TY - JOUR T1 - IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update JF - British Journal of Sports Medicine JO - Br J Sports Med SP - 687 LP - 697 DO - 10.1136/bjsports-2018-099193 VL - 52 IS - 11 AU - Margo Mountjoy AU - Jorunn Kaiander Sundgot-Borgen AU - Louise M Burke AU - Kathryn E Ackerman AU - Cheri Blauwet AU - Naama Constantini AU - Constance Lebrun AU - Bronwen Lundy AU - Anna Katarina Melin AU - Nanna L Meyer AU - Roberta T Sherman AU - Adam S Tenforde AU - Monica Klungland Torstveit AU - Richard Budgett Y1 - 2018/06/01 UR - http://bjsm.bmj.com/content/52/11/687.abstract N2 - In 2014, the IOC published a consensus statement entitled ‘Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)’. The syndrome of RED-S refers to ‘impaired physiological functioning caused by relative energy deficiency and includes, but is not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health’. The aetiological factor of this syndrome is low energy availability (LEA).1The publication of the RED-S consensus statement stimulated activity in the field of Female Athlete Triad science, including some initial controversy2 3 followed by numerous scientific publications addressing:The health parameters identified in the RED-S conceptual model (figure 1).1 4Relative energy deficiency in male athletes.The measurement of LEA.The performance parameters identified in the RED-S conceptual model (figure 2).1 4The IOC RED-S consensus authors have reconvened to provide an update summary of the interim scientific progress in the field of relative energy deficiency with the ultimate goal of stimulating advances in RED-S awareness, clinical application and scientific research to address current gaps in knowledge.Figure 1 Health consequences of Relative Energy Deficiency in Sport (RED-S) showing an expanded concept of the Female Athlete Triad to acknowledge a wider range of outcomes and the application to male athletes (*Psychological consequences can either precede RED-S or be the result of RED-S).1 4Figure 2 Potential Performance consequences of Relative Energy Deficiency in Sport (*Aerobic and anerobic performance).1 4Low energy availabilityLEA, which underpins the concept of RED-S, is a mismatch between an athlete’s energy intake (diet) and the energy expended in exercise, leaving inadequate energy to support the functions required by the body to maintain optimal health and performance. Operationally, energy availability (EA) is defined as:where exercise energy expenditure (EEE) is calculated as the additional energy expended above that of … ER -