New Epidemic of Malnutrition in Young Slovenian Athletes

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Anthropometric characteristics and disease states of athletes_

	Middle adolescents (14–17 years)		Late adolescents (18–21 years)
	Female	Male	Female	Male
Average height [cm]	167.8±5.6	176.4±12.6	168.6±5.9	179.1±7.1
Average body mass [kg]	57.5±10	65.8±13	58.1±8.3	74.3±8.7
Average BMI [kg/cm2]	20.4±2.7	20.9±2.1	20.4±2.5	22.9±2.6
Body fat [%]	20.7±4.7	12.8±5.7	17.3±3.5	9.6±3.5
FFMI [kg/cm2]	16.1±1.8	18.1±1.7	16.5±1.1	20.4±2.4
Chronic illness [number of athletes]	Asthma (5), Chronic gastritis (4), Hashimoto thyroiditis (2), Atopic dermatitis (1)		Asthma (5)Chronic gastritis (2)Gastro oesophageal reflux disease (1), Arterial hypertension (1), Atopic dermatitis (1)
Hours training per week [h]	16.9±0.6		19.2±1.0
Type of sport [number of athletes]	Anaerobic: acrobatics (1), skiing (1), sprint (4), gymnastics (1), wild water kayak (1), climbing (1)Aerobic: long distance running (4), biathlon (3), road cycling (1), mountain biking (1), mountain running (2), rowing (6), cross country skiing (3), triathlon (2)Aerobic-anaerobic: heptathlon (1), middle distance running (4), badminton (1), hockey (3), basketball (2), football (14), Nordic combine (1), short and middle-distance swimming (20), dance (1), handball (1), figure skating (1), tennis (4)		Anaerobic: skiing (1), snowboarding (1), triple jump (1) sprint (2), wild water kayak (4), climbing (2), ski jumping (4)Aerobic: long distance running (1), biathlon (4), rowing (2), cross country skiing (3), triathlon (1)Aerobic-anaerobic: heptathlon (1), Nordic combine (1), volleyball (1), short and middle-distance swimming (3), handball (1), tennis (1)

Number of RED-S-related health disorders and performance problems in nutrition-related risk factors_ Rows in the first column are the potential nutrition-related risk factors, and the numbers in the following columns are the numbers of RED-s related (with standard deviation) in athletes that have the particular nutritional risk (YES column) or don’t have this risk (NO column)_

				Comparison by gender						Comparison by age group
	All			Female			Male			Middle Adolescents (14–17 year)			Late Adolescents (18–21 year)
	Yes	No	p-value	Yes	No	p-value	Yes	No	p-value	Yes	No	p-value	Yes	No	p-value
CHO< 3g/kg body mass	4.2±1.9	3.3±2.0	0.05	4.9±2.0	4.2±2.0	0.20	3.0±0.8	2.6±1.6	0.32	4.6±1.8	3.5±1.9	0.02	2.2±1.0	3.0±2.0	0.50
CHO<6g/kg body mass	3.6±2.0	3.2±1.9	0.32	4.4±2.0	3.9±2.1	0.43	2.6±1.3	2.8±1.8	0.51	4.0±2.0	3.1±1.7	0.09	2.8±1.7	3.2±2.5	0.70
Dietary fibre intake>35 g	4.0±2.1	3.5±1.9	0.40	4.5±2.2	4.3±2.0	0.76	2.7±1.5	2.6±1.5	0.90	4.6±1.8	3.7±1.9	0.17	2.3±2.3	3.0±1.9	0.58
LEA	3.5±2.0	3.7±1.8	0.45	4.4±2.1	4.0±1.9	0.48	2.4±1.3	3.5±1.7	0.03	3.9±2.0	3.5±1.7	0.56	2.6±1.8	5.0±1.8	0.03
Desire to lose body weight	4.6±1.8	3.3±1.9	0.002	5.8±1.4	4.0±2.0	0.006	3.5±1.4	2.4±1.4	0.02	5.2±1.8	2.4±1.4	0.003	3.8±1.7	2.7±1.9	0.13
Lost weight in past year	4.6±1.8	3.3±1.9	0.002	5.8±1.4	4.0±2.0	0.006	3.5 ± 1.4	2.4±1.4	0.02	5.2±1.8	2.4±1.4	0.003	3.8±1.7	2.7±1.9	0.13
Meal 2–3h before training	3.5±2.0	5.5±0.7	0.09	4.3±2.0	5.5±0.7	0.26	2.6 ± 1.5	/	/	2.8±1.9	5.0	0.19	3.7±1.9	6.0	0.25
Meal 1h before training	3.3±1.9	4.5±1.9	0.01	4.2±2.0	4.8±2.1	0.18	2.5 ± 1.5	3.7±1.3	0.03	3.5±1.9	4.9±1.7	0.005	2.9±1.9	2.8±1.9	0.96
Meal after training	3.4±2.0	4.5±0.9	0.05	4.3±2.1	4.5±0.6	0.84	2.5 ± 1.4	4.5±1.3	0.01	3.7±2.0	4.6±1.0	0.10	2.9±1.9	4.0	0.54
Have suitable meal before, during and after training	3.4±1.8	3.6±2.0	0.81	4.2±1.6	4.4±2.2	0.63	2.3± 1.5	2.7±1.5	0.40	3.5±2.0	3.8±1.9	0.46	3.2±1.4	2.8±2.1	0.47
Takes dietary supplements	3.6±2.0	3.3±1.9	0.48	4.5±2.1	4.0±1.9	0.38	2.6 ± 1.3	2.7±1.8	0.97	3.9±2.0	3.5±1.9	0.45	3.0±1.8	2.8±2.2	0.68

Prevalence of RED-S-related health disorder_

RED-S-related health disorders	Middle adolescents (14–17 years)						Late adolescents (18–21 years)
	Female			Male			Female			Male
	Y	N	Prev.	Y	N	Prev.	Y	N	Prev.	Y	N	Prev.
Reproductive system
Primary amenorrhea (F)	3	43	6.5%				0	15	0%
Secondary amenorrhea (F)	13	33	28.2%				5	10	35.7%
Other disorders (F)	18	28	39.1%				5	10	33.3%
Low testosterone (M)				1	37	2.6%				0	19	0%
Immunological system
Several viral infections	22	24	47.8%	15	23	39.5%	5	10	33.3%	4	15	21.1%
Lymphopenia	1	28	3.4%	1	18	5.2%	1	10	9.1%	0	12	0%
Leukopenia	3	26	10.3%	1	19	5%	2	10	16.7%	1	11	8.3%
Skeletal system
Stress fractures	3	43	6.5%	0	38	0%	0	15	0%	0	19	0%
Osteoporosis/Osteopenia	3	43	6.5%	0	38	0%	0	15	0%	0	19	0%
Endocrine system
T3<3.1 pmol/l	0	7	0%	0	3	0%	0	2	0%	0	1	0%
T4<12 pmol/l	0	7	0%	1	2	33.3%	1	1	50%	1	0	100%
Glucose<4 mmol/l	1	18	5.2%	0	16	0%	1	7	12.5%	1	10	9.1%
TSH < 0.5 mU/l	0	9	0%	0	5	0%	0	2	0%	0	1	0%
TSH>4.3 mU/l	2	7	22.2%	0	5	0%	0	2	0%	0	1	0%
Haematological system
Ferritin<30 µg/l	7	21	25%	3	16	15.8%	2	7	22.2%	1	11	8.3%
Iron<10µmol/l	2	24	7.7%	2	15	11.7%	1	9	10%	0	12	0%
Haemoglobin < 120 g/l	0	30	0%	0	20	0%	0	12	0%	0	12	0%
Psychological disorders
Eating disorders	7	39	15.2%	1	37	2.6%	3	12	20%	0	19	0%
Disordered eating	30	16	65.2%	12	21	44.7%	7	8	46.7%	7	12	36.8%
Psychological problems	29	17	63.0%	8	29	21.6%	6	9	40%	1	18	5.3%
Cardiovascular system
Cholesterol<4 mmol/l	7	14	33.3%	8	9	47.1%	3	3	50%	3	8	27.3%
Cholesterol >5.2 mmol/l	1	20	4.8%	0	17	0%	2	4	33.3%	2	9	18.2%
HDL-cholesterol<1.45 mmol/l	2	6	25%	3	6	33.3%	1	2	33.3%	0	2	0%
LDL-cholesterol>2.59 mmol/l	3	5	37.5%	4	6	40%	1	2	33.3%	1	1	50%
Triglycerides>2.62 mmol/l	0	8	0%	0	8	0%	0	3	0%	0	2	0%
Gastrointestinal system
Gastrointestinal disorders	13	33	28.2%	0	38	0%	3	12	20%	3	16	15.8%
Digestion disorders (gastritis, constipation, diarrhoea, gastroesophageal reflux)	4	42	8.7%	0	38	0%	1	14	6.7%	1	18	5.3%
Growth and development disorders
Growth disorders	4	42	8.7%	6	32	15.8%	1	14	6.7%	0	19	0%
RED-S-related performance problems
Problems in training process
Tiredness	35	11	76.1%	24	14	63.2%	12	3	80%	13	6	68.4%
Muscle cramps	8	38	17.4%	13	25	34.2%	1	14	6.7%	8	11	42.1%
Other problems (Concentration, coordination, strength…)	33	13	71.7%	21	17	55%	10	5	66.7%	12	7	63.2%
Other problems
Recurring injury	13	33	28.2%	3	35	7.9%	1	14	6.7%	5	14	26.3%
Maintaining focus	18	28	39.1%	5	33	13.2%	2	13	13.3%	0	19	0%