Low Energy Availability Surrogates Are Associated With Relative Energy Deficiency In Sport Outcomes In Male Athletes

PURPOSE: To determine the association between surrogates of low energy availability (EA) and proposed health and performance outcomes of Relative Energy Deficiency in Sport (REDs) in a clinical sample of adolescent and young adult male athletes. METHODS: Male athletes ages 15-30 years presenting to a sports medicine clinic at a tertiary care center were invited to complete a survey about athlete health and well-being. Participants were divided into low EA and adequate EA groups based on survey responses to surrogate markers for low EA (self-reported history of eating disorder/disordered eating; Eating Disorder Examination Questionnaire; Eating Disorder Screen for Primary Care). Associations between low EA and REDs outcomes (defined in 2018 IOC Consensus Statement) were evaluated using chi-squared tests and odds ratios were calculated using binomial logistic regression (α = 0.05). RESULTS: Low EA was associated with increased frequency of impaired immunological, metabolic, psychological, cardiovascular, and gastrointestinal function (Figure 1); reduced endurance performance, response to training, judgment, coordination, and muscle strength; and increased irritability and depression (Figure 2). Those with low EA had increased odds of reduced psychological and cardiovascular function, endurance performance, and training response. CONCLUSIONS: Low EA is associated with many adverse health outcomes and performance effects of REDs in male athletes. Future research should explore the relationship between low EA in males and health and performance outcomes proposed in the 2023 IOC REDs models.