Casa DJ, Close GL, Costa RJS, Desbrow
B, Halson SL, Lis DM, Melin AK, Peeling P, et al. International
association of athletics federations consensus statement 2019:
Nutrition for athletics. Int J Sport Nutr Exerc Metab. 2019;29(2):
73–84. doi:10.1123/ijsnem.2019-0065.
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 7
6. Parnell JA, Wiens KP, Erdman KA. Dietary intakes and supple-
ment use in pre-adolescent and adolescent canadian athletes.
Nutrients. 2016;8(9):526. doi:10.3390/nu8090526.
7. Heikura IA, Burke LM, Mero AA, Uusitalo ALT, Stellingwerff T.
Dietary microperiodization in elite female and male runners and
race walkers during a block of high intensity precompetition
training. Int J Sport Nutr Exerc Metab. 2017;27(4):297–304. doi:
10.1123/ijsnem.2016-0317.
8. Masson G, Lamarche B. Many non-elite multisport endurance
athletes do not meet sports nutrition recommendations for car-
bohydrates. Appl Physiol Nutr Metab. 2016;41(7):728–734. doi:
10.1139/apnm-2015-0599.
9. Burkhart SJ, Pelly FE. Dietary intake of athletes seeking nutrition
advice at a major international competition. Nutrients. 2016;
8(10):638. doi:10.3390/nu8100638.
10. Sugiura K, Suzuki I, Kobayashi K. Nutritional intake of elite
Japanese track-and-field athletes. Int J Sport Nutr. 1999;9(2):
202–212. doi:10.1123/ijsn.9.2.202.
11. Ludbrook C, Clark D. Energy expenditure and nutrient intake in
long-distance runners. Nutr Res. 1992;12(6):689–699. doi:10.
1016/S0271-5317(05)80566-4.
12. Onywera VO, Kiplamai FK, Tuitoek PJ, Boit MK, Pitsiladis YP.
Food and macronutrient intake of elite Kenyan distance runners.
Int J Sport Nutr Exerc Metab. 2004;14(6):709–719. doi:10.1123/
ijsnem.14.6.709.
13. Guest NS, Barr SI. Cognitive dietary restraint is associated with
stress fractures in women runners. Int J Sport Nutr Exerc Metab.
2005;15(2):147–159. doi:10.1123/ijsnem.15.2.147.
14. Nieves JW, Melsop K, Curtis M, Kelsey JL, Bachrach LK,
Greendale G, Sowers MF, Sainani KL. Nutritional factors that
influence change in bone density and stress fracture risk among
young female cross-country runners. PM R. 2010;2(8):740–750.
doi:10.1016/j.pmrj.2010.04.020.
15. Wentz L, Liu PY, Ilich JZ, Haymes EM. Dietary and training
predictors of stress fractures in female runners. Int J Sport Nutr
Exerc Metab. 2012;22(5):374–382. doi:10.1123/ijsnem.22.5.374.
16. Leachman Slawson D, McClanahan BS, Clemens LH, Ward KD,
Klesges RC, Vukadinovich CM, Cantler ED. Food sources of cal-
cium in a sample of African-American an Euro-American colle-
giate athletes. Int J Sport Nutr Exerc Metab. 2001;11(2):199–208.
doi:10.1123/ijsnem.11.2.199.
17. Hinton PS, Sanford TC, Davidson MM, Yakushko OF, Beck NC.
Nutrient intakes and dietary behaviors of male and female colle-
giate athletes. Int J Sport Nutr Exerc Metab. 2004;14(4):389–405.
doi:10.1123/ijsnem.14.4.389.
18. Gropper SS, Blessing D, Dunham K, Barksdale JM. Iron status of
female collegiate athletes involved in different sports. Biol Trace
Elem Res. 2006;109(1):1–14. doi:10.1385/BTER:109:1:001.
19. Shriver LH, Betts NM, Wollenberg G. Dietary intakes and eating
habits of college athletes: Are female college athletes following
the current sports nutrition standards? J Am Coll Health. 2013;
61(1):10–16. doi:10.1080/07448481.2012.747526.
20. Niekamp RA, Baer JT. In-season dietary adequacy of trained
male cross-country runners. Int J Sport Nutr. 1995;5(1):45–55.
doi:10.1123/ijsn.5.1.45.
21. Tanaka JA, Tanaka H, Landis W. An assessment of carbohydrate
intake in collegiate distance runners. Int J Sport Nutr. 1995;5(3):
206–214. doi:10.1123/ijsn.5.3.206.
22. Giffin KL, Knight KB, Bass MA, Valliant MW. Predisposing
risk factors and stress fractures in division I cross country
runners. J Strength Cond Res. 2017;117(9):31. doi:10.1519/JSC.
0000000000002408.
23. Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini
N, Lebrun C, Meyer N, Sherman R, Steffen K, Budgett R, et al.
The IOC consensus statement: Beyond the female athlete triad-
Relative Energy Deficiency in Sport (RED-S). Br J Sports Med.
2014;48(7):491–497. doi:10.1136/bjsports-2014-093502.
24. Nattiv A, American College of Sports MedicineAmerican college
of sports medicine position stand. The female athlete triad. Med
Sci Sports Exerc. 2007;39(10):1867–1882., Loucks AB, Manore
8 B. L. BEERMANN ET AL.
MM, Sanborn CF, Sundgot-Borgen J, Warren MP. doi:10.1249/
mss.0b013e318149f111.
25. Mountjoy M, Sundgot-Borgen J, Burke L, Ackerman KE,
Blauwet C, Constantini N, Lebrun C, Lundy B, Melin A, Meyer
N, et al. International olympic committee (IOC) consensus state-
ment on Relative Energy Deficiency in Sport (RED-S): 2018
update. Int J Sport Nutr Exerc Metab. 2018;28(4):316–331. doi:
10.1123/ijsnem.2018-0136.
26. Tenforde AS, Nattiv A, Ackerman K, Barrack MT, Fredericson M.
Optimising bone health in the young male athlete. Br J Sports
Med. 2017;51(3):148–149. doi:10.1136/bjsports-2016-097000.
27. McCormack WP, Shoepe TC, LaBrie J, Almstedt HC. Bone min-
eral density, energy availability, and dietary restraint in collegiate
cross-country runners and non-running controls. Eur J Appl
Physiol. 2019;119(8):1–10. doi:10.1007/s00421-019-04164-z.
28. Loucks AB. Low energy availability in the marathon and other
endurance sports. Sports Med. 2007;37(4):348–352. doi:10.2165/
00007256-200737040-00019.
29. Sygo J, Coates AM, Sesbreno E, Mountjoy ML, Burr JF.
Prevalence of indicators of low energy availability in elite female
sprinters. Int J Sport Nutr Exerc Metab. 2018;28(5):490–496. doi:
10.1123/ijsnem.2017-0397.
30. Loucks AB, Stachenfeld NS, DiPietro L. The female athlete triad:
Do female athletes need to take special care to avoid low energy
availability? Med Sci Sports Exerc. 2006;38(10):1694–1700. doi:
10.1249/01.mss.0000239397.01203.83.
31. Melin A, Tornberg AB, Skouby S, Moller SS, Sundgot-Borgen J,
Faber J, Sidelmann JJ, Aziz M, Sjodin A. Energy availability and
the female athlete triad in elite endurance athletes. Scand J Med
Sci Sports. 2015;25(5):610–622. doi:10.1111/sms.12261.
32. Fahrenholtz IL, Sjodin A, Benardot D, Tornberg AB, Skouby S,
Faber J, Sundgot-Borgen JK, Melin AK. Within-day energy deficiency
and reproductive function in female endurance athletes. Scand J Med
Sci Sports. 2018;28(3):1139–1146. doi:10.1111/sms.13030.
33. Viner RT, Harris M, Berning JR, Meyer NL. Energy availability
and dietary patterns of adult male and female competitive
cyclists with lower than expected bone mineral density. Int J
Sport Nutr Exerc Metab. 2015;25(6):594–602. doi:10.1123/ijsnem.
2015-0073.
34. Woodruff SJ, Meloche RD. Energy availability of female varsity
volleyball players. Int J Sport Nutr Exerc Metab. 2013;23(1):
24–30. doi:10.1123/ijsnem.23.1.24.
35. Torstveit MK, Fahrenholtz I, Stenqvist TB, Sylta O, Melin A.
Within-day energy deficiency and metabolic perturbation in
male endurance athletes. Int J Sport Nutr Exerc Metab. 2018;
28(4):419–427. doi:10.1123/ijsnem.2017-0337.
36. Koehler K, Hoerner NR, Gibbs JC, Zinner C, Braun H, De
Souza MJ, Schaenzer W. Low energy availability in exercising
men is associated with reduced leptin and insulin but not with
changes in other metabolic hormones. J Sports Sci. 2016;34(20):
1921–1929. doi:10.1080/02640414.2016.1142109.
37. Burke LM, Lundy B, Fahrenholtz IL, Melin AK. Pitfalls of con-
ducting and interpreting estimates of energy availability in free-
living athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):
350–363. doi:10.1123/ijsnem.2018-0142.
38. Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero
AA, Burke LM. Low energy availability is difficult to assess but
outcomes have large impact on bone injury rates in elite distance
athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):403–411. doi:
10.1123/ijsnem.2017-0313.
39. Ihle R, Loucks AB. Dose-response relationships between energy
availability and bone turnover in young exercising women. J Bone
Miner Res. 2004;19(8):1231–1240. doi:10.1359/JBMR.040410.
40. Loucks AB, Thuma JR. Luteinizing hormone pulsatility is dis-
rupted at a threshold of energy availability in regularly menstru-
ating women. J Clin Endocrinol Metab. 2003;88(1):297–311. doi:
10.1210/jc.2002-020369.
41. Ackland TR, Lohman TG, Sundgot-Borgen J, Maughan RJ,
Meyer NL, Stewart AD, Muller W. Current status of body com-
position assessment in sport: Review and position statement on
behalf of the ad hoc research working group on body compos-
ition health and performance, under the auspices of the I.O.C.
Medical commission. Sports Med. 2012;42(3):227–249. doi:10.
2165/11597140-000000000-00000.
42. Block G, Woods M, Potosky A, Clifford C. Validation of a self-
administered diet history questionnaire using multiple diet
records. J Clin Epidemiol. 1990;43(12):1327–1335. doi:10.1016/
0895-4356(90)90099-B.
43. Block G, Subar AF. Estimates of nutrient intake from a food fre-
quency questionnaire: The 1987 national health interview survey.
J Am Diet Assoc. 1992;92(8):969–977.
44. Block G, Thompson FE, Hartman AM, Larkin FA, Guire KE.
Comparison of two dietary questionnaires validated against mul-
tiple dietary records collected during a 1-year period. J Am Diet
Assoc. 1992;92(6):686–693.
45. U.S. Department of Health, Human Services and U.S.
Department of Agriculture. 2015–2020 dietary guidelines for
Americans. In 2015–2020 dietary guidelines for Americans; 2015.
46. Institute of medicine, Food and Nutrition Board. Dietary refer-
ence intakes: Energy, carbohydrate, fiber, fat, fatty acids, choles-
terol, protein and amino acids. In: Institute of medicine, food
and nutrition board, dietary reference intakes: Energy, carbohy-
drate, fiber, fat, fatty acids, cholesterol, protein and amino acids.
Washington: The National Academy; 2005.
47. Institute of Medicine, Food and Nutrition Board. Dietary refer-
ence intakes for calcium, phosphorus, magnesium, vitamin D,
and fluoride. In: Dietary reference intakes for calcium, phos-
phorus, magnesium, vitamin D, and fluoride. Washington D.C.:
National Academy Press; 1997.
48. Institute of Medicine Standing Committee. Scientific evaluation of
dietary reference intakes. In Dietary reference intakes for thiamin,
riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic
acid, biotin, and choline. USA: National Academies Press; 1998.
49. Food, Nutrition Board Institute of Medicine. Dietary reference
intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper,
iodine, iron, manganese, molybdenum, nickel, silicon, vanadium,
and zinc. Washington D.C.: National Academy of Medicine; 2001.
50. Stallings VA, Harrison M, Oria M. Dietary reference intakes for
sodium and potassium. USA: National Academies Press; 2019.
51. Monsen ER. Dietary reference intakes for the antioxidant
nutrients: Vitamin C, vitamin E, selenium, and carotenoids. J
Acad Nutr Diet. 2000;100(6):637.
52. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett
DR, Jr., Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC,
Leon AS. 2011 compendium of physical activities: A second
update of codes and met values. Med Sci Sports Exerc. 2011;
43(8):1575–1581. doi:10.1249/MSS.0b013e31821ece12.
53. Guebels CP, Kam LC, Maddalozzo GF, Manore MM. Active
women before/after an intervention designed to restore men-
strual function: Resting metabolic rate and comparison of four
methods to quantify energy expenditure and energy availability.
Int J Sport Nutr Exerc Metab. 2014;24(1):37–46. doi:10.1123/ijs-
nem.2012-0165.
54. Cunningham JJ. Body composition as a determinant of energy
expenditure: A synthetic review and a proposed general predic-
tion equation. Am J Clin Nutr. 1991;54(6):963–969. doi:10.1093/
ajcn/54.6.963.
55. De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ,
Gibbs JC, Olmsted M, Goolsby M, Matheson G. 2014 female athlete
triad coalition consensus statement on treatment and return to play
of the female athlete triad: 1st international conference held in San
Francisco, California, may 2012 and 2nd international conference
held in Indianapolis, Indiana, may 2013. Br J Sports Med. 2014;
48(4):289–289. doi:10.1097/JSM.0000000000000085.
56. Williamson E, Kato H, Volterman KA, Suzuki K, Moore DR.
The dffect of dietary protein on protein metabolism and per-
formance in endurance-trained males. Med Sci Sports Exerc.
2019;51(2):352–360. doi:10.1249/MSS.0000000000001791.
57. Koehler K, Achtzehn S, Braun H, Mester J, Schaenzer W.
Comparison of self-reported energy availability and metabolic

hormones to assess adequacy of dietary energy intake in young
elite athletes. Appl Physiol Nutr Metab. 2013;38(7):725–733. doi:
10.1139/apnm-2012-0373.
58. Day J, Wengreen H, Heath E, Brown K. Prevalence of low
energy availability in collegiate female runners and implementa-
tion of nutrition education intervention. Sports Nutr Ther. 2015;
1(1):1–7. doi:10.4172/2473-6449.1000101.
59. Burke LM, Close GL, Lundy B, Mooses M, Morton JP, Tenforde
AS. Relative energy deficiency in sport in male athletes: A com-
mentary on its presentation among selected groups of male ath-
letes. Int J Sport Nutr Exerc Metab. 2018;28(4):364–374. doi:10.
1123/ijsnem.2018-0182.
60. Ackerman KE, Holtzman B, Cooper KM, Flynn EF, Bruinvels G,
Tenforde AS, Popp KL, Simpkin AJ, Parziale AL. Low energy
availability surrogates correlate with health and performance
consequences of relative energy deficiency in sport. Br J Sports
Med. 2019;53(10):628–633. doi:10.1136/bjsports-2017-098958.
61. Elliott-Sale KJ, Tenforde AS, Parziale AL, Holtzman B,
Ackerman KE. Endocrine effects of relative energy deficiency in
sport. Int J Sport Nutr Exerc Metab. 2018;28(4):335–349. doi:10.
1123/ijsnem.2018-0127.
62. Close GL, Sale C, Baar K, Bermon S. Nutrition for the preven-
tion and treatment of injuries in track and field athletes. Int J
Sport Nutr Exerc Metab. 2019;29(2):189–197. doi:10.1123/ijsnem.
2018-0290.
JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION 9
63. Wentz LM, Liu PY, Ilich JZ, Haymes EM. Female distance run-
ners training in southeastern United States have adequate vita-
min d status. Int J Sport Nutr Exerc Metab. 2016;26(5):397–403.
doi:10.1123/ijsnem.2014-0177.
64. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ.
Athletic performance and vitamin D. Med Sci Sports Exerc.
2009;41(5):1102–1110. doi:10.1249/MSS.0b013e3181930c2b.
65. Ruohola JP, Laaksi I, Ylikomi T, Haataja R, Mattila VM, Sahi T,
Tuohimaa P, Pihlajamaki H. Association between serum 25(oh)d
concentrations and bone stress fractures in Finnish young men. J
Bone Miner Res. 2006;21(9):1483–1488. doi:10.1359/jbmr.060607.
66. Halliday TM, Peterson NJ, Thomas JJ, Kleppinger K, Hollis BW,
Larson-Meyer DE. Vitamin D status relative to diet, lifestyle,
injury, and illness in college athletes. Med Sci Sports Exerc.
2011;43(2):335–343. doi:10.1249/MSS.0b013e3181eb9d4d.
67. Hildebrand RA, Miller B, Warren A, Hildebrand D, Smith BJ.
Compromised vitamin D status negatively affects muscular
strength and power of collegiate athletes. Int J Sport Nutr Exerc
Metab. 2016;26(6):558–564. doi:10.1123/ijsnem.2016-0052.
68. Zourdos MC, Sanchez-Gonzalez MA, Mahoney SE. A brief
review: The implications of iron supplementation for marathon
runners on health and performance. J Strength Cond Res. 2015;
29(2):559–565. doi:10.1519/JSC.0000000000000636.
69. DellaValle DM. Iron supplementation for female athletes: Effects
on iron status and performance outcomes. Curr Sports Med Rep.
2013;12(4):234–239. doi:10.1249/JSR.0b013e31829a6f6b.