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IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update

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Mountjoy, Margo, Sundgot-Borgen, Jorunn Kaiander, Burke, Louise M, Ackerman, Kathryn E, Blauwet, Cheri, Constantini, Naama, Lebrun, Constance, Lundy, Bronwen +6 more·2018·British Journal of Sports Medicine
DOI 10.1136/bjsports-2018-099193
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Abstract

In 2014, the IOC published a consensus statement entitled ‘Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)’. The syndrome of RED-S refers to ‘impaired physiological functioning caused by relative energy deficiency and includes, but is not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health’. The aetiological factor of this syndrome is low energy availability (LEA).1 The publication of the RED-S consensus statement stimulated activity in the field of Female Athlete Triad science, including some initial controversy2 3 followed by numerous scientific publications addressing: 1. The health parameters identified in the RED-S conceptual model (figure 1).1 4 2. Relative energy deficiency in male athletes. 3. The measurement of LEA. 4. The performance parameters identified in the RED-S conceptual model (figure 2).1 4 The IOC RED-S consensus authors have reconvened to provide an update summary of the interim scientific progress in the field of relative energy deficiency with the ultimate goal of stimulating advances in RED-S awareness, clinical application and scientific research to address current gaps in knowledge. Figure 1 Health consequences of Relative Energy Deficiency in Sport (RED-S) showing an expanded concept of the Female Athlete Triad to acknowledge a wider range of outcomes and the application to male athletes (*Psychological consequences can either precede RED-S or be the result of RED-S).1 4 Figure 2 Potential Performance consequences of Relative Energy Deficiency in Sport (*Aerobic and anerobic performance).1 4 ### Low energy availability LEA, which underpins the concept of RED-S, is a mismatch between an athlete’s energy intake (diet) and the energy expended in exercise, leaving inadequate energy to support the functions required by the body to maintain optimal health and performance. Operationally, energy availability (EA) is defined as: ![Formula][1] where exercise energy expenditure (EEE) is calculated as the additional energy expended above that of … [1]: /embed/mml-math-1.gif

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  • REDs is a syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and/or severe) low energy availability.

    “a syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and/or severe) low energy availability.”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [6]

    The Introduction defines RED-S as impaired physiological functioning caused by relative energy deficiency and identifies low energy availability as its cause. The Conclusions figure caption extends the concept to male athletes and says psychological consequences can be a result of RED-S. The copy does not define the causative exposure as specifically ‘problematic (prolonged and/or severe)’ low energy availability; the male-athlete section says the threshold and duration required to induce RED-S in men are unknown. Page numbers are unavailable in the indexed passages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • There have been numerous scientific advances in the field of REDs since the publication of the 2018 IOC consensus update statement.

    “As evidenced by this consensus statement, there have been numerous scientific advances in the field of REDs since the publication of the 2018 IOC consensus update statement 6”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [6]

    The Introduction and Conclusions report numerous scientific advances since the original 2014 IOC consensus statement. The cited 2018 update does not establish that advances occurred after its own publication, which is the timeframe the citing sentence attributes to it. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Low energy availability is more common in female athletes compared to male athletes.

    “LEA is more common in female athletes compared to male athletes [8].”

    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 [8]

    The section ‘Low energy availability in male athletes’ says that LEA prevalence ‘has been suggested to be higher in females than in males,’ but adds that ‘precise differences are unknown.’ The citing sentence presents that suggested difference as an established fact. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Although the 2014 and 2018 consensus statements alluded to the impact of LEA and REDs in male athletes, the available research on males at the time was scant.

    “Although the 2014 IOC REDs consensus statement 5 and the 2018 update paper 6 alluded to the impact of LEA and REDs in male athletes, the available research on males at the time was scant.”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [6]

  • There has been increased awareness of the risk factors for and consequences of REDs, where psychological factors contributing to LEA and mental health consequences have been highlighted, although less well understood.

    “A parallel focus has been the increased awareness of the risk factors for and the consequences of REDs, where psychological factors contributing to LEA and mental health consequences have been highlighted, 5 although less well understood.6 35 66”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [6]

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Authors
Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A. K., Meyer, N. L., Sherman, R. T., Tenforde, A. S., Klungland Torstveit, M., & Budgett, R.
Affiliations
  • McMaster University (CA)
  • Norwegian School of Sport Sciences (NO)
  • Boston Children's Hospital (US)
  • Brigham and Women's Hospital (US)
  • Hebrew University of Jerusalem (IL)
  • University of Alberta (CA)
  • University of Copenhagen (DK)
  • University of Colorado Colorado Springs (US)
  • Harvard University (US)
  • International Olympic Committee (CH)
Corresponding author
Mountjoy, Margo
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2018-05-17
Volume
52
Issue
11
Pages
687-697
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2018-099193
OpenAlex
W2803329575
Cited by
883
References
11
Citations by year
2026: 125 · 2025: 77 · 2024: 119 · 2023: 131 · 2022: 126 · 2021: 136 · 2020: 94 · 2019: 56 · 2018: 15 · 2017: 1 · 2016: 1
FWCI
88.43
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
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
relative energy deficiency in sport, low energy availability, female athlete triad, energy balance, exercise energy expenditure, menstrual function, bone health, immune function, protein synthesis, cardiovascular health, athletic performance, male athletes, energy intake
MeSH terms
Energy Intake, Energy Metabolism, Ethnicity, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Consensus, Malnutrition, Female Athlete Triad Syndrome, Sports Nutritional Physiological Phenomena

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