scholarly journals Prevalence of Low Energy Availability in Competitively Trained Male Endurance Athletes

Medicina ◽  
2019 ◽  
Vol 55 (10) ◽  
pp. 665 ◽  
Author(s):  
Lane ◽  
Hackney ◽  
Smith-Ryan ◽  
Kucera ◽  
Registar-Mihalik ◽  
...  
Keyword(s):  
Resting Metabolic Rate ◽  
Relative Energy ◽  
Low Energy ◽  
Endurance Athletes ◽  
Risk Level ◽  
Future Research ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Cut Points ◽  
Low Energy Availability

Background and Objectives: Relative energy deficiency in sport (RED-S) has been introduced as a broad-spectrum syndrome leading to possible dysfunction in numerous physiological systems, driven primarily by low energy availability (EA). Research in females has identified specific EA cut-points indicative of risk level for developing physiological and performance disturbances. Cut-points in males have yet to be evaluated. This study examined the prevalence of low EA in competitive (non-elite), recreationally trained (CRT) male endurance athletes. Materials and Methods: Subjects were 108 CRT (38.6 ± 13.8 y; 12.2 ± 5.4 h/wk training) male endurance athletes (runners, cyclists, triathletes) who completed a descriptive survey online via Qualtrics® and returned 3 day diet and exercise training records. EA was calculated from returned surveys and training records. Resting metabolic rate (RMR) and lean body mass (LBM) were estimated from self-reported survey data. Prevalence of risk group was categorized based on the female cut-points: at risk (AR) ≤30 kcal/kg LBM, moderate risk (MR) = 30–45 kcal/kg LBM, or no risk (NR) ≥45 kcal/kg LBM. Results: In this sample, 47.2% (n = 51) were classified as AR, 33.3% (n = 36) as MR, and 19.4% (n = 21) as NR for low EA. Cyclists had lower EA (26.9 ± 17.4 kcal/kg LBM, n = 45) than runners (34.6 ± 13.3 kcal/kg LBM, n = 55, p = 0.016) and all other sport categories (39.5 ± 19.1 kcal/kg LBM, n = 8, p = 0.037). Conclusions: The findings indicate this sample had a high prevalence of risk for low EA, at 47.2%. Only 19.4% of participants were at no risk, meaning ~80% of participants were at some degree of risk of experiencing low EA. Cyclists were at greater risk in this cohort of low EA, although why this occurred was unclear and is in need of further investigation. Future research should address whether the current female cut-points for low EA are appropriate for use in male populations.

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 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 Energy Availability and RED-S Risk Factors in Competitive, Non-elite Male Endurance Athletes

2021 ◽  
pp. 25-32
Author(s):  
Amy R Lane ◽  
Anthony C Hackney ◽  
Abbie E Smith-Ryan ◽  
Kristen Kucera ◽  
Johna K Register-Mikalik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Resting Metabolic Rate ◽  
Relative Energy ◽  
Fat Free Mass ◽  
Endurance Athletes ◽  
Energy Availability ◽  
Bone Biomarkers ◽  
Mineral Density ◽  
Maximal Aerobic Capacity ◽  
Energy Deficiency

Energy Availability and RED-S Risk Factors in Competitive, Non-elite Male Endurance Athletes Amy R Lane1, Anthony C Hackney()1, Abbie E Smith-Ryan1, Kristen Kucera1, Johna K Register-Mihalik1 and Kristin Ondrak1  1Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC 27599, USA © The Authors   Abstract Relative Energy Deficiency in Sport (RED-S) is predicated on the assumption that low energy availability (EA) induces deficiencies-dysfunction in multiple physiologic systems. However, research on RED-S and EA in male athletes is limited in comparison to women. The aim of this study is to investigate EA and the risk factors for RED-S, and their potential associations in non-elite male endurance athletes. Laboratory assessments for resting metabolic rate (RMR), bone mineral density (BMD), blood hormonal biomarkers and maximal aerobic capacity were conducted on 60 competitive, recreationally trained male endurance athletes (age=43.4±11.6 years [mean±SD], training=10.9±2.7 h/wk, 7.1±8.8 years). Participants provided 7-days of training logs and 4-days of diet records. Diet and training records were used to calculate EA. Correlations were used to examine associations between EA and RMR, BMD, stress fractures and reproductive, metabolic and bone biomarkers. Mean EA was 28.7±13.4 kcal/kg fat free mass (FFM), which categorized our sample as low EA (based upon published criterion, < 30 kcal/kg FFM) and at a high risk for RED-S. Hormonal and bone biomarkers were in normal clinical ranges, even though EA was low. The only interesting significant association was EA being negatively associated with total body BMD (r=–0.360, P=0.005), opposite of expectations. On average our subjects displayed a state of low EA based upon the criterion which has been primarily developed from female-based research. Nonetheless, our participants displayed no major hormonal or bone health disturbances found in athletes diagnosed with RED-S. A value of < 30 kcal/kg FFM to diagnose low EA may not be appropriate for non-elite endurance trained men. 

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 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.

Prevalence of impaired physiological function consistent with Relative Energy Deficiency in Sport (RED-S): an Australian elite and pre-elite cohort

2020 ◽  
Vol 55 (1) ◽  
pp. 38-45
Author(s):  
Margot Anne Rogers ◽  
Renee Newcomer Appaneal ◽  
David Hughes ◽  
Nicole Vlahovich ◽  
Gordon Waddington ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Point Prevalence ◽  
Energy Availability ◽  
Mineral Density ◽  
Energy Deficiency ◽  
S Model ◽  
Low Energy Availability

ObjectivesAthlete health, training continuity and performance can be impeded as a result of Relative Energy Deficiency in Sport (RED-S). Here we report the point prevalence of symptoms described by the RED-S model in a mixed-sport cohort of Australian female athletes.MethodsElite and pre-elite female athletes (n=112) from eight sports completed validated questionnaires and underwent clinical assessment to assess the point prevalence of RED-S symptoms. Questionnaires included the Depression, Anxiety and Stress Questionnaire (DASS-21), Generalized Anxiety Disorder (GAD-7), Center for Epidemiological Studies Depression Scale (CES-D), SCOFF questionnaire for disordered eating, Low Energy Availability in Females Questionnaire (LEAF-Q), and a custom questionnaire on injury and illness. Clinical assessment comprised resting metabolic rate (RMR) assessment, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, venous and capillary blood samples, and the Mini International Neuropsychiatric Interview (MINI 7.0.2). Descriptive prevalence statistics are presented.ResultsAlmost all (80%) participants (age 19 (range 15–32) years; mass 69.5±10.3 kg; body fat 23.1%±5.0%) demonstrated at least one symptom consistent with RED-S, with 37% exhibiting between two and three symptoms. One participant demonstrated five symptoms. Impaired function of the immunological (28%, n=27), haematological (31%, n=33) and gastrointestinal (47%, n=51) systems were most prevalent. A moderate to high (11%–55%) prevalence of risk of low energy availability was identified via RMR and LEAF-Q, and identified mental illnesses were prevalent in one-third of the assessed cohort.ConclusionSymptoms described by the RED-S model were prevalent in this cohort, supporting the need for improved awareness, monitoring and management of these symptoms in this population.

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 Indicators and correlates of low energy availability in male and female dancers

2020 ◽  
Vol 6 (1) ◽  
pp. e000906
Author(s):  
Nicola Keay ◽  
AusDancers Overseas ◽  
Gavin Francis
Keyword(s):  
At Risk ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Male And Female ◽  
Energy Deficiency ◽  
Physiological Indicators ◽  
Dance Training ◽  
High Level ◽  
Low Energy Availability

ObjectivesTo investigate indicators and correlates of low energy availability (LEA) in male and female dancers.MethodsA Dance-Specific Energy Availability Questionnaire (DEAQ) was developed and administered online internationally to dancers training at preprofessional, professional or advanced amateur level. 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 potential correlates. 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 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 one-third (29%) of dancers were aware of RED-S.ConclusionThis study found dancers to be a specific group of high-level artistic performers 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.

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