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Identifying latent classes of Relative Energy Deficiency in Sport (RED-S) consequences in a sample of collegiate female cross country runners
  1. Traci Lyn Carson1,
  2. Brady T West2,
  3. Kendrin Sonneville3,
  4. Ronald F Zernicke4,
  5. Philippa Clarke1,
  6. Sioban Harlow1,
  7. Carrie Karvonen-Gutierrez1
  1. 1Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  2. 2Institute for Social Research (ISR), University of Michigan, Ann Arbor, Michigan, USA
  3. 3Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  4. 4School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Traci Lyn Carson, Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA; tlcars{at}umich.edu

Abstract

Objective The purpose of this study was to identify patterns of clustering of the 10 health consequences identified in the Relative Energy Deficiency in Sport (RED-S) framework among collegiate female Cross-Country runners. We also assessed risk characteristics associated with each cluster.

Methods This randomly sampled population included 211 current National Collegiate Athletics Association (NCAA) Division I (DI) female cross country runners who completed a quantitative survey. We used latent class analysis (LCA) to group athletes into mutually exclusive classes based on shared response patterns of RED-S consequences. We computed descriptive statistics to identify demographics, personal characteristics, disordered eating and emotional health characteristics associated with each class.

Results The average age of the sample was 21 years with mean body mass index 20.4 kg/m2. The LCA identified three unique classes of potential RED-S presentations: (1) low probability of RED-S consequences; (2) complex physical and psychological concerns with a higher burden of cardiovascular concern and (3) very high probability of anxiety with high burden of menstrual disturbance, bone injury and gastrointestinal concern. All classes were characterised by high levels of menstrual disturbance and distinguished by the number and burden of other potential RED-S consequences and in reported abuse history, emotional regulation and perfectionism.

Conclusion This study identified a high burden of menstrual disturbance in NCAA D1 cross country runners, and three unique presentations of RED-S consequences. Future research is warranted to better understand how early prevention and intervention strategies may mitigate RED-S consequences in distance runners.

  • female athlete triad syndrome
  • female
  • running
  • physiology

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the first author (tlcars@umich.edu).

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request to the first author (tlcars@umich.edu).

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Footnotes

  • Twitter @traci_Carson

  • Collaborators Thank Dr Kamryn Eddy, Dr Jenny Thomas and Dr Debra Franko with the Eating Disorders and Clinical Research Programme at Massachusetts General Hospital.

  • Contributors The first author is responsible for the overall content as the guarantor, conducted all analyses and was the sole writer of this paper. The subsequent authors provided essential guidance in the design of the study, as well as substantive feedback and edits to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

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

  • 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.