Relative energy deficiencies in sports (RED-S) Flashcards
(28 cards)
What is Relative Energy Deficiency in Sport (RED-S)?
RED-S is a syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and/or severe) Low Energy Availability (LEA). It was formerly known as the Female Athlete Triad but the name was changed to be inclusive of men.
What is the underlying factor in RED-S?
Low energy availability is the underlying factor in the RED-S syndrome
Define energy balance in the context of RED-S.
Energy balance = Energy Intake (EI) – Energy Expenditure (EO)
What happens when an athlete is in negative energy balance for an extended period?
When in negative energy balance for weeks to months, athletes will exhibit signs/symptoms of RED-S
What are some detrimental outcomes of RED-S?
Detrimental outcomes of RED-S include, but are not limited to, decreases in:
* Energy metabolism
* Reproductive function
* Musculoskeletal health
* Immunity
* Glycogen synthesis
* Cardiovascular health
* Haematological health
These can all individually and synergistically lead to impaired well-being, increased injury risk, and decreased sports performance.
Can RED-S be related to disordered eating?
Yes, RED-S may be a sign of disordered eating.
Describe the spectrum of disordered eating.
Disordered eating is a continuum that ranges from “healthy dieting” to extreme weight loss and can include clinical eating disorders.
How common is disordered eating among athletes?
Disordered eating affects up to 62% of female athletes and 33% of male athletes.
Is RED-S the same as an eating disorder?
No, RED-S is not an eating disorder, though it can be a sign of one. There can be an unhealthy relationship with food involved.
What are the diagnostic manuals for feeding and eating disorders?
For more information on feeding and eating disorders and definitions, see the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders (DSM; 2013).
What are the key diagnostic criteria for Anorexia Nervosa related to energy availability?
Key criteria for Anorexia Nervosa include:
* Refusal to maintain body weight for age & height (e.g., BMI <17.5 or <85% of expected weight); failure to gain weight during growth
* Intense fear of gaining weight or fat
* Disturbed body image or denial of seriousness of current low body weight
* Amenorrhea
What are the key diagnostic criteria for Bulimia Nervosa related to energy availability?
Key criteria for Bulimia Nervosa include:
* Recurrent episodes of binge eating: Eating a larger amount of food in a discrete time with a sense of lack of control
* Recurrent, inappropriate, compensatory behavior to prevent weight gain
* Binge eating and inappropriate compensatory behaviors occur at least twice a week for 3 months
* Self-evaluation influenced by body image
* May occur with or without Anorexia Nervosa
Define menarche, eumenorrhea, oligomenorrhea, and amenorrhea.
- Menarche: first menstrual cycle (12.5 years average)
- Eumenorrhea: menstrual cycles at intervals near the median interval for young adult women (28 days; range 21-35)
- Oligomenorrhea: menstrual cycles at intervals longer than 35 days (or infrequent menstrual cycle; 3-6/yr)
- Amenorrhea: Absence of menstrual cycle lasting >3 months.
Differentiate between primary and secondary amenorrhea.
- Primary Amenorrhea: delayed menarche (15 yr)
- Secondary Amenorrhea: occurs after menarche.
Define luteal suppression and anovulation.
- Luteal suppression: a menstrual cycle with a luteal phase shorter than 11 days or with a low concentration of progesterone.
- Anovulation: a menstrual cycle without ovulation
What is the estimated prevalence of primary amenorrhea in the general population and in some sports?
Primary amenorrhea has been estimated at ~7% overall, with 22% in cheerleading, diving, and gymnastics.
What is the estimated prevalence of secondary amenorrhea in the general female population and in certain athletic groups?
Secondary amenorrhea has been estimated to be 2-5% in women, and as high as 69% in dancers and 65% in long-distance runners.
How quickly can menstrual dysfunction occur due to low energy availability? How long can recovery take?
Menstrual dysfunction can occur in as little as 1 month of low energy availability but more likely 2-3 months. It takes 3-6 months to recover after improvement in energy availability. For some girls, it may take double the amount of time to recover.
What are some important questions to consider regarding menstrual dysfunction in athletes?
Important questions include: What is the cause? (e.g., low energy intake, high energy expenditure leading to functional hypothalamic amenorrhea). It’s important to be aware if the absence of a period is due to an underlying condition like PCOS or something else.
Explain the relationship between LH pulsatility and menstrual dysfunction.
Disruption of LH pulsatility is a cause of menstrual dysfunction. Low Energy Availability (LEA) reduced LH pulsatility by ~60%.
What is the misconception some athletes, coaches, and trainers have about amenorrhea?
Some consider amenorrhea a benign consequence of training, an indicator of good training, and that body fat levels are at an optimal level for performance - this is a serious misconception.
What are some potential causes of menstrual problems in athletes?
Causes of menstrual problems in athletes are multifactorial (physiological and psychological), and insufficient energy availability may result in menstrual problems.
Define low bone mineral density (osteopenia) and osteoporosis based on Z-scores.
- Low Bone Mineral Density (BMD) (aka osteopenia): bone mineral density Z-score between -1.0 and -2.0.
- Osteoporosis: bone mineral density Z-score < -2.0 with secondary risk factors for fracture (e.g., undernutrition, hypoestrogenism, prior fractures). A DEXA scan can reveal BMD.
Why is estrogen important for bone health?
It influences bone metabolism by affecting cells like osteoblasts (bone-building) and osteoclasts (bone-resorbing).
