International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update

Mountjoy, Margo; Sundgot‐Borgen, Jorunn; Burke, Louise M.; Ackerman, Kathryn E.; Blauwet, Cheri; Constantini, Naama; Lebrun, Constance M.; Lundy, Bronwen; Melin, Anna; Meyer, Nanna L.; Sherman, Roberta; Tenforde, Adam S.; Torstveit, Monica Klungland; Budgett, Richard

doi:10.1123/ijsnem.2018-0136

Cited by 286 publications

(368 citation statements)

References 173 publications

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“…37 Restrictive eating, menstrual disturbances, low BF%, and reduction in body weight have all been found to cause impairments in BMD. 7,8 Still, a period of more than 4-6 months may be needed to detect any changes in BMD, 24 which exceed the duration of the current study. Unfortunately, the design and resources available confined us from a longer follow-up, and as such, a question remains regarding the effects from this sport on BMD.…”

Section: F I G U R E 4 Changes In Body Weightmentioning

confidence: 86%

“…This is of special concern considering the fact that some individuals prolong their dieting period for several weeks or months, or initiate several dieting periods per year. Hence, along with the acute impairments comes a risk of negative long-term consequences, [6][7][8] which specifically may be detrimental to young females with less robust hormonal systems. 6,7 The findings in the current study reveal female FA experience several symptoms of RED-s during and after a dieting period.…”

Section: F I G U R E 4 Changes In Body Weightmentioning

confidence: 99%

“…7 Females are prone to such impairments, which specifically raise concern to the potential detrimental effect on bone mineral density (BMD), and hormonal disturbances affecting metabolism and fertility. 7,8 Hence, recommendations for optimal regulation of BW and body composition have been suggested, in order to minimize the risk of negative health consequences. 5,6,9,10 These guidelines specifically emphasize frequent and regular meal intake, high protein intake, adequate carbohydrate intake, saturating diets (eg, high in dietary fiber), slow rate of weight reduction, and a moderate energy deficit.…”

mentioning

confidence: 99%

“…[12][13][14][15] Additionally, they emphasize resistance exercise, [13][14][15][16][17] which specifically may be favorable in reducing the detrimental effect of dieting and low BW on lean body mass and BMD. 5,[13][14][15][16][17][18][19] However, FA are understudied with regard to physical and mental health variables, like the ones identified as symptoms of RED-s. 1,3,7 Previous studies of athletes in bodybuilding sports reveal issues with binge eating, and report on a high prevalence of previous eating disorders, specifically among females. 3 Recent findings in groups of fitness athletes are indications of a continued, strict dieting behavior beyond the competitive season, not to enhance performance, but to comply with the modern lean and fit body ideal.…”

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confidence: 99%

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Physical health and symptoms of relative energy deficiency in female fitness athletes

Mathisen

Heia

Raustøl

et al. 2019

Scandinavian Med Sci Sports

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Introduction Competing in aesthetic sports increases the risk of low energy availability and associated health impairments. Fitness physique sport is a popular, but understudied aesthetic sport. We evaluated health and symptoms of relative energy deficiency in sport (RED‐s) in female fitness athletes (FA) and female references (FR) during a competitive season. Methods Totally, 25 FA and 26 FR, mean (SD) age of 28.9 (5.7), were included. Assessments were at baseline (T1), 2‐weeks pre‐competition (T2), and 1‐month post‐competition (T3), by dual‐energy x‐ray absorptiometry scan, indirect calorimetry, diet registration, The Low Energy Availability in Females Questionnaire, The Beck Depression Inventory, and Eating Disorder Examination Questionnaire (EDE‐Q). Results A history of eating disorders was reported by 35% FA and 12% FR. There were no between‐group differences at T1, besides less mean (99% CI) fat mass (FM) of 3.1 kg (−0.4, 6.5) in FA (P = .02). At T2, FA had lower BW of 6.7 kg (−12.0, −1.3), fat mass of −9.0 kg (−12.5, −5.5), and resting heart rate of −8.0 beats per minute (−14.5, −1.5) compared to FR (P ≤ .006). FA reduced resting metabolic rate by −191 kcal (−11, −371) and increased symptoms of gastrointestinal dysfunction (GD) by 1.4 points (0.3, 2.5) and prevalence of amenorrhea from 8% to 24%, (P < .003). At T3, there was a between‐group difference in fat mass, and a high number of FA with amenorrhea and GD. Conclusion Manifestation of symptoms of RED‐s, some with persistence one‐month post‐competition, raises concern for the health of FA and those complying with the fit body ideal.

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Section: F I G U R E 4 Changes In Body Weightmentioning

confidence: 86%

Section: F I G U R E 4 Changes In Body Weightmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Physical health and symptoms of relative energy deficiency in female fitness athletes

Mathisen

Heia

Raustøl

et al. 2019

Scandinavian Med Sci Sports

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“…The Triad is associated with additional health concerns (e.g., cardiovascular disease, musculoskeletal, and bone stress injury) even in athletes who do not have a clinical ED (De Souza & Williams, 2004;Rauh, Nichols, & Barrack, 2010;Tenforde et al, 2017). Notably, in 2014, the International Olympic Committee updated the "Triad" to a more comprehensive syndrome: relative energy deficiency in sport (Mountjoy et al, 2018); however, because the present study was initiated before this update, this study targeted the Triad in addition to ED risk factors and symptoms.…”

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confidence: 99%

The Female Athlete Body project study: 18‐month outcomes in eating disorder symptoms and risk factors

Stewart

Pollard

Hildebrandt

et al. 2019

Intl J Eating Disorders

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Objective To evaluate the efficacy of the Female Athlete Body project (FAB) in reducing eating disorder (ED) symptoms and risk factors. Method This study was a community participatory three‐site, two‐arm, cluster randomized controlled trial (RCT). Female collegiate athletes (N = 481) were randomly assigned by team to the FAB intervention, a behavioral ED risk factor reduction program, or a waitlist control condition. Primary analyses examined 18‐month effects for ED pathology. Secondary analyses examined risk factors and correlates (e.g., thin‐ideal internalization, negative mood, Female Athlete Triad knowledge, and body mass index [BMI]). Results Linear mixed effects models with team as a cluster level variable and study condition as a between‐subjects variable revealed significantly reduced dietary restraint in FAB teams relative to control teams. FAB teams also reported significantly fewer objective and subjective binge episodes than control teams. Finally, FAB teams showed significantly lower thin‐ideal internalization and increased BMI at 18‐months. No other significant differences were found. Discussion This RCT examined the effects of a short intervention on ED pathology and risk factors in female collegiate athletes through 18‐month follow‐up. This trial is one of only three trials with female athletes that have shown long‐term reductions in any ED symptoms or produced positive effects on ED risk factors. The present study is the first to find such effects with athletes using a brief (i.e., 4 hr) intervention at 18‐month follow‐up. Although small effects were found, the current trial provides valuable lessons about future design and implementation of similar trials with athletes. Trial Registration Clinical trials NCT01735994.

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Iron deficiency in athletes: A narrative review

Kuwabara

Tenforde

Finoff

et al. 2022

PM&R

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Iron deficiency is a concern for athletes due to potential for performance impairments attributed to lower iron status with, or without, accompanying anemia. Despite the high interest in the topic for endurance athletes and medical providers who care for this population, the evaluation and management of athletes with iron deficiency is still evolving, particularly in relation to iron deficiency non-anemia (IDNA). This narrative review presents causes of iron deficiency in the athlete, clinical presentation, differential diagnoses, diagnostic evaluation, and proposed strategies for treatment.

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International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update

Cited by 286 publications

References 173 publications

Physical health and symptoms of relative energy deficiency in female fitness athletes

Physical health and symptoms of relative energy deficiency in female fitness athletes

The Female Athlete Body project study: 18‐month outcomes in eating disorder symptoms and risk factors

Iron deficiency in athletes: A narrative review

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