Risk and prevalence of Relative Energy Deficiency in Sport (REDs) among professional female football players

Abstract

A high prevalence of low energy availability (LEA) has been reported in femalefootball players. This is of concern as problematic LEA may evolve into a syndromicpattern known as relative energy deficiency in sport (REDs). Given the difficulties inaccurately assessing LEA, our study shifts emphasis to measurable indicators ofREDs, serving as proxies for health detriments caused by LEA. The present cross‐sectional study aimed to quantify the risk of REDs and to assess the prevalenceof indicators indicative of the syndrome. 60 players (tiers 3 and 4) from threeNorwegian football teams were analyzed as a single cohort but also stratified basedon player position and menstrual status. The proportion of players at risk for REDswas 22%, that is, 17% with mild, 3% with moderate to high, and 2% with very high/extreme risk, respectively. The majority of the cohort (71%) presented with noprimary indicators, while 20%, 7%, and 2% presented with one, two, and threeprimary indicators, respectively. Regarding secondary indicators, 57% had none,33% had one, and 10% had two indicators. For associated indicators, 30% had none,42% had one, 18% had two, 8% had three, and 2% had four indicators. Player po-sition did not affect the prevalence of REDs indicators. Among noncontraceptiveusers (n = 27), secondary amenorrhea (AME) was reported by 30%. These findingsindicate that health and performance teams should prioritize universal healthpromoting strategies rather than selective or indicative strategies. Particularly,focus on nutritional periodization to secure sufficient energy availability, mitigatingthe risk of problematic LEA and REDs should be addressed.