Relative energy deficiency in sport and athlete nutrition — branching viva

Branching framework

Open with the definition of energy availability and the threshold. Energy availability is the dietary energy intake minus the exercise energy expenditure, divided by the fat-free mass, expressed as kilocalories per kilogram of fat-free mass per day. The reproductive hormone pulsatility is disrupted when the energy availability falls below approximately thirty kilocalories per kilogram of fat-free mass per day, as the Loucks and Thuma experiment established, and the optimal function is sustained at approximately forty-five kilocalories per kilogram of fat-free mass per day and above. State these numbers aloud, because the examiner is listening for whether you hold the threshold that anchors the whole topic. ^[5]

Branch to the two frameworks. The Female Athlete Triad is the three spectra of the energy availability, the menstrual function, and the bone mineral density, operationalised by the 2014 Coalition Cumulative Risk Assessment into the low, the moderate, and the high risk. Relative energy deficiency in sport is the wider IOC web of the affected systems — the reproductive, the bone, the cardiovascular, the immune, the metabolic, the endocrine, the gastrointestinal, the psychological, and the growth — operationalised by the RED-S Clinical Assessment Tool, and it applies to the male as much as the female. Refuse the false choice between the two frameworks, because the comparison study confirmed that they place the high-risk athlete in the same restricted-from-play category. ^[4]

Branch to the risk stratification and the single most important management principle. This runner with the bone stress injury, the four-month amenorrhoea, and the falling body mass index is the high-risk athlete by the Cumulative Risk Assessment, and she is restricted from the training and the competition. The single most important management principle is the energy restoration, because it is the only treatment that reverses the functional hypothalamic amenorrhoea and rebuilds the bone. The Endocrine Society guideline frames the energy restoration as the first-line treatment, and the combined oral contraceptive pill is not the first-line treatment for the bone, because it does not restore the bone density and it masks the menstrual signal. Name this principle aloud, because the examiner probes it directly. ^{[6] [4]}