2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

Abstract

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.

Effects of fat loss and low energy availability on the serum cardiometabolic profile of physique athletes

“…Yet, sports nutrition experts do not recommend weight-loss dieting to athletes unconditionally because of the potential negative effects of extended LEA to health and athletic performance. 3 LEA may disrupt the endocrine and immune systems, 4,5,28,29 although the current evidence on cardiometabolic markers specifically appears relatively scattered. For example, it draws from studies in amenorrhoeic female athletes and patients with anorexia nervosa, where poor nutritional status and low concentrations of estrogen have been associated with increased total and LDL cholesterol, serum triglycerides, and inflammation markers under high-stress conditions.…”

“…Regarding the definition of LEA in our cohort, we concluded not to apply a universal cut‐off value. Although the cut‐off point of 30 kcal/kg FFM/day is widely used for females, it may not apply to all individuals and may be different for males 3 . Instead, we evaluated that the magnitude of changes in body composition, energy intake, exercise levels, and hormone profiles 10,11 between a healthy off‐season status and the final weeks of competition dieting led the physique competitors to a state of LEA, 4 regardless of the absolute EA value they ended up with.…”

“…3 It may compromise various metabolic functions already in the short term (days and weeks), resulting in decreased resting energy expenditure and disturbed glucose and lipid metabolism in the long-term (several months). [3][4][5] Indeed, the basic concept of LEA implies that after accounting for exercise energy expenditure, the athlete's daily energy intake is insufficient to maintain normal physiological functioning. 4 However, the independent effects of low body fat percentage, dietary energy restriction, and increased training volumes on the physiological manifestations of LEA remain unclear, despite their distinct contributions to the human metabolism.…”

“…Fat loss and energy restriction are effective ways to improve markers of lipid metabolism, inflammation, and insulin sensitivity in the general population, 1,2 but their effects on athletes' health have occasionally raised concerns. Low energy availability (LEA) caused by weight loss attempts, excessive training, or dietary restriction has been established as a risk factor for impaired bone health, reproductive function, and cardiovascular health in athletes 3 . It may compromise various metabolic functions already in the short term (days and weeks), resulting in decreased resting energy expenditure and disturbed glucose and lipid metabolism in the long‐term (several months) 3–5 .…”

“…Low energy availability (LEA) caused by weight loss attempts, excessive training, or dietary restriction has been established as a risk factor for impaired bone health, reproductive function, and cardiovascular health in athletes 3 . It may compromise various metabolic functions already in the short term (days and weeks), resulting in decreased resting energy expenditure and disturbed glucose and lipid metabolism in the long‐term (several months) 3–5 . Indeed, the basic concept of LEA implies that after accounting for exercise energy expenditure, the athlete's daily energy intake is insufficient to maintain normal physiological functioning 4 .…”