The Female Athlete Triad/Relative Energy Deficiency in Sports (RED-S)

Abstract

In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, and menstrual cycle. On the other hand, an imbalance caused by low energy availability due to a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. The present review was carried out based on a critical analysis of the most recent publications available and aims to provide a global perception of the topic relative energy deficit in sport (RED-S). The objective is to promote the acquisition of more consolidated knowledge on an undervalued theme, enabling the acquisition of preventive strategies, early diagnosis and/or appropriate treatment.

Behind the athletic body: a clinical interview study of identification of eating disorder symptoms and diagnoses in elite athletes

“…Most of these symptoms are often seen in a well-described condition called relative energy deficiency in sport (RED-S), where the body lacks the energy to meet the demands of the performed amount of exercise. A strong association between EDs and RED-S has been reported 2–6…”

“…A strong association between EDs and RED-S has been reported. [2][3][4][5][6] Clinical implications and future recommendations To detect and address symptoms of EDs among athletes, we have summarised the symptoms covered in our study in table 3. Athletes, coaches and relatives can use the table to increase knowledge and awareness of ED symptoms in athletes.…”

“…1 EDs may have serious negative health consequences, low energy availability and reduced sports performance. [2][3][4][5][6] Symptoms of EDs are described in the diagnostic manuals: WHO's 'International Statistical Classification of Diseases and Related Health Problems, 10th revision' (ICD-10) 7 and 'The Diagnostic and Statistical Manual of Mental Disorders, fifth edition' (DSM-5). 8 Anorexia nervosa (AN) is characterised by restrictive eating, low body weight, fear of weight gain and disturbed body image.…”

“…EDs may be triggered by performance pressure, comments from coaches or teammates, public weigh-ins or societal expectations of an athletic or skinny body 1. EDs may have serious negative health consequences, low energy availability and reduced sports performance 2–6…”

Training, Wellbeing and Recovery Load Monitoring in Female Youth Athletes

“…This issue can lead to athletes inaccurately reporting, potentially leading to the missed or wrong identification of menstrual dysfunction linked to relative energy deficiency in sport (RED-S) [ 60 ]. This can be a result of irregularities in menstrual cycles in youth caused by a cycle that is not fully developed or as a result of energy deficiency as seen in RED-S [ 61 ]. A final consideration when monitoring menstrual cycles in a youth population is that these athletes may not be comfortable discussing menstrual cycles and therefore do not report any changes in their cycle.…”