scholarly journals Correction to: Comparison of Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S): a Review of Low Energy Availability, Multidisciplinary Awareness, Screening Tools and Education

2020 ◽  
Vol 8 (4) ◽  
pp. 385-385
Author(s):  
Alexandra Warrick ◽  
Marcia Faustin ◽  
Brandee Waite
Keyword(s):  
Female Athlete ◽  
Relative Energy ◽  
Low Energy ◽  
Screening Tools ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Low Energy Availability

scholarly journals Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know

2022 ◽  
pp. 174795412110544
Author(s):  
Braeden T. Charlton ◽  
Sara Forsyth ◽  
David C. Clarke
Keyword(s):  
Energy Expenditure ◽  
Female Athlete ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Research Findings ◽  
And Performance ◽  
Low Energy Availability

The Female Athlete Triad (Triad) and the more encompassing Relative Energy Deficiency in Sport (RED-S) are disorders caused by low energy availability (LEA). LEA is a state of insufficient energy intake by an athlete relative to their energy expenditure. Persistent LEA results in the deleterious consequences to health and performance that comprise RED-S. With respect to both the Triad and RED-S, researchers have called for more education of those involved with sport, particularly coaches, to help reduce the incidence of these disorders. Recent studies have shown that as few as 15% of coaches are aware of the Triad, with up to 89% unable to identify even one of its symptoms. RED-S is a more recently established concept such that coach knowledge regarding it has only begun to be assessed, but the results of these initial studies indicate similar trends as for the Triad. In this review, we synthesize research findings from 1986 to 2021 that pertains to LEA and RED-S, which coaches should know so they can better guide their athletes.

scholarly journals Knowledge of Low Energy Availability, Relative Energy Deficiency in Sport and the Female Athlete Triad Amongst Female Athletes and Active Individuals

Proceedings ◽  
2019 ◽  
Vol 37 (1) ◽  
pp. 24
Author(s):  
Winter ◽  
Black ◽  
Brown
Keyword(s):  
Female Athlete ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
Low Energy Availability ◽  
Normal Physiological Function

Background: Low Energy Availability (LEA), Relative Energy Deficiency in Sport (RED-S) and the Female Athlete Triad (Triad) are generally related to the negative health effects of consuming insufficient energy to meet exercise energy expenditure and maintain normal physiological function. [...]

Characterization of Risk Quantification Differences Using Female Athlete Triad Cumulative Risk Assessment and Relative Energy Deficiency in Sport Clinical Assessment Tool

2019 ◽  
Vol 29 (6) ◽  
pp. 569-575 ◽  
Author(s):  
Bryan Holtzman ◽  
Adam S. Tenforde ◽  
Allyson L. Parziale ◽  
Kathryn E. Ackerman
Keyword(s):  
Female Athlete ◽  
Assessment Tool ◽  
Cumulative Risk ◽  
Relative Energy ◽  
Risk Level ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Energy Deficiency ◽  
Low Energy Availability

This study’s objective was to identify differences in risk for low energy availability and athletic clearance level by comparing scores on Female Athlete Triad Cumulative Risk Assessment (Triad CRA) and Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT). A total of 1,000 female athletes aged 15–30 years participating in ≥4 hr of physical activity/week for the previous ≥6 months completed an extensive survey assessing health, athletic history, family disease history, and specific Triad/RED-S risk factors. Retrospective chart review ascertained laboratory and bone mineral density measures. Triad CRA and RED-S CAT were used to assign each athlete’s risk level (low, moderate, and high), and case-by-case comparison measured the level of agreement between the tools. We hypothesized that the tools would generally agree on low-risk athletes and that the tools would be less aligned in the specific elevated risk level (moderate or high). Most of the sample was assigned moderate or high risk for Triad CRA and RED-S CAT (Triad: 54.7% moderate and 7.9% high; RED-S: 63.2% moderate and 33.0% high). The tools agreed on risk for 55.5% of athletes. Agreement increased to 64.3% when only athletes with bone mineral density measurements were considered. In conclusion, Triad CRA and RED-S CAT provide consensus on the majority of athletes at elevated (moderate or high) risk for low energy availability, but have less agreement on the specific risk level assigned.

scholarly journals Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 835 ◽  
Author(s):  
Danielle M. Logue ◽  
Sharon M. Madigan ◽  
Anna Melin ◽  
Eamonn Delahunt ◽  
Mirjam Heinen ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Energy ◽  
Narrative Review ◽  
Low Energy ◽  
Screening Tools ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
And Gender ◽  
Low Energy Availability

Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

scholarly journals URINARY INCONTINENCE IS MORE COMMON IN ADOLESCENT FEMALE ATHLETES WITH LOW ENERGY AVAILABILITY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Kristin E. Whitney ◽  
Bryan Holtzman ◽  
Allyson Parziale ◽  
Kathryn E. Ackerman
Keyword(s):  
Urinary Incontinence ◽  
Eating Disorder ◽  
Female Athlete ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Adolescent Female ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Low Energy Availability

BACKGROUND: Female Athlete Triad (Triad), an interrelated syndrome of low energy availability (EA), menstrual irregularity, and low bone mineral density. A broader, more comprehensive term was recently introduced by the International Olympic Committee: ‘Relative Energy Deficiency in Sport’ (RED-S). RED-S includes Triad, but also highlights the multiplicity of complex health and performance consequences of low EA and emphasizes that male athletes are also affected. The syndrome RED-S refers to impaired physiological function caused by relative energy deficiency including menstrual function, metabolism, bone health, immunity, protein synthesis, and cardiovascular health. Low EA has independent negative effects on reproductive function and gonadal steroid production. Urinary incontinence (UI) has many risk factors, including estrogen deficiency (which can be caused by low EA), depression, and participation in high-impact activities. A high prevalence of UI has been reported in female athletes participating in a variety of different sports. To date, research evaluating low energy availability as an independent risk factor for UI has been limited, particularly in a young female athlete population. The purpose of this study was to evaluate the association of UI and low EA in adolescent female athletes. METHODS: 1000 female athletes (ages 15–30 years) presenting to a sports medicine clinic completed a 476 question survey covering topics related to relative energy deficiency in sport (RED-S), including female athlete triad risk factors and athletic activity. For the purpose of this study, data was extracted from responses by subjects between 15–19 years of age. Low EA was defined as meeting = 1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed through a modified form of the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence (ICIQ-UI Short Form). Descriptive statistics are expressed as mean ± standard deviation and associations between EA status and UI queries were assessed by chi-squared analysis (cut off for statistical significance was defined as: p<0.05). RESULTS: Of those who completed the survey, 70.8% were adolescents between 15 and 19 years of age. UI during athletic activities was reported by 14.4% of these athletes. Of those reporting UI, UI was significantly more common in those with low EA than those with adequate EA (54.9% vs. 45.1%, p=0.003). Age was not associated with UI in this subset (p=0.83). The median onset of UI was 1–2 years prior to completing the survey and the median frequency of UI over the previous year was reported as weekly. There was no significant correlation between the presence of menstrual dysfunction and UI (p=0.104). CONCLUSIONS: Our findings demonstrate that UI is a common problem among adolescent female athletes, occurring in 14.4% of 15-19 year old female athletes surveyed in this study. UI is more prevalent in adolescent female athletes with low EA in comparison to female athletes with adequate EA. These findings are consistent with those previously observed in studies involving older populations of adult female athletes with eating disorders, where UI was more prevalent in those with low EA in comparison to controls with adequate EA. These findings suggest a potential place for genitourinary disorders in the constellation of impaired physiologic functions considered associated with low EA in athletes/RED-S, and offers a window into a commonly overlooked clinical problem impacting young female athletes.

scholarly journals The LEAF questionnaire is a good screening tool for the identification of the Female Athlete Triad/Relative Energy Deficiency in Sport among young football players

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12118
Author(s):  
Edyta Łuszczki ◽  
Pawel Jagielski ◽  
Anna Bartosiewicz ◽  
Maciej Kuchciak ◽  
Katarzyna Dereń ◽  
...  
Keyword(s):  
At Risk ◽  
Body Composition ◽  
Energy Intake ◽  
Female Athlete ◽  
Relative Energy ◽  
Screening Tools ◽  
Football Players ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Not At Risk

Background It has been noticed that Female Athlete Triad (Fat) and Relative Energy Deficiency (Red-S) in Sport are characterized by the symptoms of impaired endocrine-metabolic function and bone health in female athletes. In addition, it may be evaluated with a qualitative tool, such as Low Energy Availability in Females questionnaire (LEAF-Q) and quantitative measurements: bone mineral density (BMD), resting energy expenditure (REE), body composition, 24-hour dietary recall. Methods The aim of this study was to assess the prevalence of Triad and Red-S using the LEAF-Q in youth female football players. Additionally, the difference in the BMD, body composition, REE and energy intake (EI) were assessed between the Triad/Red-S risk and not at-risk groups. Results Almost two thirds (64.7%) of participants are classified as being at-risk for the triad according to their LEAF-Q scores. There were no statistically significant differences (p > 0.05) between most of the values among children from the analyzed groups. There was a statistically significant difference (p < 0.001) between the EI values among girls from the two analyzed groups: at-risk (1,773.18 kcal ±  232.57) and not at-risk (2,054.00 kcal ±  191.39). Girls who did not meet the energy intake recommendations were 10.00 as likely to be in the Triad/Red-S risk group. Conclusion Early identification of Fat/Red-S symptoms by screening tools such as the LEAF questionnaire is important in protecting young athletes from long-term damage due to the progression of the risk factors associated with the Fat/Red-S.

Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport

2018 ◽  
Vol 53 (10) ◽  
pp. 628-633 ◽  
Author(s):  
Kathryn E Ackerman ◽  
Bryan Holtzman ◽  
Katherine M Cooper ◽  
Erin F Flynn ◽  
Georgie Bruinvels ◽  
...  
Keyword(s):  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Clinical Population ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Increased Risk ◽  
Performance Consequences ◽  
And Performance ◽  
Low Energy Availability

Low energy availability (EA) is suspected to be the underlying cause of both the Female Athlete Triad and the more recently defined syndrome, Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee (IOC) defined RED-S as a syndrome of health and performance impairments resulting from an energy deficit. While the importance of adequate EA is generally accepted, few studies have attempted to understand whether low EA is associated with the health and performance consequences posited by the IOC.ObjectiveThe purpose of this cross-sectional study was to examine the association of low EA with RED-S health and performance consequences in a large clinical population of female athletes.MethodsOne thousand female athletes (15–30 years) completed an online questionnaire and were classified as having low or adequate EA. The associations between low EA and the health and performance factors listed in the RED-S models were evaluated using chi-squared test and the odds ratios were evaluated using binomial logistic regression (p<0.05).ResultsAthletes with low EA were more likely to be classified as having increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA. Performance variables associated with low EA included decreased training response, impaired judgement, decreased coordination, decreased concentration, irritability, depression and decreased endurance performance.ConclusionThese findings demonstrate that low EA measured using self-report questionnaires is strongly associated with many health and performance consequences proposed by the RED-S models.

scholarly journals Risk of Low Energy Availability in National and International Level Paralympic Athletes: An Exploratory Investigation

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 979
Author(s):  
Kelly Pritchett ◽  
Alicia DiFolco ◽  
Savannah Glasgow ◽  
Robert Pritchett ◽  
Katy Williams ◽  
...  
Keyword(s):  
At Risk ◽  
National Level ◽  
Relative Energy ◽  
Low Energy ◽  
Assessment Tools ◽  
Energy Availability ◽  
Mineral Density ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
Low Energy Availability

(1) Background: The purpose of this study was to examine the symptoms of low energy availability (LEA) and risk of relative energy deficiency in sport (RED-S) symptoms in para-athletes using a multi-parameter approach. (2) Methods: National level para-athletes (n = 9 males, n = 9 females) completed 7-day food and activity logs to quantify energy availability (EA), the LEA in Females Questionnaire (LEAF-Q), dual energy X-ray absorptiometry (DXA) scans to assess bone mineral density (BMD), and hormonal blood spot testing. (3) Results: Based on EA calculations, no athlete was at risk for LEA (females < 30 kcal·kg−1 FFM·day−1; and males < 25 kcal·kg−1 FFM·day−1; thresholds for able-bodied (AB) subjects). Overall, 78% of females were “at risk” for LEA using the LEAF-Q, and 67% reported birth control use, with three of these participants reporting menstrual dysfunction. BMD was clinically low in the hip (<−2 z-score) for 56% of female and 25% of male athletes (4) Conclusions: Based on calculated EA, the risk for RED-S appears to be low, but hormonal outcomes suggest that RED-S risk is high in this para-athlete population. This considerable discrepancy in various EA and RED-S assessment tools suggests the need for further investigation to determine the true prevalence of RED-S in para-athlete populations.

scholarly journals CULTURAL ADAPTATION AND VALIDATION OF THE LOW ENERGY AVAILABILITY IN FEMALES QUESTIONNAIRE (LEAF-Q)

2021 ◽  
Vol 27 (2) ◽  
pp. 184-188
Author(s):  
Uyara Pereira de Maria ◽  
Claudia Ridel Juzwiak
Keyword(s):  
Cultural Adaptation ◽  
Female Athlete ◽  
Team Sports ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Retest Reliability ◽  
Brazilian Version ◽  
Test Retest Reliability ◽  
Low Energy Availability

ABSTRACT Introduction: Low energy availability, amenorrhea and osteoporosis make up the Female Athlete Triad observed in physically active females and athletes. The Low Energy Availability in Females Questionnaire (LEAF-Q) was created with the purpose of identifying female athletes at risk for the Female Athlete Triad. Objective: To translate and culturally adapt the LEAF-Q for Brazilian Portuguese and validate it in a group of Brazilian athletes. Methods: The first stage of the study consisted of translation, cultural adaptation and content validation of the questionnaire in 20 athletes. In the second stage, for the test-retest reliability analysis and the construct validation, the final adapted version was applied in a sample of 127 athletes from various sports disciplines, 54 of whom responded to the questionnaire on a second occasion. For the test-retest reliability analysis, the intraclass correlation coefficient (ICC) was calculated and the paired t-test, McNemar’s test and Bland-Altman plot were carried out. The construct validation modeled by known or contrasted groups was carried out by comparing the mean LEAF-Q scores of group 1 (athletes who practiced weight-sensitive sports) with those of group 2 (athletes who practiced team sports) using the Student’s t test. Results: The Brazilian version of the LEAF-Q showed excellent test-retest reliability, with an ICC of 0.92. The construct validity by known or contrasted groups was confirmed after demonstrating that athletes who practiced weight-sensitive sports had a higher LEAF-Q mean score than athletes who practiced team sports (p≤0.05). Conclusion: The Brazilian version of the LEAF-Q is an important tool, which presented textual and cultural adequacy, proved to be reliable in terms of test-retest reliability, and presents evidence of validity to investigate the risk of the triad. Level of evidence II; Diagnostic Studies – Investigating a diagnostic instrument .

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