Updates on Low Energy Availability in Athletes: Relative Energy Deficiency in Sport and the Female or Male Athlete Triad.

Abstract

This paper evaluates the latest literature on low energy availability (LEA) in athletes, which is the basis for the clinical conditions known as the Female Athlete Triad, Male Athlete Triad, and Relative Energy Deficiency in Sport (REDs). It explores how these different conditions are related, and how the clinician can approach screening, diagnosis, and management of LEA in athletes. Within the past five years the Male Athlete Triad Consensus Statements were published in 2021, expanding upon knowledge regarding LEA in the Female Athlete Triad and applying this to the male population. Additionally, there has been an important update to the REDs model and a new clinical assessment tool (CAT2) published in 2023. This is based on new research into the different physiologic and psychologic sequelae of LEA. This has sparked additional discussion regarding the diagnosis, management, and prevention of LEA. The consequences of LEA can be severe, and can affect multiple different organ systems. Treatment should ideally involve a multidisciplinary team consisting of a physician, dietitian, and mental health provider, but may also include additional professionals such as athletic trainers, physical therapists, physiologists, other medical specialists, or other members of the athlete support system (including family and coaches). The mainstay of management remains optimizing energy availability (EA) through improving macro and micronutrient intake, and also requires addressing some of the more common sequelae of LEA. Prevention largely focuses on educational efforts and fostering healthy environments, particularly when discussing weight, body composition, and performance.