Relative energy deficiency in sport: Diagnosis and management in primary care

Abstract

Relative energy deficiency in sport (RED-S) describes a syndrome that affects multiple bodily systems and functions in both recreational and elite athletes. It is, fundamentally, an imbalance between energy intake and exercise-related energy expenditure, leading to globally impaired physiological function as a result of low energy availability. RED-S developed from the ‘female athlete triad’, describing a relationship between low energy availability (with or without eating disorder), amenorrhea (menstrual dysfunction) and low bone mineral density; it is now recognised to occur across many other bodily systems and also to occur in males. Given its often subtle presentation and consequences early-on, but potentially devastating consequences further down the line, timely recognition and facilitation of management in primary care is crucial to allow safe return to physical activity and to prevent long-term sequelae.