Prevalence of Surrogate Markers of Relative Energy Deficiency in Male Norwegian Olympic-Level Athletes
Open accessAbstract
The syndrome of Relative Energy Deficiency in Sport (RED-S) includes wide-ranging effects on physiological and psychological functioning, performance, and general health. However, RED-S is understudied among male athletes at the highest performance levels. This cross-sectional study aimed to investigate surrogate RED-S markers prevalence in Norwegian male Olympic-level athletes. Athletes (n = 44) aged 24.7 ± 3.8 years, body mass 81.3 ± 15.9 kg, body fat 13.7% ± 5.8%, and training volume 76.1 ± 22.9 hr/month were included. Assessed parameters included resting metabolic rate (RMR), body composition, and bone mineral density by dual-energy X-ray absorptiometry and venous blood variables (testosterone, free triiodothyronine, cortisol, and lipids). Seven athletes (16%) grouped by the presence of low RMR (RMR ratio < 0.90) (0.81 ± 0.07 vs. 1.04 ± 0.09, p < .001, effect size 2.6), also showed lower testosterone (12.9 ± 5.3 vs. 19.0 ± 5.3 nmol/L, p = .020) than in normal RMR group. In low RMR ratio individuals, prevalence of other RED-S markers (—subclinical—low testosterone, low free triiodothyronine, high cortisol, and elevated low-density lipoprotein) was (N/number of markers): 2/0, 2/1, 2/2, 1/3. Low bone mineral density ( z -score < −1) was found in 16% of the athletes, all with normal RMR. Subclinical low testosterone and free triiodothyronine levels were found in nine (25%) and two (5%) athletes, respectively. Subclinical high cortisol was found in 23% of athletes while 34% had elevated low-density lipoprotein cholesterol levels. Seven of 12 athletes with two or more RED-S markers had normal RMR. In conclusion, this study found that multiple RED-S markers also exist in male Olympic-level athletes. This highlights the importance of regular screening of male elite athletes, to ensure early detection and treatment of RED-S.
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37% of elite and pre-elite female athletes demonstrated two or more symptoms of RED-S, compared to 15.9% of male athletes.
“37% of elite and pre-elite female athletes demonstrated two or more symptoms of RED-S, compared to 15.9% of male athletes [19,20].”
From Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review (2023) · cites this paper as [19]
The RED-S criteria section (p. 6) reports that 7 of 44 male athletes (16%) had exactly two criteria, while another five had three or four. Thus 12 of 44 (27%) had two or more, not 15.9%. The study examined male athletes and provides no 37% figure for female athletes. (LLM, conf=0.88)
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Experimental — accuracy not yet measured80% of elite and pre-elite female athletes have at least one symptom of RED-S, compared with 47.7% of male Olympic-level athletes.
“80% of elite and pre-elite female athletes have at least one symptom of RED-S, compared with 47.7% of male Olympic-level athletes [19,20].”
From Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review (2023) · cites this paper as [19]
The RED-S criteria section (p. 6) reports surrogate markers in 44 male Olympic-level athletes, supporting the population and the presence of RED-S-related signs. It groups 32 athletes as having either zero or one criterion, however, so our copy does not establish that 47.7% had at least one. The female-athlete figure is not judged against this male-athlete study because the sentence carries another citation. (LLM, conf=0.82)
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- Authors
- Stenqvist, T. B., Melin, A. K., Garthe, I., Slater, G., Paulsen, G., Iraki, J., Areta, J., & Torstveit, M. K.
- Affiliations
- University of Agder (NO)
- Linnaeus University (SE)
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
- University of the Sunshine Coast (AU)
- Norwegian School of Sport Sciences (NO)
- Iraki Nutrition, Fjerdingby, Norway
- Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- ORCID
- Venue
- International Journal of Sport Nutrition and Exercise Metabolism
- Publisher
- Human Kinetics
- Published
- 2021-11-01
- Volume
- 31
- Issue
- 6
- Pages
- 497-506
- ISSN
- 1526-484X (ISSN-L)
- 1543-2742
- OpenAlex
- W3198744889
- Cited by
- 30
- References
- 8
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 6 · 2023: 9 · 2022: 1 · 2021: 3
- FWCI
- 4.69
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- International Journal of Sport Nutrition and Exercise Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Liverpool John Moores University (acceptedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- relative energy deficiency in sport, male athletes, Olympic athletes, resting metabolic rate, testosterone, free triiodothyronine, cortisol, LDL cholesterol, bone mineral density, body composition, elite athletes
- MeSH terms
- Relative Energy Deficiency in Sport, Adult, Body Composition, Cross-Sectional Studies, Humans, Male, Biomarkers, Prevalence, Young Adult, Athletes
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