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• Meta-analysis of cross sectional studies Date verified

  Athletes classified with low energy availability sat lower on body mass, BMI and bone density and higher on cortisol, while leptin did not separate the groups

  A meta-analysis pooled 11 cross sectional studies covering 1006 athletes, about half of them classified as having low energy availability. The classified group differed on body composition, bone density Z score and cortisol. Leptin showed no significant difference, and because every study measured everything at one moment, none of it establishes cause.

  European Journal of Clinical · Han et al. · Yongin University · 19 August 2026 · PMID 42618779

  energy-availabilityfemale-athletesendurance-fuelingmetabolismresearch-methodsbone-health