Female Athlete Triad Research Articles

Female Athlete Triad: Understanding the Interrelationship between Energy Availability, Menstrual Function, and Bone Health

The Female Athlete Triad (FAT) is a complex medical condition characterized by three interrelated components: low energy availability (EA) with or without disordered eating, menstrual dysfunction, and decreased bone mineral density (BMD). This syndrome is particularly prevalent among female athletes who engage in sports that prioritize leanness, endurance, and aesthetic performance, such as gymnastics, dance, and long-distance running. Prolonged exposure to inadequate caloric intake relative to energy expenditure can disrupt hormonal regulation, leading to irregular or absent menstrual cycles (amenorrhea) and compromising bone health. This cross-sectional study aims to investigate the prevalence and impact of low EA on menstrual function and BMD among 180 female athletes aged 18-30 years. Participants were divided into three menstrual status categories: eumenorrhea, oligomenorrhea, and amenorrhea. The study also categorized athletes into sports groups (aesthetic, endurance, and power sports) to identify patterns across different disciplines. Data collection included dietary intake records, exercise logs, menstrual history questionnaires, and DEXA scans to measure BMD at the lumbar spine and hip. Results indicate that 67% of participants exhibited low EA (< 30 kcal/kgFFM/day), which was significantly associated with menstrual dysfunction (p < 0.001). Among participants, 25% reported oligomenorrhea (irregular cycles), and another 25% experienced amenorrhea (absence of menstruation for more than three months). BMD analysis revealed that 30% of the athletes had osteopenia, while 5% were diagnosed with osteoporosis, highlighting the long-term risks associated with chronic low EA and menstrual irregularities. Notably, athletes engaged in aesthetic sports had the highest prevalence of low EA (80%) and menstrual dysfunction (45%), followed closely by those in endurance sports. These findings underscore the urgent need for targeted interventions to promote energy balance, safeguard reproductive health, and prevent bone deterioration among female athletes. Educational programs focusing on nutritional counseling, regular monitoring of menstrual health, and multidisciplinary care involving coaches, sports dietitians, and healthcare providers are essential to mitigate the risks of the Female Athlete Triad. Future research should further explore psychological factors influencing energy availability, including body image concerns and disordered eating patterns, to develop comprehensive prevention strategies.

‘What should I do as a coach?’: an interview study with Swedish national team coaches about their professional practice and experiences in addressing potential health risks in elite sport

Through interviews with 12 Swedish national team coaches, this qualitative study explores the ways in which these coaches experience their professional work in relation to topics such as Relative Energy Deficiency in Sport (REDs) and disordered eating behaviours/eating disorders (DE/EDs). Using Andrew Abbott’s concepts of ‘diagnosis’, ‘inference’, and ‘treatment’ as the framework for the study, it suggests that coaches believe they have a role and sufficient knowledge to detect signs and symptoms of REDs or DE/EDs in the diagnosis phase. Following the International Olympic Committee’s guidelines, the coaches prefer to delegate the clinical treatment to members of the athlete’s health and performance team. However, they find that the connection between diagnosis (the problem) and treatment (the action) is unclear, resulting in coaches wanting to ‘infer’ support for their athletes. Implications of these findings are discussed within a professionalisation context along with topics such as education, boundary work, and legitimacy.

Low energy availability surrogates are associated with Relative Energy Deficiency in Sport outcomes in male athletes

ObjectivesTo determine the association between surrogates of low energy availability (EA) and proposed health and performance outcomes of Relative Energy Deficiency in Sport (REDs) in a clinical sample of adolescent...

Energy availability and its association with health-related outcomes among national athletes at risk of relative energy deficiency in sports (REDs)

BackgroundLow energy availability (LEA) occurs when athletes’ energy intake fails to match the energy expended during exercise, resulting in insufficient energy to support essential functions for optimal health, a condition...

Prevalence of physiological and perceptual markers of low energy availability in male academy football players: a study protocol for a cross-sectional study

Low energy availability (LEA) is a core feature of the female athlete triad and relative energy deficiency in sport (REDs). LEA underpins multiple adverse health and performance outcomes in various...

Self-reported Eating Behavior Is Correlated With Health Consequences Of Relative Energy Deficiency In Sport

Self-reported Eating Behavior Is Correlated With Health Consequences Of Relative Energy Deficiency In Sport

Forefoot Pain In Young Female Runner With Relative Energy Deficiency In Sport

Forefoot Pain In Young Female Runner With Relative Energy Deficiency In Sport

Prevalence of Signs and Symptoms of Relative Energy Deficiency in Sport Amongst Collegiate Athletes with Varying Levels of Access to Sports Registered Dietitian Nutritionists

Prevalence of Signs and Symptoms of Relative Energy Deficiency in Sport Amongst Collegiate Athletes with Varying Levels of Access to Sports Registered Dietitian Nutritionists

Bone Characteristics Among Female Endurance Athletes At Risk For Relative Energy Deficiency In Sport

Bone Characteristics Among Female Endurance Athletes At Risk For Relative Energy Deficiency In Sport

The Male And Female Athlete Triad Are Associated With Anxiety In Collegiate Athletes

The Male And Female Athlete Triad Are Associated With Anxiety In Collegiate Athletes

Prevalence Of The Attributes Of The Female Athlete Triad In Competitive Nigerian Female Athletes

Prevalence Of The Attributes Of The Female Athlete Triad In Competitive Nigerian Female Athletes

Impact Of Perfectionism On The Risk Of The Female Athlete Triad In Collegiate Athletes

Impact Of Perfectionism On The Risk Of The Female Athlete Triad In Collegiate Athletes

Preliminary Evaluation of Self-Reported Training Volume as an Adjunct Measure of Female Athlete Triad Risk in Division 1 Collegiate Female Runners.

Background/Objectives: This study tested whether self-reported training volume is predictive of female athlete triad risk collected using an established twelve-question triad screening tool in National Collegiate Athletic Association (NCAA) Division I (DI) collegiate female runners. Methods: A total of 319 institutions were initially contacted, seven of which agreed to distribute surveys to their female cross-country and track and field athletes. A total of 41 of 149 respondents completed the survey and met all inclusion criteria. Linear and binomial logistic regressions examined the relationships between self-reported training volumes and estimated triad risk. Independent samples t-tests were also used to compare training volumes across the high (> 50th percentile for risk factor counts) vs. low-risk groups. Results: Total weekly competition and conditioning resistance training hours were associated with the total number of triad risk factors (p = 0.044) and were also predictive of the triad risk group (p = 0.037). Likewise, both competition and conditioning resistance training hours (p = 0.034) were higher in the high-risk group versus the low-risk group. Conclusions: These findings suggest that self-reported resistance training volume is predictive of triad risk, but additional research is required to determine if monitoring training volume can provide valuable, real-time assessments of triad risk in DI collegiate female runners.

Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

Relative energy deficiency in sport (REDs) is a widely adopted model, originally proposed by an International Olympic Committee (IOC) expert panel in 2014 and recently updated in an IOC 2023 consensus statement. The model describes how low energy availability (LEA) causes a wide range of deleterious health and performance outcomes in athletes. With increasing frequency, sports practitioners are diagnosing athletes with "REDs," or "REDs syndrome," based largely upon symptom presentation. The purpose of this review is not to "debunk" REDs but to challenge dogmas and encourage rigorous scientific processes. We critically discuss the REDs concept and existing empirical evidence available to support the model. The consensus (IOC 2023) is that energy availability, which is at the core of REDs syndrome, is impossible to measure accurately enough in the field, and therefore, the only way to diagnose an athlete with REDs appears to be by studying symptom presentation and risk factors. However, the symptoms are rather generic, and the causes likely multifactorial. Here we discuss that (1) it is very difficult to isolate the effects of LEA from other potential causes of the same symptoms (in the laboratory but even more so in the field); (2) the model is grounded in the idea that one factor causes symptoms rather than a combination of factors adding up to the etiology. For example, the model does not allow for high allostatic load (psychophysiological "wear and tear") to explain the symptoms; (3) the REDs diagnosis is by definition biased because one is trying to prove that the correct diagnosis is REDs, by excluding other potential causes (referred to as differential diagnosis, although a differential diagnosis is supposed to find the cause, not demonstrate that it is a pre-determined cause); (4) observational/cross-sectional studies have typically been short duration (< 7days) and do not address the long term "problematic LEA," as described in the IOC 2023 consensus statement; and (5) the evidence is not as convincing as it is sometimes believed to be (i.e., many practitioners believe REDs is well established). Very few studies can demonstrate causality between LEA and symptoms, most studies demonstrate associations and there is a worrying number of (narrative) reviews on the topic, relative to original research. Here we suggest that the athlete is best served by an unbiased approach that places health at the center, leaving open all possible explanations for the presented symptoms. Practitioners could use a checklist that addresses eight categories of potential causes and involve the relevant experts if and when needed. The Athlete Health and Readiness Checklist (AHaRC) we introduce here simply consists of tools that have already been developed by various expert/consensus statements to monitor and troubleshoot aspects of athlete health and performance issues. Isolating the purported effects of LEA from the myriad of other potential causes of REDs symptoms is experimentally challenging. This renders the REDs model somewhat immune to falsification and we may never definitively answer the question, "does REDssyndrome exist?" From a practical point of view, it is not necessary to isolate LEA as a cause because all potential areas of health and performance improvement should be identified and tackled.

Relative energy deficiency in sport in female gaelic athletic association players

Relative energy deficiency in sport in female gaelic athletic association players

Relative energy deficiency in sport in female gaelic athletic association players and the impact on bone health and growth and development

Relative energy deficiency in sport in female gaelic athletic association players and the impact on bone health and growth and development

Exploring the relationship between low energy availability, depression and eating disorders in female athletes: a cross-sectional study

ObjectiveThis cross-sectional study aimed to investigate the role of low energy availability (LEA) in the interplay between depression and disordered eating/eating disorders (DE/EDs) among female athletes. The International Olympic Committee...

Educational Intervention Improves Female Athlete Triad Awareness in Female Collegiate Swimmers

Introduction: The Female Athlete Triad (Triad) is characterized by high energy expenditure and low caloric intake, leading to dysregulation of menstruation and bone metabolism. Triad-associated relative energy deficiency in sport (REDs) adversely affects performance and mental health. Risk factors are underrecognized in swimmers, who are less likely to present with bone stress injuries because of swimming’s non-weightbearing nature. Our objective was to quantify knowledge about the Triad and REDs among collegiate swimmers and demonstrate the value of educational intervention. Methods: Members of two Division III women’s varsity swim teams completed a Qualtrics survey, consisting of 35 Triad and REDs questions, and 13 demographics questions. Participants then attended an in-person, 20-minute educational session focused on Triad risk factors and prevention, after which they completed a post-session survey. The post-session survey contained 13 additional questions using a Likert scale, where 1=Strongly Agree and 5=Strongly Disagree. Pre- and post-session data were analyzed using Microsoft Excel. Results: Thirty-one swimmers were included. Pre-session, 9.7% of respondents named one or more Triad components, compared to 96.8% after (p&lt;0.0001). 9.7% could define the REDs acronym pre-session, compared to 87.1% after (p&lt;0.0001). Participants better understood the Triad post-session (mean Likert score=1.23) and found the session helpful (mean=1.23), but in a hypothetical scenario, felt relatively uncomfortable contacting medical staff about Triad symptoms (mean=1.87, p=0.0002). Of the 35.5% who believed they may be experiencing Triad components, 72.7% indicated the session motivated them to seek help. Conclusions: Female collegiate swimmers’ low baseline Triad and REDs knowledge improved significantly after an educational intervention. Survey responses highlighted the importance of heightened Triad awareness, but also its continued stigmatization. The session encouraged swimmers with self-identified Triad symptoms to seek help, underscoring the importance of continued education efforts, especially in sports where the Triad is underrecognized.

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

ObjectiveThis 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...

Health problems among women in sports: The Female Athlete Triad

Introduction:Over the years the participation of women in sports and physical activities has significantly increased. The rise in the number of female athletes has brought to attention the health issues specific to this population. The Female Athlete Triad is a syndrome in which the affected woman presents the combination of three intertwined conditions such as (1) low energy availability, (2) menstrual dysfunction, and (3) low bone mineral density. The crucial factor in the pathophysiology is energy imbalance, which leads to impairment of the reproductive and skeletal system, eventually having a very harmful effect on the whole organism and leading to appalling short-term and long-term consequences. It affects women of all ages and from every sports discipline, but most at risk are those in adolescence involved in sports that prioritize leanness and endurance. Purpose:The objective of this article is to review the current state of knowledge about the Female Athlete Triad, spreading awareness of this syndrome, which is still very low in society, and highlighting the importance of early identification and multidisciplinary treatment to prevent serious complications. Materials and methods: The review was based on a comprehensive analysis of the available literature sourced from PubMed, Google Scholar, and other scientific articles, which was searched by using listed keywords and analysed for topic relevance and knowledge currency.