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Cited by 34

The DOI matches its Crossref record; 9 of the 9 references it cites were found in a registry or an index.

Application of the IOC Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) across 200+ elite athletes

Heikura, Ida A, McCluskey, Walter T P, Tsai, Ming-Chang, Johnson, Liz, Murray, Holly, Mountjoy, Margo, Ackerman, Kathryn E, Fliss, Matthew, Stellingwerff, Trent·2025·British Journal of Sports Medicine
DOI 10.1136/bjsports-2024-108121
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Abstract

Objective: This cross-sectional retrospective and prospective study implemented the 2023 International Olympic Committee Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) to determine the current severity of REDs (primary outcome) and future risk of bone stress injuries (BSI, exploratory outcome) in elite athletes. Methods: Female (n=143; 23.3±4.3 years) and male (n=70; 23.1±3.7 years) athletes (performance tier 3 (52%), tier 4 (36%), tier 5 (12%)) participated in a baseline CAT2 (with minor modifications) assessment, including a self-report questionnaire (menstrual function (females), BSI, Eating Disorder Examination Questionnaire (EDE-Q)), bone mineral density (BMD via DXA) and fasted blood analysis (triiodothyronine (T3), testosterone, cholesterol). Athletes were assigned a green, yellow, orange or red light via CAT2. The prospective risk of new self-report of physician-diagnosed BSI was assessed over a subsequent 6–24 months. Results: REDs prevalence was 55% green, 36% yellow, 5% orange and 4% red light. The CAT2 identified a greater prevalence of amenorrhoea and BSI and lower T3, testosterone and BMD (p<0.01) in red, orange and yellow (those with REDs) versus green light. ORs for a prospective self-reported BSI (majority physician diagnosed) were greater in orange vs green (OR 7.71, 95% CI (1.26 to 39.83)), in females with severe amenorrhoea (OR 4.6 (95% CI 0.98 to 17.85)), in males with low sex drive (OR 16.0 (95% CI 4.79 to 1038.87)), and athletes with elevated EDE-Q global scores (OR 1.45 (95% CI 0.97 to 1.97)). Conclusion: The CAT2 has high validity in demonstrating current severity of REDs, with increased future risk of self-reported BSI in athletes with a more severe REDs traffic light category.

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Research works printed but not linked: 39

  1. 10.1016/S0278-5919(20)30338-0 · DOI
  2. 10.1056/NEJM198408023110501 · DOI · Paper page
  3. 10.1136/bjsports-2018-099193 · DOI · Paper page
  4. 10.1093/ajcn/nqac044 · DOI · Paper page
  5. 10.3390/nu6083018 · DOI · Paper page
  6. 10.1007/BF01623770 · DOI
  7. 10.1001/jama.1986.03380030082032 · DOI · Paper page
  8. 10.1136/bjsports-2023-106932 · DOI · Paper page
  9. Mountjoy, 2015, The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT), Br J Sports Med, 49, 10.1136/bjsports-2015-094873 · DOI · Paper page
  10. 10.1136/bjsports-2023-106914 · DOI · Paper page
  11. 10.1136/bjsports-2023-106994 · DOI · Paper page
  12. 10.1249/MSS.0000000000001711 · DOI · Paper page
  13. 10.1177/0363546515572142 · DOI
  14. 10.1136/bjsports-2016-096698 · DOI
  15. 10.1249/MSS.0000000000000574 · DOI
  16. 10.1210/jc.86.11.5184 · DOI
  17. 10.1007/s00198-016-3887-x · DOI
  18. DeLoughery, 2020, Decreased bone mineral density and reproductive axis dysfunction: more than oestrogen, Neth J Med, 78, 50
  19. 10.1249/JSR.0000000000000077 · DOI
  20. 10.1177/0363546516676262 · DOI
  21. 10.1123/ijsnem.2021-0323 · DOI
  22. 10.1097/JSM.0000000000000948 · DOI · Paper page
  23. 10.1007/s40279-023-01871-8 · DOI
  24. 10.1136/bjsports-2017-098958 · DOI · Paper page
  25. 10.1016/j.jsams.2023.04.003 · DOI
  26. 10.1002/eat.23051 · DOI
  27. Fredericson, 2023, Healthy Runner Project: a 7-year, multisite nutrition education intervention to reduce bone stress injury incidence in collegiate distance runners, BMJ Open Sport Exerc Med, 9, 10.1136/bmjsem-2023-001545 · DOI
  28. 10.1136/bjsports-2022-106328 · DOI
  29. 10.1177/0363546520971782 · DOI
  30. 10.1097/JSM.0000000000001180 · DOI
  31. 10.1136/bjsports-2023-107359 · DOI · Paper page
  32. 10.1136/bjsports-2019-101517 · DOI · Paper page
  33. Fahrenholtz, 2022, Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes, Front Sports Act Living, 4, 10.3389/fspor.2022.869594 · DOI
  34. Sim, 2021, Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes, J Eat Disord, 9, 10.1186/s40337-021-00396-7 · DOI · Paper page
  35. Torstveit, 2019, Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes, BMJ Open Sport Exerc Med, 5, 10.1136/bmjsem-2018-000439 · DOI
  36. 10.1192/bjp.154.6.807 · DOI · Paper page
  37. 10.1136/bjsports-2019-101813 · DOI · Paper page
  38. 10.1123/ijsnem.10.2.128 · DOI
  39. 10.1136/bjsports-2013-093240 · DOI · Paper page

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Metadata

Authors
Heikura, I. A., McCluskey, W. T. P., Tsai, M.-C., Johnson, L., Murray, H., Mountjoy, M., Ackerman, K. E., Fliss, M., & Stellingwerff, T.
Affiliations
  • Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
  • Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
  • Wu Tsai Female Athlete Program, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
  • Ageing, Nutrition, Exercise, and Muscle Metabolism Lab, The University of British Columbia, Vancouver, British Columbia, Canada
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2024-08-20
Volume
59
Issue
1
Pages
24-35
ISSN
  • 0306-3674
  • 1473-0480
DOI
10.1136/bjsports-2024-108121
Cited by
34
References
9
Language
en
Funders
  • Mitacs (FR51666, FR51667, FR51668)
  • 94Forward (NA)
  • Own the Podium (NA)
  • Wu Tsai Human Performance Alliance (NA)
  • B2ten (NA)

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CoChat. (2026). Citation check: Application of the IOC Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) across 200+ elite athletes. https://app.cochat.ai/papers/10.1136/bjsports-2024-108121
The paper
Heikura, I. A., McCluskey, W. T. P., Tsai, M.-C., Johnson, L., Murray, H., Mountjoy, M., Ackerman, K. E., Fliss, M., & Stellingwerff, T. (2025). Application of the IOC Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) across 200+ elite athletes. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2024-108121

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