Exploring different interventions for Relative Energy Deficiency in Sport (REDs): A systematic review

Area of Science:

• Sports Medicine
• Nutritional Science
• Exercise Physiology

Background:

• Relative Energy Deficiency in Sport (REDs) arises from an energy intake and expenditure imbalance, leading to low energy availability.
• Growing awareness of REDs necessitates a synthesis of intervention efficacy for athletes.
• This review aims to guide clinicians and athletes toward optimal REDs management strategies.

Purpose of the Study:

• To synthesize the available literature on the efficacy of various interventions for athletes experiencing REDs.
• To identify the most effective strategies for managing REDs and improving athlete health outcomes.
• To inform clinical practice and athlete support regarding REDs interventions.

Main Methods:

• A comprehensive literature search was conducted across Medline, Embase, and Web of Science databases.
• Two independent reviewers screened studies by title, abstract, and full text, assessing risk of bias using the Joanna Briggs Institute tool.
• Data were extracted and a narrative synthesis was performed on the 11 eligible studies.

Main Results:

• Interventions included increasing energy intake (n=3), combined energy intake and expenditure modification (n=1), dietary approaches (n=1), education/counseling (n=5), and hormonal intervention (n=1).
• Increased energy intake facilitated return of menses but did not significantly improve bone mineral density.
• Dietary approaches positively impacted body image and mood states, while nutrition education enhanced bone health, energy availability, and eating behaviors. Hormonal interventions showed limited effects on bone mineral density.

Conclusions:

• Increasing energy intake is crucial for REDs management, potentially enhanced by concurrent education and hormonal therapy.
• Dietary approaches and nutrition education offer significant benefits for athlete well-being and physiological markers.
• Limited research underscores the need for further investigation into the efficacy of various REDs interventions.