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:10.1136/bjsports-2018-099193

Cited by 574 publications

(801 citation statements)

References 189 publications

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“…The Triad has three components: (a) low energy availability (LEA) with or without disordered eating (DE), (b) menstrual dysfunction, and (c) low bone mineral density (BMD) . The International Olympic Committee (IOC) suggested that relative energy deficiency in sport (RED‐S) affects growth, mental conditioning, cardiovascular function, immunity, and bone mineral density (BMD), resulting in decreased overall performance . Both RED‐S and the Triad emphasize the importance of appropriate energy intake to support exercise …”

Section: Introductionmentioning

confidence: 99%

“…2 The International Olympic Committee (IOC) suggested that relative energy deficiency in sport (RED-S) affects growth, mental conditioning, cardiovascular function, immunity, and bone mineral density (BMD), resulting in decreased overall performance. [3][4][5][6] Both RED-S and the Triad emphasize the importance of appropriate energy intake to support exercise. [2][3][4][5][6] For female athletes who have one component of the Triad, the risk of developing stress fractures is 2.5 times higher than that of athletes with no components of the Triad; the risk is 4.7 times higher for those with two or more components.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] Both RED-S and the Triad emphasize the importance of appropriate energy intake to support exercise. [2][3][4][5][6] For female athletes who have one component of the Triad, the risk of developing stress fractures is 2.5 times higher than that of athletes with no components of the Triad; the risk is 4.7 times higher for those with two or more components. 7 Stress fractures are one example of overuse syndromes and are most common between the ages of 16 and 17 years, regardless of competition level.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Nose‐Ogura

Yokosuka

Dohi

et al. 2019

Scandinavian Med Sci Sports

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Background The female athlete triad (Triad), defined by the American College of Sports Medicine as low energy availability (LEA) with or without disordered eating, menstrual dysfunction, and low bone mineral density (BMD), is associated with stress fractures and athletes aged 16‐17 years are most susceptible. Purpose To examine whether the Triad increases the risk of stress fractures, athletes were assigned to a “teenage” group and a “20s” group. Methods This prospective study enrolled 390 elite female athletes and was conducted from 2012 to 2016 at Japan Institute of Sports Sciences. Blood concentrations of various hormones were examined, and BMD was measured at the lumbar spine and throughout the whole body using dual‐energy X‐ray absorptiometry. LEA was defined as body weight ≤85% of the ideal body weight for teenage athletes, or BMI ≤17.5 for athletes in their 20s. Low BMD was defined as a BMD Z‐score of <−1.0 in the lumbar spine and the whole body. Results Among 390 athletes enrolled, 36 developed new stress fractures within 3 months of registration. The risk for stress fractures due to the Triad in teenage athletes was higher than for athletes in their 20s. In teenage female athletes, secondary amenorrhea, low BMD for the whole body, and a low ratio of actual body weight to ideal body weight increased the risk for stress fractures by 12.9 times, 4.5 times, and 1.1 times, respectively. Conclusion To prevent stress fractures in female athletes with the Triad, age of athletes should be taken into consideration.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Nose‐Ogura

Yokosuka

Dohi

et al. 2019

Scandinavian Med Sci Sports

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“…Given this association with suppressed RMR and suboptimal EA, RMR has been used to estimate EA in determining individuals with low energy availability (LEA; De Souza et al., ; De Souza, Hontscharuk, Olmsted, Kerr, & Williams, ; Gibbs, Williams, Scheid, Toombs, & De Souza, ; Melin et al., ). Low energy availability is correlated with detrimental physiological, psychological and performance effects (De Souza & Williams, ; Logue et al., ; Mountjoy et al., ; Nattiv et al., ; VanHeest, Rodgers, Mahoney, & De Souza, ); it is known that there is a negative linear relationship between absolute and relative RMR and training (Woods, Garvican‐Lewis, Lundy, Rice, & Thompson, ). Therefore, accuracy of RMR measurements becomes paramount in monitoring EA and prevention of LEA.…”

Section: Introductionmentioning

confidence: 99%

Resting metabolic rate prediction equations and the validity to assess energy deficiency in the athlete population

Schofield

Thorpe

Sims

2019

Experimental Physiology

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New Findings What is the topic of this review?We review the issues with using predicted resting metabolic rate equations in athletic populations. What advances does it highlight?The use of dated predicted resting metabolic rate equations is not appropriate for athletic populations until more studies have been conducted among these unique populations. Abstract Resting metabolic rate (RMR) is the amount of energy the body uses at rest. A suppressed RMR has been correlated with low energy availability and therefore used as an indicator of an individual's energy state. Furthermore, confounding identification of low energy availability within an athletic population are the physiological measures required, which can be time consuming and require professional expertise. To negate the demands of laboratory protocols in measuring RMR, predicted RMR (pRMR) equations were developed. Caution should be exercised when applying the pRMR equations for determining low energy availability in athletes owing to the population used to develop the equations and the higher metabolic cost of fat‐free mass, thus elevated RMR, associated with athletes. Moreover, a low ratio of measured RMR to pRMR is often used as an alternative marker for energy deficiency. Predictive equations should implement fat‐free mass within the algorithm when estimating RMR in athletic populations. The purpose of this paper is to describe pRMR equation development and the issues associated with use of pRMR equations for athletic populations. As professional sport increases, validation of pRMR equations in the modern athlete population is needed to monitor energy availability for athletic health and performance.

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“…The female athlete triad (Triad) is described as the interrelationship of energy availability, menstrual function, and bone health and exists on a continuum of health to disease . The terminology Triad has been expanded to relative energy deficiency in sport [RED‐S], describing how the low energy availability state may contribute to multiple physiological changes including risk for impaired bone health and injury . The presence of Triad risk factors can delay healing from a BSI .…”

mentioning

confidence: 99%

Re: Protocol for 8‐Week Return to Running after a Femoral Stress Reaction: No Bone Stress Injury is the Same

Tenforde

2019

PM&R

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IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update

Cited by 574 publications

References 189 publications

Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Risk factors of stress fractures due to the female athlete triad: Differences in teens and twenties

Resting metabolic rate prediction equations and the validity to assess energy deficiency in the athlete population

Re: Protocol for 8‐Week Return to Running after a Femoral Stress Reaction: No Bone Stress Injury is the Same

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