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

The reported prevalence of low energy availability (LEA) in female and male track and field athletes is between 18% and 58% with the highest prevalence among athletes in endurance and jump events. In male athletes, LEA may result in reduced testosterone levels and libido along with impaired training capacity. In female track and field athletes, functional hypothalamic amenorrhea as consequence of LEA has been reported among 60% of elite middle- and long-distance athletes and 23% among elite sprinters. Health concerns with functional hypothalamic amenorrhea include impaired bone health, elevated risk for bone stress injury, and cardiovascular disease. Furthermore, LEA negatively affects recovery, muscle mass, neuromuscular function, and increases the risk of injuries and illness that may affect performance negatively. LEA in track and field athletes may occur due to intentional alterations in body mass or body composition, appetite changes, time constraints, or disordered eating behavior. Long-term LEA causes metabolic and physiological adaptations to prevent further weight loss, and athletes may therefore be weight stable yet have impaired physiological function secondary to LEA. Achieving or maintaining a lower body mass or fat levels through long-term LEA may therefore result in impaired health and performance as proposed in the Relative Energy Deficiency in Sport model. Preventive educational programs and screening to identify athletes with LEA are important for early intervention to prevent long-term secondary health consequences. Treatment for athletes is primarily to increase energy availability and often requires a team approach including a sport physician, sports dietitian, physiologist, and psychologist.

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Rachael E. Flatt and Craig Barr Taylor

Energy Deficiency in Sports (RED-S; formerly known as the Female Athlete Triad), a disorder common to many athletes. The symptoms of this disorder overlap with AN and may reflect an eating disorder ( Mountjoy et al., 2014 ). A screening tool for RED-S is available, but has not yet been validated

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Louise M. Burke, Asker E. Jeukendrup, Andrew M. Jones and Martin Mooses

of brief periods of controlled low energy availability within the endurance training framework. Problems associated with chronic or severe low energy availability, known as relative energy deficiency in sports, are well known ( Mountjoy et al., 2018 ); specific issues in relation to Athletics are

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) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S). Fifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed