Relative Energy Deficiency in Sport (REDs): Risk Assessment in Collegiate Female Athletes

Alterations in energy intake (EI) and exercise energy expenditure (EEE) may increase low energy availability (LEA) risk in Division II female collegiate athletes. Chronic LEA can transition to problematic LEA, leading to Relative Energy Deficiency in Sport (REDs). The purpose of this study was to assess the current severity and prevalence of REDs using the REDs Clinical Assessment Tool 2 (CAT2) and the Female Athlete Triad Cumulative Risk Assessment tool (FAT CRA) in Division II collegiate female ball sport athletes. Twenty-seven female athletes (volleyball, soccer, basketball, and rugby) at Central Washington University were included. Participants reported demographics; history of injuries, depression, and eating disorders (EDs); Eating Disorder Examination Questionnaire (EDE-Q), Low Energy Availability in Females Questionnaire (LEAF-Q) and dual X-ray absorptiometry (DXA) of the lumbar spine, hips, and whole body to determine REDs risk using the REDs CAT2 Tool and Triad risk using the FAT CRA. 85.2% (n=23) of athletes had no or low risk of REDs, while 15% (n=4) had a mild risk. An elevated EDE-Q score had a higher prevalence in the yellow group (p<0.001), and global and shape concern were strongly associated with (rs (25) = 0.61, p<0.001), (rs (25) = 0.6, p<0.001) an increased REDs risk. In this cohort of athletes, REDs risk was low, with an elevated EDE-Q global score serving as the most prevalent primary indicator contributing to risk for REDs. Our findings suggest that disordered eating risk may be just as influential as physiological markers in identifying athletes at risk for REDs.