2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs)
Open accessAbstract
Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee’s expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
AI snapshot
Written from the paper’s full text.
TL;DR
This 2023 IOC consensus statement updates the 2018 REDs consensus, redefining Relative Energy Deficiency in Sport as a syndrome of impaired physiological and/or psychological functioning in female and male athletes caused by exposure to problematic (prolonged and/or severe) low energy availability. It introduces a novel REDs Physiological Model, an updated four-colour IOC REDs Clinical Assessment Tool-Version 2 (CAT2), and methodological guidelines for future research.
Key findings
- Since 2018 there have been ~178 REDs and/or LEA original research publications featuring ~23,822 participants (80% female), with ~62% cross-sectional, ~14% longitudinal observational and ~12% longitudinal intervention designs.
- Reported estimated prevalence of LEA/REDs indicators ranges widely: 23%–79.5% in female athletes and 15%–70% in male athletes across sports, attributed to lack of a singular definitive diagnosis and methodological variation.
- Six emerging themes are highlighted: (1) additive/magnifying impact of low carbohydrate availability (LCA) with LEA; (2) symptom overlap between REDs and overtraining syndrome (OTS); (3) time-course of biomarker responses; (4) mental health associations; (5) REDs in male athletes; and (6) para athletes.
- LCA studies show deleterious effects sometimes in the absence of LEA — e.g., a 3-day intervention in young females showed a 264% increase in hepcidin with a low energy, low CHO diet versus only 69% with isocaloric low energy but higher CHO; ~3.5 weeks of LCHF diet impaired bone remodelling markers.
- A universal LEA threshold of 30 kcal/kg FFM/day is debated; the threshold at which males experience REDs-related symptoms appears lower (e.g., ~9 to 25 kcal/kg FFM/day).
- In para athletes, among US para athletes preparing for Paralympic Games, 62% attempted to alter weight/body composition, 32% had elevated EDE-Q pathological behaviour subscale scores, and 44% of female athletes reported menstrual dysfunction.
Methods
- Consensus methodology used the RAND-UCLA Appropriateness Method (RAM) with a diverse expert panel (sports medicine physicians, sports endocrinologist, sports dietitians, physiologists, scientists, an athlete, a coach, a mental performance consultant; 10 females and 7 males from four continents).
- Working groups prepared referenced literature summaries and voting statements; these underwent online confidential Delphi voting, in-person discussion at the Olympic House in Lausanne (September 2022), and a second round of electronic voting.
- Agreement thresholds: agreement = ≥80% agreeing without any disagreement; agreement with minority disagreement = ≥80% agreeing but with one or more disagreeing; disagreement = <80% agreeing. Round 1 presented 135 statements (76 full agreement); round 2 presented 44 statements; overall 144 statements, of which 27 remained with minority disagreement.
Limitations
- The paper states there is no singular validated diagnostic method for REDs, requiring exclusion of other aetiologies in the differential diagnosis for each indicator; the IOC REDs CAT2 guidelines are "less reliable when it is impossible to assess all indicators" and are not to be used in isolation or solely for diagnosis.
- The paper notes the REDs education and behaviour modification research field is underdeveloped, and that specific REDs education programmes require further exploration and validation; time-course cut-offs for LEA require further scientific validation and may differ between males and females.
- The paper states that only 20% of original studies from 2018 to 2022 include male athletes, and that the picture remains unclear regarding mental health and DE behaviour dynamics by sex, level of competition, and in athletes with physical disabilities; the estimated prevalence of REDs in para athletes is unknown.
- Evident from the text: the consensus is based largely on cross-sectional studies with acknowledged limitations (lack of standardisation of recruitment and assessment protocols, poor characterisation of menstrual status, poor or non-existent assessment of EA), and the one cited 12-month intention-to-treat RCT had a high drop-out rate (57%).
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
68 of 152 cited sources checked · 28 supported · 0 flagged · accuracy not yet measured
- Premisecitation
Inadequate energy intake or an increased energy commitment to one biological process favours trade-offs that allocate energy away from other processes, especially growth, reproduction or maintenance.
“Inadequate EI or an increased energy commitment to one biological process favours trade-offs that allocate energy away from other processes, especially growth, reproduction or maintenance.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [32] Shirley, 2022, Life history perspective on athletes with low energy availability, Sports Med source
- Findingcitation
Six studies since 2019 have shown an energy-independent and/or magnifying impact of LCA in the accelerated development of REDs outcomes.
“Six studies since 2019 have shown an energy-independent and/or magnifying impact of LCA in the accelerated development of REDs outcomes.[52][53][54][55][56][57]”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [52] Hammond, 2019, Post-exercise carbohydrate and energy availability induce independent effects on Skeletal muscle cell signalling and bone turnover: implications for training adaptation, J Physiol source
The Bone metabolism results and Discussion (page unavailable) show that low carbohydrate availability affected an acute marker of bone resorption independently of overall energy availability. The paper does not establish accelerated development of RED-S outcomes: its Discussion says the acute study could not determine whether the regimen causes longer-term changes to bone. The claim about six studies belongs to the citing paper’s collective summary, not a finding this single source must establish. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [53] Fensham, 2022, Short-term carbohydrate restriction impairs bone formation at rest and during prolonged exercise to a greater degree than low energy availability, J Bone Miner Res source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [54] McKay, 2022, Six days of low carbohydrate, not energy availability, alters the iron and immune response to exercise in elite athletes, Med Sci Sports Exerc source
- Interpretationcitation
In the real world, the magnitude of LCA is likely to be even greater considering the emphasis on protein intake during periods of calorie restriction.
“In the real world, the magnitude of LCA is likely to be even greater considering the emphasis on protein intake during periods of calorie restriction.”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [49] source
- cites [50] Pardue, 2017, Case study: unfavorable but transient physiological changes during contest preparation in a drug-free male bodybuilder, Int J Sport Nutr Exerc Metab source
- cites [51] Hector, 2018, Protein recommendations for weight loss in elite athletes: a focus on body composition and performance, Int J Sport Nutr Exerc Metab source
- Premisecitation
In the real world, athletes experience exposure to LEA (purposefully or inadvertently) in various manners along the continuum from adaptable to problematic.
“In the real world, athletes experience exposure to LEA (purposefully or inadvertently) in various manners along the continuum from adaptable to problematic.”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [3] Areta, 2021, Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males, Eur J Appl Physiol source
The Introduction describes athletes at risk of chronic LEA, while Perspectives and future research describes substantial day-to-day variation in free-living athletes and proposes periodising energy availability for weight loss while maintaining health and performance. The paper also contrasts limited effects of short exposure with possible harms of prolonged LEA. These passages support varied exposure and outcomes, but do not establish that athletes encounter LEA both purposefully and inadvertently or define an adaptable-to-problematic continuum. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [40] Heikura, 2022, Low energy availability in female athletes: from the lab to the field, Eur J Sport Sci source
The Figure 2 legend describes several ways athletes may experience LEA in real-world settings, and the Introduction describes a continuum from health to disease. Our copy does not say whether exposure is purposeful or inadvertent, or specifically describe an adaptable-to-problematic continuum. (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Findingcitation
A 3-day intervention in young females showed a 264% increase in hepcidin with a low energy, low CHO diet compared with a 69% increase with isocaloric low energy but higher CHO diet.
“More recently, a 3-day intervention in young females also showed a 264% increase in hepcidin with a low energy, low CHO diet compared with only a 69% increase in hepcidin with isocaloric low energy but higher CHO diet.55”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [55] Hayashi, 2022, Influence of an energy deficient and low carbohydrate acute dietary manipulation on iron regulation in young females, Physiol Rep source
- Premisecitation
Many forms of performance pressure contribute to scenarios that either intentionally or unintentionally alter energy intake and exercise energy expenditure, resulting in low energy availability.
“Many forms of performance pressure contribute to scenarios that either, intentionally or unintentionally, alter energy intake (EI) and exercise energy expenditure (EEE), resulting in low energy availability (LEA).”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [2] source
- cites [3] Areta, 2021, Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males, Eur J Appl Physiol source
The Introduction explains that insufficient dietary intake combined with the energy demands of sport and exercise can produce low energy availability. The energy-availability section also identifies energy intake and exercise energy expenditure as its components. Our copy does not establish the claimed role of performance pressure or distinguish intentional from unintentional changes. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [4] Loucks AB . Chapter 5: energy balance and energy availability. In: Maughan R , ed. The encyclopaedia of sports medicine. New Jersey, USA: John Wiley & Sons Ltd, 2013. doi:10.1002/9781118692318 source
- Premisecitation
Humans, like other animals, are adapted to cope with periods of LEA by downregulating biological processes that are temporarily unnecessary or reducible.
“Therefore, humans, like other animals, are adapted to cope with periods of LEA by downregulating biological processes that are temporarily unnecessary or reducible.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [32] Shirley, 2022, Life history perspective on athletes with low energy availability, Sports Med source
- Findingcitation
There is a wide range in the reported estimated prevalence of LEA/REDs indicators in female (23%-79.5%) and male (15%-70%) athletes across a variety of sports.
“There is a wide range in the reported estimated prevalence of LEA/REDs indicators in female (23%-79.5% [7][8][9][10][11][12][13][14][15][16] ) and male (15%-70% [12][13][14][15][16][17][18][19][20] ) athletes across a variety of sports”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [7] Condo, 2019, Nutritional intake, sports nutrition knowledge and energy availability in female Australian rules football players, Nutrients source
The Results report that 8 of 27 female Australian rules football players (30%) screened as at risk of low energy availability, a figure within the cited female range. The Introduction also reports a 33–46% range from other female-athlete studies. This paper does not establish the claimed 23%–79.5% range or provide prevalence estimates for male athletes. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites [8] source
- cites [9] Staal, 2018, Low RMRRatio as a Surrogate marker for energy deficiency, the choice of predictive equation vital for correctly identifying male and female ballet dancers at risk, Int J Sport Nutr Exerc Metab source
- Premisecitation
Endurance sports (often more than 30 hours of training per week) can sometimes result in extreme exercise energy expenditure that exceeds the capacity of the human alimentary tract for sustained energy absorption.
“This is especially the case in endurance sports (often >30 hours of training/week), 37 which can sometimes result in extreme EEE that exceeds the capacity of the human alimentary tract for sustained energy absorption.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [37] Stellingwerff, 2021, Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S): shared pathways, symptoms and complexities, Sports Med source
- cites [38] source
The Discussion reports that endurance-event energy expenditure above roughly 2.5× basal metabolic rate cannot be met by additional intake and instead draws on energy stores, consistent with an alimentary limit that cannot be exceeded indefinitely. The paper does not establish that endurance sports often involve more than 30 hours of training per week. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingcitation
Another study of EA estimates in wheelchair athletes reported that nearly the entire cohort fulfilled criteria of LEA across at least one 24-hour period during the week-long study.
“Another study of EA estimates in wheelchair athletes reported that nearly the entire cohort fulfilled criteria of LEA across at least one 24-hour period during the week-long study.114”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [114] Egger, 2020, Energy availability in male and female elite wheelchair athletes over seven consecutive training days, Nutrients source
The Results (section 3; page unavailable) report LEA on 73% of analyzed days for female athletes and 30% for male athletes during the seven-day study. The paper does not state that nearly all 14 athletes had at least one day of LEA. Its conclusion that 13 of 14 had suboptimal EA concerns a different threshold and does not establish the claimed count. (LLM, conf=0.86)
Experimental — accuracy not yet measured
- Findingcitation
The presence of central neurological injury may result in alterations of the HPG axis and baseline menstrual function, regardless of energy status.
“Additionally, the presence of central neurological injury may result in alterations of the HPG axis and baseline menstrual function, regardless of energy status.116 117”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [116] Colantonio, 2010, Women’s health outcomes after traumatic brain injury, J Womens Health (Larchmt) source
The discussion (p. 1112) says traumatic brain injury can lead to hypopituitarism and that associated low sex-hormone levels can cause amenorrhea and other menstrual disorders. The Reproductive health results also report more amenorrhea and irregular cycles among women with TBI than controls. The paper does not establish that these changes occur regardless of energy status, or directly measure HPG-axis changes. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [117] Ripley, 2008, The impact of female reproductive function on outcomes after traumatic brain injury, Arch Phys Med Rehabil source
- Interpretationcitation
Our scientific understanding of the time-course of LEA leading to validated signs/symptoms is still emerging, largely due to difficulties in accurately assessing and controlling for EA in prospective research.
“Our scientific understanding of the time-course of LEA leading to validated physiological and psychological signs/symptoms are still emerging, largely due to difficulties in accurately assessing and controlling for EA in prospective research.21”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [21] Ackerman KE , Rogers MA , Heikura IA , et al . Methodology for studying relative energy deficiency in sport (REDs): a narrative review by a sub-group of the IOC consensus on REDs. Br J Sports Med bjsports-2023-107359 [Preprint] 2023. source
- Findingcitation
There is evidence that most males can sustain a lower EA before physiological and psychological disturbances manifest.
“Indeed, there is evidence that most males can sustain a lower EA before physiological and psychological disturbances manifest.”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [17] Lane, 2019, Prevalence of low energy availability in competitively trained male endurance athletes, Medicina (Kaunas) source
Section 4.2 suggests that men may require a greater reduction in energy availability before dysfunction occurs, but says the appropriate male thresholds remain unknown. It does not establish that most males can sustain a lower level, or assess when psychological disturbances manifest. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [46] Koehler, 2016, Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones, J Sports Sci source
- cites [72] Langan-Evans, 2021, The psychological and physiological consequences of low energy availability in a male combat sport athlete, Med Sci Sports Exerc source
The discussion (Changes in Anthropometric Measurements; page not provided) reports that one male athlete maintained physiological function and mood during seven weeks of fluctuating energy availability averaging 20 kcal·kg FFM⁻¹·day⁻¹. It explicitly says this single-participant case report cannot be extrapolated to wider populations, so it does not establish that most males can sustain a lower energy availability before disturbances appear. (LLM, conf=0.89)
Experimental — accuracy not yet measured
- Premisecitation
Protocols to undertake EA assessments or EA-based diet prescription will continue to be challenged by the errors associated with accurately measuring EI, EEE and other contributing components (eg, FFM, resting metabolic rate (RMR)).
“Also, protocols to undertake EA assessments or EA-based diet prescription will continue to be challenged by the errors associated with accurately measuring EI, EEE and other contributing components (eg, FFM, resting metabolic rate (RMR)), 40 49 129”
Quote in the paperSubstantial claim1 of 3 sources checked - Premisecitation
More recent information has identified large differences in the EA level associated with health and performance concerns between individuals, the sexes, and among different body systems.
“more recent information gleaned from real-life clinical observations, as well as short-term studies, 88 theoretical constructs and methodological challenges in assessment, around the frailty of a single, universal threshold, 129 have identified large differences in the EA level associated with health and performance concerns between individuals, the sexes, and among different body systems.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [88] Lieberman, 2018, Menstrual disruption with exercise is not linked to an energy availability threshold, Med Sci Sports Exerc source
The Discussion (page unavailable) reports no demonstrated EA threshold for menstrual disruption and suggests that individual sensitivity and thresholds for different reproductive responses may vary. Those differences are proposed as possibilities, not established as large differences. The paper studies active young women and does not establish differences between sexes or EA levels associated with performance concerns. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [129] Burke, 2018, Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes, Int J Sport Nutr Exerc Metab source
- Premisecitation
Other studies reported similar knowledge gaps among physiotherapists and athletic trainers.
“other studies reported similar knowledge gaps among physiotherapists and athletic trainers.142 145”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [142] Gillbanks, 2022, Insufficient knowledge and Inapproriate Physiotherapy management of relative energy deficiency in sport (RED-S) in lightweight rowers, Phys Ther Sport source
- cites [145] Lodge, 2022, Knowledge of the female athlete triad and relative energy deficiency in sport among female cross-country athletes and support staff, J Athl Train source
The introduction (page unavailable) reports prior assessments finding gaps in athletic trainers’ knowledge of the female athlete triad, and the Discussion (page unavailable) describes a prior survey in which few trainers identified a key component correctly. The paper does not report a comparable finding about physiotherapists, so it supports only the athletic-trainer part of the claim. (LLM, conf=0.87)
Experimental — accuracy not yet measured
- Premisecitation
Short-term education programmes have been shown to improve nutritional knowledge and reduce signs of dieting and body image concerns in female and male athletes.
“Short-term education programmes, using various delivery methods and focusing on factors associated with EDs, DE behaviours, and REDs have been shown to improve nutritional knowledge and reduce signs of dieting and body image concerns in female and male athletes.70 152-158”
Quote in the paperNot a substantial claim5 of 8 sources checked- cites [70] Martinsen, 2014, Preventing eating disorders among young elite athletes: a randomized controlled trial, Med Sci Sports Exerc source
- cites [152] Stewart, 2019, The female athlete body project study: 18-month outcomes in eating disorder symptoms and risk factors, Int J Eat Disord source
The Results (page unavailable) report reduced dietary restraint and thin-ideal internalization after the brief intervention, supporting the dieting and body-image portions of the claim. But the study enrolled only female collegiate athletes, not male athletes, and its Results report greater Female Athlete Triad knowledge in the control group rather than an improvement in the intervention group. Nutritional knowledge was not established as an improved outcome. (LLM, conf=0.90)
Experimental — accuracy not yet measured - cites [153] Perelman, 2022, Reducing eating disorder risk among male athletes: a randomized controlled trial investigating the male athlete body project, Int J Eat Disord source
- cites [154] Heikkilä, 2019, The impact of nutrition education intervention with and without a mobile phone application on nutrition knowledge among young endurance athletes, Nutrients source
The Discussion and Results (section 3.1; page unavailable) report improved nutrition knowledge after three short education sessions in a group including female and male athletes. They do not report reduced signs of dieting or body-image concerns; the questionnaire section on food choices and body image did not show a significant score increase (p = 0.142). (LLM, conf=0.91)
Experimental — accuracy not yet measured - cites [155] Fahrenholtz, 2023, Effects of a 16-week digital intervention on sports nutrition knowledge and behavior in female endurance athletes with risk of relative energy deficiency in sport (REDs), Nutrients source
The Discussion (page unavailable) reports improved nutrition knowledge after the 16-week intervention in female endurance athletes and cites an earlier short-term education study involving male and female athletes that also improved knowledge. The cited paper does not report that these programmes reduced signs of dieting or body-image concerns; its Methods (page unavailable) describe eating-disorder screening for eligibility, not an improvement in those outcomes. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [156] source
The Abstract and Discussion report that short peer-led interventions reduced dietary restraint and shape or weight concerns in female college athletes at six weeks. The Methods describe nutrition-related content and self-ratings of learning, but the paper does not establish improved nutritional knowledge or report intervention outcomes for male athletes. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [157] Coelho, 2014, Prevention of eating disorders in female athletes, Open Access J Sports Med source
The Prevention strategies section reports that several interventions used different methods, that the ATHENA programme lasted eight weeks, and that studies generally found positive results concerning female athletes’ intentions. It does not establish the claimed improvements in nutritional knowledge or reductions in dieting signs and body-image concerns, and it does not report those intervention outcomes for male athletes. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [158] source
- Interpretationcitation
Erroneous and intensive body composition measurement could lead to allegations of harassment and abuse by athletes.
“In some instances, erroneous and intensive body composition measurement could lead to allegations of harassment and abuse by athletes.132 135”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [132] source
- cites [135] Mountjoy, 2022, Beneath the surface: mental health and Harassment and abuse of athletes participating in the FINA (Aquatics) world championships, 2019, Clin J Sport Med source
The Results (page unavailable) report athletes’ experiences of unwanted comments about body or appearance and forced dieting as situations of harassment or abuse. The paper does not say that erroneous or intensive body-composition measurement led, or could lead, to athletes’ allegations; that mechanism is unsupported. (LLM, conf=0.79)
Experimental — accuracy not yet measured
- Premisecitation
Significant scientific progress in REDs severity and risk assessment has been made since the original IOC REDs Clinical Assessment Tool (CAT) was published in 2015.
“Significant scientific progress in REDs severity and risk assessment has been made since the original IOC REDs Clinical Assessment Tool (CAT) was published in 2015.141”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [141] Mountjoy, 2015, The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT), Br J Sports Med source
- Premisecitation
Many sports have engrained cultures where coaches and members of the athlete health and performance team exert subtle to extreme pressure on athletes to regulate body weight and composition.
“Many sports have engrained cultures where coaches and members of the athlete health and performance team exert subtle to extreme pressure on athletes to regulate body weight and composition.131 134”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [131] Kontele, 2022, Weight pressures and eating disorder symptoms among adolescent female gymnasts of different performance levels in Greece, Children (Basel) source
The Introduction describes weight and shape pressures from coaches, teammates, and judges, including comments, weigh-ins, and expectations about performance; it also mentions similar pressures in several sports. The paper does not identify members of athlete health and performance teams as exerting those pressures, and its evidence does not establish that such cultures are ingrained across many sports. Its Conclusions instead describe dietitians and mental-health experts as sources of support. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [134] Boudreault, 2022, Extreme weight control behaviors among adolescent athletes: links with weight-related maltreatment from parents and coaches and sport ethic norms, Int Rev Sociol Sport source
The section on weight-related maltreatment reports coach pressure to lose weight and describes a sports culture emphasizing weight and shape. The Discussion also addresses subtle forms of weight-related maltreatment. The paper discusses coaches and parents, but does not establish that members of an athlete health and performance team exert this pressure. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Premisecitation
With operator training and sampling several sites, reliable assessments of subcutaneous adipose tissue thicknesses can be obtained via skinfolds and B-mode ultrasound, demonstrating good accuracy and sensitivity, especially for lean individuals.
“Conversely, with operator training and sampling several sites, reliable assessments of subcutaneous adipose tissue thicknesses can be obtained via skinfolds (compressed and skin included) and brightness-mode (B-mode) ultrasound (uncompressed) method demonstrating good accuracy and sensitivity, especially for lean individuals.137”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [137] Müller, 2020, Relative body weight and standardised brightness-mode ultrasound measurement of subcutaneous fat in athletes: an international multicentre reliability study, under the auspices of the IOC Medical Commission, Sports Med source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
- Premisecitation
Less than half of coaches and physicians surveyed were able to identify the three components of the female athlete triad.
“For example, less than half of coaches and physicians surveyed were able to identify the three components of the female athlete triad 147 148 150 151”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [147] Pantano, 2017, Knowledge, attitude, and skill of high school coaches with regard to the female athlete Triad, J Pediatr Adolesc Gynecol source
- cites [148] Curry, 2015, Female athlete Triad awareness among Multispecialty physicians, Sports Med Open source
- cites [150] Brown, 2014, Knowledge of the female athlete Triad, and prevalence of Triad risk factors among female high school athletes and their coaches, J Pediatr Adolesc Gynecol source
- Interpretationcitation
Early identification of symptoms using screening instruments, individual health interviews and objective assessment of REDs biomarkers may be useful as secondary prevention.
“Furthermore, early identification of symptoms using screening instruments, individual health interviews and objective assessment of REDs biomarkers may be useful as secondary prevention.25”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [25] Stellingwerff T , Mountjoy M , McCluskey W , et al . The scientific rationale, development and validation of the Internaional Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool 2 (IOC REDs CAT2) - a review by a subgroup of the IOC consensus on REDs. Br J Sports Med bjsports-2023-106914 [Preprint] 2023. doi:10.1007/s00223-023-01120-0 source
- Premisecitation
Most of the research since the seminal REDs research has involved cross-sectional study designs investigating the prevalence of various LEA indicators.
“Although the seminal REDs research implemented randomised clinical trials with strict laboratory-controlled EA interventions in habitually sedentary females, 45 125 127 160 165 most of the research since has involved cross-sectional study designs investigating the prevalence of various LEA indicators (indirectly via questionnaires or directly via indicators).8 11 21 49 78 166 167”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [8] source
- cites [11] Sygo, 2018, Prevalence of indicators of low energy availability in elite female sprinters, Int J Sport Nutr Exerc Metab source
- cites [21] Ackerman KE , Rogers MA , Heikura IA , et al . Methodology for studying relative energy deficiency in sport (REDs): a narrative review by a sub-group of the IOC consensus on REDs. Br J Sports Med bjsports-2023-107359 [Preprint] 2023. source
- Premisecitation
Studies of LEA exposure have identified a somewhat more prominent effect of poor EI, rather than excessive EEE, in causing most of the physiological perturbations.
“Studies of LEA exposure have identified a somewhat more prominent effect of poor EI, rather than excessive EEE, in causing most of the physiological perturbations.127 160”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [127] Loucks, 1998, Low energy availability, not stress of exercise, alters LH pulsatility in exercising women, J Appl Physiol (1985) source
- cites [160] Hilton, 2000, Low energy availability, not exercise stress, suppresses the diurnal rhythm of Leptin in healthy young women, Am J Physiol Endocrinol Metab source
The paper’s summary (in the section labeled “Associated effects on LH pulsatility,” pp. E43–E49) reports that low energy availability suppressed leptin rhythms, and that the effects were greater when low availability was caused by dietary restriction than by exercise energy expenditure. This supports the intake-versus-expenditure comparison for leptin, but the paper does not establish that poor energy intake causes most physiological perturbations generally. (LLM, conf=0.87)
Experimental — accuracy not yet measured
- Premisecitation
There are some useful pharmacological and psychological approaches emerging to treat clinical issues associated with REDs.
“There are some useful pharmacological and psychological approaches emerging to treat clinical issues associated with REDs.27”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [27] Torstveit MK , Ackerman KE , Constantini N , et al . Primary, secondary, and tertiary prevention of Relative Energy Deficiency in sport (REDs): a narrative review by a sub-group of the IOC consensus on REDs. Br J Sports Med bjsports-2023-106932 [Preprint] 2023. doi:10.3389/fpsyg.2023.1168423 source
- Premisecitation
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”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [6] source
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
- Findingcitation
A recent narrative review found that 18 of 21 identified OTS-based studies showed indications of LEA and LCA and thus may have demonstrated REDs outcomes rather than OTS.
“a recent narrative review found that 18 of 21 identified OTS-based studies showed indications of LEA and LCA due to large increases in training while failing to compensate with increased EI, and thus may have demonstrated REDs outcomes rather than OTS.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Stellingwerff, 2021, Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S): shared pathways, symptoms and complexities, Sports Med source
- Findingreasoning
Several investigations have elucidated carbohydrate's energy-independent or magnifying role in REDs-related health outcomes.
“Recently, several investigations have elucidated CHO's energy-independent or magnifying role in REDs-related health outcomes.”
Quote in the paperSubstantial claim - Findingnone given
Some signs/symptoms and REDs outcomes that appear to present temporally to various exposure periods of LEA have emerged.
“Still, some signs/symptoms and REDs outcomes that appear to present temporally to various exposure periods of LEA have emerged.”
Quote in the paperNot a substantial claim - Findingcitation
Recent qualitative studies involving mainly subelite endurance athletes report that LEA from intentional or unintentional origins can be associated with short-term positive results such as performance improvements or social approval.
“Recent qualitative studies 1 67 involving mainly subelite endurance athletes provide support for this premise, reporting that LEA from intentional (eg, weight regulation) or unintentional (eg, failing to consciously increase EI with increased EEE) origins can be associated with short-term positive results such as performance improvements or social approval from the coach and the sports culture. 1”
Quote in the paperNot a substantial claim0 of 2 sources checked - Findingown data
Currently only 20% of original studies from 2018 to 2022 include male athletes as subjects.
“Since then, although the research community has emphasised the need for studies in men, currently only 20% of original studies from 2018 to 2022 include male athletes as subjects”
Quote in the paperSubstantial claim - Findingcitation
In unilateral amputees, the affected limb may exhibit reduced bone mineral density (BMD).
“Furthermore, in unilateral amputees, the affected limb may exhibit reduced bone mineral density (BMD).115”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [115] source
- Interpretationcitation
Under certain circumstances, some practices associated with LEA, such as body composition manipulation, periods of intensified training or competition workloads involving prodigious exercise energy expenditure, can be safely and effectively periodised into an athlete's annual plan.
“under certain circumstances, some practices associated with LEA, such as body composition manipulation, periods of intensified training or competition workloads involving prodigious EEE, can be safely and effectively periodised into an athlete's annual plan”
Quote in the paperNot a substantial claim0 of 2 sources checked - Premisecitation
Humans did not evolve to tolerate some modern elite training programs or sports-related practices.
“However, although humans evolved to be physically active, they did not evolve to tolerate some modern elite training programs 36 or sports-related practices.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [36] Lieberman DE . Exercised: why something we never evolved to do is healthy and rewarding. New York: Vintage Books, 2021.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
The spectrum of exposure to LEA can include scenarios that, in conjunction with moderating factors, are associated with negative effects on various body systems.
“the spectrum of exposure to LEA can include scenarios (eg, significant duration, magnitude, frequency-see Definitions box 1), that in conjunction with moderating factors (eg, sex, age, health status), are associated with negative effects on various body systems.”
Quote in the paperSubstantial claim - Interpretationreasoning
Such signs or symptoms do not always reflect a problematic LEA exposure leading to REDs.
“Such signs or symptoms do not always reflect a problematic LEA exposure leading to REDs.”
Quote in the paperSubstantial claim - Interpretationreasoning
Problematic LEA can lead to impaired bone health and bone-related injury secondary to factors such as altered skeletal loading experienced by para athletes.
“Problematic LEA can lead to impaired bone health and bonerelated injury secondary to factors such as altered skeletal loading experienced by para athletes”
Quote in the paperSubstantial claim - Interpretationreasoning
These short-term 'positive' outcomes make it more challenging for athletes to recognise the longer-term potential health and performance implications of exposure to problematic LEA.
“These short-term 'positive' outcomes make it more challenging for athletes to recognise the longer-term potential health and performance implications of exposure to problematic LEA.”
Quote in the paperSubstantial claim - Interpretationreasoning
Using skinfolds, DXA, and B-mode ultrasound are the proposed body composition assessment methods available at the time of publication.
“In summary, using skinfolds, DXA, and B-mode ultrasound are the proposed body composition assessment methods available at the time of publication.”
Quote in the paperSubstantial claim - Interpretationnone given
Each sign or symptom within the REDs Conceptual Models can occur due to aetiologies other than problematic LEA.
“Each sign or symptom within the REDs Conceptual Models can occur due to aetiologies other than problematic LEA (tables 2 and 3).”
Quote in the paperSubstantial claim - Premisecitation
Seminal research around EA in habitually sedentary females identified a continuum of zones ranging from low to high risk of harm (eg, high EA for mass gain and growth ≥45 kcal/kg FFM/day; adequate EA for weight maintenance and support of body function = ~45 kcal/kg FFM/day; reduced EA for body...).
“Seminal research 45 125 around EA in habitually sedentary females identified a continuum of zones ranging from low to high risk of harm (eg, high EA for mass gain and growth ≥45 kcal/kg FFM/day; adequate EA for weight maintenance and support of body function = ~45 kcal/kg FFM/day; reduced EA for body”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationreasoning
There are risks in setting a definitive clinical threshold of EA due to many moderating factors.
“Therefore, although EA calculations may inform research interventions or observations, there are risks in setting a definitive clinical threshold of EA due to many moderating factors.”
Quote in the paperSubstantial claim - Premisecitation
The concept of the LEA threshold (30 kcal/kg FFM/day), below which health problems occurred, was based on short-term laboratory studies in a small sample of sedentary females.
“The concept of the LEA threshold (30 kcal/kg FFM/day), below which health problems occurred, was based on elegant but short-term laboratory studies that investigated stepwise changes in EA, perturbations of sex hormones 45 127 128 and changes in markers of bone turnover 125 in a small sample of sedentary females.”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationnone given
Problematic LEA is associated with a variety of adverse REDs health outcomes.
“problematic LEA is associated with a variety of adverse REDs outcomes (arrow depicted in red).”
Quote in the paperSubstantial claim - Premisecitation
Findings show significant individualised responses concerning the type, prevalence and severity of the impairments of various body systems associated with this exposure.
“findings also show significant individualised responses concerning the type, prevalence and severity of the impairments of various body systems associated with this exposure, 8 11 49 78 166 167”
Quote in the paperSubstantial claim0 of 3 sources checked - Premisecitation
Results have confirmed the aetiology of REDs is problematic LEA.
“While results have confirmed the aetiology of REDs is problematic LEA”
Quote in the paperSubstantial claim0 of 3 sources checked - Interpretationreasoning
LEA exposure (either problematic or adaptable), with associated moderating factors, leads to changes in health and/or performance outcomes in individual athletes.
“LEA exposure (either problematic or adaptable), with associated moderating factors, leading to changes in health and/or performance outcomes in individual athletes.”
Quote in the paperSubstantial claim - Interpretationnone given
The effects of low energy availability (LEA) exist on a continuum.
“The effects of LEA exist on a continuum.”
- Also stated in: § Consensus statement · plain
“The effects of LEA exist on a continuum.”
Quote in the paperNot a substantial claim - Also stated in: § Consensus statement · plain
- Premisecitation
There are few prospective or cohort studies in which groups of athletes with and without signs of LEA have been monitored longitudinally to note changes in health and performance.
“It is noted that there are few prospective or cohort studies in which groups of athletes with and without signs of LEA have been monitored longitudinally to note changes in health and performance.168 169”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationnone given
Problematic LEA is associated with a variety of adverse REDs performance outcomes.
“problematic LEA is associated with a variety of adverse REDs performance outcomes (arrow depicted in red).”
Quote in the paperSubstantial claim
- Classified as probably not a substantial claim. 54
- May combine two claims. 51
Classified as probably not a substantial claim.
InterpretationcitationREDs 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.”
- Also stated in: § Consensus statement · plain
“the updated 2023 definition of 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.”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [5] source
- cites [6] source
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
- Also stated in: § Consensus statement · plain
May combine two claims.
InterpretationcitationThe wide range in prevalence is due to the lack of a singular definitive diagnosis, mistaken use of LEA and REDs as interchangeable terms, lack of standardisation and accuracy of research methodologies, variation in physiological demands among study populations, and participant study volunteering biases.
“due to the lack of a singular definitive diagnosis, mistaken use of LEA and REDs as interchangeable terms, lack of standardisation and accuracy of research methodologies (eg, inaccurate EA measurements), variation in physiological demands among the study populations and participant study volunteering biases.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [21] Ackerman KE , Rogers MA , Heikura IA , et al . Methodology for studying relative energy deficiency in sport (REDs): a narrative review by a sub-group of the IOC consensus on REDs. Br J Sports Med bjsports-2023-107359 [Preprint] 2023. source
The Review and Data collection methods sections describe inconsistent REDs assessment methods, measurement limitations, and the need for standardisation. The Introduction also cautions that findings from narrow athlete samples may not apply to all athletes. Our copy does not establish that these factors explain a wide range of prevalence estimates, or identify participant volunteering bias or interchangeable use of LEA and REDs as causes. (LLM, conf=0.83)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationMost LEA intervention studies are accompanied by a substantial reduction (25%-60%) in carbohydrate ingestion, resulting in concurrent LCA.
“Most LEA intervention studies are also accompanied by a substantial reduction (25%-60%, depending on magnitude of LEA) in carbohydrate (CHO) ingestion, resulting in concurrent LCA.”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [45] source
- cites [46] Koehler, 2016, Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones, J Sports Sci source
- cites [47] Papageorgiou, 2017, Effects of reduced energy availability on bone metabolism in women and men, Bone source
The Experimental Diets section says this study halved dietary energy intake while maintaining participants’ habitual dietary composition, which supports a substantial reduction in carbohydrate intake in this intervention. The paper does not establish that most LEA intervention studies reduce carbohydrate intake by 25%–60%, or explicitly characterize the resulting intake as concurrent low carbohydrate availability. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Classified as probably not a substantial claim.
PremisecitationLife History Theory proposes that various biological processes related to growth, health, activity and reproduction compete for finite energy resources, with different priorities depending on the phase in the life cycle and other circumstances.
“Life History Theory proposes that various biological processes related to growth, health, activity and reproduction compete for finite energy resources, with different priorities depending on the phase in the life cycle and other circumstances.”
Quote in the paperSubstantial claim1 of 3 sources checkedMay combine two claims.
FindingcitationShort-term (≤6 days) investigations in male endurance athletes have reported increases in bone resorption biomarkers with concomitant impairment in bone formation biomarkers, and increased postexercise IL-6 and hepcidin after LCA.
“These studies have reported increases in bone resorption biomarkers 52 53 with a concomitant impairment in biomarkers of bone formation, 53 as well as increased postexercise concentrations of interleukin-6 (IL-6) and hepcidin after LCA.54”
Quote in the paperSubstantial claim2 of 3 sources checked- cites [52] Hammond, 2019, Post-exercise carbohydrate and energy availability induce independent effects on Skeletal muscle cell signalling and bone turnover: implications for training adaptation, J Physiol source
The Interleukin-6 (IL-6) responses section (page unavailable) reports a greater postexercise IL-6 increase in the low-carbohydrate, low-energy (LCAL) condition than in either comparison condition. The Discussion says carbohydrate availability alone did not apparently affect IL-6. Citation 54 is attached to the IL-6 and hepcidin claim, but our copy does not report hepcidin measurements or an increase in hepcidin. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [53] Fensham, 2022, Short-term carbohydrate restriction impairs bone formation at rest and during prolonged exercise to a greater degree than low energy availability, J Bone Miner Res source
- cites [54] McKay, 2022, Six days of low carbohydrate, not energy availability, alters the iron and immune response to exercise in elite athletes, Med Sci Sports Exerc source
May combine two claims.
FindingcitationApproximately 3.5 weeks of LCHF diet in elite endurance athletes resulted in impaired markers of bone remodelling and elevated postexercise IL-6 compared with an isocaloric high CHO treatment.
“Additionally, ~3.5 weeks of LCHF diet in elite endurance athletes resulted in impaired markers of bone remodelling both at rest as well as around exercise (up to 3 hours postexercise), 56 and elevated postexercise IL-6 concentrations compared with an isocaloric high CHO treatment.57”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [56] Heikura, 2019, A short-term ketogenic diet impairs markers of bone health in response to exercise, Front Endocrinol (Lausanne) source
- cites [57] McKay, 2019, Acute carbohydrate ingestion does not influence the post-exercise iron-regulatory response in elite Keto-adapted race Walkers, J Sci Med Sport source
May combine two claims.
InterpretationcitationThe estimated prevalence of REDs in para athletes is unknown; however, there are concerns that para athletes may be at even higher risk of problematic LEA than able-bodied athletes.
“The estimated prevalence of REDs in para athletes is unknown; however, there are concerns that para athletes may be at even higher risk of problematic LEA than able-bodied athletes.112”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [112] Jonvik, 2022, How do we assess energy availability and RED-S risk factors in para athletes?, Nutrients source
May combine two claims.
InterpretationcitationThere 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”
Quote in the paperNot a substantial claim1 of 3 sources checkedMay combine two claims.
FindingcitationTwo emerging potential indicators of REDs in males are the presence of low libido and decreased morning erections, which have been identified as physiological consequences of LEA.
“Two emerging potential indicators of REDs in males are the presence of low libido and decreased morning erections, which have been identified as physiological consequences of LEA.[108][109][110][111]”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [108] Lundy, 2022, Screening for low energy availability in male athletes: attempted validation of LEAM-Q, Nutrients source
The Results (section 3.3) report that low sex-drive scores distinguished LEA cases from controls, and the Methods (section 2.3) show that the score included questions about morning erections. The paper does not establish decreased morning erections as an independent indicator or demonstrate that either symptom is a physiological consequence caused by LEA. (LLM, conf=0.84)
Experimental — accuracy not yet measured - cites [109] Hackney, 2022, Marathon running and sexual libido in adult men: exercise training and racing effects, J Endocrinol Sci source
The Discussion links reduced libido and fewer erections to possible RED-S development and suggests sexual drive may indicate energy status. But it calls that link speculative, and the study did not measure energy availability or establish that low libido and decreased morning erections are physiological consequences of LEA. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [110] Hackney, 2017, Endurance exercise training and male sexual libido, Med Sci Sports Exerc source
May combine two claims.
FindingcitationWhile a universal cut-off of 30 kcal/kg FFM/day as a threshold of LEA leading to some REDs outcomes in females is debated, such a cut-off or range at which males experience REDs-related symptoms is even less understood, but appears to be lower (eg, ~9 to 25 kcal/kg FFM/day).
“While a universal cut-off of 30 kcal/kg FFM/day as a threshold of LEA leading to some REDs outcomes in females is debated, 88 such a cut-off or range at which males experience REDs-related symptoms is even less understood, 89 but appears to be lower (eg, ~9 to 25 kcal/kg FFM/day).17 46 72 90 91”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [17] Lane, 2019, Prevalence of low energy availability in competitively trained male endurance athletes, Medicina (Kaunas) source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [46] Koehler, 2016, Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones, J Sports Sci source
- cites [72] Langan-Evans, 2021, The psychological and physiological consequences of low energy availability in a male combat sport athlete, Med Sci Sports Exerc source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
InterpretationcitationDE behaviours and EDs may be exacerbated by social media influence, societal pressures, the athlete's training/coaching entourage, a belief that a specific physique/weight/appearance will improve performance and/or overall body dissatisfaction.
“DE behaviours and EDs may be exacerbated by social media influence, societal pressures, the athlete's training/coaching entourage, a belief that a specific physique/weight/appearance will improve performance and/or overall body dissatisfaction.69”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [69] Wasserfurth, 2020, Reasons for and consequences of low energy availability in female and male athletes: social environment, adaptations, and prevention, Sports Med Open source
May combine two claims.
FindingcitationPsychological indicators associated with problematic LEA and REDs are mood disturbances/fluctuations, cognitive dietary restraint, drive for thinness, reduced sleep quality and perfectionistic tendencies.
“Psychological indicators associated with problematic LEA and REDs are mood disturbances/fluctuations, 8 71 72 cognitive dietary restraint, 73 drive for thinness, 74 75 reduced sleep quality 50 76 and perfectionistic tendencies.77”
Quote in the paperNot a substantial claim2 of 3 sources checked- cites [8] source
- cites [71] Schaal, 2021, Decreased energy availability during training overload is associated with non-functional overreaching and suppressed ovarian function in female runners, Appl Physiol Nutr Metab source
The Results report increased perceived fatigue in non-functionally overreached runners, and the Discussion reports no baseline difference in restrictive eating attitudes. Our copy does not report reduced sleep quality or establish the listed psychological indicators as markers of problematic low energy availability or REDs; searches for sleep quality and mood found no supporting passage. (LLM, conf=0.75)
Experimental — accuracy not yet measured - cites [72] Langan-Evans, 2021, The psychological and physiological consequences of low energy availability in a male combat sport athlete, Med Sci Sports Exerc source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationEmerging definitions highlight short-term LEA as a few days to weeks, medium-term as weeks to months and long-term as months to years.
“Emerging definitions highlight short-term LEA as a few days to weeks, mediumterm as weeks to months and long-term as months to years.37 40”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [37] Stellingwerff, 2021, Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S): shared pathways, symptoms and complexities, Sports Med source
- cites [40] Heikura, 2022, Low energy availability in female athletes: from the lab to the field, Eur J Sport Sci source
The Introduction defines medium-term LEA as weeks to under three months and long-term LEA as more than three months to years, matching the claim broadly. It defines short-term LEA as less than seven days, however, so the claim's 'few days to weeks' extends that category beyond the paper's definition. (LLM, conf=0.87)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationAlthough 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.”
Quote in the paperSubstantial claim1 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationThese outcomes occur over different timeframes and with different severity and significance to the individual athlete due to various moderating factors.
“Undoubtedly, these outcomes occur over different timeframes and with different severity and significance to the individual athlete due to various moderating factors.24”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [24] Burke LM , Ackerman KE , Heikura I , et al . Mapping the complexities of relative energy deficiency in sport (REDs): development of a physiological model by a subgroup of the IOC consensus on REDs. Br J Sports Med bjsports-2023-107335 [Preprint] 2023. source
May combine two claims.
FindingcitationProblematic LEA can occur in male athletes and is associated with negative effects on the hypothalamic-pituitary-gonadal (HPG) axis and associated hormones; changes in metabolic hormones; impairments to immune function; detriments to bone health; negative performance outcomes and decreased lean body mass accrual.
“Nevertheless, problematic LEA can occur in male athletes and is associated with negative effects on the hypothalamic-pituitary-gonadal (HPG) axis and associated hormones 72 92-100 ; changes in metabolic hormones 46 101-103 ; impairments to immune function 104 ; detriments to bone health 105 ; as well as negative performance outcomes 18 90 104 106 and decreased lean body mass accrual.107”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [72] Langan-Evans, 2021, The psychological and physiological consequences of low energy availability in a male combat sport athlete, Med Sci Sports Exerc source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured - cites [92] source
- cites [93] Roberts, 1993, Overtraining affects male reproductive status, Fertility and Sterility source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe sports community has prioritised the mental health of elite-level athletes as evidenced by a sharp rise in consensus statements and prevalence studies.
“The sports community has prioritised the mental health of elitelevel athletes as evidenced by a sharp rise in consensus statements [60][61][62] and prevalence studies [63][64][65] on this theme.”
Quote in the paperNot a substantial claim1 of 3 sources checked- cites [60] source
- cites [61] Henriksen, 2020, Athlete mental health in the Olympic/Paralympic Quadrennium: a multi-societal consensus statement, Int J Sport Exerc Psychol source
- cites [62] Henriksen, 2020, Consensus statement on improving the mental health of high performance athletes, Int J Sport Exerc Psychol source
May combine two claims.
FindingcitationDisordered eating (DE) behaviours, eating disorders (EDs) and/or REDs are common among certain athlete cohorts.
“Disordered eating (DE) behaviours, eating disorders (EDs) and/or REDs are common among certain athlete cohorts.68”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [68] source
The Background section, under “Prevalence and contributing factors to DE in athletes” (page not provided), reports substantial variation in DE and ED prevalence and identifies aesthetically judged, gravitational and weight-class sports as high-risk cohorts. The copy links DE and EDs to possible RED-S but does not establish that RED-S itself is common in those cohorts. (LLM, conf=0.84)
Experimental — accuracy not yet measured
May combine two claims.
InterpretationreasoningThe IOC REDs CAT2 introduces a four-colour traffic-light severity/risk categorisation, in contrast to the three-colour stratification in the 2015 RED-S CAT, due to the appreciation that the 2015 yellow zone had an extensive clinical severity/risk range of very low to very high.
“The IOC REDs CAT2 25 introduces a four-colour traffic-light severity/risk categorisation, in contrast to the three-colour stratification in the 2015 RED-S CAT, 141 due to the appreciation that the 2015 yellow zone had an extensive clinical severity/risk range of very low (a few minor symptoms) to very high (a few indicators away from removal from sport).”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [25] Stellingwerff T , Mountjoy M , McCluskey W , et al . The scientific rationale, development and validation of the Internaional Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool 2 (IOC REDs CAT2) - a review by a subgroup of the IOC consensus on REDs. Br J Sports Med bjsports-2023-106914 [Preprint] 2023. doi:10.1007/s00223-023-01120-0 source
- cites [141] Mountjoy, 2015, The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT), Br J Sports Med source
Classified as probably not a substantial claim.
PremisecitationBody composition assessment and management are important for optimising health and athletic performance, particularly in weight-sensitive and leanness-demanding sports.
“Body composition assessment and management are important for optimising health and athletic performance, particularly in weight-sensitive and leanness-demanding sports.130”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [130] source
May combine two claims.
Study design and conductcitationThe IOC REDs CAT2 has undergone internal expert voting statement validation and external REDs expert clinical cross-agreement validation.
“which has undergone internal expert voting statement validation (see online supplemental files 2-4) and external REDs expert clinical cross-agreement validation.25”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [25] Stellingwerff T , Mountjoy M , McCluskey W , et al . The scientific rationale, development and validation of the Internaional Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool 2 (IOC REDs CAT2) - a review by a subgroup of the IOC consensus on REDs. Br J Sports Med bjsports-2023-106914 [Preprint] 2023. doi:10.1007/s00223-023-01120-0 source
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationUnlike earlier REDs models, LEA is placed at the centre of the hub to note its role as an exposure variable.
“Unlike earlier REDs models, 5 6 LEA is placed at the centre of the hub to note its role as an exposure variable.”
Quote in the paperNot a substantial claim1 of 2 sources checkedMay combine two claims.
PremisecitationSome easy-to-use body composition methods are 'doubly indirect', relying on regression equations to derive a body fat per cent; they do not provide valid data, use spurious assumptions and/or are influenced greatly by athlete presentation (eg, hydration levels).
“Some easy-to-use methods are 'doubly indirect', relying on regression equations to derive a body fat per cent; they do not provide valid data, use spurious assumptions and/ or are influenced greatly by athlete presentation (eg, hydration levels).136”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [136] Kasper, 2021, Come back skinfolds, all is forgiven: a narrative review of the efficacy of common body composition methods in applied sports practice, Nutrients source
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationAthletes may experience internal and/or external pressure to attain an 'athletic look' (aesthetic), potentially leading to body dissatisfaction and LEA, and then to symptoms of REDs, DE behaviours or EDs.
“Athletes may experience internal and/or external pressure to attain an 'athletic look' (aesthetic), potentially leading to body dissatisfaction and LEA, and then to symptoms of REDs, DE behaviours or EDs.76 131”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [76] Gillbanks, 2022, Lightweight rowers' perspectives of living with relative energy deficiency in sport (RED-S), PLoS One source
The Results sections report societal pressure to have a masculine physique, negative body image, restricted intake, excessive exercise, disordered eating, and RED-S implications among lightweight rowers (pages not provided). They do not establish the claimed pathway from pressure to attain an ‘athletic look’ through body dissatisfaction to low energy availability and RED-S; the reported weight-loss practices were primarily tied to making competition weight. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [131] Kontele, 2022, Weight pressures and eating disorder symptoms among adolescent female gymnasts of different performance levels in Greece, Children (Basel) source
The Discussion (§4.3) links appearance and performance weight pressures in female gymnasts to body dissatisfaction and eating-disorder symptoms. The Introduction (§1) says unhealthy weight-control practices may put gymnasts at risk of both low energy availability (LEA) and disordered eating or eating disorders, but does not establish the claimed sequence from LEA to those symptoms; it does not address REDs. (LLM, conf=0.87)
Experimental — accuracy not yet measured
May combine two claims.
PremisecitationDXA is a reliable method for assessing BMD and estimating fat and lean masses, provided standard test protocols are used.
“Though costlier, DXA is a reliable method for assessing BMD and estimating fat and lean masses, provided standard test protocols are used.[138][139][140]”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [138] source
The DXA discussion (section ‘Insert Table II near here’; page unavailable) describes bone-mineral assessment and estimates of fat and fat-free soft tissue, and calls DXA a reasonably precise whole-body method. But it explicitly says DXA is not reliable for accurate fat estimates in lean athletes; the cited passages do not establish that following standard test protocols removes this limitation. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [139] source
- cites [140] source
May combine two claims.
PremisecitationThe REDs education and behaviour modification research field is underdeveloped, and specific REDs education programmes targeting athletes and other key personnel require further exploration and validation.
“However, the REDs education and behaviour modification research field is underdeveloped, and specific REDs education programmes targeting athletes and other key personnel require further exploration and validation.27”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [27] Torstveit MK , Ackerman KE , Constantini N , et al . Primary, secondary, and tertiary prevention of Relative Energy Deficiency in sport (REDs): a narrative review by a sub-group of the IOC consensus on REDs. Br J Sports Med bjsports-2023-106932 [Preprint] 2023. doi:10.3389/fpsyg.2023.1168423 source
May combine two claims.
PremisecitationIn the one intention-to-treat 12-month, randomised controlled clinical trial that implemented dietary changes to increase EI in exercising females with REDs-related biomarkers, there was a high drop-out rate (57%), and improvement in some but not all symptoms.
“Indeed, in the one intention-to-treat 12-month, randomised controlled clinical trial that implemented dietary changes to increase EI in exercising females with REDs-related biomarkers, there was a high drop-out rate (57%), and improvement in some (eg, menstrual function resumption in select participants), 161 but not all symptoms (eg, inability to retard bone loss).162”
Quote in the paperSubstantial claim1 of 2 sources checked- cites [161] De Souza, 2021, Randomised controlled trial of the effects of increased energy intake on Menstrual recovery in exercising women with Menstrual disturbances: the 'REFUEL' study, Hum Reprod source
- cites [162] De Souza, 2022, Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea/amenorrhea: the REFUEL randomized controlled trial, Am J Clin Nutr source
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenEmerging data demonstrate the growing role of low carbohydrate availability in REDs.
“emerging data demonstrating the growing role of low carbohydrate availability”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Findingnone givenSince the 2018 REDs consensus, there have been more than 170 original research publications advancing the field of REDs science.
“Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThere is further evidence of the interplay between mental health and REDs.
“further evidence of the interplay between mental health and REDs”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Findingnone givenThere has been significant growth in the number of studies clearly showing that problematic LEA is the underlying aetiology of REDs.
“There has been significant growth in the number of studies clearly showing that problematic LEA is the underlying aetiology of REDs.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataAll voting statements reached an agreement or minority disagreement after two rounds of voting, providing a total of 144 statements of which 27 remained with a minority disagreement.
“All voting statements reached an agreement or minority disagreement after two rounds of voting, providing a total of 144 statements of which 27 remained with a minority disagreement”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenMore data elucidate the impact of LEA in males.
“more data elucidating the impact of LEA in males”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataIn the second round of confidential voting, 44 statements were presented to the authors; of these, 24 were previous statements with disagreement that required a revote, and 20 were new statements.
“In the second round of confidential voting, 44 statements were presented to the authors.Of these, 24 were previous statements with disagreement that required a revote, and 20 were new statements.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataIn the first round of online voting, 135 evidence statements were presented to the panel, and full agreement was reached for 76 of the statements.
“In the first round of online voting, we presented 135 evidence statements to the panel.Full agreement was reached for 76 of the statements.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingnone givenSince 2018, there have been approximately 178 REDs and/or LEA original research publications featuring approximately 23,822 participants (80% female), with approximately 62% cross-sectional, 14% longitudinal observational, and 12% longitudinal intervention.
“Since 2018, there have been considerable scientific advancements in the REDs research field including ~178 REDs and/ or LEA original research publications featuring ~23 822 participants; (80% female), with ~62% of these studies implementing a cross-sectional design, ~14% as longitudinal observational and ~12% longitudinal intervention”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenAdvances in knowledge pertaining to REDs in male athletes is an emerging theme.
“(5) advances in knowledge pertaining to REDs in male athletes”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThe time-course of biomarker responses to problematic LEA in the development of REDs is an emerging theme.
“(3) the time-course of biomarker responses to problematic LEA in the development of REDs”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenImproved understanding of mental health associations of REDs is an emerging theme.
“(4) improved understanding of mental health associations of REDs”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenAdvances in knowledge pertaining to REDs in para athletes is an emerging theme.
“(6) para athletes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThe overlap of REDs and overtraining syndrome (OTS) symptomology is an emerging theme.
“(2) the overlap of REDs and overtraining syndrome (OTS) symptomology”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationDepressive symptoms and affective disorders, subjectively reported reduced well-being, primary or secondary exercise dependence/addiction, anxiety related to injury and/or recovery, sport-specific issues such as difficulty coping with weight requirements and the development of EDs are additional adverse mental health outcomes associated with problematic LEA and REDs.
“Depressive symptoms and affective disorders, 8 78 79 subjectively reported reduced well-being, 73 primary or secondary exercise dependence/addiction, 80 81 anxiety related to injury and/or recovery, sport-specific issues such as difficulty coping with weight requirements 67 76 and the development of EDs 1 82 are additional adverse mental health outcomes associated with problematic LEA and REDs.”
Quote in the paperSubstantial claim0 of 3 sources checkedMay combine two claims.
FindingcitationAmong US para athletes preparing for Paralympic Games, 62% attempted to alter weight or body composition, 32% had elevated EDE-Q pathological behaviour subscale scores and 44% of female athletes reported menstrual dysfunction.
“Among US para athletes preparing for Paralympic Games, 62% attempted to alter weight or body composition to enhance performance, 32% had elevated scores on the Eating Disorder Examination Questionnaire (EDE-Q) pathological behaviour subscale scores and 44% of the female athletes reported menstrual dysfunction.113”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [113] Brook, 2019, Low energy availability, menstrual dysfunction, and impaired bone health: a survey of elite para athletes, Scand J Med Sci Sports source
May combine two claims.
InterpretationcitationThe detrimental outcomes of REDs include decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis, and cardiovascular and haematological health, which can lead to impaired well-being, increased injury risk, and decreased sports performance.
“The detrimental outcomes include, but are not limited to, decreases in energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis and cardiovascular and haematological health, which can all individually and synergistically lead to impaired well-being, increased injury risk and decreased sports performance.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAuthors were invited based on their expertise, as demonstrated by previous research, clinical and/or coaching experiences with REDs.
“Authors were invited based on their expertise, as demonstrated by previous research, clinical and/or coaching experiences with REDs.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThis REDs consensus statement used the RAND-UCLA Appropriateness Method (RAM).
“This REDs consensus statement used the RAND-UCLA Appropriateness Method (RAM).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [43] Fitch K , Bernstein SJ , Aguilar MD . The RAND/UCLA appropriateness method user’s manual. Santa Monica, CA: Rand Corp, 2001.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAthletes are driven by strong internal and external pressure to achieve optimal performance.
“Athletes are driven by strong internal and external pressure to achieve optimal performance.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA diverse expert panel of authors was invited, consisting of sports medicine physicians, a sports endocrinologist, registered sports dietitians, sports physiologists, sports scientists, an athlete, a coach and a mental performance consultant.
“A diverse (ie, gender, geographic location, expertise) expert panel of authors was invited, consisting of sports medicine physicians, a sports endocrinologist, registered sports dietitians, sports physiologists, sports scientists, an athlete, a coach and a mental performance consultant.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenAuthors were allowed to write a minority opinion in the event of disagreement with a statement when the consensus threshold was reached.
“Authors were allowed to write a minority opinion in the event of disagreement with a statement when the consensus threshold was reached.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationSome perturbations to body systems from LEA might be considered mild and/or transient, representing physiological plasticity, and could be termed adaptable LEA.
“Some of these perturbations to body systems might be considered mild and/or transient, representing physiological plasticity 35 and could be termed adaptable LEA”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [35] De Souza, 2022, The path towards progress: a critical review to advance the science of the female and male athlete Triad and relative energy deficiency in sport, Sports Med source
Classified as probably not a substantial claim.
Interpretationnone givenREDs is a clinically diagnosed, multifactorial syndrome characterised by the accumulation of the deleterious health and performance outcomes resulting from exposure to problematic LEA.
“REDs is a clinically diagnosed, multifactorial syndrome characterised by the accumulation of the deleterious health and performance outcomes resulting from exposure to problematic LEA.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Interpretationnone givenThe new Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes.
“This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationREDs and OTS are syndromes involving the hypothalamic-pituitary-adrenal axis and have no single validated diagnostic biomarker; they feature a complex overlap of symptoms that hinge on a diagnosis utilising exclusion criteria.
“REDs and OTS are syndromes involving the hypothalamicpituitary-adrenal axis and have no single validated diagnostic biomarker; they feature a complex overlap of symptoms that hinge on a diagnosis utilising exclusion criteria.37 58”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Premisenone givenScenarios commonly encountered in sport include extreme volumes of exercise energy expenditure, attempts to improve power-to-weight ratios, desire for excessive leanness and sport-specific physique alterations.
“Scenarios commonly encountered in sport include extreme volumes of EEE, attempts to improve power-to-weight ratios, desire for excessive leanness and sport-specific physique alterations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThese scientific advances have improved our understanding of the underpinning physiology and psychology of REDs and the different clinical presentations between the sexes.
“These scientific advances have improved our understanding of the underpinning physiology and psychology of REDs and the different clinical presentations between the sexes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenThree levels of agreement were defined: Agreement (≥80% agreeing, no disagreement), Agreement with minority disagreement (≥80% agreeing, one or more disagreeing), and Disagreement (<80% agreeing).
“We defined three levels of agreement based on which subsequent discussions were held: 1. Agreement: ≥80% of authors agreeing on the voting statement, without any author disagreeing.2. Agreement with minority disagreement: ≥80% of authors agreeing on the voting statement, but with one or more authors disagreeing.3. Disagreement: <80% of authors agreeing on the voting statement.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationThese findings suggest deleterious effects on bone, immunity and iron biomarkers as a result of LCA, sometimes in the absence of LEA.
“These findings suggest deleterious effects on bone, immunity and iron biomarkers as a result of LCA, sometimes in the absence of LEA.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningAll of these scenarios can lead to problematic LEA, which can result in negative health and performance implications known as REDs.
“All of these scenarios can lead to problematic LEA (see Definitions box 1), which can result in negative health and performance implications known as 'Relative Energy Deficiency in Sport' (REDs).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [5] source
May combine two claims.
InterpretationreasoningSome short-term signs or symptoms during acute assessment may only represent a snapshot of a current LEA state and require exclusion of other potential aetiologies.
“Importantly, some short-term signs or symptoms during the acute assessment may only represent a snapshot of a current LEA state and require the exclusion of other potential aetiologies (differential diagnoses).”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
InterpretationreasoningTime-course cut-offs require further scientific validation, may differ between males and females and change with the severity and duration of LEA dose.
“However, time-course cut-offs require further scientific validation, may differ between males and females and change with the severity and duration of LEA dose.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationLEA and/or LCA should be excluded from an OTS diagnosis as LEA is the underlying aetiology for a REDs diagnosis.
“It is important to note that LEA and/or LCA, although challenging to assess, should be excluded from an OTS diagnosis as LEA is the underlying aetiology for a REDs diagnosis.37 59”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [37] Stellingwerff, 2021, Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S): shared pathways, symptoms and complexities, Sports Med source
- cites [59] Kuikman, 2022, Markers of low energy availability in overreached athletes: a systematic review and meta-analysis, Sports Med source
May combine two claims.
Interpretationnone givenAlthough acute mild periods of LEA do not always lead to adverse outcomes, problematic LEA exposure leads to REDs.
“Although acute mild periods of LEA do not always lead to adverse outcomes, problematic LEA exposure leads to REDs.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenFigure 1 (REDs Health Model) and figure 2 (REDs Performance Model) are conceptual models that demonstrate the range of body systems for which there is theoretical, empirical, and/or clinical evidence of impairments that manifest in different ways.
“Figure 1 (REDs Health Model) and figure 2 (REDs Performance Model) are conceptual models that demonstrate the range of body systems for which there is theoretical, empirical, and/or clinical evidence of impairments that manifest in different ways.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationA prior history of DE behaviours or an ED might perpetuate continued under-fuelling of energy and must be considered an important risk factor for developing REDs.
“A prior history of DE behaviours or an ED might perpetuate a continued under-fuelling of energy 1 and must therefore be considered an important risk factor for developing REDs.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenThe REDs Conceptual Models were developed to raise awareness of the athletic, coach, sports science and sports medicine communities to this syndrome.
“The REDs Conceptual Models were developed to raise awareness of the athletic, coach, sports science and sports medicine communities to this syndrome.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningAlthough changes are comparable to those REDs outcomes found in female athletes, the magnitude of the effects on some physiological parameters and the threshold at which these effects manifest appear to be variable between the sexes.
“Although changes are comparable to those REDs outcomes found in female athletes, the magnitude of the effects on some physiological parameters and the threshold at which these effects manifest appear to be variable between the sexes.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationcitationThe risk of bone stress injury (BSI) is of particular concern in athletes with spinal cord injury who experience a substantial loss of BMD immediately postinjury and hence have a high incidence of low BMD for age and/or osteoporosis.
“The risk of bone stress injury (BSI) is of particular concern in athletes with spinal cord injury who experience a substantial loss of BMD immediately postinjury and hence have a high incidence of low BMD for age and/ or osteoporosis.118”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [118] source
Classified as probably not a substantial claim.
InterpretationcitationThe development of a physiological model for each body system, underpinned by a 'systems biology mindset', will enable a more nuanced assessment of the individual athlete and whether their specific combination of LEA exposure and secondary moderators is likely to lead to positive, neutral or negative health and/or performance outcomes.
“The development of a physiological model for each body system, underpinned by a 'systems biology mindset', 124 will enable a more nuanced assessment of the individual athlete and whether their specific combination of LEA exposure and secondary moderators is likely to lead to positive, neutral or negative health and/or performance outcomes.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [124] source
May combine two claims.
InterpretationreasoningThere is no singular validated diagnostic method for REDs, as the syndrome has a complex mosaic of signs and symptoms, necessitating the exclusion of other potential aetiologies in the differential diagnosis for each REDs indicator.
“It is important to note that despite diagnostic progress, there is no singular validated diagnostic method for REDs, as the syndrome has a complex mosaic of signs and symptoms, necessitating the exclusion of other potential aetiologies in the differential diagnosis for each REDs indicator.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
InterpretationreasoningThis is of concern, especially for young athletes, due to potentially long-lasting negative physical and psychological outcomes.
“This is of concern, especially for young athletes, due to potentially long-lasting negative physical and psychological outcomes.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenApplying LEA exposure (ie, severity, duration, frequency) on subsequent REDs short, medium and long-term outcomes is complex and dependent on many moderating factors.
“Experts in the field have long realised that applying LEA exposure (ie, severity, duration, frequency) on subsequent REDs short, medium and long-term outcomes is complex and dependent on many moderating factors.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Interpretationnone givenThe REDs Health and Performance Conceptual Models are not separate entities; they involve considerable overlap.
“It is important to note that the REDs Health and Performance Conceptual Models are not separate entities; they involve considerable overlap.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationreasoningThe exclusion of primary aetiologies (differential diagnoses) should occur when diagnosing REDs.
“Therefore, the exclusion of primary aetiologies (differential diagnoses) should occur when diagnosing REDs”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
InterpretationcitationGraded arrows illustrate a continuum from adaptable LEA to problematic LEA exposure, with the former representing benign physiological adaptations to energy fluctuations (ie, physiological plasticity), while the outer region of the hub notes the range of health and performance concerns which can be associated with the latter.
“Graded arrows illustrate a continuum from adaptable LEA to problematic LEA exposure, with the former representing benign physiological adaptations to energy fluctuations (ie, physiological plasticity), 44 while the outer region of the hub notes the range of health and performance concerns which can be associated with the latter.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA spectrum of energy mismatches, with differing severity of consequences, was part of the original concept of EA.
“A spectrum of energy mismatches, with differing severity of consequences, was part of the original concept of EA. 2 4”
Quote in the paperNot a substantial claim0 of 2 sources checkedClassified as probably not a substantial claim.
InterpretationreasoningImplementing a standardised approach can better manage the errors associated with EA assessment.
“but these can be better managed in the future by implementing a standardised approach.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningFuture use of standardised methodologies should assist in better assessment of EA, more nuanced interpretation of past and future data, and better replication or comparison of work in this area.
“Future use of standardised methodologies should assist in better assessment of EA, more nuanced interpretation of past and future data, and better replication or comparison of work in this area.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningProtocols that achieve a harmonised time-course for assessment and the individual components of EA may assist in future LEA and REDs activities by standardising the errors and limitations of the assessment, and balancing the issues of time and resource burden, feasibility and measurement precision.
“Protocols that achieve a harmonised time-course for assessment and the individual components of EA may assist in future LEA and REDs activities by standardising the errors and limitations of the assessment, and balancing the issues of time and resource burden, feasibility and measurement precision.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenThe updated model uses qualitative terms (adaptable, problematic) as an alternative to the previous focus on quantitative assessments with universally applied thresholds of concern.
“However, the updated model uses qualitative terms (adaptable, problematic) as an alternative to the previous focus on quantitative assessments with universally applied thresholds of concern.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
InterpretationreasoningTo progress the REDs scientific field forward, we need integrated dynamic physiological models that can help explain the biological complexity and interaction within and between various body systems, as well as the inconsistencies in the manifestation of REDs signs and symptoms resulting from problematic LEA.
“To progress the REDs scientific field forward, we need integrated dynamic physiological models that can help explain the biological complexity and interaction within and between various body systems, as well as the inconsistencies in the manifestation of REDs signs and symptoms resulting from problematic LEA.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenA more researched and clinically based unifying physiological model has been developed.
“Accordingly, and novel to this 2023 consensus update, a more researched and clinically based unifying physiological model has been developed.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningCross-sectional studies are useful for clinical REDs assessment and prevalence, but an analysis of this literature reveals multiple limitations.
“Cross-sectional studies are useful for clinical REDs assessment and prevalence, but an analysis of this literature reveals multiple limitations (eg, lack of a classification of subject calibre/training status; lack of a standardisation of recruitment and assessment protocols; poor characterisation of menstrual status and hormonal contraceptive use; varied use of indicators of physiological, Hormon”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenSome exposure to LEA is mild and transient, termed adaptable LEA.
“While some exposure to LEA is mild and transient termed adaptable LEA (arrow depicted in white)”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe IOC REDs CAT2 guidelines are less reliable when it is impossible to assess all indicators in table 4.
“Furthermore, these guidelines are less reliable when it is impossible to assess all indicators in table 4.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe overall outcome of the online Delphi survey was 144 total votes, with 117 agreement and 27 minority disagreement.
“overall outcome | 144 | 117 | 27”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationreasoningBy the triangulation of data from cross-sectional, longitudinal, and interventional studies, the complexity of the relationship between LEA and REDs can be realised.
“By the triangulation of data from these various approaches (cross-sectional/longitudinal/interventional studies), the complexity of the relationship between LEA and REDs can be realised.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn round 1 of the online Delphi survey, there were 135 total votes, with 76 agreement, 29 minority disagreement, and 30 disagreement.
“round 1 voting | 135 | 76 | 29 | 30”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIn round 2 of the online Delphi survey, there were 44 total votes, with 41 agreement and 3 disagreement.
“round 2 voting | 44 | 41 | 3”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationnone givenMental health issues can either precede REDs or be the result of REDs.
“*Mental Health Issues can either precede REDs or be the result of REDs.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The expert panel's consensus reflects the best available evidence on REDs.
“consensus methodology also harnesses experts' insights to enable more validated recommendations to be made when the published evidence ranges from insufficient to adequate.”
The paper relies on this without support.
The RAND-UCLA Appropriateness Method is a valid method for developing consensus recommendations on REDs.
“This REDs consensus statement used the RAND-UCLA Appropriateness Method (RAM).43”
The paper relies on this without support.
The literature search identified all relevant studies on REDs and LEA.
“Since 2018, there have been considerable scientific advancements in the REDs research field including ~178 REDs and/ or LEA original research publications featuring ~23 822 participants; (80% female), with ~62% of these studies implementing a cross-sectional design, ~14% as longitudinal observational and ~12% longitudinal intervention (see literature summary in online supplemental file 1).”
The paper relies on this without support.
The measurement of EA in free-living athletes is challenged by a high level of burden (eg, time, effort) to the participant and assessor.
“Unfortunately, the measurement of EA in free-living athletes is challenged by a high level of burden (eg, time, effort) to the participant and assessor.”
The paper relies on this without support.
Many members of the athlete entourage lack the knowledge of safe regulation of body weight and composition and how it can be utilised to improve performance while maintaining health.
“many members of the athlete entourage appear to ( 1) lack the knowledge of safe regulation of body weight and composition and how it can be utilised to improve performance while maintaining health;”
The paper relies on this without support.
Many members of the athlete entourage have ignorance of the suitability of various body composition methods and the possible negative health effects consequent to inappropriate assessment.
“(2) have ignorance of the suitability of various body composition methods and the possible negative health effects consequent to inappropriate assessment”
The paper relies on this without support.
Many members of the athlete entourage have inadequate communication skills, with lack of optimised protocols on how to manage and safely implement the data to promote health and performance without the added risk of developing REDs, DE behaviours or EDs.
“(3) have inadequate communication skills, with lack of optimised protocols on how to manage and safely implement the data to promote health and performance without the added risk of developing REDs, DE behaviours or EDs.”
The paper relies on this without support.
Choosing an appropriate body composition assessment method involves consideration of its accuracy, repeatability, utility and cost.
“Choosing an appropriate body composition assessment method involves consideration of its accuracy, repeatability, utility and cost.”
The paper relies on this without support.
For para athletes, adjustments of the assessment protocol and analysis of results may be needed.
“For para athletes, adjustments of the assessment protocol and analysis of results may be needed.”
The paper relies on this without support.
Problematic LEA is the underlying aetiology for the health and performance outcomes of REDs.
“Because problematic LEA is the underlying aetiology for the health and performance outcomes of REDs”
The paper relies on this without support.
Various LEA indicators (signs and symptoms) have emerged as the current best practice for clinical assessment and research purposes.
“various LEA indicators (signs and symptoms) have emerged as the current best practice for clinical assessment and research purposes.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The prevalence of relative energy deficiency in endurance sport athletes (REDs), especially in females, may impact SmO2 kinetics.
“the prevalence of relative energy deficiency in endurance sport athletes (REDs) (Mountjoy et al., 2023; Dasa et al., 2024), especially in females, may also impact SmO2 kinetics.”
From Monitoring skeletal muscle oxygen saturation kinetics during graded exercise testing in NCAA division I female rowers (2025) · cites this paper as Mountjoy et al., 2023
The energy-availability section reports a wide range of estimated LEA/REDs-indicator prevalence in female and male athletes across sports, and the References include studies of endurance athletes. It does not establish an endurance-specific prevalence or say that REDs may affect SmO2 kinetics; searches for SmO2 and muscle oxygenation found no such discussion. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn 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].”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [29]
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)
Experimental — accuracy not yet measuredIndependent 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].”
From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [29]
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
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Self-citation
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Sporting Mind: The Interplay of Physical Activity and Psychological Health
Martín-Rodríguez, A., Gostian, L. A., Beltrán-Velasco, A. I., Belando‐Pedreño, N., Simón, J. A., López-Mora, C., Navarro-Jiménez, E., Tornero-Aguilera, J. F., & Clemente‐Suárez, V. J. (2024) · Sports · doi:10.3390/sports12010037 · Cited by 450 · see citing works
Mathisen, T. F., Ackland, T. R., Burke, L. M., Constantini, N., Haudum, J., Macnaughton, L. S., Meyer, N. L., Mountjoy, M. L., Slater, G., & Sundgot‐Borgen, J. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106812 · Cited by 122 · see citing works
Self-citationTorstveit, M. K., Ackerman, K. E., Constantini, N., Holtzman, B., Koehler, K., Mountjoy, M. L., Sundgot-Borgen, J., & Melin, A. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106932 · Cited by 100 · see citing works
Self-citationRelative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments
Angelidi, A. M., Stefanakis, K., Chou, S. H.-H., Valenzuela‐Vallejo, L., Δίπλα, Κ., Boutari, C., Ntoskas, K. T., Tokmakidis, P., Kokkinos, A. D., Goulis, D. G., et al. (2024) · Endocrine Reviews · doi:10.1210/endrev/bnae011 · Cited by 95 · see citing works
Gallant, T. L., Ong, L. F., Wong, L., Sparks, M., Wilson, E., Puglisi, J. L., & Gerriets, V. A. (2025) · Sports Medicine · doi:10.1007/s40279-024-02130-0 · Cited by 75 · see citing works
“For example, in 2023, the International Olympic Committee estimated that the prevalence of REDs was somewhere between 15 and 80% among elite athletes [29].”
Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?
Jeukendrup, A. E., Areta, J. L., Genechten, L. V., Langan‐Evans, C., Pedlar, C. R., Rodas, G., Sale, C., & Walsh, N. P. (2024) · Sports Medicine · doi:10.1007/s40279-024-02108-y · Cited by 75 · see citing works
The brain–body energy conservation model of aging
Shaulson, E. D., Cohen, A. A., & Picard, M. A. (2024) · Nature Aging · doi:10.1038/s43587-024-00716-x · Cited by 76 · see citing works
“…with menstrual cycle and quality sperm production through similar mechanisms as overtraining syndrome 228 and relative energy deficit in sport 120 Decreased immune repertoire/complexity Pathological degradation of immune function (immunosenescence) 229 Pruning of naive/memory cell…”
InfluentialBergeron, M. F., Côté, J., Cumming, S. P., Purcell, R., Armstrong, N., Basilico, L., Burrows, K., Charrin, J.-B., Felix, A., Groesswang, H., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108186 · Cited by 63 · see citing works
“152 154 A similar risk is evident with late-maturing female athletes where the pubertal growth spurt is accompanied by a greater training and/or competition load characteristic of older adolescents.”
Self-citationNaderi, A., Rothschild, J. A., Santos, H. O., Hamidvand, A., Koozehchian, M. S., Ghazzagh, A., Berjisian, E., & Podlogar, T. (2025) · Sports Medicine · doi:10.1007/s40279-025-02213-6 · Cited by 43 · see citing works
“Nutritional strategies play a pivotal role in the recovery process by replenishing energy stores, maintaining energy availability [4], and promoting repair mechanisms and adaptive responses to exercise [5, 6].”
Ihalainen, J. K., Mikkonen, R. S., Ackerman, K. E., Heikura, I. A., Mjøsund, K., Valtonen, M., & Hackney, A. C. (2024) · Sports Medicine · doi:10.1007/s40279-024-02065-6 · Cited by 45 · see citing works
Self-citationFemale Athlete Triad and Relative Energy Deficiency in Sport (REDs): Nutritional Management
Grabia, M., Perkowski, J., Socha, K., & Markiewicz‐Żukowska, R. (2024) · Nutrients · doi:10.3390/nu16030359 · Cited by 59 · see citing works
“To sustain optimal muscle protein synthesis and strength, it is advisable to consume 10 g of essential amino acids (equivalent to 15–25 g of high-biological-value protein) within 2 h after training [74].”
BackgroundInfluentialEnergy Expenditure in Humans: Principles, Methods, and Changes Throughout the Life Course
Fernández‐Verdejo, R., Sánchez‐Delgado, G., & Ravussin, É. (2024) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-062122-031443 · Cited by 46 · see citing works
An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes
Fatt, S. J., George, E. S., Hay, P., JEACOCKE, N. A., Gotkiewicz, E., & Mitchison, D. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13144171 · Cited by 49 · see citing works
Ackerman, K. E., Rogers, M. A., Heikura, I. A., Burke, L. M., Stellingwerff, T., Hackney, A. C., Verhagen, E., Schley, S., Saville, G. H., Mountjoy, M., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107359 · Cited by 43 · see citing works
Self-citationInternational Delphi consensus on bone stress injuries in athletes
Hoenig, T., Hollander, K., Popp, K. L., Fredericson, M., Kraus, E., Warden, S. J., & Tenforde, A. S. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108616 · Cited by 41 · see citing works
“11 36 59 Consensus was not reached for routinely obtaining a dual-energy X-ray absorptiometry study to measure bone mineral density (BMD) values in at-risk sports such as running if athletes are injury free.”
Society for endocrinology guideline for understanding, diagnosing and treating female hypogonadism
Jayasena, C. N., Devine, K., Barber, K., Comninos, A. N., Conway, G. S., Crown, A. L., Davies, M. C., Ewart, A., Seal, L., Smyth, A., et al. (2024) · Clinical Endocrinology · doi:10.1111/cen.15097 · Cited by 39 · see citing works
“The International Olympic Committee (IOC) does not favour the routine use of COC (or HRT) in athletes with HA, 164 who in any case benefit from direct access to expert multidisciplinary care from specialist sports physicians, dieticians, exercise physiologists and psychologists; generally undergo serial measurement of…”
InfluentialDeering, R. E., Donnelly, G., Brockwell, E., Bø, K., Davenport, M. H., VIVO, M. D., Dufour, S. P., Forner, L. B., Mills, H., Moore, I. S., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107490 · Cited by 38 · see citing works
Cao, W., He, Y., Fu, R. G., Chen, Y., Yu, J., & He, Z. (2025) · Nutrients · doi:10.3390/nu17050918 · Cited by 36 · see citing works
“These changes may lead to fatigue, injury, and disruptions in energy metabolism and physiological function, ultimately influencing athletic performance [46] (Figure 3).”
Jeppesen, J. S., Caldwell, H. G., Lossius, L. O., Melin, A., Gliemann, L., Bangsbo, J., & Hellsten, Y. (2024) · Redox Biology · doi:10.1016/j.redox.2024.103250 · Cited by 36 · see citing works
“Low energy availability (LEA) is defined as a mismatch between dietary energy intake (EI) and exercise energy expenditure (EEE) that leads to inadequate energy [3,4] to support bodily functions required to maintain optimal health and performance [5].”
BackgroundSelf-citationSchulz, J. M., Pohlod, L., Myers, S., Chung, J., & Thornton, J. S. (2024) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.100981 · Cited by 31 · see citing works
“52 Although some studies included questions/recommendations related to nutrition/ eating habits ( n = 31), 7 (cid:1) 9,14 (cid:1) 21,24,25,27 (cid:1) 39,43,45,46,48,49 body weight/image ( n = 24), 7 (cid:1) 9,14,15,17 (cid:1) 21,23,24,28,30 (cid:1) 35,37,39,45,46,48 bone health ( n = 16), 7,8,15…”
InfluentialLoucks, A. B., Stachenfeld, N. S., & DiPietro, L. (2006) · Springer eBooks · doi:10.1007/978-3-032-05988-8_80 · Cited by 30 · see citing works
Nutritional counseling in athletes: a systematic review
Fiorini, S., Neri, L. D. C. L., Guglielmetti, M., Pedrolini, E., Tagliabue, A., Quatromoni, P. A., & Ferraris, C. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1250567 · Cited by 30 · see citing works
Jones, B. P., L’Heveder, A., Bishop, C., Kasaven, L. S., Saso, S., Davies, S. R., Chakraverty, R., Brown, J. C., & Pollock, N. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1296189 · Cited by 35 · see citing works
Safarpour, A., Laleh, S. S., & Soltani, S. (2024) · Progress in Engineering Science · doi:10.1016/j.pes.2024.100035 · Cited by 28 · see citing works
Heikura, I. A., McCluskey, W. T. P., Tsai, M., Johnson, L. J., Murray, H. J., Mountjoy, M. L., Ackerman, K. E., Fliss, M. D., & Stellingwerff, T. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108121 · Cited by 29 · see citing works
Self-citationWarneke, K., Thomas, E., Blazevich, A. J., Afonso, J. R., Behm, D. G., Marchetti, P. H., Trajano, G. S., Nakamura, M., Ayala, F., Longo, S., et al. (2025) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2025.101067 · Cited by 40 · see citing works
Costa, R. J. S., Gaskell, S. K., Henningsen, K., JEACOCKE, N. A., Martinez, I. G., Mika, A. S., Scheer, V., Scrivin, R., Snipe, R. M. J., Wallett, A. M., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02186-6 · Cited by 31 · see citing works
“These can include predisposition, established diseases/disorders, or other underlying health influencing behaviors that may alter gastrointestinal integrity and/or functional response to exercise [165].”
InfluentialMenstrual cycle tracking in professional volleyball athletes
Roffler, A., Fleddermann, M., de Haan, H., Krüger, K., & Zentgraf, K. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1408711 · Cited by 25 · see citing works
Are we asking the right questions? Female athletes’ perspectives on the menstrual cycle in sport
van den Berg, C. A., & Doyle–Baker, P. K. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102767 · Cited by 25 · see citing works
Stellingwerff, T., Burke, L. M., Caldwell, H. G., Gathercole, R. J., McNeil, C. J., Napier, C., Purcell, S. A., Boegman, S., Johnson, E. A., Hoar, S., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02227-0 · Cited by 28 · see citing works
“…way to assess the impact and outcomes of extreme conditions [e.g., such as athlete eating disorders, relative energy deficiency in sport (REDs) [48], or the extreme physical output required to train ~ 30,000 km/year and successfully finish the Tour de France [49, 50]] is to monitor…”
Self-citationCrossley, K. M., Haberfield, M. J., Ross, A. G., Gracias, L., Bruder, A. M., Whittaker, J. L., Chintoh, A. F., Thornton, J. S., Davenport, M. H., Mountjoy, M. L., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-109946 · Cited by 24 · see citing works
“54 Our data did not represent the perception of female/woman/girl athletes being ‘fragile and dainty’, 60 which could result in overprotective behaviours and diminished exposure to injury prevention activities.”
Self-citationHerring, S. A., Putukian, M., Kibler, W. B., LeClere, L. E., Boyajian-O’Neill, L. A., Day, M. A., Franks, R., Indelicato, P. A., Matuszak, J. M., MILLER, T. L., et al. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003371 · Cited by 24 · see citing works
Crossley, K. M., Whittaker, J. L., Patterson, B., Shill, I., Heming, E. E., Bullock, G. S., Dijkstra, H. P., Donaldson, A., McKay, C. D., Mountjoy, M. L., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-110889 · Cited by 24 · see citing works
Self-citationDietary Intake of Masters Athletes: A Systematic Review
Guo, S., Shaoni, G. L. L., Stuart‐Smith, W., Davies, A. J., & Gifford, J. A. (2023) · Nutrients · doi:10.3390/nu15234973 · Cited by 21 · see citing works
“Alternatively, underconsumption may be part of a state of low energy availability (LEA), where energy intake minus exercise energy expenditure and energy intake (per kg of fat free mass) is suboptimal for health [56].”
BackgroundAgreement Between the 2- and 3-Step Methods for Identifying Subtle Menstrual Disturbances
Noordhof, D. A., Taylor, M., Topranin, V. D. M., Engseth, T. P., Sandbakk, Ø. B., & Osborne, J. O. (2024) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2024-0057 · Cited by 21 · see citing works
Coen, S. E., Downie, V., Follett, L., McCaig, S., & Parsons, J. L. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108717 · Cited by 22 · see citing works
Alcock, R., Hislop, M., Vidgen, H. A., & Desbrow, B. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9040221 · Cited by 27 · see citing works
Williams, N. I., Souza, M. J. D., Misra, M. D. D. S. K., Nattiv, A., Joy, E. A., Barrack, M. T., Ricker, E. A., Gorrell, S., Koltun, K. J., O’Donnell, E., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02332-0 · Cited by 32 · see citing works
Nutrition for optimising immune function and recovery from injury in sports
Kozjek, N. R., Tonin, G., & Gleeson, M. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.01.031 · Cited by 20 · see citing works
Jeppesen, J. S., Hellsten, Y., Melin, A., & Hansen, M. (2025) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.70089 · Cited by 21 · see citing works
Self-citationConsensus Statements—Optimizing Performance of the Elite Athlete
Bangsbo, J., Hostrup, M., Hellsten, Y., Hansen, M., Melin, A., Kjær, M., Burr, J. F., Engebretsen, L., Egan, B., Hackney, A. C., et al. (2025) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.70112 · Cited by 19 · see citing works
“Athletes and coaches should be aware that low energy availability (LEA) may have adverse effects on performance, injury risk, and health [11, 22] (see also Section 3.3 and Section 4.5).”
InfluentialSelf-citationBMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107549 · Cited by 17 · see citing works
Association between Low Energy Availability (LEA) and Impaired Sleep Quality in Young Rugby Players
Saidi, O., Souabni, M., Sordo, G. C. D., Maviel, C., Peyrel, P., Maso, F., Vercruyssen, F., & Duché, P. (2024) · Nutrients · doi:10.3390/nu16050609 · Cited by 17 · see citing works
“EA was calculated as the amount of dietary energy remaining after EEE, normalized to fat-free mass (FFM) [24,33].”
BackgroundMethodInfluentialRelative energy deficiency in dance (RED-D): a consensus method approach to REDs in dance
Allen, N., Kelly, S., Lanfear, M., Reynolds, A., Clark, R., Mountjoy, M. L., Wyon, M. A., & Wolman, R. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001858 · Cited by 17 · see citing works
Self-citationPrioritise safety, optimise success! Return to rugby postpartum
Donnelly, G., Coltman, C., Dane, K., Elliott-Sale, K. J., Hayman, M., McCarthy-Ryan, M. F., Perkins, J., Rollins, S., & Moore, I. S. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12144 · Cited by 17 · see citing works
“Calorific demands of breastfeeding should be factored into player fueling to ensure that an energy deficit and subsequent predisposition to problematic low energy availability do not present (Deering et al., 2023; Mountjoy et al., 2018; World Rugby, 2024).”
Holtzman, B., Kelly, R. K., Saville, G. H., McCall, L. M., Adelzedah, K. A., Sarafin, S. R., Nikam, P., Meneguzzi, I., McIntyre, A., Kraus, E., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-109165 · Cited by 21 · see citing works
Self-citationVarðardóttir, B., Ólafsdóttir, A. S., & Guðmundsdóttir, S. L. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001731 · Cited by 21 · see citing works
Moore, I. S., McCarthy-Ryan, M. F., Palmer, D., Perkins, J., & Verhagen, E. A. L. M. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12089 · Cited by 16 · see citing works
“Similarly secondary amenorrhea (absence of periods for 3 months or more) should be recorded, as it can serve as a potential indicator of problematic low energy availability or relative energy deficiency (Mountjoy et al., 2023) allowing early detection and management.”
Self-citationVarðardóttir, B., Guðmundsdóttir, S. L., Tryggvadóttir, E. A., & Ólafsdóttir, A. S. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1390558 · Cited by 19 · see citing works
UEFA consensus statement on menstrual cycle tracking in women’s football
Verhagen, E. A. L. M., Ferrer, E., Antero, J., Bahtijarević, Z., Barlow, A., Bolling, C. S., Gabarro, M., Harrison, M., Jarrin, P., de Jonge, X. J., et al. (2025) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2025-002769 · Cited by 16 · see citing works
Self-citationOleka, C. T., Anderson, T., Ackerman, K. E., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108261 · Cited by 15 · see citing works
Self-citationRyall, S., Ohrling, H., Stellingwerff, T., Black, S. E., Reilly, K. C., & Thornton, J. S. (2024) · Sports Medicine · doi:10.1007/s40279-024-02078-1 · Cited by 15 · see citing works
“These include but are not limited to fatigue, rapid weight loss, frequent illness, irritability and depression, performance and training plateaus or declines, and bone stress injury [46, 47].”
Self-citationPersonalized Nutrition for the Enhancement of Elite Athletic Performance
Sutehall, S., & Pitsiladis, Y. P. (2025) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.70044 · Cited by 15 · see citing works
Dasa, M. S., Friborg, O., Kristoffersen, M., Pettersen, G., Sagen, J. V., Torstveit, M. K., Sundgot‐Borgen, J., & Rosenvinge, J. H. (2024) · European Journal of Sport Science · doi:10.1002/ejsc.12129 · Cited by 15 · see citing works
“In light of recent evidence delineating the adverse effects of low carbohydrate availability and its role in the emergence or REDs (Mountjoy et al., 2023), it is crucial to direct focus toward enhancing nutritional literacy among female football players in general.”
BackgroundMethodInfluentialSelf-citationMacMillan, C., Olivier, B., Viljoen, C. T., van Rensburg, D. C. J., & Sewry, N. A. (2024) · Sports Medicine · doi:10.1007/s40279-024-02074-5 · Cited by 14 · see citing works
“It is crucial for both male and female athletes, particularly emphasising the significant health and performance implications for female athletes [18, 19].”
BackgroundAbnormal electrocardiogram findings in athletes
Finocchiaro, G., Zorzi, A., Abela, M., Baggish, A. L., Castelletti, S., Cavarretta, E., Claessen, G., Corrado, D., la Garza, M. S., Gati, S., et al. (2025) · European Heart Journal · doi:10.1093/eurheartj/ehaf646 · Cited by 16 · see citing works
“It is important to note that marked bradycardia may be exacerbated by certain medications and is often associated with severe relative energy deficiency 12 (e.g. in athletes with anorexia nervosa).”
von Brackel, F. N., Munzinger, R., Bartosik, M., Simon, A., Barvencik, F., Oheim, R., & Amling, M. (2025) · Journal of Cachexia Sarcopenia and Muscle · doi:10.1002/jcsm.70082 · Cited by 14 · see citing works
Oxfeldt, M., Marsi, D., Christensen, P. M., Andersen, O. E., Johansen, F. T., Bangshaab, M., Risikesan, J., Jeppesen, J. S., Hellsten, Y., Phillips, S. M., et al. (2023) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003370 · Cited by 14 · see citing works
“Future studies are needed to establish best practice guidelines for body mass manipulation with a focus on feasibility and reducing the risks associated with problematic LEA (3).”
BackgroundInfluentialSelf-citationThe race within a race: Together on the marathon starting line but miles apart in the experience
Burke, L. M., Whitfield, J., & Hawley, J. A. (2024) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2024.10.277 · Cited by 16 · see citing works
Self-citationNutrition Knowledge and Perceived Dietary Requirements of Adolescent Student-Athletes: A Pilot Study
Jagim, A. R., Merfeld, B. R., Ambrosius, A., Carpenter, M., Fields, J. B., & Jones, M. T. (2024) · Nutrients · doi:10.3390/nu17010133 · Cited by 14 · see citing works
“Failure to adhere to sports-specific nutritional recommendations may increase the risk of energy and nutrient deficiencies in adolescent athletes, which may subsequently increase the risk of conditions such as REDs and the female or male athlete triads [5,6].”
InfluentialRelative Energy Deficiency in Sport—Multidisciplinary Treatment in Clinical Practice
Meyer, A., Haigis, D., Klos, B., Zipfel, S., Resmark, G., Rall, K., Dreser, K., Hagmann, D., Niess, A. M., Kopp, C., et al. (2025) · Nutrients · doi:10.3390/nu17020228 · Cited by 17 · see citing works
Solli, G. S., Sandbakk, Ø., & McGawley, K. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00792-8 · Cited by 14 · see citing works
“However, suggesting such changes must be approached individually, with high caution and in association with clinical expertise due to the potential physical and mental health risks associated with relative energy deficiency in sport (REDs) [71].”
Giagio, S., Adami, P. E., Bermon, S., et al. (2025) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2025-002564 · Cited by 13 · see citing works
“The survey’s availability in four languages enhanced accessibility and inclusivity.”
Investigating pre-professional dancer health status and preventative health knowledge
Nicholas, J., & Grafenauer, S. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1271362 · Cited by 14 · see citing works
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Self-citationInjury incidence and prevalence in elite short-course triathletes: a 4-year prospective study
Crunkhorn, M. L., Toohey, L. A., Charlton, P. C., Drew, M. K., Watson, K., & Etxebarria, N. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107327 · Cited by 13 · see citing works
Lempke, A. F. D., Reece, L. M., & Whitney, K. E. (2025) · PLoS ONE · doi:10.1371/journal.pone.0314506 · Cited by 14 · see citing works
Whittaker, J. L., Räisänen, A. M., Martin, C. L., Galarneau, J.-M. F., Martin, M. D., Losciale, J. M., Bullock, G. S., Dubé, M.-O., Bizzini, M., Bourne, M. N., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-109902 · Cited by 13 · see citing works
Self-citationREDs and the lactating athlete: an evidence gap
Deering, R. E., & Mountjoy, M. L. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107080 · Cited by 13 · see citing works
Self-citationHerring, S. A., Putukian, M., Kibler, W. B., LeClere, L. E., Boyajian-O’Neill, L. A., Day, M. A., Franks, R., Indelicato, P. A., Matuszak, J. M., Miller, T. L., et al. (2024) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000001169 · Cited by 12 · see citing works
Steffen, K., Bahr, R., Clarsen, B. M., Fossan, B., Fredriksen, H., Gjelsvik, H., Haugvad, L., Hoksrud, A. F., Iversen, E., Koivisto, A., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107942 · Cited by 12 · see citing works
Fat-Free Mass Index in Sport: Normative Profiles and Applications for Collegiate Athletes
Jagim, A. R., Harty, P. S., Jones, M. T., Fields, J. B., Magee, M. K., Smith‐Ryan, A. E., Luedke, J. A., & Kerksick, C. M. (2024) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000004864 · Cited by 12 · see citing works
Kuikman, M. A., Smith, E. S., McKay, A. K. A., McCormick, R., Ackerman, K. E., Harris, R., Elliott-Sale, K. J., Stellingwerff, T., & Burke, L. M. (2024) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003555 · Cited by 12 · see citing works
“A proposed physiological outcome of LEA within the REDs model is impaired energy metabolism resulting in a suppressed resting metabolic rate (RMR) (2), with RMR representing the energy necessary to sustain normal bodily function at rest (7).”
Self-citationMcNulty, K. L., Taim, B. C., Freemas, J. A., Hassan, A. A., Lupton‐Smith, C., Oleka, C. T., Scott, D., Howatson, G., Moore, I. S., Yung, K. K., et al. (2024) · Women in Sport and Physical Activity Journal · doi:10.1123/wspaj.2024-0064 · Cited by 12 · see citing works
Low Energy Availability Risk Is Associated with Anxiety in Female Collegiate Athletes
Scheid, J. L., Basile, S., & West, S. (2024) · Sports · doi:10.3390/sports12100269 · Cited by 14 · see citing works
“…is one area with little research related to low energy availability, despite the 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) highlighting a bidirectional relationship between mental health issues and low energy availability [10].”
BackgroundKirschbaum, E. M., Fischer, K., Speiser, D., Lautenbach, F., Schwenkreis, F., Dathan-Stumpf, A., & Legerlotz, K. (2025) · Sports Medicine - Open · doi:10.1186/s40798-025-00845-6 · Cited by 17 · see citing works
“…to recognize that elite female athletes from all sports disciplines, not just from endurance and aesthetic sports, are at risk of developing MD. Additionally, other REDs-related negative health consequences, such as stress urinary incontinence [8], were frequently observed among female athletes.”
InfluentialREDs alert: male athletes be wary and scientists take action!
Hackney, A. C., Melin, A., Ackerman, K. E., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106719 · Cited by 12 · see citing works
Self-citationLiang, Y.-H., Li, Y., Chen, Y., Meng, K., Zhou, F., Pei, Y.-R., Liu, Y., & Qiu, J.-Q. (2025) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2025.2490170 · Cited by 11 · see citing works
“Since 2014, the International Olympic Committee’s consensus statement on Relative Energy Deficiency in Sport (RED-S) has been updated three times, continually refining research on the potential impact of LEA on physiological function and athletic performance [10–12].”
Souza, M. D. D., Williams, N., Misra, M., Nattiv, A., Joy, E. A., Barrack, M., Ricker, E. A., Gorrell, S., Koltun, K. J., O'Donnell, E., et al. (2025) · Sports Medicine · doi:10.1007/s40279-025-02333-z · Cited by 21 · see citing works
Energetics of a World-Tour Female Road Cyclist During a Multistage Race (Tour de France Femmes)
Areta, J. L., Meehan, E., Howe, G., & Redman, L. M. (2024) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2023-0275 · Cited by 11 · see citing works
Multi-organ Transcriptome Atlas of a Mouse Model of Relative Energy Deficiency in Sport (REDs)
van Rosmalen, L., Zhu, J.-Y., Maier, G., Gacasan, E., Lin, T., Zhemchuzhnikova, E., Rothenberg, V., Razu, S. S., Deota, S., Ramasamy, R. K., et al. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2024.08.001 · Cited by 11 · see citing works
Rueda-Córdoba, M., Martín-Olmedo, J. J., Espinar, S., Ruiz, J. R., & Jurado‐Fasoli, L. (2025) · Nutrients · doi:10.3390/nu17071172 · Cited by 11 · see citing works
“Dietary intake of energy and macronutrients is also relevant for athletes, as it provides energy for training and recovery, supports muscle repair and growth, regulates metabolic processes, and optimizes performance [36].”
Up-to-date understanding of overtraining syndrome and overlap with related disorders
Haghighat, N., & Stull, T. (2024) · Sports Psychiatry · doi:10.1024/2674-0052/a000072 · Cited by 11 · see citing works
The relationship between nutrition knowledge and low energy availability risk in collegiate athletes
Burger, S., Bray, A., & Kim, B. (2024) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2024.03.010 · Cited by 10 · see citing works
Relative Energy Deficiency in Sport (REDs) and knee injuries: current concepts for female athletes
Wang, M., Chee, J., Tanaka, M. J., & Lee, Y. H. D. (2024) · Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine · doi:10.1016/j.jisako.2024.05.012 · Cited by 10 · see citing works
Return to Running for Postpartum Elite and Subelite Athletes
Woodroffe, L. M., Slayman, T. G., Paulson, A., Kruse, N., Mancuso, A. C., & Hall, M. M. (2024) · Sports Health A Multidisciplinary Approach · doi:10.1177/19417381241256973 · Cited by 11 · see citing works
“50 Physically active mothers should be aware of their energy balance and consume enough calories to cover their expended calories on a daily basis.”
Popp, K. L., Bozzini, B. N., Reynoso, M., Coulombe, J. C., Guerriere, K. I., Proctor, S. P., Castellani, C. M., Walker, L. A., Zurinaga, N., Kuhn, K., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107716 · Cited by 11 · see citing works
Whitney, K. E., Lempke, A. F. D., Stellingwerff, T., Burke, L. M., Holtzman, B., Baggish, A. L., d’Hemecourt, P. A., Dyer, S., Troyanos, C., Adelzadeh, K., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108181 · Cited by 10 · see citing works
Self-citationFatt, S. J., George, E. S., Hay, P., JEACOCKE, N. A., & Mitchison, D. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00791-9 · Cited by 11 · see citing works
Wasserfurth, P., Halioua, R., Toepffer, D., Lautz, Z., Engel, H., Melin, A., Torstveit, M. K., Claussen, M., & Koehler, K. (2025) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000003644 · Cited by 8 · see citing works
“Although DE and EDs are often discussed concurrently in the LEA/REDs literature, only clinically diagnosed EDs and/or an elevated EDE-Q score are considered as a primary REDs indicator (2).”
InfluentialSelf-citationAlvares, L. A. M., Quaresma, M. V. L. D. S., Nakamoto, F. P., Santos, L. M., Navarro, L. S., Navarro, G. S., Orozco, B. M. M., Sá, B. M. C., Achkar, G. B., Marques, C. G., et al. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108601 · Cited by 9 · see citing works
“11 14–16 Sleep is also critical to exercise-related recovery due to anabolic hormones (eg, growth hormone) release, and athletes experience higher inflammatory states and mental fatigue following sleep restriction periods.”
Sundgot-Borgen, C., Sundgot-Borgen, J. K., Sølvberg, N., Torstveit, M. K., Mountjoy, M. L., & Mathisen, T. F. (2025) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108808 · Cited by 11 · see citing works
“One might speculate that the last decade’s attention to ED and Relative Energy Deficiency in Sports 41 within female elite sport may have facilitated improved attention and measures for elite females, hence the lower prevalence of ED-diagnosis.”
Self-citationCampbell, A. J., Claydon, V. E., Liva, S., et al. (2025) · BMC Women s Health · doi:10.1186/s12905-025-03597-3 · Cited by 10 · see citing works
“…discuss with their doctor, or inquiring about a method like an IUD that may supress their menstrual symptoms, doctors need to be aware and counsel them that HC use could mask amenorrhea, which can diminish awareness that an athlete is suffering from Relative Energy Deficiency in Sport (REDs) [27].”
Thibodeau, D. E., Sutherland, S., Brown, D. M., Quesnel, D. A., & Sabiston, C. M. (2025) · Qualitative Health Research · doi:10.1177/10497323251331800 · Cited by 10 · see citing works
“Athletes with RED-S are at a greater risk for menstrual dysfunction, injury, anxiety and depression, and decreased performance (Mountjoy et al., 2023; Stellingwerff et al., 2023).”
Assessment of Relative Energy Deficiency in Sport (REDs) Risk among Adolescent Acrobatic Gymnasts
Besor, O., Redlich, N., Constantini, N., Weiler‐Sagie, M., Ornan, E. M., Lieberman, S., Bentur, L., & Bar‐Yoseph, R. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14040363 · Cited by 12 · see citing works
Self-citationWitkoś, J., Luberda, E., Błażejewski, G., & Strój, E. (2024) · PLoS ONE · doi:10.1371/journal.pone.0303703 · Cited by 13 · see citing works
“Unfortunately, low energy availability, the achievement of polyuria and forced water excretion from the body undoubtedly have a detrimental effect on an athlete’s body condition, which may lead to an increased risk of relative energy deficiency in sport (RED-S) symptoms [12].”
BackgroundInfluentialContemporary Issue: Health and Safety of Female Wrestlers
Jagim, A. R., Moschelli, J. S., Woodroffe, L. M., Horswill, C. A., Bloomfield, S. A., & Oppliger, R. A. (2024) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000001183 · Cited by 9 · see citing works
A literature review of biomarkers used for diagnosis of relative energy deficiency in sport
Dvořáková, K., Paludo, A. C., Wagner, A., Puda, D., Gimunová, M., & Kumstát, M. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1375740 · Cited by 11 · see citing works
Brown, G. A., Jones, M. D., Cole, B., Shawdon, A., & Duffield, R. (2024) · International Journal of Sports Physiology and Performance · doi:10.1123/ijspp.2023-0522 · Cited by 9 · see citing works
McHaffie, S. J., Langan-Evans, C., Strauss, J. A., Areta, J., Rosimus, C., Evans, M., Waghorn, R., Grant, J., Cuthbert, M., Hambly, C., et al. (2024) · Experimental Physiology · doi:10.1113/ep091589 · Cited by 5 · see citing works
- Authors
- Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., Sundgot-Borgen, J. K., Torstveit, M. K., Jacobsen, A. U., Verhagen, E., Budgett, R., Engebretsen, L., & Erdener, U.
- Affiliations
- International Olympic Committee (CH)
- Boston Children's Hospital (US)
- Australian Catholic University (AU)
- Hebrew University of Jerusalem (IL)
- University of North Carolina at Chapel Hill (US)
- University of Victoria (CA)
- Linnaeus University (SE)
- Norwegian School of Sport Sciences (NO)
- University of Agder (NO)
- Amsterdam University Medical Centers (NL)
- Hacettepe University (TR)
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2023-09
- Volume
- 57
- Issue
- 17
- Pages
- 1073-1098
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W4387036470
- Cited by
- 724
- References
- 454
- Citations by year
- 2026: 279 · 2025: 243 · 2024: 179 · 2023: 22
- FWCI
- 198.49
- Type
- journal article
- Language
- en
- Update notices
- correction (2024-02-07)
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- British Journal of Sports Medicine (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (acceptedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Funders
- International Olympic Committee
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- relative energy deficiency in sport, low energy availability, athletes, female athletes, male athletes, mental health, physiological modeling, body composition assessment, risk stratification, prevention and treatment
- MeSH terms
- Relative Energy Deficiency in Sport, Body Composition, Female, Humans, Male, Sports, Exercise, Athletes
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