The Path Towards Progress: A Critical Review to Advance the Science of the Female and Male Athlete Triad and Relative Energy Deficiency in Sport

The Use of Continuous Glucose Monitors in Sport: Possible Applications and Considerations

“…LEA refers to a state of energy deficiency resulting from a mismatch between dietary EI and exercise energy expenditure, leading to a reduction in the available energy to support primary physiological systems, with its numerical calculation expressed relative to an athlete's fat-free (metabolically active) mass (FFM; Logue et al, 2020). LEA is the key exposure variable underpinning the syndromes commonly known as relative energy deficiency in sport (Mountjoy et al, 2018) and the female athlete and male athlete triad (De Souza et al, 2022). Periodic exposure to energy deficits within and between days is an inherent part of life and may be experienced during activities known to enhance sports performance (e.g., body composition manipulation or intensified training).…”

“…Periodic exposure to energy deficits within and between days is an inherent part of life and may be experienced during activities known to enhance sports performance (e.g., body composition manipulation or intensified training). However, the severity and duration of exposure to LEA can be associated with disturbances to normal physiological functioning, often resulting in an increased risk of illness and injury, and a decrease in well-being, training adaptation, and sporting performance (De Souza et al, 2022). These syndromes can have substantial long-term repercussions for an athlete with the potential to prematurely end their sporting career and cause chronic health problems, such as premature osteoporosis (Mountjoy et al, 2018).…”

Relative energy deficiency in sport: Health implications in female athletes

“…Further research is needed to better understand the implications of energy deficiency on body systems outside of the triad (ie, gastrointestinal, immunologic, psychological, etc.). 30 Research linking direct causeand-effect relationships between LEA and pathologic effects along with consistent and quantifiable measures of clinical outcomes will strengthen the clinical usefulness of the model. 30 Although more needs to be understood about RED-S and science will continue to develop, scientists have already made great discoveries in this field over the past two decades.…”

“…30 Research linking direct causeand-effect relationships between LEA and pathologic effects along with consistent and quantifiable measures of clinical outcomes will strengthen the clinical usefulness of the model. 30 Although more needs to be understood about RED-S and science will continue to develop, scientists have already made great discoveries in this field over the past two decades. Sadly, there is a knowledge deficit among clinicians.…”

Insights in the Effect of Fluctuating Female Hormones on Injury Risk—Challenge and Chance

“…Changes in bone health as a result of hormonal and metabolic changes due to insufficient energy intake and/or excessive exercise energy expenditure, known as the female athlete triad, have predominantly been investigated in women. Today, it is accepted that detrimental effects of energy deficiency, respectively, the relative energy deficiency syndrome are not limited to exercising girls and women and but are also occurring in men ( de Souza et al, 2021 ). However, the overall imbalance in research cannot be neglected, which also raises ethically relevant questions about whether women receive lesser chances of performance progression and about whether women are subjected to a higher risk of injury compared to men due to a limitation of specific knowledge.…”