{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:24:22Z","timestamp":1779110662182,"version":"3.51.4"},"reference-count":51,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Eleanor and Miles Shore Faculty Development Awards Program, Harvard Medical School: Boston Children's Hospital Department of Orthopaedic Surgery and Sports Medicine Award","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Joe and Clara Tsai Foundation as part of the Wu Tsai Human Performance Alliance","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2024,10,15]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To determine the association between survey-based self-reported problematic low energy availability indicators (LEA-I) and race performance and intra-event medical encounters during the Boston Marathon.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>1030 runners who were registered for the 2022 Boston Marathon completed an electronic survey (1\u20134 weeks pre-race) assessing LEA-I, training and medical history. De-identified survey data were linked to event wearable timing chips and medical encounter records. LEA-I was defined as: an elevated Eating Disorder Examination Questionnaire score, elevated Low Energy Availability (LEA) in Females Questionnaire score, LEA in Males Questionnaire with a focus on gonadal dysfunction score and\/or self-report of diagnosed eating disorder\/disordered eating.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The prevalence of LEA-I was 232\/546 (42.5%) in females and 85\/484 (17.6%) in males. Athletes without LEA-I (non-LEA-I) achieved significantly better race times versus those with LEA-I (accounting for demographic and anthropomorphic data, training history and marathon experience), along with better division finishing place (DFP) mean outcomes (women\u2019s DFP: 948.9\u00b157.6 versus 1377.4\u00b182.9, p&lt;0.001; men\u2019s DFP: 794.6\u00b141.0 versus 1262.4\u00b1103.3, p&lt;0.001). Compared with non-LEA-I athletes, LEA-I athletes had 1.99-fold (95%\u2009CI: 1.15 to 3.43) increased relative risk (RR) of an intra-event medical encounter of any severity level, and a 2.86-fold increased RR (95%\u2009CI:1.31 to 6.24) of a major medical encounter.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This is the largest study to link LEA-I to intra-event athletic performance and medical encounters. LEA-I were associated with worse race performance and increased risk of intra-event medical encounters, supporting the negative performance and medical risks associated with problematic LEA-I in marathon athletes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bjsports-2024-108181","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T23:35:11Z","timestamp":1731368111000},"page":"222-230","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Boston Marathon athlete performance outcomes and intra-event medical encounter risk associated with low energy availability indicators"],"prefix":"10.1136","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1612-3852","authenticated-orcid":false,"given":"Kristin E","family":"Whitney","sequence":"first","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Sports Medicine, Boston Children's 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