Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’. The term ‘Relative Energy Deficiency in Sport’ (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a ‘triad’ of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The ‘Sport Risk Assessment and Return to Play Model’ categorises the syndrome into three groups and translates these classifications into clinical recommendations.

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A focus on low body weight and body fat content, combined with regulations in some weight-sensitive sports, are considered risk factors for extreme dieting, eating disorders (EDs) and related health consequences among athletes. At present there are, from a health perspective, no generally accepted optimum values for body weight or percentage of fat mass in different sports and there is no 'gold standard' method for body composition assessment in athletes. On the basis of health considerations as well as performance, medical support teams should know how to approach elite athletes who seek to achieve an unrealistic body composition and how to prevent restrictive eating practices from developing into an ED. In addition, these teams must know when to raise the alarm and how to advice athletes who are affected by extreme dieting or clinical EDs. However, there is no consensus on when athletes struggling with extreme dieting or EDs should be referred for specialist medical treatment or removed from competition. Based on the present review, we conclude that there is a need for (1) sport-specific and gender-specific preventive programmes, (2) criteria for raising alarm and 'does not start' (DNS) for athletes with EDs and (3) modifications to the regulations in some sports. Further, the key areas for research identified include the development of standard methods for body composition assessment in elite athletes; screening measures for EDs among athletes; development and testing of prevention programmes; investigating the short and long-term effects of extreme dieting; and EDs on health and performance. INTRODUCTIONIn various sports body weight and body composition are crucial performance variables.1 Some athletes are genetically suited to the specific anthropometric demands of the sport/weight class in which they compete, but many elite athletes struggle with extreme dieting and eating disorders (EDs) as they attempt to conform to competition regulations that are ill suited to their physique.2 As a consequence, athletes with very low body weight and/or body fat, frequent weight fluctuation, EDs and insufficient bone density are often found in weight-sensitive sports, with a high prevalence of menstrual dysfunction in women.3 Medical staff, including sports physicians, nutritionists and exercise scientists, experience challenges in handling the issues of optimum body composition, dieting and EDs in elite athletes.4 5 Furthermore, most sport nutritionists experience challenges related to application of minimum/maximum body composition or body mass values for health and performance, especially when confronted with a lack of knowledge among coaches and other support team members.5 Therefore, the aim of this article is to review the current knowledge related to minimising the risks associated with extreme weight control and EDs in elite athletes. DefinitionsWeight-sensitive sports can be classified into three main groups: (1) gravitational sports, in which high body weight restricts performance because moving the b...

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på link.springer.com: http://dx.doi.org/10.2165/11597140-000000000-00000 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. The original publication is available at link.springer.com: http://dx.doi.org/10.2165/11597140-000000000-00000 . Figure 3. Semi-automatic image evaluation: The edge detection algorithm for subcutaneous adipose tissue (SAT) thickness determination enables selecting areas of interest, distances (d US ) measurement series, color-coding of distance values, and statistical evaluations [48] . In this example of a SAT-layer above the triceps muscle, with the transducer held parallel to the humerus, 119 d US values ranging from 2.3 mm to 4.3 mm were automatically detected by the algorithm; the median was 3.4 mm (c = 1470 m/s). Layers and interfaces: A: gel, B: gel-epidermis, C: dermis, D: dermis-SAT, E: SAT, F: SAT-fascia of muscle, G: muscle. [77] . Abbreviations: mid dist = middle distance track runners; long dist = long distance runners; Scot long dist = Scottish long distance runners; SASI mid dist = South Australian Sports Institute middle distance track runners; SASI sprint = sprint runners; SASI jump = jumpers. Figure 6. Selected skinfold ratios in extremely lean male and female endurance athletes, and mean values from 106 male and 33 female athletes [80] . 4 ABSTRACTQuantifying human body composition has played an important role in monitoring all athlete performance and training regimens, but especially so in gravitational, weight class and aesthetic sports wherein the tissue composition of the body profoundly affects performance or adjudication. Over the past century, a myriad of techniques and equations have been proposed, but all have some inherent problems, whether in measurement methodology or in the assumptions they make. To date, there is no universally applicable criterion or "gold standard" methodology for body composition assessment.Having considered issues of accuracy, repeatability and utility, the multi-component model might be employed as a performance or selection criterion, provided the selected model accounts for variability in the density of FFM in its computation. However, when profiling change in interventions, single methods whose raw data are surrogates for body composition (with the notable exception of the BMI) remain useful.

BackgroundPrecise and accurate field methods for body composition analyses in athletes are needed urgently.AimStandardisation of a novel ultrasound (US) technique for accurate and reliable measurement of subcutaneous adipose tissue (SAT).MethodsThree observers captured US images of uncompressed SAT in 12 athletes and applied a semiautomatic evaluation algorithm for multiple SAT measurements.ResultsEight new sites are recommended: upper abdomen, lower abdomen, erector spinae, distal triceps, brachioradialis, lateral thigh, front thigh, medial calf. Obtainable accuracy was 0.2 mm (18 MHz probe; speed of sound: 1450 m/s). Reliability of SAT thickness sums (N=36): R2=0.998, SEE=0.55 mm, ICC (95% CI) 0.998 (0.994 to 0.999); observer differences from their mean: 95% of the SAT thickness sums were within ±1 mm (sums of SAT thicknesses ranged from 10 to 50 mm). Embedded fibrous tissues were also measured.ConclusionsA minimum of eight sites is suggested to accommodate inter-individual differences in SAT patterning. All sites overlie muscle with a clearly visible fascia, which eases the acquisition of clear images and the marking of these sites takes only a few minutes. This US method reaches the fundamental accuracy and precision limits for SAT measurements given by tissue plasticity and furrowed borders, provided the measurers are trained appropriately.

Results show high use of BC assessment but also a lack of standardisation and widespread perception of problems related to BM and BC in sport. Future work should emphasise standardisation with appropriate training opportunities and more research on BC and performance.

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