Prevalence of impaired physiological function consistent with Relative Energy Deficiency in Sport (RED-S): An Australian elite and pre-elite cohort

Objectives: Athlete health, training continuity and performance can be impeded as a result of Relative Energy Deficiency in Sport (RED-S). Here we report the point prevalence of symptoms described by the RED-S model in a mixed-sport cohort of Australian female athletes. Methods: Elite and pre-elite female athletes (n=112) from eight sports completed validated questionnaires and underwent clinical assessment to assess the point prevalence of RED-S symptoms. Questionnaires included the Depression, Anxiety and Stress Questionnaire (DASS-21), Generalized Anxiety Disorder (GAD-7), Centerfor Epidemiological Studies Depression Scale (CES-D), SCOFF questionnaire for disordered eating, Low Energy Availability in Females Questionnaire (LEAF-Q), and a custom questionnaire on injury and illness. Clinical assessment comprised resting metabolic rate (RMR) assessment, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, venous and capillary blood samples,and the Mini International Neuropsychiatric Interview (MINI 7.0.2). Descriptive prevalence statistics are presented. Results: Almost all (80%) participants (age 19 (range 15-32) years; mass 69.5±10.3 kg; body fat 23.1%±5.0%) demonstrated at least one symptom consistent with RED-S, with 37% exhibiting between two and three symptoms. One participant demonstrated five symptoms. Impaired function of the immunological (28%, n=27), haematological (31%, n=33) and gastrointestinal (47%, n=51) systems were most prevalent. A moderate to high (11%-55%) prevalence of risk of low energyavailability was identified via RMR and LEAF-Q, and identified mental illnesses were prevalent in one-third of the assessed cohort. Conclusion: Symptoms described by the RED-S model were prevalent in this cohort, supporting the need for improved awareness, monitoring and management of these symptoms in this population.