Low Energy Availability (LEA), Nutritional Deficiencies and Hypertension in Black Division I Athletes - Title: Low Energy Availability (LEA), Nutrient Deficiencies, and Hypertension in Black Division I Athletes
SPECIFIC AIMS: The International Olympic Committee on Sports Nutrition (IOCSN) recognized low energy
availability (LEA), defined as inadequate calorie intake relative to energy expenditure. LEA may be particularly
important cardiovascular disease (CVD) risk among minority athlete populations, especially those exposed to
poor Social Determinants of Health (SDOH). This includes Black NCAA Division I collegiate athletes (BD1As),
who make up 21% of the Division I population and have a 5x higher risk of sudden cardiac death compared
to white athletes. Many of the SDOH indicators are alleviated as a Division I athlete (food is available, education
support staff, economic stability, etc.). However, many BD1As come from areas described above and have limited
awareness of nutritional factors that impact their health. Our pilot data indicate that BD1As with LEA, were over
seven times (OR = 7.2) more likely to have hypertension. Further work is required to identify the mechanisms
linking LEA to CVD. However, unraveling the mechanism’s two gaps in the literature should be addressed: (i)
establish whether the association between LEA and CVD risk is measurable; and (ii) determine whether the
association between LEA and CVD is modifiable. Filling these gaps will make it possible to identify at-risk athletes
and to prescribe strategies to restore energy balance (LEA) and/or directly decrease CVD risk.
Our long-term goal is to develop a practical, scalable, and effective non-pharmacological intervention to
decrease LEA as a way to mitigate CVD risk in BD1As. To support this goal, the overall objective of this
proposal is to robustly measure the strength of the association between LEA and HBP risk (in a larger cohort)
and determine whether SDOH moderates this association. We hypothesize that those identified as LEA will
significantly increase CVD risk and therefore propose two specific aims. Aim 1 will test the hypothesis that LEA
is positively associated with cardio-femoral pulse wave velocity (cfPWV), a measure of aortic arterial stiffness
and the gold-standard biomarker of vascular aging. Aim 2 will test the hypothesis that LEA and cfPWV is
moderated by SDOH. While SDOH research among BD1As does not exist, AAs are more likely to be deficient in
fruits, vegetables while southern regions consume larger quantities of added fats, fried foods, processed meats,
and sugar-sweetened beverages known to negatively impact cardiovascular health.
Completion of this work will help mitigate the empirical understanding that BD1As are >7x more likely to
experience HBP and 5x more likely to experience sudden cardiac death.
The proposed longitudinal observational study will recruit a cohort of >120 BD1As aged 18-25 years recruited
from various sports that include an equitable male/female population from a large HBCU. Participants will be
assessed twice, ~4 months apart contingent on the beginning and end of their respective competitive season.
For each assessment, traditional (nutrition) and novel (pulse wave velocity) CVD risk biomarkers will be
measured, then questionnaires will collect information on SDOH: (i) built environment/food security (e.g.
accessibility to food); (ii) health literacy (e.g.: ability to find/understand, use health related information); (iii) sport
nutrition knowledge (e.g. knowledge of energy and nutrients); (iv) discrimination (e.g.: social/community context).
Aim 1. Determine the strength of the association between LEA and increased cfPWV. The strength of the
association using a general linear model we hypothesize that LEA will be strongly associated with cfPWV
increase across the competitive season. Measuring cfPWV evaluates the velocity of the pulse wave or forward
pressure transmitted between the carotid and femoral arteries. Decreased compliance of the aortic artery
increases the velocity of the pulse wave and is known as arterial stiffness. Arterial stiffness is significantly
associated with CVD risk and all cause death. cfPWV is known as the gold standard to evaluate arterial stiffness.
We predict that LEA will increase cfPWV by >1 m/s increasing CVD risk by 14%.
Aim 2. Determine if the association between LEA and cfPWV is moderated by SDOH. The 4 SDOH
variables will be added as covariates to the Aim 1 model independently and then in a multivariable model to test
the strength of association between variables. Questionnaires will evaluate information related to: (i) built
environment/food security by accessing published public demographic information/geomapping; (ii) health
literacy skills instrument short form; (iii) sport nutrition knowledge using the athlete diet index; (iv) discrimination
with the everyday discrimination scale. Three of the domains are shown to significantly affect health outcomes
in AAs while poor sport nutrition knowledge is highly related to eating disorders and physiological dysfunction.
We predict that each SDOH will be a significant effect moderator to the LEA/cfPWV association.
Impact. PWV is a highly sensitive and continuous measure of vascular aging and the gold-stand non-invasive
biomarker of CVD risk that has never been applied to BD1As. The final product will be an evidence-based
reduction intervention to target LEA related CVD risk. Several factors increase the likelihood of high impact:
established relationship with college athlete sample pool, and applicability to the larger athletic population, and
our multi-disciplinary team and novel approach.
