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. [...]

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.

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 A Review of Prevention, Diagnosis, and Treatment of Relative Energy Deficiency in Sport in Artistic (Synchronized) Swimming

2018 ◽  
Vol 28 (4) ◽  
pp. 375-384 ◽  
Author(s):  
Sherry Robertson ◽  
Margo Mountjoy
Keyword(s):  
Dietary Habits ◽  
Female Athletes ◽  
Assessment Tool ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Synchronized Swimming ◽  
And Performance ◽  
Low Energy Availability

The syndrome of relative energy deficiency in sport (RED-S) is a clinical entity characterized by low energy availability, which can negatively affect the health and performance of both male and female athletes. The underlying mechanism of RED-S is an inadequacy of dietary energy to support optimal health and performance. This syndrome refers to impaired physiological function, including metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health, with psychological consequences that can either precede (through restrictive dietary habits) or result from RED-S. The term RED-S extends beyond the condition termed the “Female Athlete Triad.” Formerly known as synchronized swimming, artistic swimming is an Olympic sport requiring a high level of fitness as well as technical skill and artistry. The risk of RED-S is high in artistic swimming as it is an aesthetic, judged sport with an emphasis on a lean physique. RED-S is of significant concern in the sport of artistic swimming because of the potential negative effects on physical and mental health as well as consequences on athletic performance. This paper reviews health and performance consequences associated with low energy availability resulting in RED-S in artistic swimming. Medical and nutritional considerations specific to artistic swimming are reviewed, and methods to help detect and manage RED-S are discussed. Prevention and management of RED-S in this athlete population should be a priority for coaches, and the sport medicine professionals working with artistic swimming athletes should utilize the RED-S CAT, a Clinical Assessment Tool for screening and managing RED-S.

scholarly journals The Female Athlete Triad: A Metabolic Phenomenon

2014 ◽  
Vol 12 (1) ◽  
pp. 1-23 ◽  
Author(s):  
Anne B. Loucks
Keyword(s):  
Energy Expenditure ◽  
Female Athlete ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Dietary Energy ◽  
Menstrual Disorders ◽  
Skeletal Health ◽  
Restrictive Eating ◽  
Low Energy Availability

The Female Athlete Triad (Triad) is a syndrome in which low energy availability triggers a broad range of endocrine mechanisms that conserve energy expenditure, and thereby impairs reproductive and skeletal health.  Energy availability is the amount of dietary energy remaining after exercise training for all other physiological functions each day.  The specific kind of reproductive dysfunctions caused by low energy availability are functional hypothalamic menstrual disorders.  To ensure that affected athletes receive appropriate care, endocrine tests are required to diagnose these disorders by the exclusion of other types of menstrual disorders unrelated to the Triad.  In addition, low energy availability impairs skeletal health by uncoupling bone turnover, in which the rate of bone resorption increases while the rate of bone formation declines.  The result is a progressive loss or failure to accrue bone mass, which increases the risks of stress fractures and osteoporosis.  Low energy availability originates in one or more of three sources:  restrictive eating disorders, especially anorexia nervosa; intentional efforts to lose body weight or body fat to improve athletic performance or appearance; and the inadvertent suppression of appetite by exercise and diets containing a high percentage of carbohydrates.  It is necessary to know the origin of low energy availability in a particular athlete in order to intervene effectively with her.  The key behavior modification for preventing and treating the Triad is to increase energy availability, either by increasing dietary energy intake, reducing exercise energy expenditure, or both.  Guidelines for doing so are provided.

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 Awareness and indicators of low energy availability in male and female dancers

2020 ◽  
Author(s):  
Nicola Keay ◽  
AusDancers Overseas ◽  
Gavin Francis
Keyword(s):  
At Risk ◽  
Relative Energy ◽  
Low Energy ◽  
List Type ◽  
Energy Availability ◽  
Full Time ◽  
Male And Female ◽  
Dance Training ◽  
And Performance ◽  
Low Energy Availability

AbstractObjectivesTo investigate awareness and indicators of low energy availability (LEA) in male and female dancersMethodsA dance-specific energy availability questionnaire (DEAQ) was developed and administered online internationally to dancers in full time training. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Questions addressed recognised physiological indicators and consequences of LEA in the context of dance, together with psychological drivers and aetiological factors specific to dance training. LEA was quantified using a scoring system to include these characteristics.Results247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with transition to full time training at 15.0 years (SD 7.9) and 85% practising ballet. Psychological, physiological and physical characteristics consistent with LEA were reported by 57% of the female dancers and 29% of male dancers, indicating a risk of RED-S. The unique nature of dance training, in terms of demands and environment, was found to be potentially influential in development of this situation. Less than a third (29%) of dancers were aware of RED-S.ConclusionThis study found dancers to be a specific group of high-level exercisers displaying indicators of LEA and consequently at risk of developing the adverse clinical health and performance consequences of RED-S. Awareness of RED-S was low. The DEAQ has the potential to raise awareness and be a practical, objective screening tool to identify dancers in LEA, at risk of developing RED-S.Summary boxesWhat are the new findings?Dancers reported many recognised indicators of low energy availability (LEA) and consequently are at risk of developing the adverse health and performance outcomes of relative energy deficiency in sport (RED-S).Few dancers in this study demonstrated an awareness of RED-S.The unique nature of dance training, in terms of demands and environment, was found to be influential in the development of LEA in dancersThe DEAQ is the first questionnaire specific to dancers. Applying a scoring system to the responses from the DEAQ can provide an objective assessment of LEAHow might this study impact on clinical practice in the future?As LEA and subsequent risk of RED-S is not matched by awareness, providing educational resources for dancers is important. A British Association of Sport and Exercise Medicine website has been developed by the research team for both athletes and dancers www.health4performance.co.ukThe DEAQ has the potential to be a practical, objective, screening tool to identify male and female dancers worldwide in LEA. By identifying these dancers, support could be targeted to modify dancer behaviours to reduce the risk of dancers developing the adverse health and performance sequelae of RED-SEarly identification of dancers at risk of developing RED-S is of particular importance when situations arise out of dancers’ control, such as lock down in pandemics COVID-19 or time off dancing due to illness/injury. Targeted support may be required as a dancer’s tendencies towards exercise dependence and disordered eating patterns may increase as a way to seek control and combat uncertainty.

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.

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