Relative Energy Deficiency in Sports (REDs) in Swedish Athletes

NCT06371963 | Completed

• 1 other identifier: LinnaeusU REDs
• Study Type: observational
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

Background: Relative Energy Deficiency in Sport (REDs) describes impairment of health and performance due to problematic (long-term/severe) low energy availability (LEA), with or without eating disorders. LEA is frequently reported in sports with high training volumes, especially in leanness demanding sports, and 20% of female and 9% of male Norwegian national team athletes have been reported to have eating disorders. Potential trigger factors are e.g., dieting, injuries, coaching behavior, and subculture aspects e.g., focus on low body weight. The main questions that will be addressed are: 1. What is the prevalence of eating disorders and REDs among Swedish elite athletes and controls? 2. What is the impact of problematic LEA on health and performance aspects in both male and female athletes? Methods: National team athletes and gender and matched controls will be invited to an anonymous on-line survey. Elite athletes who agree to participate, will be invited to assessment of eating disorders, nutritional and physiological status (e.g., metabolic and endocrine markers, bone health, microbiota, dietary intake, energy availability, and performance).

Conditions

RED S; Eating Disorders

Keywords

Observational study; REDs; Eating disorders; Cross-sectional study; Elite athletes; Sweden; Physiological assessments; Performance; Microbiota; Immune function; Resting metabolic rate; Energy availability; Biomarkers; Reproductive dysfunction; The biological passport; Exercise addiction; Gastrointestinal function

Outcome Measures

Primary Outcomes (1)

• Self-reported eating disorders

  Participants: Female and male elite athletes and age and gender matched controls. An on-line version of the Eating Disorder Examination Questionnaire (EDE-Q) will be used comprising of 28 items, 4 sub-scales (restrained eating, eating-, body-, and weight concerns), and a global score. An EDE-Q global score ≥ 2.3 for females and ≥1.7 for males indicate risk of eating disorder.

  Day one

Secondary Outcomes (23)

• Eating disorders

  Through study completion, an average of 1 year

• Self-reported reproductive function in females not using hormonal contraceptives

  Day one

• Reproductive function in females not using hormonal contraceptives

  Through study completion, an average of 1 year

• Self-reported reproductive function in males

  Day one

• Reproductive function in males

  Through study completion, an average of 1 year

Study Arms (2)

Elite Athletes

Senior Swedish male and female national team and recruiting squad athletes.

Gender and age matched controls

Healthy male and female non-elite athletic controls.

Eligibility Criteria

• Age: 18 Years - 45 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

Swedish male and female national team athletes and gender- and age matched controls.

You may qualify if:

• National-team level athletes
• Non-elite athletic controls
• chronic illness (e.g., diabetes, hypothyroidism)
• injury
• smoking
• pregnancy
• hormonal contraceptive use

Sponsors & Collaborators

• Linnaeus University: lead
• Swedish Olympic Committee: collaborator
• Swedish Research Council for Sport Science: collaborator
• World Anti-Doping Agency: collaborator

Study Sites (1)

Linnaeus University

Kalmar, Småland, Sweden

Location

Related Publications (19)

• Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023 Sep;57(17):1073-1097. doi: 10.1136/bjsports-2023-106994.

  PMID: 37752011 BACKGROUND

• Melin A, Tornberg AB, Skouby S, Moller SS, Sundgot-Borgen J, Faber J, Sidelmann JJ, Aziz M, Sjodin A. Energy availability and the female athlete triad in elite endurance athletes. Scand J Med Sci Sports. 2015 Oct;25(5):610-22. doi: 10.1111/sms.12261. Epub 2014 May 30.

  PMID: 24888644 BACKGROUND

• Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, Lebrun C, Lundy B, Melin AK, Meyer NL, Sherman RT, Tenforde AS, Klungland Torstveit M, Budgett R. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018 Jun;52(11):687-697. doi: 10.1136/bjsports-2018-099193. No abstract available.

  PMID: 29773536 BACKGROUND

• Heikura IA, Uusitalo ALT, Stellingwerff T, Bergland D, Mero AA, Burke LM. Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes. Int J Sport Nutr Exerc Metab. 2018 Jul 1;28(4):403-411. doi: 10.1123/ijsnem.2017-0313. Epub 2018 Jun 12.

  PMID: 29252050 BACKGROUND

• Lundy SD, Sangwan N, Parekh NV, Selvam MKP, Gupta S, McCaffrey P, Bessoff K, Vala A, Agarwal A, Sabanegh ES, Vij SC, Eng C. Functional and Taxonomic Dysbiosis of the Gut, Urine, and Semen Microbiomes in Male Infertility. Eur Urol. 2021 Jun;79(6):826-836. doi: 10.1016/j.eururo.2021.01.014. Epub 2021 Feb 8.

  PMID: 33573862 BACKGROUND

• Hackney AC, Lane AR, Register-Mihalik J, O'leary CB. Endurance Exercise Training and Male Sexual Libido. Med Sci Sports Exerc. 2017 Jul;49(7):1383-1388. doi: 10.1249/MSS.0000000000001235.

  PMID: 28195945 BACKGROUND

• Logue DM, Madigan SM, Melin A, Delahunt E, Heinen M, Donnell SM, Corish CA. Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients. 2020 Mar 20;12(3):835. doi: 10.3390/nu12030835.

  PMID: 32245088 BACKGROUND

• Konda R, Orikasa S. [Studies on reflux nephropathy, I. Evaluation of renal function by urinary excretion of beta 2-microglobulin]. Nihon Hinyokika Gakkai Zasshi. 1984 Feb;75(2):245-54. No abstract available. Japanese.

  PMID: 6379250 BACKGROUND

• Rankin A, O'Donovan C, Madigan SM, O'Sullivan O, Cotter PD. 'Microbes in sport' -The potential role of the gut microbiota in athlete health and performance. Br J Sports Med. 2017 May;51(9):698-699. doi: 10.1136/bjsports-2016-097227. Epub 2017 Jan 25. No abstract available.

  PMID: 28432108 BACKGROUND

• Tornberg AB, Melin A, Koivula FM, Johansson A, Skouby S, Faber J, Sjodin A. Reduced Neuromuscular Performance in Amenorrheic Elite Endurance Athletes. Med Sci Sports Exerc. 2017 Dec;49(12):2478-2485. doi: 10.1249/MSS.0000000000001383.

  PMID: 28723842 BACKGROUND

• Griffiths MD, Szabo A, Terry A. The exercise addiction inventory: a quick and easy screening tool for health practitioners. Br J Sports Med. 2005 Jun;39(6):e30. doi: 10.1136/bjsm.2004.017020.

  PMID: 15911594 BACKGROUND

• Melin A, Tornberg AB, Skouby S, Faber J, Ritz C, Sjodin A, Sundgot-Borgen J. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med. 2014 Apr;48(7):540-5. doi: 10.1136/bjsports-2013-093240. Epub 2014 Feb 21.

  PMID: 24563388 BACKGROUND

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  PMID: 9101736 BACKGROUND

• Bech P, Timmerby N, Martiny K, Lunde M, Soendergaard S. Psychometric evaluation of the Major Depression Inventory (MDI) as depression severity scale using the LEAD (Longitudinal Expert Assessment of All Data) as index of validity. BMC Psychiatry. 2015 Aug 5;15:190. doi: 10.1186/s12888-015-0529-3.

  PMID: 26242577 BACKGROUND

• Lundgren T, Parling T. Swedish Acceptance and Action Questionnaire (SAAQ): a psychometric evaluation. Cogn Behav Ther. 2017 Jun;46(4):315-326. doi: 10.1080/16506073.2016.1250228. Epub 2016 Dec 9.

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• Gard G, Rivano M, Grahn B. Development and reliability of the Motivation for Change Questionnaire. Disabil Rehabil. 2005 Sep 2;27(17):967-76. doi: 10.1080/09638280500052682.

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• Vanheest JL, Rodgers CD, Mahoney CE, De Souza MJ. Ovarian suppression impairs sport performance in junior elite female swimmers. Med Sci Sports Exerc. 2014 Jan;46(1):156-66. doi: 10.1249/MSS.0b013e3182a32b72.

  PMID: 23846160 BACKGROUND

• Woods AL, Rice AJ, Garvican-Lewis LA, Wallett AM, Lundy B, Rogers MA, Welvaert M, Halson S, McKune A, Thompson KG. The effects of intensified training on resting metabolic rate (RMR), body composition and performance in trained cyclists. PLoS One. 2018 Feb 14;13(2):e0191644. doi: 10.1371/journal.pone.0191644. eCollection 2018.

  PMID: 29444097 BACKGROUND

• Loucks AB, Thuma JR. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. J Clin Endocrinol Metab. 2003 Jan;88(1):297-311. doi: 10.1210/jc.2002-020369.

  PMID: 12519869 BACKGROUND

Related Links

• Eating Disorder Examination, EDITION 16.0D, (Fairburn, 2008)
• The REDs Seden project Web Site

Biospecimen

Retention: SAMPLES WITH DNA

Gut microbiota composition bacterial DNA from fecal samples,whole blood, serum (only eligible elite athletes participating in physiological testing, anticipated n=44).

MeSH Terms

Conditions

Relative Energy Deficiency in Sport; Feeding and Eating Disorders

Condition Hierarchy (Ancestors)

Mental Disorders; Signs and Symptoms, Digestive; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Anna Melin, PhD

  Linnaeus University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: CROSS SECTIONAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: February 26, 2024
• First Posted: April 17, 2024
• Study Start: May 10, 2022
• Primary Completion: May 30, 2024
• Study Completion: May 30, 2024
• Last Updated: March 10, 2025

Record last verified: 2024-05

Data Sharing

• IPD Sharing: Will not share

Locations

SE (1)