A review of nonpharmacological strategies in the treatment of relative energy deficiency in sport

Journal article


Kuikman, Megan A., Mountjoy, Margo, Stellingwerff, Trent and Burr, Jamie F.. (2021). A review of nonpharmacological strategies in the treatment of relative energy deficiency in sport. International Journal of Sport Nutrition and Exercise Metabolism. 31(3), pp. 268-275. https://doi.org/10.1123/ijsnem.2020-0211
AuthorsKuikman, Megan A., Mountjoy, Margo, Stellingwerff, Trent and Burr, Jamie F.
Abstract

Relative energy deficiency in sport (RED-S) can result in negative health and performance outcomes in both male and female athletes. The underlying etiology of RED-S is low energy availability (LEA), which occurs when there is insufficient dietary energy intake to meet exercise energy expenditure, corrected for fat-free mass, leaving inadequate energy available to ensure homeostasis and adequate energy turnover (optimize normal bodily functions to positively impact health), but also optimizing recovery, training adaptations, and performance. As such, treatment of RED-S involves increasing energy intake and/or decreasing exercise energy expenditure to address the underlying LEA. Clinically, however, the time burden and methodological errors associated with the quantification of energy intake, exercise energy expenditure, and fat-free mass to assess energy availability in free-living conditions make it difficult for the practitioner to implement in everyday practice. Furthermore, interpretation is complicated by the lack of validated energy availability thresholds, which can result in compromised health and performance outcomes in male and female athletes across various stages of maturation, ethnic races, and different types of sports. This narrative review focuses on pragmatic nonpharmacological strategies in the treatment of RED-S, featuring factors such as low carbohydrate availability, within-day prolonged periods of LEA, insufficient intake of bone-building nutrients, lack of mechanical bone stress, and/or psychogenic stress. This includes the implementation of strategies that address exacerbating factors of LEA, as well as novel treatment methods and underlying mechanisms of action, while highlighting areas of further research.

Keywordsathlete; bone health; female/male hypogonadism; low energy availability; reproductive function
Year2021
JournalInternational Journal of Sport Nutrition and Exercise Metabolism
Journal citation31 (3), pp. 268-275
PublisherHuman Kinetics
ISSN1526-484X
Digital Object Identifier (DOI)https://doi.org/10.1123/ijsnem.2020-0211
PubMed ID33465762
Scopus EID2-s2.0-85105334075
Page range268-275
FunderNatural Sciences and Engineering Research Council of Canada (NSERC)
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online19 Jan 2021
Publication process dates
Deposited20 Sep 2023
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