Comparison of Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S): a Review of Low Energy Avail
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SPORTS MEDICINE REHABILITATION (B LIEM AND BJ KRABAK, SECTION EDITORS)
Comparison of Female Athlete Triad (Triad) and Relative Energy Deficiency in Syndrome (RED-S): a Review of Low Energy Availability, Multidisciplinary Awareness, Screening Tools and Education Alexandra Warrick 1 & Marcia Faustin 1 & Brandee Waite 1 Accepted: 22 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper aims to review low energy availability (low EA), compare the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S) screening tools and eating disorder/disordered eating questionnaires, and discuss multidisciplinary awareness, education, and treatment strategies. It provides an overview on the current state of the Triad and RED-S and assists clinicians with an overview of options for screening tools for their practice. Recent Findings Triad Consensus Panel Screening Questions, Preparticipation Physical Exam (PPE), and Periodic Health Exam (PHE) share overlapping questions from the Triad Consensus Panel Screening Questions. The Low Energy Availability in Females Questionnaire (LEAF-Q) is used in complement with eating disorder/disordered eating questionnaires (Table 2). Summary It is important to screen athletes for low EA during the PPE. If concerned for low EA, referral to healthcare professional and registered dietician is warranted. Education for athletes, coaches, and multidisciplinary providers is needed to increase awareness of low EA. Keywords Triad . RED-S . Athlete . Energy . Deficiency . Screening
Introduction In 1992, the Female Athlete Triad (Triad) was originally defined as an association of disordered eating, amenorrhea, and osteoporosis [1••, 2, 3]. In 2007, it was re-defined as three interrelated components of the Triad existing on a spectrum of low energy availability (EA) (with or without disordered eating), menstrual dysfunction, and low bone mineral density among female athletes [4•, 5••, 6–10]. In 2014, the Female Athlete Triad Coalition Consensus Statement proposed a risk stratification system regarding sports participation and return to play [1••]. That same year, the International Olympic Committee (IOC) introduced the term Relative Energy Deficiency in Sport (RED-S) as a more comprehensive syndrome than the Female Athlete Triad [11••]. This article belongs to the Topical Collection on Sports Medicine Rehabilitation * Brandee Waite [email protected] 1
Department of Physical Medicine and Rehabilitation, Sports Medicine, University of California Davis School of Medicine, 3301 C Street, Suite1600, Sacramento, CA 95816, USA
Underpinning both the Triad and RED-S is low EA, which is caused by insufficient energy intake to account for the cost of exercise [1•, 11••]. Low EA can be challenging to diagnose because of subtle symptomatology and health consequences that are not readily apparent. Weight is not an accurate sole indicator of energy availability [7, 12]; therefore, further investigation is indicated. Many athletes al
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