Relative energy deficiency in sport

Relative Energy Deficiency in Sport (RED-S) is a syndrome resulting from insufficient caloric intake relative to the energy expended by an athlete, leading to impaired physiological functioning. This condition encompasses a wide range of health and performance consequences, including but not limited to alterations in hormones, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health. RED-S is an evolution of the concept previously known as the Female Athlete Triad, expanding its scope to include male athletes and a broader spectrum of health consequences beyond menstrual dysfunction, low energy availability, and decreased bone mineral density.

Definition and Causes

Relative Energy Deficiency in Sport is defined by the International Olympic Committee (IOC) as the result of insufficient caloric intake and/or excessive energy expenditure. It does not exclusively pertain to athletes with eating disorders, although individuals with such disorders are at a higher risk. RED-S can be intentional, stemming from an athlete's desire to alter body composition for performance or aesthetic reasons, or unintentional, due to a lack of awareness or understanding of nutritional needs.

Health Consequences

The health consequences of RED-S are extensive and impact multiple body systems. Key areas affected include:

• Endocrine Function: Reduced energy availability can lead to alterations in the hypothalamic-pituitary axis, affecting hormones such as leptin, ghrelin, insulin, and reproductive hormones, which can result in menstrual dysfunction in females and decreased testosterone in males.
• Bone Health: Chronic low energy availability can lead to decreased bone mineral density, increasing the risk of osteoporosis and fractures.
• Cardiovascular Health: RED-S can lead to changes in heart rate, blood pressure, and vascular function.
• Immune Function: Energy deficiency can impair immune function, increasing the risk of infections and illnesses.
• Mental Health: There is a strong association between RED-S and psychological issues such as depression, anxiety, and disordered eating behaviors.

Diagnosis and Management

Diagnosis of RED-S involves a comprehensive assessment including dietary history, exercise history, psychological assessment, and physiological measurements. Early detection and intervention are crucial for preventing long-term health consequences. Management of RED-S requires a multidisciplinary approach involving nutritionists, physicians, psychologists, and sport coaches. The primary goal is to restore energy balance either by increasing energy intake, reducing energy expenditure, or a combination of both.

Prevention

Prevention strategies for RED-S include education of athletes, coaches, and healthcare providers on the importance of adequate energy intake and the risks associated with energy deficiency. Regular monitoring of athletes' health and performance can also help in early detection and prevention of RED-S.

See Also

• Sports nutrition
• Eating disorders in athletes
• Female Athlete Triad
• Osteoporosis
• Menstrual cycle

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