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Relative Energy Deficiency in Sport (REDs): Endocrine Manifestations, Pathophysiology and Treatments

Angelidi, Angeliki M, Stefanakis, Konstantinos, Chou, Sharon H, Valenzuela-Vallejo, Laura, Dipla, Konstantina, Boutari, Chrysoula, Ntoskas, Konstantinos, Tokmakidis, Panagiotis, Kokkinos, Alexander, Goulis, Dimitrios G, Papadaki, Helen A, Mantzoros, Christos S·2024·Endocrine Reviews
DOI 10.1210/endrev/bnae011
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Abstract

Research on lean, energy-deficient athletic and military cohorts has broadened the concept of the Female Athlete Triad into the Relative Energy Deficiency in Sport (REDs) syndrome. REDs represents a spectrum of abnormalities induced by low energy availability (LEA), which serves as the underlying cause of all symptoms described within the REDs concept, affecting exercising populations of either biological sex. Both short- and long-term LEA, in conjunction with other moderating factors, may produce a multitude of maladaptive changes that impair various physiological systems and adversely affect health, well-being, and sport performance. Consequently, the comprehensive definition of REDs encompasses a broad spectrum of physiological sequelae and adverse clinical outcomes related to LEA, such as neuroendocrine, bone, immune, and hematological effects, ultimately resulting in compromised health and performance. In this review, we discuss the pathophysiology of REDs and associated disorders. We briefly examine current treatment recommendations for REDs, primarily focusing on nonpharmacological, behavioral, and lifestyle modifications that target its underlying cause-energy deficit. We also discuss treatment approaches aimed at managing symptoms, such as menstrual dysfunction and bone stress injuries, and explore potential novel treatments that target the underlying physiology, emphasizing the roles of leptin and the activin-follistatin-inhibin axis, the roles of which remain to be fully elucidated, in the pathophysiology and management of REDs. In the near future, novel therapies leveraging our emerging understanding of molecules and physiological axes underlying energy availability or lack thereof may restore LEA-related abnormalities, thus preventing and/or treating REDs-related health complications, such as stress fractures, and improving performance.

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Metadata

Authors
Angelidi, A. M., Stefanakis, K., Chou, S. H., Valenzuela-Vallejo, L., Dipla, K., Boutari, C., Ntoskas, K., Tokmakidis, P., Kokkinos, A., Goulis, D. G., Papadaki, H. A., & Mantzoros, C. S.
Affiliations
  • Department of Medicine, Boston VA Healthcare System, Boston, MA 02115 , USA
  • Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital (BWH), Harvard Medical School , Boston, MA 02115 , USA
  • Exercise Physiology and Biochemistry Laboratory, Department of Sports Science at Serres, Aristotle University of Thessaloniki , Serres 62100 , Greece
  • Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki 54642 , Greece
  • Department of Internal Medicine, 251 Air Force General Hospital , Athens 11525 , Greece
  • First Propaedeutic Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens , Athens 11527 , Greece
  • Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki , Thessaloniki 54124 , Greece
  • Department of Hematology, University Hospital of Heraklion, School of Medicine, University of Crete , Heraklion 71500 , Greece
ORCID
Venue
Endocrine Reviews
Publisher
The Endocrine Society
Published
2024-03-15
Volume
45
Issue
5
Pages
676-708
ISSN
  • 0163-769X
  • 1945-7189
DOI
10.1210/endrev/bnae011
Cited by
83
References
71
Language
en

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