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Int J Sport Nutr Exerc Metab 2021 Jun 7:1-8. Epub 2021 Jun 7.

San Diego State University.

This prospective study evaluated the 3-year change in menstrual function and bone mass among 40 female adolescent endurance runners (age 15.9 ± 1.0 years) according to baseline disordered eating status. Read More

Clin J Sport Med 2021 Jul;31(4):349-366

Department of Family Medicine, University of California, Los Angeles, Los Angeles, California.

Abstract: The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Read More

Clin J Sport Med 2021 Jul;31(4):335-348

Department of Orthopaedic Surgery, Stanford University, Stanford, California.

Abstract: The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. Read More

Rev Bras Ginecol Obstet 2021 Jun 2. Epub 2021 Jun 2.

Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário, Lisboa, Portugal.

In a healthy athlete, the caloric intake is sufficient for sports energy needs and body physiological functions, allowing a balance between energy availability, bone metabolism, and menstrual cycle. On the other hand, an imbalance caused by low energy availability due to a restrictive diet, eating disorders or long periods of energy expenditure leads to multisystemic deregulation favoring the essential functions of the body. This phenomenon, described as the female athlete triad, occurs in a considerable percentage of high-performance athletes, with harmful consequences for their future. Read More

Front Endocrinol (Lausanne) 2021 12;12:524762. Epub 2021 May 12.

Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

The purpose of this case series was to evaluate the presence of low Energy Availability (EA) and its impact on components of Relative Energy Deficiency in Sport (RED-S) in a population of female collegiate runners. Seven female NCAA Division I athletes (age: 22.3 ± 1. Read More

Eur J Sport Sci 2021 Jun 17:1-13. Epub 2021 Jun 17.

Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, England, UK.

Weight making can be described as the process of reducing body mass in events where aesthetics, propulsion or the requirement to meet a specific weight category limit, are considered to be of competitive importance. Cross sectional research specifically focussed on weight category sports, has highlighted behaviours and practices that are similar in athletes of both sexes. Regardless of this and despite parallel participation in weight category sporting events, females are drastically underrepresented in studies examining body mass loss interventions across both chronic and acute timeframes. Read More

J Am Coll Nutr 2021 May 25:1-8. Epub 2021 May 25.

Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.

Despite the evidence of an elevated prevalence of low bone mass in adolescent endurance runners, reports on dietary intake in this population is limited. This study aimed to evaluate energy availability (EA) and dietary intake among 72 (n = 60 female, n = 12 male) high school cross-country runners. The sample consisted of a combined dataset of two cohorts. Read More

Hormones (Athens) 2021 Apr 22. Epub 2021 Apr 22.

Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Purpose: Low energy availability (LEA) may lead to menstrual disorders and low bone mineral density, predisposing to the female athlete triad. The primary aim of the present review was to systematically investigate the impact of chronic strenuous exercise on the energy status of professional female athletes compared to sedentary, recreationally active controls as concerns their menstrual status and bone mineral density (BMD). A secondary aim was evaluation of the combined prevalence of the components of the female athlete triad in athletes as compared to non-athletes. Read More

PeerJ 2021 6;9:e11092. Epub 2021 Apr 6.

Athlete Support Research Center, Niigata University of Health and Welfare, Niigata, Japan, Niigata, Niigata, Japan.

Background: This study aimed to clarify the relationship between the triad risk assessment score and the sports injury rate in 116 female college athletes (average age, 19.8 ± 1.3 years) in seven sports at the national level of competition; 67 were teenagers, and 49 were in their 20s. Read More

Eur J Sport Sci 2021 May 3:1-11. Epub 2021 May 3.

Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.

Decades of laboratory research have shown impairments to several body systems after only 4-5 days of strictly controlled consistent low energy availability (LEA); where energy availability (EA) = Energy Intake (EI) - Exercise Energy Expenditure (EEE)/Fat-Free Mass. Meanwhile, cross-sectional reports exist on the interrelatedness of LEA, menstrual dysfunction and impaired bone health in females (the Female Athlete Triad). These findings have demonstrated that LEA is the key underpinning factor behind a broader set of health and performance outcomes, recently termed as Relative Energy Deficiency in Sport (RED-S). Read More

J Eat Disord 2021 Mar 31;9(1):41. Epub 2021 Mar 31.

Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore, 637616, Singapore.

Background: A sustained mismatch between energy intake and exercise energy expenditure (EEE) can lead to Low Energy Availability (LEA), health and performance impairments characteristic of Relative Energy Deficiency in Sport (RED-S). Questionnaires can conveniently identify symptoms and/or LEA/ RED-S risk factors. This study aimed to systematically identify, and critique questionnaires used or developed to measure LEA/ RED-S risk in athletic populations. Read More

Rev Prat 2020 Oct;70(8):881-885

Institut national du sport, de l'expertise et de la performance (INSEP), Paris, France.

Risk of intensive practice in sportswomen. Intensive sports practice in women exposes to specific risks, depending on the sport, such as the athlete triad, the increased risk of stress fracture, and lastly the perineal dysfunction. Risk factor screening including the relativ energy deficiency in sport, the sub clinical menstrual disturbances and a special vigilance ahead of perineal constrained sports help preserve the sportswoman's health. Read More

Med Sci Sports Exerc 2021 Mar 12. Epub 2021 Mar 12.

University of Michigan Medical School, Ann Arbor, MI Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.

Purpose: The Female Athlete Triad (Triad) is common in female athletes. The Triad is caused by low energy availability (EA), which is often difficult to measure and has been postulated to be associated with low iron status. Here, we explore whether markers of low iron status may be associated with indicators of low EA including Triad risk factors. Read More

J Athl Train 2021 Feb 24. Epub 2021 Feb 24.

1Sports Medicine Center, Children's Hospital Colorado, Aurora, CO.

Context: Adolescent female athletes are at risk for menstrual dysfunction in the setting of exercise and low energy availability. Education regarding menstrual dysfunction and its associated consequences is important to promote athlete well-being.

Objectives: The primary aim was to determine the prevalence and characteristics of female athletes who believe that losing their period is a normal response to high training demands. Read More

J Clin Densitom 2021 Jan 30. Epub 2021 Jan 30.

Division of Endocrinology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, Rio de Janeiro, Brasil.

Female Athlete Triad, initially described as the association of disordered eating, amenorrhea and osteoporosis, was further redefined to focus on low energy availability (EA), which has a central role in development of hypoestrogenism and low bone mineral density (BMD). However, the contribution of each variable, that is, low EA and hypoestrogenism, for bone derangements is still an open question. To evaluate body composition and bone status in long-distance triathletes without hypoestrogenism, as compared to non-athletes, using DXA and HR-pQCT, and the influence of EA. Read More

J Sports Sci 2021 Feb 11:1-10. Epub 2021 Feb 11.

School of Sport and Exercise Science, University of Lincoln, Lincoln, UK.

Relative Energy Deficiency in Sport (RED-S) is a syndrome of impaired health and performance that occurs as a result of low energy availability (LEA). Whilst many health effects associated with RED-S have been widely studied from a physiological perspective, further research exploring the psychological antecedents and consequences of the syndrome is required. Therefore, the aim of this study was to qualitatively explore athlete experiences of RED-S. Read More

J Int Soc Sports Nutr 2021 Feb 5;18(1):12. Epub 2021 Feb 5.

Department of Science Policy and Scientometrics, Library and Information Centre of the Hungarian Academy of Sciences (MTA), Arany János street 1, Budapest, 1050, Hungary.

Background: The tool kits of bibliometrics and science mapping provide a standard methodology to map the knowledge base of specific fields of science. The aim of the present research is the analysis of the recent international trends of sport nutrition science, as well as the primary identification of the research topics and results of sport nutrition science via enhanced bibliometric methods for the 2000-2018 time period.

Methods: Altogether, 3889 publications were included in this study. Read More

Curr Sports Med Rep 2021 Jan;20(1):7-9

Sports Medicine and Orthopedics, St. Joseph Regional Medical Center, Medical Office Building at Mishawaka Medical Center, Mishawaka, IN.

J Athl Train 2020 Dec 22. Epub 2020 Dec 22.

University of South Carolina, Email: Twitter Handle:

Context: Female athletes/performing artists can present with low energy availability (LEA) either through unintentional (e.g., inadvertent undereating) or intentional methods (e. Read More

Sports Med 2021 Mar;51(3):391-403

School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.

Endurance athletes expend large amounts of energy in prolonged high-intensity exercise and, due to the weight-sensitive nature of most endurance sports, often practice periods of dietary restriction. The Female Athlete Triad and Relative Energy Deficiency in Sport models consider endurance athletes at high-risk for suffering from low energy availability and associated health complications, including an increased chance of bone stress injury. Several studies have examined the effects of low energy availability on various parameters of bone structure and markers of bone (re)modelling; however, there are differences in findings and research methods and critical summaries are lacking. Read More

Case Rep Womens Health 2021 Jan 27;29:e00276. Epub 2020 Nov 27.

Mayo Clinic, Minnesota, Rochester, MN, USA.

PM R 2020 Dec 19. Epub 2020 Dec 19.

Department of Physiatry, Hospital for Special Surgery, New York, NY, USA.

Background: Menstrual irregularity (MI) is common in female athletes and is a component of the Female Athlete Triad (Triad). Many athletes with the Triad are started on hormonal contraceptives (HC) for MI, but this interferes with the ability to monitor menstrual cycle regularity and can mask other causes of MI. There are limited studies investigating the relationship between MI, HC use, and injury in female collegiate athletes. Read More

BMJ Open Sport Exerc Med 2020 26;6(1):e000906. Epub 2020 Nov 26.

Science4Performance, London, UK.

Objectives: To investigate indicators and correlates of low energy availability (LEA) in male and female dancers.

Methods: A Dance-Specific Energy Availability Questionnaire (DEAQ) was developed and administered online internationally to dancers training at preprofessional, professional or advanced amateur level. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Read More

J Am Acad Orthop Surg 2021 Jan;29(1):e14-e21

From the Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health Systems (L. Vopat), the Department of Orthopedic Surgery, University of Kansas Medical Center (Mackay), the Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health Systems (B.G. Vopat), Kansas City, KS, and Women's Sports Medicine Program, Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA (Mulcahey).

Relative energy deficiency in sport (RED-S) is a constellation of clinical findings related to low energy availability. Manifestations are variable but may include endocrine and reproductive dysfunction, impaired bone and muscle health, psychological complaints, and performance issues, among many others. Unlike the previously common terminology, the female athlete triad, RED-S encompasses a broader range of signs and symptoms and includes descriptions for the male athlete. Read More

J Shoulder Elbow Surg 2021 May 18;30(5):977-985. Epub 2020 Nov 18.

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. Electronic address:

Unique biologic and biomechanical aspects of the female body make women more prone to certain orthopedic injuries. Sex differences are well understood with regard to certain orthopedic pathologies such as anterior cruciate ligament injury, hallux valgus, carpal tunnel, and carpometacarpal joint arthritis; however, sex differences are less commonly discussed with regard to shoulder and elbow pathology. The purpose of this review is to elucidate sex differences specific to sports-related shoulder and elbow injuries in the female athlete population. Read More

J Dance Med Sci 2020 Nov;24(4):161-167

CISSN, University of Idaho, Moscow, Idaho, USA.

The female athlete triad (triad) is prevalent among aesthetic athletes, including dancers. However, there is limited research regarding triad knowledge or triad educational interventions among collegiate dancers. This study was intended to help correct that shortage. Read More

Orthop J Sports Med 2020 Oct 27;8(10):2325967120959725. Epub 2020 Oct 27.

Division of Pediatric Orthopedic Surgery and Sports Medicine, Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA.

Background: Investigations of the female athlete triad (Triad) in high school athletes have found that 36% had low energy availability, 54% had menstrual abnormalities, and 16% had low bone mineral density (BMD). Limited data are available showing the prevalence of these risk factors in high school distance runners or regarding best practice on screening for the Triad in the adolescent population.

Purpose: To (1) evaluate the prevalence of Triad risk factors and iron supplementation in high school distance runners and (2) pilot a screening tool for Triad risk score. Read More

Br J Sports Med 2021 Apr 2;55(8):433-437. Epub 2020 Nov 2.

Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.

Objective: We aimed to describe current and former National Collegiate Athletic Association (NCAA) Division One (DI) female distance runners' experiences of perceived norms of body image and disordered eating in their sport, as well as the emergence and influence of coach-athlete power dynamics.This manuscript reports a qualitative research study (consisting of interviews and thematic analysis) of women athletes' experiences of perceived norms of body image and disordered eating in their sport. We also report athletes' experiences of coach-athlete power dynamics. Read More

Nutrients 2020 Oct 25;12(11). Epub 2020 Oct 25.

Institute for Sports Medicine, Swiss Paraplegic Centre, 6207 Nottwil, Switzerland.

Background: Low energy availability (LEA) is a major problem as athletes often restrict their energy intake. It has been shown that LEA occurs often in female and endurance athletes and in athletes from weight-sensitive or aesthetic sports. The purpose of this study was to investigate energy availability (EA) in elite wheelchair athletes. Read More