The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S)

Abstract

Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’. The term ‘Relative Energy Deficiency in Sport’ (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a ‘triad’ of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The ‘Sport Risk Assessment and Return to Play Model’ categorises the syndrome into three groups and translates these classifications into clinical recommendations.

Weight Management for Athletes: Important Things to be Considered

“…But, this approach should be avoided because athletes are leading in a number of other negative performance and health consequences [28]. For example, decreased athletic performance effects due to decreased muscle strength, glycogen stores, concentration, coordination and training responses, and increased irritability.…”

“…Generally, this type of diet is lower in fat and reduces or eliminates energy dense beverages particularly sweetened beverages and alcohol [28]. More specifically, a lowenergy dense diet is composed with a high consumption of vegetables, whole fruits and grains as well as incorporates low-fat dairy products.…”

Bone Quality in Female Ballet Dancers: A Possible Determinant of Bone Health

“…FAT can be clinically manifested by stress fractures. It has been recently addressed by the International Olympic Committee (IOC), and focus was mainly on relative energy deficiency in FAT [3] [4]. In regard to bone health, the position stands have related only to bone mineral density (BMD), but BMD is only one of bone strength indicators: even amongst patients with the same BMD values, fractures develop only in few.…”

Comparison of Body Composition and Energy Intake of Young Female Ballet Dancers and Ordinary School Girls

“…Adolescents in leanness-demanding sports have an increased risk of relative energy deficiency in sport syndrome (RED-S) and of developing disordered eating behaviour and eating disorders (EDs) (Melin et al, 2015). RED-S, which is called the 'Female Athlete Triad', refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health (Mountjoy et al, 2014).…”