Relative Energy Deficiency in Sports (Reds) Risk Factors in Physique – Focused vs. Non-Physique Focused Female Athletes

Relative Energy Deficiency in Sport (REDs) is a multifaceted condition characterized by low energy availability (LEA) and its subsequent impact on health and athletic performance. While REDs research has traditionally focused primarily on female endurance athletes in physique-focused (PF) sports (which emphasize leanness), there is less information regarding prevalence of REDs risk factors in non-physique-focused (NPF) athletes. This study aimed to assess the prevalence of REDs risk factors among collegiate female athletes participating in either PF or NPF sports. Methods: Thirty-three NCAA Division I and II female athletes were recruited and evaluated for REDs risk through anthropometric measurements, blood biomarkers, bone mineral density (BMD) via dual-energy x-ray absorptiometry (DXA), and questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Low Energy Availability in Females Questionnaire (LEAF-Q). REDs risk was categorized using the traffic light categories proposed by the International Olympic Committee REDs Clinical Assessment Tool version 2 (CAT2). Results: PF athletes were of shorter stature and had significantly lower body mass and lean body mass than NPF athletes. There were no significant differences in the measured biomarkers leptin or cortisol, LEAF-Q total score, or global EDE-Q score. PF athletes had significantly lower BMD at AP spine, dual femur, and total body. Conclusions: Although REDs risk factors were similar between female collegiate athletes competing in PF and NPF sports, PF athletes exhibited lower BMD despite similar REDs risk. Further research is needed to understand the complex associations between low BMD and REDs risk.