Relative Energy Deficiency in Sport risk assessment model for sport participation (modified from Skårderud et al)140
| High risk: no start red light | Moderate risk: caution yellow light | Low risk: green light |
|---|---|---|
| ▸ Anorexia nervosa and other serious eating disorders ▸ Other serious medical (psychological and physiological) conditions related to low energy availability ▸ Extreme weight loss techniques leading to dehydration induced haemodynamic instability and other life-threatening conditions | ▸ Prolonged abnormally low % body fat measured by DXA or anthropometry using The International Society for the Advancement of Kinanthropometry ISAK141 or non-ISAK approaches142 ▸ Substantial weight loss (5–10% body mass in 1 month) ▸ Attenuation of expected growth and development in adolescent athlete | ▸ Healthy eating habits with appropriate energy availability |
| ▸ Abnormal menstrual cycle: FHA amenorrhoea >6 months ▸ Menarche >16 years ▸ Abnormal hormonal profile in men | ▸ Normal hormonal and metabolic function | |
| ▸ Reduced BMD (either from last measurement or Z-score < −1 SD). ▸ History of 1 or more stress fractures associated with hormonal/menstrual dysfunction and/or low EA | ▸ Healthy BMD as expected for sport, age and ethnicity ▸ Healthy musculoskeletal system | |
| ▸ Athletes with physical/psychological complications related to low EA/disordered eating - ECG abnormalities- Laboratory abnormalities | ||
| ▸ Prolonged relative energy deficiency ▸ Disordered eating behaviour negatively affecting other team members ▸ Lack of progress in treatment and/or non-compliance |
BMD, bone mineral density; DXA, dual-energy X-ray absorptiometry; EA, energy availability; FHA, functional hypothalamic amenorrhoea; ISAK, International Society for the Advancement of Kinanthropometry