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Prevalence of impaired physiological function consistent with Relative Energy Deficiency in Sport (RED-S): an Australian elite and pre-elite cohort
  1. Margot Anne Rogers1,2,
  2. Renee Newcomer Appaneal2,3,
  3. David Hughes4,
  4. Nicole Vlahovich4,
  5. Gordon Waddington2,4,
  6. Louise M Burke1,5,
  7. Michael Drew2,3
  1. 1 Sports Nutrition, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
  2. 2 Research Institute for Sport and Exercise, University of Canberra, Bruce, Australian Capital Territory, Australia
  3. 3 Applied Technology and Innovation, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
  4. 4 Sports Medicine, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
  5. 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
  1. Correspondence to Margot Anne Rogers, Australian Institute of Sport, Bruce, ACT 2617, Australia;{at}


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), Center for 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 energy availability 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.

  • relative energy deficiency
  • athlete
  • female
  • health

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  • Twitter @MargotRogers_, @PrepareNPerform, @_mickdrew

  • Contributors This study was designed by MAR, MD and LMB; data were collected and analysed by MAR, MD, LMB and RNA; data interpretation and manuscript preparation were undertaken by MAR, MD, LMB, GW, NV, RNA and DH. All authors approved the final version of the paper. All data presented are part of the ‘Stay Healthy’ project, an initiative that supports Australia’s elite athletes.

  • Funding This work was supported by the Australian Institute of Sport High Performance Research Fund (Immune Health Multiple Sports, 2017) and the University of Canberra Research Institute for Sport and Exercise (internal grant).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval for this study, which adheres to the Declaration of Helsinki, was obtained through the AIS and University of Canberra Human Research Ethics Committees (approval number: AIS 20170402).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Due to the personal nature of the health data collected from participants, no data are available to be shared.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.