Abstract
Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.
Highlights
Considerable research has been undertaken to understand the health and performance consequences of relative energy deficiency in sports (RED-S), a condition frequently observed among high performing male and female athletes [1,2]
It is apparent that low energy availability (EA) exists in males as well as females as evidenced by studies conducted in male road cyclists [9] and elite distance athletes [23,24,25]
Most recently (Table 3), athletes are being screened for symptoms of low EA using questionnaires that screen for physiological symptoms associated with the Female Athlete Triad (Triad) and RED-S, an example of which is the Low EA in Females Questionnaire (LEAF-Q) [30]
Summary
Considerable research has been undertaken to understand the health and performance consequences of relative energy deficiency in sports (RED-S), a condition frequently observed among high performing male and female athletes [1,2]. Following publication of our 2018 review on the prevalence of low EA and associated health and performance consequences [7], the volume of research on RED-S has substantially increased (peer-reviewed articles in 2018 (n = 21), 2019 (n = 24) vs 2016 (n = 6) and 2017 (n = 10)). The purpose of this investigation is to identify other potential methods for assessing low EA given that the current methods used remain challenging. The published literature on awareness and knowledge of RED-S among athletes and coaches has been evaluated to identify gaps in the practical application of low EA education in sports [8,9,10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
