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Claire E. Badenhorst, Katherine E. Black and Wendy J. O’Brien

In 2014, the International Olympic Committee first used the term Relative Energy Deficiency in Sport (RED-S) to describe the lack of energy for performance and health in female and male athletes. The underlying premise of RED-S is low energy availability (LEA), whereby the amount of dietary energy

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Jennifer Sygo, Alexandra M. Coates, Erik Sesbreno, Margo L. Mountjoy and Jamie F. Burr

systems, including, but not limited to, the endocrine, cardiovascular, immune, and gastrointestinal systems, as well as menstrual function and bone health. The underlying cause of RED-S is low energy availability (LEA), defined as the amount of energy relative to fat-free mass remaining for physiological

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Ida A. Heikura, Arja L.T. Uusitalo, Trent Stellingwerff, Dan Bergland, Antti A. Mero and Louise M. Burke

Low energy availability (EA) is the failure of athletes to consume sufficient energy to cover the energy cost of exercise as well as energy required for optimal metabolic function and health ( Loucks et al., 2011 ). Low EA has been reported in both female ( Melin et al., 2015 ) and male ( Viner et

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Joanne Slater, Rebecca McLay-Cooke, Rachel Brown and Katherine Black

Low energy availability (LEA) describes the disruption in normal physiological function existent when insufficient energy intake is combined with exercise. To conserve energy a range of endocrine adaptations occur, impairing health and athletic performance. The prevalence of LEA has not been fully established especially among recreational exercisers. Determining recreational exercisers at risk of LEA may help to maximize prevention, early diagnosis and treatment. The design of this study was a cross-sectional online survey. One-hundred and nine female recreational exercisers, with a mean age of 23.8 (SD 6.9) years were recruited via gyms and fitness centers throughout NZ. Participants completed an online questionnaire including questions from the LEAF-Q (Low Energy Availability in Females Questionnaire). A total of 45.0% (CI, 35.4%, 54.8%) of participants were classified as “at risk“ of LEA. For every extra hour of exercise per week the odds of being at risk of LEA were 1.13 times greater (CI 1.02, 1.25, p = .016). All participants reporting previous stress fracture injuries (n = 4) were classified as at risk for LEA. Significantly more subjects participating in an individual sport were classified as at risk for LEA (69.6%, CI 24.3%, 54.8%) compared with team sports (34.8%, CI 18.7%, 40.5%) (p = .006). The high prevalence of female recreational exercisers at risk of LEA is of concern, emphasizing the importance of increasing awareness of the issue, and promoting prevention and early detection strategies, so treatment can be implemented before health is severely compromised.

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Petter Fagerberg

; VO 2peak  = peak oxygen uptake; MPS = muscle protein synthesis; EB = energy balance; ED = energy deficiency; LEA = low energy availability; FSR = fractional synthetic rate. *Statistically significant change. The most comprehensive evaluation of energy restriction among males was conducted by Ancel

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Ida A. Heikura, Marc Quod, Nicki Strobel, Roger Palfreeman, Rita Civil and Louise M. Burke

nutrition is the recognition of the relative energy deficiency in sport syndrome in male athletes. 6 , 7 The underpinning cause of this issue is low energy availability (LEA)—a mismatch between energy intake and the energy committed to the athlete’s daily training/event program, such that the energy costs

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Bryan Holtzman, Adam S. Tenforde, Allyson L. Parziale and Kathryn E. Ackerman

Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S) are two similar syndromes underpinned by low energy availability (LEA) that can have negative health consequences in athletes ( De Souza et al., 2014 ; Mountjoy et al., 2014 ). Triad was originally described in 1993

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Nura Alwan, Samantha L. Moss, Kirsty J. Elliott-Sale, Ian G. Davies and Kevin Enright

prolonged periods of sustained energy restriction and intensive training regimens in an attempt to acquire and maintain a lean body composition, indicating an increased risk of low energy availability (LEA) and its associated consequences ( Fagerberg, 2017 ). For a thorough understanding of the existence

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Kirsty J. Elliott-Sale, Adam S. Tenforde, Allyson L. Parziale, Bryan Holtzman and Kathryn E. Ackerman

.A. , & Burke , L.M. ( 2017 ). Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes . International Journal of Sport Nutrition and Exercise Metabolism, 1 – 30 . doi:10.1123/ijsnem.2017-0313 Hilton , L.K. , & Loucks , A.B. ( 2000

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Margo Mountjoy, Jorunn Sundgot-Borgen, Louise Burke, Kathryn E. Ackerman, Cheri Blauwet, Naama Constantini, Constance Lebrun, Bronwen Lundy, Anna Melin, Nanna Meyer, Roberta Sherman, Adam S. Tenforde, Monica Klungland Torstveit and Richard Budgett

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) ( Mountjoy et al., 2014 ). The publication of the RED-S consensus statement stimulated