Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis primarily pooling observational studies
PubMed 39485653 · doi:10.1007/s40279-024-02130-0
What was done
Authors conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO CRD42023469253) searching PubMed, Embase, and Cochrane online databases. Inclusion criteria encompassed studies examining the prevalence of low energy availability (LEA) or relative energy deficiency in sport (REDs), and their impacts on athletic performance or injury risk.
What was found
Across 59 included studies, LEA was identified in 2,737 of 6,118 athletes in 46 studies (44.7%), affecting 44.2% of female and 49.4% of male athletes. Risk of REDs was found in 460 of 730 athletes in 8 studies (63.0%). LEA was associated with declines in run performance, training response, endurance, coordination, concentration, judgment, explosive power, and agility, alongside increased illness-related training absence. Evidence on overall injury risk was mixed, though most studies linked LEA to impaired bone health and higher risk of bone stress injuries. The abstract did not report numerical effect sizes or confidence intervals for performance and injury outcomes.
Why it matters
This review synthesizes multi-sport data showing that LEA affects nearly half of surveyed athletes, providing a benchmark for screening protocols targeting bone stress injury prevention and training optimization.
Limits
The underlying literature is predominantly observational and cross-sectional, limiting causal conclusions. The abstract provides no pooled effect estimates, variance metrics, or heterogeneity statistics for performance deficits and injury risk, and overall injury findings remained conflicting across studies.
Cited by
- context Relative Energy Deficiency in Sport (RED-S) occurs when physical activity exceeds nutritional energy intake, and female athletes—particularly in endurance disciplines—are more prone to underfueling than male athletes.