Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know

The Female Athlete Triad (Triad) and the more encompassing Relative Energy Deficiency in Sport (RED-S) are disorders caused by low energy availability (LEA). LEA is a state of insufficient energy intake by an athlete relative to their energy expenditure. Persistent LEA results in the deleterious consequences to health and performance that comprise RED-S. With respect to both the Triad and RED-S, researchers have called for more education of those involved with sport, particularly coaches, to help reduce the incidence of these disorders. Recent studies have shown that as few as 15% of coaches are aware of the Triad, with up to 89% unable to identify even one of its symptoms. RED-S is a more recently established concept such that coach knowledge regarding it has only begun to be assessed, but the results of these initial studies indicate similar trends as for the Triad. In this review, we synthesize research findings from 1986 to 2021 that pertains to LEA and RED-S, which coaches should know so they can better guide their athletes.

Reproductive health of the fem ale athletes

Physicians, including gynecologists, who deal with sportswomen, do not always consider in their everyday practice the changes in female reproductive function caused by severe physical exercises. A t the same time, this problem is so important, that in 1992 American College of Sports Medicine introduced the term Female Athlete Triad, describing interrelationships between eating disorders, amenorrhea and osteoporosis. It is well known that menarche in athletes occur later than in sedentary women, 5-50% o f athletes are amenorrheic, anovulation takes place in 16%, luteal phase deficiency -in 4 2 % of female athletes. The high rate of ovarian insufficiency among athletes and theirprobable unfavorable sequelae require the problems in treatment andprevention of reproductive disorders in female athletes to be solved. This must be done within the modem standards of reproductive medicine.

Сучасний погляд на проблему синдрому «тріада жінки-спортсменки»

Резюме. Наведено аналіз наукової літератури про сучасне подання проблеми синдрому «тріада жінки-спортсменки». Розглядаючи питання в історичному аспекті, зазначимо, що в 1992 р. Американським коледжем спортивної медицини (ACSM) уперше було визначено тер-мін «тріада спортсменок» (Тhe female athlete triad) як синдром, що включає розлад харчової поведінки, аменорею та остеопороз. Таке рішення комісії ACSM було викликане збільшенням повідомлень у науковій медичній літературі про зростаючу частоту серед спортсменок порів-няно з неспортсменками порушень функцій репродуктивної системи в поєднанні з розладами харчової поведінки й зниженням кісткової маси. Протягом трьох десятиліть вивченню цього синдрому присвячено велику кількість наукових досліджень, здебільшого зарубіжних фахів ців. Мета. Представити класичну наукову характеристику синдрому «тріада жінки-спортсменки» і сучасні протиріччя в цьому питанні в практиці спортивної медицини. Методи. Аналіз наукової літератури. Результати. Більша частина фахівців схильна вважати, що «тріада» має місце серед спортсменок багатьох спеціалізацій. Складно погодитися із представниками спортивної меди-цини, у працях яких встановлено такий синдром у 5–72 % спортсменок, і уявити спортсменку, яка тренується з остеопорозом і страждає на нейрогенну анорексію – психоендокринні пору-шення. З часом у спеціальній літературі почали з’являтися сумніви щодо існування цьо го син-дрому. У 2015 р. групою експертів Міжнародного олімпійського комітету було внесено пропо-зицію про розширення терміна «тріада жінки-спортсменки» на більш всеосяжний – «відносний дефіцит енергії в спорті» (RED-S – «Relative Energy Deficiency in Sport). Новий напрям RED-S включає рівноспрямоване обстеження і чоловіків-спортсменів. Ключові слова: синдром «тріада жінки-спортсменки», анорексія, аменорея, остеопороз, «від-носний дефіцит енергії в спорті» (RED-S).

The LEAF questionnaire is a good screening tool for the identification of the Female Athlete Triad/Relative Energy Deficiency in Sport among young football players

Background It has been noticed that Female Athlete Triad (Fat) and Relative Energy Deficiency (Red-S) in Sport are characterized by the symptoms of impaired endocrine-metabolic function and bone health in female athletes. In addition, it may be evaluated with a qualitative tool, such as Low Energy Availability in Females questionnaire (LEAF-Q) and quantitative measurements: bone mineral density (BMD), resting energy expenditure (REE), body composition, 24-hour dietary recall. Methods The aim of this study was to assess the prevalence of Triad and Red-S using the LEAF-Q in youth female football players. Additionally, the difference in the BMD, body composition, REE and energy intake (EI) were assessed between the Triad/Red-S risk and not at-risk groups. Results Almost two thirds (64.7%) of participants are classified as being at-risk for the triad according to their LEAF-Q scores. There were no statistically significant differences (p > 0.05) between most of the values among children from the analyzed groups. There was a statistically significant difference (p < 0.001) between the EI values among girls from the two analyzed groups: at-risk (1,773.18 kcal ± 232.57) and not at-risk (2,054.00 kcal ± 191.39). Girls who did not meet the energy intake recommendations were 10.00 as likely to be in the Triad/Red-S risk group. Conclusion Early identification of Fat/Red-S symptoms by screening tools such as the LEAF questionnaire is important in protecting young athletes from long-term damage due to the progression of the risk factors associated with the Fat/Red-S.

2 The prevalence of musculoskeletal injuries, menstrual irregularity and disordered eating in junior elite athletics in the UK

The prevalence of injury in adolescent elite track and field competitors is high,1 however only one study has been conducted with UK athletes.2 Relative Energy Deficiency in Sport (RED-S), encapsulating the Female Athlete Triad, is a syndrome whereby decreased energy availability affects health and performance, potentially leading to an increased injury risk; particularly to bone (3). Calculating decreased energy availability is difficult, however identifying contributing factors, such as disordered eating and menstrual dysfunction, is more viable.3AimThis study was conducted to identify the prevalence of musculoskeletal injury, disordered eating and menstrual dysfunction in elite junior UK track and field athletes.MethodData was collected from track and field athletes ranked within the top 10 of the UK U17 rankings in 2017 or 2018, with 138 athletes participating. Participants completed a self-reported musculoskeletal injury, disordered eating and menstrual dysfunction questionnaire relating to a 12-month time period.ResultsThis study found a 12-month retrospective injury prevalence of 43.5%. 13% of participants presented with disordered eating, whilst 37.7% of female participants presented with menstrual dysfunction. There was a statistically significant difference in injury prevalence according to gender, with more male athletes sustaining an injury compared with female athletes. No differences in injury prevalence were noted according to event group, menstrual dysfunction or disordered eating. The anatomical location displaying the highest prevalence of injury was the ankle and foot (22.5%). The anatomical structure displaying the highest 12-month injury prevalence was muscle (43.6%), followed by bone (30.9%). Additionally, 21.7% of respondents reported having previously sustained a stress fracture prior to taking part in this study.ConclusionThere is a high prevalence of injuries in junior UK track and field athletes, with most injuries affecting the lower limb. Although there was no difference noted in injury risk for athletes with menstrual dysfunction or disordered eating, the prevalence of bone injuries was alarmingly high. This study indicates the requirement for future research investigating RED-S within this population.ReferenceZemper, E. Track andField Injuries. In: Caine DJ, Maffulli N. (eds). Epidemiology of Pediatric Sports Injuries. Individual Sports. Med Sport Science: Volume 48. Basel, Karger; 2005. p. 138–151D’Souza D. Track and field athletics injuries - a one-year survey. British Journal of Sports Medicine 1994; 28 (3): 197–202.Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014; 48: 491–497.