INTRODUCTION
Combat sport athletes experience transient periods of low energy availability (LEA) when making weight for competition, leading to potential consequences of Athlete Triad (TRIAD) and Relative Energy Deficiency in Sports (RED-S) (1). Previous research has highlighted that females may be particularly susceptible to these consequences when exposed to both acute and chronic periods of LEA, although recent evidence in this area is equivocal (2, 3). The aim of this case study was to outline the impact of repeatedly making weight, utilising a structured nutrition and training intervention across a two year long period, on symptoms of TRIAD and RED-S in a female combat sport athlete who competes in the Ultimate Fighting Championship (UFC).
METHODS
Over 26 months and within 6 individual 8-week periods, the athlete adhered to periodised daily energy intakes (1,600 ± 305 kcal.day-1; 2.2 g.kg-1 protein, 4.2 g.kg-1 carbohydrate and 1.0 g.kg-1 fat) equivalent to resting metabolic rate (RMR). Training consisted of sport specific, cardiorespiratory conditioning and strength sessions equating to 20-22 hours.wk-1 and exercise energy expenditure (EEE) was assessed utilising combined heart rate and portable actigraphy. Body composition (Dual X-ray Absorptiometry [DXA]; Bioelectrical Impedance Analysis [BIA]), RMR & VO2peak (indirect calorimetry), venous blood sampling, cardiac screening (12-lead electrocardiogram and echocardiography) strength (1 repetition maximums), power (force velocity profile) and total mood disturbance (TMD) via a profile of mood states (POMS) were assessed at regular intervals. BM and menstrual cycle data were collected daily. 
RESULTS
EEE varied between 776 ± 39 to 1298 ± 71 kcal.day-1, equating to estimated EA ranging from 13 ± 1 to 22 ± 1 kcal.kg.day-1. BM loss was 0.7 ± 0.3 kg.wk-1, resulting in total BM losses of 5.1 ± 1.2 kg, predominantly attributed to decreases in fat mass of 4.1 ± 0.9 kg. Lean mass remained relatively unchanged, ranging from 44.4 to 47.0 kg and RMR was stable throughout (1534 ± 25 – 1468 ± 95 kcal.day-1), eliciting no adaptive thermogenic responses. Despite LEA status, endocrine markers of reproductive/metabolic function and bone metabolism, alongside left and right ventricular structure and function, did not diverge beyond smallest worthwhile or minimal detectable change and were all within normal clinical reference ranges across all assessed timepoints. Measures of cardiorespiratory (VO2peak 42.5 ml.kg.min-1/2.7 L.min-1 – 63.8 ml.kg.min-1/3.9 L.min-1), strength (1RM Squat 1.7 – 2.1 x BM) and power (>N.kg-1 & W.kg-1) based performance all consistently improved, with no detrimental effect on psychological (TMD ≤2 – 7) health status. 
DISCUSSION
This nutritional strategy represented a major alteration in the athlete’s habitual BM loss practices, as they previously employed several acute dehydration methods resulting in extreme states of hypohydration. The intervention demonstrates that a gradual approach to making weight in combat sport athletes can be successfully achieved, via a combination of restricted and periodised energy intake according to the daily demands of training, therefore reducing the need to employ aggressive acute BM loss strategies. Fundamentally, the repeated phases of LEA across a chronic period did not result in any negative consequences of either female TRIAD or RED-S.