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Cited by 75Eating Disorders and BehaviorsSports Performance and TrainingLower Extremity Biomechanics and Pathologies

Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis

Open access
Gallant, Tara L., Ong, Lauren F., Wong, Laura, Sparks, Michael, Wilson, Ethan, Puglisi, Jose L., Gerriets, Valerie A.·2025·Sports Medicine
DOI 10.1007/s40279-024-02130-0
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Abstract

Introduction Low energy availability (LEA) occurs when energy expenditure from athletic training and bodily functions exceeds caloric intake. This imbalance results in declines in athletic performance and increases the risk of injury. Relative energy deficiency in sport (REDs) is a condition that occurs when the energy deficit is severe enough to cause alterations to metabolic rate, menstrual function, immune function, bone health, protein synthesis, and cardiovascular function. Many athletes, particularly those competing in endurance, aesthetic, or weight-class sports, are adversely impacted by this condition. Objectives This study aims to determine the prevalence of LEA and REDs among athletes and present the first secondary analysis of the impacts of these phenomena on sports performance and risk of injury. Methods This systematic review was registered on PROSPERO (CRD42023469253). Literature searches were performed following PRISMA guidelines using PubMed, Embase, and Cochrane online databases. Inclusion criteria were articles discussing the prevalence of LEA or REDs, the impact of LEA or REDs on athletic performance, or the impact of LEA or REDs EA on injury. Results A total of 59 studies met the inclusion criteria for this meta-analysis, and 2737 of 6118 athletes (44.7%) in 46 different studies were determined to have LEA, including 44.2% of female athletes and 49.4% of male athletes. In addition, 460 of 730 athletes (63.0%) in eight different studies were determined to be at risk of REDs. Athletes with LEA were found to have decreased run performance, training response, endurance performance, coordination, concentration, judgment, explosive power, and agility relative to athletes with normal energy availability, as well as an increased likelihood of absence from training due to illness. Studies had mixed results as to whether LEA increased the risk of injury in general. However, most studies concluded that athletes with LEA have impaired bone health and a higher risk of bone stress injuries. Discussion To our knowledge, this is the first systematic review analyzing the impacts of LEA and REDs on athletic performance and risk of injury. Due to the high estimated prevalence of LEA among athletes, coaches may want to consider employing surveys such as the low energy availability in females questionnaire (LEAF-Q) to identify athletes at risk for LEA, as early identification and correction of LEA can prevent the development of symptoms of REDs, reduce the risk of impaired bone health and bone stress injuries, and help athletes optimize the performance benefits from their training.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis pooled 59 studies and estimated LEA prevalence at 45.10% (95% CI 40.60–49.70) among 6,118 athletes and REDs prevalence at 61.10% (95% CI 54.4–67.8) among 730 athletes. Athletes with LEA showed performance decrements and generally higher bone stress injury risk, though overall injury findings were mixed.

Key findings

  • LEA pooled prevalence was 45.10% (95% CI 40.60–49.70) from 46 studies and 6,118 athletes; 2,737/6,118 athletes (44.7%) were determined to have LEA. Sub-analyses found 44.2% in female athletes (1,826/4,134), 49.4% in male athletes (277/561), 48.9% in U.S. studies (822/1,682), and 43.4% in middle- or long-distance runners (483/1,113).
  • REDs pooled prevalence was 61.10% (95% CI 54.4–67.8) from 8 studies; the authors state this is likely an overestimate because REDs should not exceed LEA and REDs definitions varied across studies.
  • LEA was associated with decreased run performance, training response, endurance performance, coordination, concentration, judgment, explosive power, and agility, plus increased absence from training due to illness. Examples include Ackerman et al. odds ratios for decreased training response (OR 2.13, 95% CI 1.53–2.97), impaired judgment (OR 4.33, 95% CI 2.20–8.55), and Jurov et al. induced LEA reducing vertical jump by 1.5–4.4 cm (p = 0.001).
  • Most studies found higher bone stress injury rates with LEA, e.g. O’Leary et al. reported OR 3.62 (95% CI 2.07–6.49) for past-12-month bone stress injury and OR 2.08 (95% CI 1.66–2.59) for historical bone stress injury; however, some studies found no increased overall injury risk, such as Ackerman et al. (OR 1.12, 95% CI 0.87–1.45, p = 0.39).

Methods

  • PRISMA and PICOTS framework; registered on Prospero (CRD42023469253). Searched Embase, PubMed, and Cochrane from inception to October 3, 2023, using terms ["relative energy deficiency" OR "low energy availability"] AND ["sport" OR "athlete"]; 3,242 records were identified, 1,735 duplicates removed, 1,507 title-screened, 148 full-text assessed, and 59 studies included.
  • Included primary studies assessing LEA/REDs prevalence, impact on athletic performance, and/or impact on injury in athletes of any age or sex; exclusions included non-human studies, conference abstracts, non-primary studies, no full text, and non-English articles.
  • Data extraction was independent; risk of bias assessed with ROBINS-I. Pooled prevalence used a random-effects model, with heterogeneity assessed by I², τ², and Q; sensitivity analyses excluded high-risk-of-bias studies. LEA meta-analysis had Q = 499.10, I² = 91.38, τ² = 0.0186; REDs meta-analysis had Q = 29.86, I² = 72.4, τ² = 0.002.

Limitations

  • Stated by the authors: LEA definitions were consistent but relied on self-report methods that are imperfect and may overestimate LEA; high heterogeneity was present (Q = 499.10, I² = 91.38). REDs prevalence was based on only 8 studies with variable definitions, likely making it less accurate and possibly overestimated; no REDs prevalence studies were conducted in the United States.
  • Stated by the authors: the LEAF-Q is designed for female athletes, so a male-specific survey is needed; standardized REDs definitions and screening protocols are lacking.
  • Evident from the text: most included studies were cross-sectional or observational, so causal relationships between LEA/REDs and performance or injury outcomes cannot be established; many studies had small samples and diverse sport populations, contributing to heterogeneity.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s40279-024-02130-0

Cites

91 of 91 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

37 of 71 cited sources checked · 12 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    LEA sets the stage for the Female Athlete Triad and Relative Energy Deficiency in Sport.

    “It is important to understand and identify LEA because it sets the stage for the Female Athlete Triad (FAT) and Relative Energy Deficiency in Sport (REDs) [5].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Logue DM, Madigan SM, Melin A, et al. Low energy availability in athletes 2020: an updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients. 2020;12(3):835. https://doi.org/10.3390/nu12030835. source
  • Findingcitation

    Regression analysis showed that change in run performance was directly correlated to change in energy intake (R = 0.61, p = 0.017).

    “Regression analysis showed that change in run performance was directly correlated to change in energy intake (Correlation coefficient (R) = 0.61, p = 0.017), suggesting that runners who increased their energy intake sufficiently saw performance improvements, whereas those who did not fuel properly saw declining run performance [78].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [78] Schaal K, VanLoan MD, Hausswirth C, Casazza GA. Decreased energy availability during training overload is associated with non-functional overreaching and suppressed ovarian function in female runners. Appl Physiol Nutr Metab. 2021;46(10):1179–88. https://doi.org/10.1139/apnm-2020-0880. source

      The Energy Variables section reports a direct correlation between change in running performance and change in energy intake, but gives it as R = 0.59, P = 0.021. The cited R = 0.61, P = 0.017 instead belongs to the correlation with energy availability. No page number is provided in our copy. (LLM, conf=0.94)

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  • Findingcitation

    Schaal et al. found female runners who did not adequately increase energy intake commensurate with an increase in training load (up to 130% of baseline) over 4 weeks had decreased run performance of ≥1.8% below baseline at the end of 4 weeks and after a 2-week recovery period.

    “Schaal et al. found that female runners who did not adequately increase their energy intake commensurate with an increase in training load (up to 130% of baseline training volume) over a 4-week period had decreased run performance of ≥ 1.8% below baseline both at the end of the 4 weeks and following a subsequent 2-week recovery period (down to 50% of baseline training volume).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [78] Schaal K, VanLoan MD, Hausswirth C, Casazza GA. Decreased energy availability during training overload is associated with non-functional overreaching and suppressed ovarian function in female runners. Appl Physiol Nutr Metab. 2021;46(10):1179–88. https://doi.org/10.1139/apnm-2020-0880. source
  • Premisecitation

    Being in a state of relative energy deficiency can predispose athletes to developing anxiety, depression, or other mental illnesses even without a history of psychological problems.

    “Even in those without a history of psychological problems, being in a state of relative energy deficiency can predispose athletes to developing anxiety, depression, or other mental illnesses [17,18].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [17] Langbein RK, Martin D, Allen-Collinson J, Crust L, Jackman PC. “I’d got self-destruction down to a fine art”: a qualitative exploration of relative energy deficiency in sport (RED-S) in endurance athletes. J Sports Sci. 2021. https://doi.org/10.1080/02640414.2021.1883312. source
    • cites [18] Conviser JH, Tierney AS, Nickols R. Essentials for best practice: treatment approaches for athletes with eating disorders. J Clin Sport Psychol. 2018;12(4):495–507. https://doi.org/10.1123/jcsp.2018-0013. source

      Clinical Treatment Implications (page unavailable) says prolonged energy deficiency in athletes with eating disorders can have far-reaching health consequences. Adjusting Physical Activity (page unavailable) describes emotional dysregulation and anxiety in the context of eating disorders, overtraining, or recovery. It does not establish that relative energy deficiency itself predisposes athletes without prior psychological problems to develop anxiety, depression, or other mental illnesses. (LLM, conf=0.78)

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  • Findingcitation

    Jurov et al. first study found no measurable differences in VO2 max, peak power output, relative power output, or anaerobic threshold between well-trained male athletes with and without LEA.

    “In their first study (n = 12), there were no measurable differences in VO2 max, peak power output, relative power output, or anaerobic threshold between well-trained male athletes with and without LEA [55].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [55] Jurov I, Keay N, Hadžić V, Spudić D, Rauter S. Relationship between energy availability, energy conservation and cognitive restraint with performance measures in male endurance athletes. J Int Soc Sports Nutr. 2021;18(1):24. https://doi.org/10.1186/s12970-021-00419-3. source

      The Discussion (‘What is the threshold for LEA?’; page unavailable) reports no differences in endurance performance between participants above and below 30 kcal/kg FFM/day. The Results list VO2max, peak power output, relative power output, and anaerobic threshold among the measured performance parameters. However, the paper cautions that 30 kcal/kg FFM/day may not be the LEA threshold for men, so it does not establish that the groups were definitively with and without LEA. (LLM, conf=0.84)

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  • May combine two claims. 34
  • Classified as probably not a substantial claim. 23

  • May combine two claims.

    Premisecitation

    Women with functional hypothalamic amenorrhea are at higher risk of bone stress injuries and may develop premature osteoporosis.

    “Because estrogen is important for bone health, women with functional hypothalamic amenorrhea are at higher risk of bone stress injuries and may even develop premature osteoporosis [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Popat VB, Calis KA, Vanderhoof VH, et al. Bone mineral density in estrogen-deficient young women. J Clin Endocrinol Metab. 2009;94(7):2277–83. https://doi.org/10.1210/jc.2008-1878. source

      The Abstract reports lower bone mineral density in young women with estrogen deficiency, but the study population had primary ovarian insufficiency, not functional hypothalamic amenorrhea. The Discussion links menstrual irregularity to later osteoporosis and fractures; it does not establish an increased risk of bone stress injuries specifically in women with functional hypothalamic amenorrhea. (LLM, conf=0.86)

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  • May combine two claims.

    Premisecitation

    Those scoring ≥8 of 49 possible points on the LEAF-Q are determined to be at heightened risk of LEA, and high scores are very common among female endurance athletes.

    “Those scoring ≥ 8 of 49 possible points are determined to be at a heightened risk of LEA, and high scores are very common among female endurance athletes [26].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [26] Sim A, Burns SF. Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. J Eat Disord. 2021;9(1):41. https://doi.org/10.1186/s40337-021-00396-7. source

      The Results section on the LEAF-Q states that a score of ≥8 out of 49 indicates LEA risk in female endurance athletes. It reports 44.1% Triad risk among female ultra-marathon athletes assessed with the LEAF-Q and another tool, but does not establish that high LEAF-Q scores themselves are very common among female endurance athletes generally. (LLM, conf=0.85)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2023, the International Olympic Committee estimated that the prevalence of REDs was between 15-80% among elite athletes.

    “For example, in 2023, the International Olympic Committee estimated that the prevalence of REDs was somewhere between 15-80% among elite athletes [29].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [29] Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on relative energy deficiency in sport (REDs). Br J Sports Med. 2023;57(17):1073–98. https://doi.org/10.1136/bjsports-2023-106994. source

      The consensus statement’s energy-availability section reports estimated prevalence ranges of 23%–79.5% in female athletes and 15%–70% in male athletes, which roughly explains the cited 15%–80% range. But those figures concern LEA/REDs indicators across a variety of sports, not diagnosed REDs specifically among elite athletes. The indexed passage provides no page number. (LLM, conf=0.88)

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  • May combine two claims.

    Premisecitation

    LEA and REDs lead to a decline in athletic performance in the long term because gradual reduction in body weight results in slower muscle glycogen synthesis, loss of muscle protein, and increased risk for stress fractures.

    “However, regardless of the potential for shortterm gains in athletic performance, LEA and REDs lead to a decline in athletic performance in the long term because gradual reduction in body weight results in slower muscle glycogen synthesis, loss of muscle protein, and increased risk for stress fractures [4,24].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [4] Coelho AR, Cardoso G, Brito ME, Gomes IN, Cascais MJ. The female athlete triad/relative energy deficiency in sports (RED-S). Rev Bras Ginecol Obstet. 2021;43(5):395–402. https://doi.org/10.1055/s-0041-1730289. source

      The “Other Consequences” section (page not provided) links low energy availability to impaired recovery, changes in muscle mass and function, and interference with glycogen reserves and protein synthesis, but says evidence for a measured performance decline is scarce. “Bone Metabolism” reports a higher fracture risk. The paper does not establish that gradual weight loss causes these effects or that athletic performance necessarily declines in the long term. (LLM, conf=0.86)

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    • cites [24] Fogelholm M. Effects of bodyweight reduction on sports performance. Sports Med. 1994;18(4):249–67. https://doi.org/10.2165/00007256-199418040-00004. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    LEA and REDs are considered to be most prevalent in endurance, aesthetic, and weight-class sports.

    “Similarly to eating disorders, LEA and REDs are considered to be most prevalent in endurance, aesthetic, and weight-class sports [1].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Vardardottir B, Gudmundsdottir SL, Olafsdottir AS. Health and performance consequences of relative energy deficiency in sport (RED-s). Laeknabladid. 2020;106(9):406–13. https://doi.org/10.17992/lbl.2020.09.596. source

      The Introduction (Inngangur; page unavailable) says RED-s prevalence varies by sport and that risk is thought highest in endurance, aesthetic, and weight-class sports. The paper defines RED-s as consequences of low energy availability, but the cited passages do not separately establish that low energy availability itself is most prevalent in those sports. (LLM, conf=0.84)

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  • May combine two claims.

    Premisecitation

    Hypogonadism can occur in males who have REDs, resulting in decreased levels of testosterone and luteinizing hormone.

    “For instance, hypogonadism, defined as decreased function of the testes, can occur in males who have REDs, resulting in decreased levels of testosterone and luteinizing hormone [11].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] Kumar P, Kumar N, Thakur DS, Patidar A. Male hypogonadism: symptoms and treatment. J Adv Pharm Technol Res. 2010;1(3):297–301. https://doi.org/10.4103/0110-5558.72420. source

      The Introduction defines male hypogonadism as reduced gonadal function with testosterone deficiency. The Classification section associates excessive physical activity and weight loss with hypogonadism, but the paper does not specifically discuss REDs or report decreased luteinizing hormone in males with REDs. (LLM, conf=0.86)

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    This study follows PRISMA guidelines and uses the PICOTS framework.

    “This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and uses the Population, Intervention, Comparator, Outcomes, Timing, and Study Design (PICOTS) framework, as shown in Table 1 [30].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [30] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. https://doi.org/10.1136/bmj.n71. source

      The Abstract identifies this paper as the PRISMA 2020 reporting guideline, supporting the PRISMA part of the citation. The passages retrieved for “PICOTS” and its expanded terms do not identify or describe a PICOTS framework, so the source does not support that part of the sentence. The source also cannot verify whether the citing study actually followed either framework. (LLM, conf=0.86)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    REDs offers a broader diagnostic lens for identifying possible symptoms and signs of LEA in athletes than prior definitions.

    “Thus, REDs offers a broader diagnostic lens for identifying possible symptoms and signs of LEA in athletes than prior definitions [9].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] Cabre H, Moore S, Smith-Ryan A, Hackney A. Relative energy deficiency in sport (RED-S): scientific, clinical, and practical implications for the female athlete. Dtsch Z Sportmed. 2022;73(7):225–34. https://doi.org/10.5960/dzsm.2022.546. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Two independent reviewers employed the ROBINS-I tool to appraise the quality of the included studies.

    “Two independent reviewers employed the Risk Of Bias In Non-Randomized Studies -of Interventions (ROBINS-I) tool to appraise the quality of the included studies [31].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355: i4919. https://doi.org/10.1136/bmj.i4919. source

  • May combine two claims.

    Premisecitation

    Changes in leptin, ghrelin, peptide YY, insulin, and increased cortisol negatively impact GnRH secretion, resulting in functional hypothalamic amenorrhea in females.

    “Changes in these four hormones, as well as increased cortisol levels in response to bodily stress, all negatively impact gonadotropin-releasing hormone (GnRH) secretion, resulting in functional hypothalamic amenorrhea in females [4,12].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [4] Coelho AR, Cardoso G, Brito ME, Gomes IN, Cascais MJ. The female athlete triad/relative energy deficiency in sports (RED-S). Rev Bras Ginecol Obstet. 2021;43(5):395–402. https://doi.org/10.1055/s-0041-1730289. source
    • cites [12] Sophie Gibson ME, Fleming N, Zuijdwijk C, Dumont T. Where have the periods gone? The evaluation and management of functional hypothalamic amenorrhea. J Clin Res Pediatr Endocrinol. 2020;12(Suppl 1):18–27. https://doi.org/10.4274/jcrpe.galenos.2019.2019.S0178. source

      The Pathophysiology section reports altered leptin, ghrelin, peptide YY, and insulin levels in patients with FHA, increased cortisol, and suppressed GnRH secretion. It hypothesizes that stress-related CRH suppresses GnRH pulsatility, but does not say that cortisol or each of the four metabolic hormones directly suppresses GnRH and thereby causes FHA. Page numbers are not available in our copy. (LLM, conf=0.88)

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  • May combine two claims.

    Findingcitation

    Jurov et al. subsequent study found a significant decrease in explosive power, with reduced vertical jump performance by 1.5-4.4 cm (p = 0.001).

    “However, they did find a significant decrease in explosive power, as athletes had reduced vertical jump performance by 1.5-4.4cm (p = 0.001) [84].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [84] Jurov I, Keay N, Spudić D, Rauter S. Inducing low energy availability in trained endurance male athletes results in poorer explosive power. Eur J Appl Physiol. 2022;122(2):503–13. https://doi.org/10.1007/s00421-021-04857-4. source

  • May combine two claims.

    Premisecitation

    An immediate boost in performance with decreased body weight is far from guaranteed, and athletes may experience performance stagnation, fatigue-related injuries, or gastrointestinal problems with even short-term LEA.

    “However, an immediate boost in performance with decreased body weight is far from guaranteed, and athletes may experience performance stagnation, fatigue-related injuries, or gastrointestinal problems with even short-term LEA [89].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [89] Cupka M, Sedliak M. Hungry runners—low energy availability in male endurance athletes and its impact on performance and testosterone: mini-review. Eur J Transl Myol. 2023. https://doi.org/10.4081/ejtm.2023.11104. source

      The Final considerations section (page unavailable) describes a trade-off between lower body weight and LEA and lists performance stagnation, fatigue fractures, and digestive problems as possible manifestations. The Energy availability and endurance performance in males section reports worsened performance after four weeks of reduced energy supply. The copy does not establish that fatigue fractures or digestive problems can occur with even short-term LEA. (LLM, conf=0.86)

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  • May combine two claims.

    Premisecitation

    Low energy availability can be detrimental to athletes, as insufficient caloric intake leads to decreased aerobic and anaerobic performance, poor muscle regeneration, and higher injury incidence leading to missed training.

    “Low energy availability can be detrimental to athletes, as insufficient caloric intake leads to decreased aerobic and anaerobic performance, poor muscle regeneration, and higher injury incidence leading to missed training [89].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [89] Cupka M, Sedliak M. Hungry runners—low energy availability in male endurance athletes and its impact on performance and testosterone: mini-review. Eur J Transl Myol. 2023. https://doi.org/10.4081/ejtm.2023.11104. source

      The “Energy availability and endurance performance in males” section (page unavailable) reports decreased aerobic and anaerobic performance in cyclists, worsened regeneration in rowers, and increased injury risk with low energy availability. It also reports more missed training among athletes at risk of low energy availability, but describes that training loss as disease-related, not injury-related. The cited passage does not specifically establish poor muscle regeneration. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Gillbanks et al. found 91.7% of 12 lightweight rowers with REDs reported a history of musculoskeletal pain and injuries, and 83.3% had a history of recurrent injuries, including rib stress fractures, intervertebral disc extrusions, joint pain, and wrist/ankle injuries.

    “Finally, in Gillbanks et al.'s descriptive study of 12 lightweight rowers with REDs, 91.7% reported a history of musculoskeletal pain and injuries, and 83.3% had a history of recurrent injuries, including rib stress fractures, intervertebral disc extrusions, joint pain, and wrist/ankle injuries [83].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [83] Gillbanks L, Mountjoy M, Filbay SR. Lightweight rowers’ perspectives of living with relative energy deficiency in sport (RED-S). PLoS ONE. 2022;17(3): e0265268. https://doi.org/10.1371/journal.pone.0265268. source

  • May combine two claims.

    Findingcitation

    Two studies on cheerleaders (n = 19) and young athletic males (n = 14) found that no athletes had low BMD, although the majority of subjects in both studies had LEA.

    “Two of the studies on cheerleaders (n = 19) [33] and young athletic males (n = 14) [34] found that no athletes had low BMD, although the majority of subjects in both studies had LEA.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [33] Smith AB, Gay JL, Arent SM, Sarzynski MA, Emerson DM, Torres-McGehee TM. Examination of the prevalence of female athlete triad components among competitive cheerleaders. Int J Environ Res Public Health. 2022. https://doi.org/10.3390/ijerph19031375. source
    • cites [34] Moore EM, Drenowatz C, Stodden DF, et al. Examination of athlete triad symptoms among endurance-trained male athletes: a field study. Front Nutr. 2021;8: 737777. https://doi.org/10.3389/fnut.2021.737777. source

  • May combine two claims.

    Findingcitation

    Gillbanks et al. found 83.3% of twelve lightweight rowers with REDs reported disrupted sleep and fatigue, and 100% had objectively decreased performance and impaired recovery.

    “In Gillbanks et al.'s study of twelve lightweight rowers with REDs, 83.3% reported disrupted sleep and fatigue, and 100% had objectively decreased performance and impaired recovery [83].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [83] Gillbanks L, Mountjoy M, Filbay SR. Lightweight rowers’ perspectives of living with relative energy deficiency in sport (RED-S). PLoS ONE. 2022;17(3): e0265268. https://doi.org/10.1371/journal.pone.0265268. source

      The Results (Physical implications; page not provided) say ten of twelve participants believed dieting disrupted their sleep and caused fatigue, and all reported decreased performance and impaired recovery. The study reports participants’ experiences; it does not say performance was objectively measured, so “objectively decreased” is unsupported. (LLM, conf=0.91)

      Experimental — accuracy not yet measured

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    Premisecitation

    Independent studies report variable rates of LEA and REDs among athletes, and the most recent IOC consensus statement in 2023 provided a wide range (15-80%) for the estimated prevalence of these conditions among elite athletes.

    “Independent studies report variable rates of LEA and REDs among athletes, and the most recent consensus statement from the International Olympic Committee in 2023 provided a wide range (15-80%) for the estimated prevalence of these conditions among elite athletes [29].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [29] Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on relative energy deficiency in sport (REDs). Br J Sports Med. 2023;57(17):1073–98. https://doi.org/10.1136/bjsports-2023-106994. source

      The Consensus statement section says prevalence studies of LEA and REDs have methodological limitations that hinder cross-study comparisons, supporting the general point that estimates vary. Our copy does not give a 15–80% prevalence range for LEA or REDs among elite athletes (searched for both endpoints and the range). No page number was provided for these passages. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Jurov et al. subsequent study induced LEA in 12 well-trained male athletes by decreasing energy availability by 25% relative to baseline over two weeks, and found no changes in VO2 max, peak power output, relative power output, or anaerobic threshold after 14 days.

    “In a subsequent study, Jurov et al. induced LEA in 12 well-trained male athletes with no prior evidence of LEA by decreasing energy availability by 25% relative to baseline over two weeks.Again, they found no changes in VO2 max, peak power output, relative power output, or anaerobic threshold after 14 days of induced LEA.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [84] Jurov I, Keay N, Spudić D, Rauter S. Inducing low energy availability in trained endurance male athletes results in poorer explosive power. Eur J Appl Physiol. 2022;122(2):503–13. https://doi.org/10.1007/s00421-021-04857-4. source

  • May combine two claims.

    Findingcitation

    Karlsson et al. found 41/85 (48%) female recreational runners experienced a sports injury in the previous year, but there was no statistically significant relationship between either LEA or eating disorders and overall injury rate.

    “In Karlsson et al.'s study of female recreational runners, they found that 41/85 (48%) athletes experienced a sports injury in the previous year, but there was no statistically significant relationship between either LEA or eating disorders and overall injury rate [51].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [51] Karlsson E, Alricsson M, Melin A. Symptoms of eating disorders and low energy availability in recreational active female runners. BMJ Open Sport Exerc Med. 2023;9(3): e001623. https://doi.org/10.1136/bmjsem-2023-001623. source

      The Results (Symptoms of LEA) report that 41 of 85 runners (48%) were absent or markedly limited by a sports injury in the previous year. The Discussion (Symptoms of EDs and LEA) says no association was found between sports injuries and symptoms of eating disorders, but it does not report the same finding for LEA and overall injury rate; it says injury responses could not conclusively be attributed to LEA. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Cognitive Behavioral Therapy (CBT) is an effective psychological treatment to address eating disorders, anxiety, and/or depression, while also helping the patient develop a healthy relationship with food and exercise.

    “Similarly, Cognitive Behavioral Therapy (CBT) is an effective psychological treatment to address eating disorders, anxiety, and/or depression, while also helping the patient develop a healthy relationship with food and exercise.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] Conviser JH, Tierney AS, Nickols R. Essentials for best practice: treatment approaches for athletes with eating disorders. J Clin Sport Psychol. 2018;12(4):495–507. https://doi.org/10.1123/jcsp.2018-0013. source

      The Evidence-Based Psychotherapy section identifies CBT as an evidence-based treatment for eating disorders and says behavioral therapies have strong support for related psychiatric disorders. It describes normalized eating as a treatment target, but does not specifically say CBT treats anxiety or depression or helps patients develop a healthy relationship with exercise; the Adjusting Physical Activity section assigns exercise-related support to the multidisciplinary team. Page numbers are unavailable in our copy. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One study defined athletes as at risk of REDs if their LEAF-Q score was ≥ 8.

    “For example, one study stated that athletes were at risk of REDs if their LEAF-Q score was ≥ 8 [45].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] Civil R, Lamb A, Loosmore D, et al. Assessment of dietary intake, energy status, and factors associated with RED-S in vocational female ballet students. Front Nutr. 2018;5:136. https://doi.org/10.3389/fnut.2018.00136. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    None of the studies analyzing the prevalence of REDs were conducted in the United States.

    “None of the studies analyzing the prevalence of REDs were conducted in the United States.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    After duplicates were removed, 1,507 articles remained; 148 were selected for full-text analysis; 89 were excluded; 59 articles were included in the review.

    “After the articles were collected, 1,735 duplicates were removed, narrowing the list of articles to 1,507.These 1,507 articles were then assessed for eligibility based on title, and 148 studies were selected for full-text analysis to determine if they met inclusion criteria, as detailed in the following paragraph.”
    • Also stated in: § 2.1 Study Selection · plain
      “Of the 148 articles selected for full-text analysis based on title, 89 studies were excluded, and 59 articles were included in the review, as shown in Figure 1.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The search produced 996 articles from Pubmed, 1,997 from Embase, and 249 from Cochrane, for a total of 3,242.

    “This search produced 996 articles from Pubmed, 1,997 from Embase, and 249 from Cochrane, for a total of 3,242, as shown in Figure 1.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For LEA, the heterogeneity factor Q was 499.10, with I2 = 91.38 and τ2 = 0.0186.

    “The heterogeneity factor (Q) was 499.10, with I² = 91.38 and τ² = 0.0186.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Heikura et al. found male distance runners and race walkers had relative risk of all-time fractures 0.6 vs 0.7 vs 3.2 for low, moderate, and high-risk REDs groups, respectively; p = 0.021 low vs high, p = 0.039 moderate vs high.

    “• Males (n = 24): Relative risk of 0.6 vs. 0.7 vs. 3.2 for low, moderate, and high-risk of REDs groups, respectively; p = 0.021 low vs. high, p = 0.039 moderate vs. high”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. Int J Sport Nutr Exerc Metab. 2018;28(4):403–11. https://doi.org/10.1123/ijsnem.2017-0313. source

  • May combine two claims.

    Findingcitation

    Haines et al. found no difference in fracture incidence between runners vs controls, or between runners with low EA vs high EA.

    “No difference in fracture incidence between runners vs. controls, or between runners with low EA vs. high EA.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Haines MS, Kaur S, Scarff G, et al. male runners with lower energy availability have impaired skeletal integrity compared to nonathletes. J Clin Endocrinol Metab. 2023;108(10):e1063–73. https://doi.org/10.1210/clinem/dgad215. source

  • May combine two claims.

    Findingown data

    The REDs meta-analysis had substantial heterogeneity (Q = 29.86, I2 = 72.4%), though less pronounced than that observed for LEA.

    “The heterogeneity factor (Q = 29.86)and the I² value of 72.4% indicate substantial heterogeneity, though less pronounced than that observed for LEA.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For the pooled REDs prevalence estimate, heterogeneity was Q = 29.86, I2 = 72.4, and τ2 = 0.002.

    “The heterogeneity factor (Q) was 29.86, I² = 72.4 and τ² = 0.002.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For the pooled LEA prevalence estimate, heterogeneity was Q = 499.10, I2 = 91.38, and τ2 = 0.0186.

    “The heterogeneity factor (Q) was 499.10,I² = 91.38 and τ² = 0.0186.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Other studies required athletes to exhibit symptoms such as menstrual dysfunction, impaired bone health, endocrine dysfunction, metabolic dysfunction, hematological abnormalities, psychological decline, or cardiovascular dysfunction to meet the criteria for REDs.

    “Other studies stated that athletes must exhibit symptoms such as menstrual dysfunction, impaired bone health, endocrine dysfunction, metabolic dysfunction, hematological abnormalities, psychological decline, or cardiovascular dysfunction to meet the criteria for REDs [82].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] Rogers MA, Appaneal RN, Hughes D, et al. Prevalence of impaired physiological function consistent with relative energy deficiency in sport (RED-S): an Australian elite and pre-elite cohort. Br J Sports Med. 2021;55(1):38–45. https://doi.org/10.1136/bjsports-2019-101517. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Sensitivity analyses were performed to evaluate the robustness of the meta-analysis results by excluding studies with high risk of bias.

    “Sensitivity analyses were performed to evaluate the robustness of the meta-analysis results.These sensitivity analyses involved excluding studies with high risk of bias to determine if their inclusion significantly impacted the overall findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    REDs broadens the scope of physiological impacts described by FAT to include alterations in metabolic rate, menstrual function, immune function, bone health, protein synthesis, and cardiovascular function.

    “The term “REDs” broadens the scope of physiological impacts described by FAT to include alterations in metabolic rate, menstrual function, immune function, bone health, protein synthesis, and cardiovascular function [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] 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). Br J Sports Med. 2014;48(7):491–7. https://doi.org/10.1136/bjsports-2014-093502. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    REDs is a condition that occurs when athletes do not consume enough calories to sustain daily energy expenditure and athletic training, resulting in a decline in athletic performance and bodily functions.

    “REDs is a condition that occurs when athletes do not consume enough calories to sustain their daily energy expenditure and athletic training, which results in a decline in athletic performance and bodily functions [8].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Barker J. Relative energy deficiency in sport (RED-S): when athletes run on empty. Boston Children’s Hospital. Published February 16, 2022. https://answers.childrenshospital.org/relative-energy-deficiency-red-s/. Accessed 27 May 2024.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Psychological symptoms are very common in athletes with REDs, including fatigue, mood changes, irritability, and elevated anxiety.

    “In addition to the physiological impacts of underfueling, psychological symptoms are very common in athletes with REDs.These psychological effects can include, but are not limited to, fatigue, mood changes, irritability, and elevated anxiety [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Pensgaard AM, Sundgot-Borgen J, Edwards C, Jacobsen AU, Mountjoy M. Intersection of mental health issues and relative energy deficiency in sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med. 2023;57(17):1127–35. https://doi.org/10.1136/bjsports-2023-106867. source

  • Classified as probably not a substantial claim.

    Interpretationnone given

    This study presents the first secondary analysis of the prevalence of LEA and REDs and the impacts of low energy availability on sports performance and injury risk.

    “To our knowledge, we present the first secondary analysis of the prevalence of LEA and REDs and the impacts of low energy availability on sports performance and injury risk.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning

    The name shift from FAT to REDs allows the term to describe the impacts of LEA on male athletes in addition to female athletes.

    “Furthermore, the name shift from FAT to REDs allows this term to describe the impacts of LEA on male athletes in addition to their female counterparts.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The pooled prevalence rates of LEA and REDs were calculated using a random-effects model to account for variability among studies.

    “The pooled prevalence rates of LEA and REDs were calculated using a random-effects model to account for variability among studies.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Heterogeneity among the included studies was assessed using the I2 and τ2 statistics.

    “Heterogeneity among the included studies was assessed using the I² and τ² (tau squared) statistics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Two studies were excluded from analysis due to high risk of bias and significantly impacted statistical calculations.

    “Two studies were excluded from analysis due to high risk of bias and significantly impacted statistical calculations.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Out of the initial 3,242 articles, fifty-nine met the inclusion criteria for this systematic review with no overall high risk of bias.

    “Out of the initial 3,242 articles, fifty-nine met the inclusion criteria for this systematic review with no overall high risk of bias, as shown in Appendix S2.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Athletes with LEA may experience disruptions in metabolism, hormonal regulation, menstrual cycles, bone health, immune function, protein synthesis, the hematologic system, cardiovascular function, and growth and development.

    “Athletes with LEA may experience disruptions in metabolism, hormonal regulation, menstrual cycles, bone health, immune system function, protein synthesis, the hematologic system, cardiovascular function, and growth and development [1,[3][4].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1,[3][4]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Computer systematic literature searches were performed in Embase, Pubmed, and Cochrane databases from inception to October 3, 2023.

    “Computer systematic literature searches were performed in the Embase, Pubmed, and Cochrane databases from inception to October 3, 2023.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data extraction was performed independently utilizing a standardized extraction guide.

    “Data extraction was performed independently utilizing a standardized extraction guide with the following information collected: study characteristics, population demographics, study type, estimated prevalence of LEA or REDs (count and percentage), impact on athletic performance (performance outcome, count, and percentage), and impact on injury (injury type, count, and percentage).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No studies were excluded from the REDs analysis due to high risk of bias.

    “No studies were excluded from this analysis due to high risk of bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This study was registered on Prospero (CRD42023469253) prior to initiating the analysis.

    “In addition, this study was registered on Prospero (CRD42023469253) prior to initiating the analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The 61.10% overall effect size of REDs among 730 athletes in the meta-analysis is an overestimation, or the 45.10% overall effect size of LEA among 6,118 athletes may be an underestimation.

    “This suggests that the 61.10% overall size effect of REDs among 730 athletes studied in our meta-analysis is an overestimation, or, possibly, that the 45.10% overall size effect of LEA among 6,118 athletes may be an underestimation.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: REDs describes physiological dysfunctions resulting from LEA, and therefore the true prevalence of REDs should not be higher than the true prevalence of LEA.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Definitions of LEA were consistent across studies, as athletes were said to be at high risk of LEA if their LEAF-Q score was ≥8 or if their energy intake was <30 kcal/kg of fat-free mass.

    “However, it is important to note that, while definitions of LEA were consistent across studies, as athletes were said to be at high risk of LEA if their LEAF-Q score was ≥ 8 or if their energy intake was < 30 kcal/kg of fat-free mass, these reporting methods are not perfect, and this is one of the limitations of the meta-analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    While 44.7% is likely a reasonable estimate of the prevalence of LEA among athletes, it is possible that the true prevalence is lower or higher due to inaccurate self-reporting of caloric intake or exercise.

    “Thus, while 44.7% is likely a reasonable estimate of the prevalence of LEA among athletes, it is certainly possible that the true prevalence is lower or higher due to inaccurate self-reporting of caloric intake or exercise.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Because of variable definitions for REDs, it is difficult to accurately and precisely determine the true prevalence of REDs, and this is a limitation of the REDs portion of the meta-analysis.

    “Because of the variable definitions for REDs, it is difficult to accurately and precisely determine the true prevalence of REDs, and this is a limitation of the REDs portion of this meta-analysis.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Early identification and correction of LEA can prevent the development of symptoms of REDs, reduce the risk of impaired bone health and bone stress injuries, and help athletes gain the greatest performance benefits from their training.

    “Early identification and correction of LEA can prevent the development of symptoms of REDs, reduce the risk of impaired bone health and bone stress injuries, and help athletes gain the greatest performance benefits from their training.”
    Quote in the paperSubstantial claim
51 of 51

  • The paper relies on this without support.

    The included studies' prevalence estimates are sufficiently representative of athletes generally to allow pooled prevalence estimates to generalize to athletes.

    “Out of the 59 studies that met the inclusion criteria for our meta-analysis, 46 studies [28, analyzing the data of 6,118 athletes discussed the prevalence of low energy availability.”

  • The paper relies on this without support.

    The different definitions of REDs used across included studies are sufficiently comparable to pool into a single prevalence estimate.

    “Notably, these studies used different definitions of REDs when calculating its prevalence among their subjects.”

  • The paper relies on this without support.

    REDs describes physiological dysfunctions resulting from LEA, and therefore the true prevalence of REDs should not be higher than the true prevalence of LEA.

    “It is important to note that, because REDs describes physiological dysfunctions resulting from LEA, the true prevalence of REDs should not be higher than the true prevalence of LEA.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported female and male runner counts do not total the sample

    Minor

    The 83 female and 124 male participants total 207, rather than the stated 223 participants.

    Reported 223 · recomputed 207

  • Database search counts differ from the reported search results

    Minor

    The methods report 996 PubMed results and 1,997 Embase results, while the search details report 986 and 797, respectively, for the same search date.

  • Percentage of runners at risk for LEA does not match the count

    Minor

    The reported 133 of 223 runners is 59.6%, not 64.3%.

    Reported 64.3 · recomputed 59.641256

  • Claim of consistent LEA definitions conflicts with a listed study threshold

    Minor

    The discussion says the studies used a LEAF-Q score of at least 8 or energy intake below 30 kcal/kg to identify high LEA risk. The study summary also labels participants as having LEA using a threshold of 45 kcal/kg lean body mass.

  • LEA percentages conflict across nested energy-availability thresholds

    Minor

    Athletes below 30 kcal/kg FFM/day must also be below 45 kcal/kg FFM/day, yet the summary reports a larger percentage below 30 than below 45.

  • Fracture counts are described as relative risks

    Minor

    The bone-stress-injury summary calls the values 0.6, 0.7, and 3.2 relative risks, but the study appendix identifies those same values as mean numbers of all-time fractures.

  • Civil et al.'s REDs prevalence is reported as both 60% and 65%

    Minor

    The discussion gives a 60% REDs rate for Civil et al., whereas the summary of that study lists 65%.

7 of 7

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Hay PJ. Understanding bulimia. Aust Fam Physician. 2007;36(9):708–712, 731.
  2. Battista RA, Foster C, Davis J, Wright G. The female athlete triad in physically active college aged females. Gazzetta Medica Italiana Archivio per le Scienze Mediche. 2012;171(1):35–43.

Cited by

Sorted by citations

Related

Authors
Gallant, T. L., Ong, L. F., Wong, L., Sparks, M., Wilson, E., Puglisi, J. L., & Gerriets, V. A.
Affiliations
  • Dartmouth–Hitchcock Medical Center (US)
  • California Northstate University (US)
  • California State University, Chico (US)
Corresponding author
Gerriets, Valerie A.
ORCID
Venue
Sports Medicine
Publisher
Springer Science and Business Media LLC
Published
2024-11-01
Volume
55
Issue
2
Pages
325-339
ISSN
  • 0112-1642 (ISSN-L)
  • 1179-2035
DOI
10.1007/s40279-024-02130-0
OpenAlex
W4403985462
Cited by
75
References
90
Citations by year
2026: 50 · 2025: 25
FWCI
8.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords
low energy availability, relative energy deficiency in sport, athletes, prevalence, athletic performance, sports injury risk, bone stress injuries, bone health, menstrual function, LEAF-Q, energy balance, female athletes, endurance sports, weight-class sports, aesthetic sports, training response, sports nutrition, athlete mental health
MeSH terms
Relative Energy Deficiency in Sport, Athletic Injuries, Energy Intake, Energy Metabolism, Female, Humans, Prevalence, Athletic Performance, Athletes

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-13.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-13.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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