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George Wilson, Dan Martin, James P. Morton and Graeme L. Close

The relative energy deficiency in sport (RED-S) syndrome was recently developed in recognition that male athletes display evidence of impaired physiological function that may be related to low energy availability ( Mountjoy et al., 2014 ). Jockeys are unique among professional athletes in that they

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Sarah Staal, Anders Sjödin, Ida Fahrenholtz, Karen Bonnesen and Anna Katarina Melin

Ballet dancers are reported to have an increased risk for low energy availability (EA) with or without disordered eating (DE) behavior or eating disorders ( Doyle-Lucas et al., 2010 ; Lagowska et al., 2014 ; Nattiv et al., 2007 ). Energy deficiency is related to impaired performance and a wide

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Sherry Robertson and Margo Mountjoy

components—that is, low energy availability (LEA), menstrual dysfunction (MD), and low bone mineral density (BMD) ( Nattiv et al., 2007 ). The International Olympic Committee (IOC) Consensus Group coined the more comprehensive term, RED-S, to more accurately describe the pathophysiology and multisystem

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Graeme L. Close, Craig Sale, Keith Baar and Stephane Bermon

leafy kind) are likely to be useful sources of the main nutrients that support bone health. Of the more specific issues for the athlete, undoubtedly the biggest factor is the avoidance of low energy availability, which is essential to avoid negative consequences for bone ( Papageorgiou et al., 2018a

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Anna K. Melin, Ida A. Heikura, Adam Tenforde and Margo Mountjoy

Track and field athletes have intense physiological demands and require optimized nutrition ( Burke et al., 2019 ; Slater et al., 2018 ; Stellingwerff et al., 2018 ; Sygo et al., 2019 ). Track and field athletes may experience low energy availability (LEA) due to disordered eating (DE) behavior

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José L. Areta

The female athlete triad has been identified as a condition where chronic low energy availability (LEA) is typically concomitant with menstrual dysfunction and/or low bone mineral density ( Nattiv et al., 2007 ). Elements of the triad are often observed in athletes from sports focusing on leanness

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Louise M. Burke, Graeme L. Close, Bronwen Lundy, Martin Mooses, James P. Morton and Adam S. Tenforde

Recognition of low energy availability (LEA) in male athletes, associated with a range of negative outcomes, played a role in the framing of the Relative Energy Deficiency in Sport (RED-S) syndrome ( Mountjoy et al., 2014 ). Indeed, a variety of scenarios have been investigated in which male

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Paula B. Costa, Scott R. Richmond, Charles R. Smith, Brad Currier, Richard A. Stecker, Brad T. Gieske, Kimi Kemp, Kyle E. Witherbee and Chad M. Kerksick

high physical training load, increased anxiety, and emotional stress in conjunction with insufficient energy intake (EI) may result in a scenario where low energy availability (EA) persists in this population. 3 Training in an environment that is weight supported with reduced mechanical loading

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Julia L. Bone and Louise M. Burke

The measurement of basal metabolism, the lowest amount of energy required for the body to function, is of interest to athletes due to its potential as a diagnostic tool to detect low energy availability ( Loucks et al., 2011 ; Mountjoy et al., 2015 ). The terms basal energy expenditure (BEE) and

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Nancy I. Williams, Clara V. Etter and Jay L. Lieberman

An understanding of the health consequences of abnormal menstrual function is an important consideration for all exercising women. Menstrual disturbances in exercising women are quite common and range in severity from mild to severe and are often associated with bone loss, low energy availability, stress fractures, eating disorders, and poor performance. The key factor that causes menstrual disturbances is low energy availability created by an imbalance of energy intake and energy expenditure that leads to an energy deficit and compensatory metabolic adaptations to maintain energy balance. Practical guidelines for preventing and treating amenorrhea in exercising women include evidence-based dietary practices designed to achieve optimal energy availability. Other factors such as gynecological age, genetics, and one’s susceptibility to psychological stress can modify an individual’s susceptibility to menstrual disturbances caused by low energy availability. Future research should explore the magnitude of these effects in an effort to move toward more individualized prevention and treatment approaches.