Sport-specific prevalence of relative energy deficiency in sport (REDs) risk among Finnish female national- and international-level athletes

OBJECTIVES: To determine the prevalence and sport-specific patterns of Relative Energy Deficiency in Sport risk among Finnish national- and international-level female athletes and active non-athletes. DESIGN: Cross-sectional comparison of baseline female data from the Athletic Performance and Nutrition cohort, including endurance athletes (number = 50), speed and power athletes (number = 50), team and interval sport athletes (number = 37), and active non-athletes (number = 20). METHODS: Relative Energy Deficiency in Sport risk was assessed using the four-level Relative Energy Deficiency in Sport Clinical Assessment Tool Version 2 framework. Clinical, hormonal, metabolic, and bone-related indicators were examined descriptively. Group differences were tested using analysis of variance, Kruskal-Wallis, and chi-square tests, and odds of risk were estimated using logistic regression. RESULTS: Overall, 70% of participants were at risk of Relative Energy Deficiency in Sport. Prevalence was 82% among endurance athletes and 65% among non-endurance athletes; endurance athletes had 2.4-fold higher odds of risk. Severe risk occurred in 17.9% of endurance athletes, while no non-athletes were classified in the most severe category. Endurance athletes showed the least favorable indicator profile: 30% reported amenorrhea, 48.9% had low triiodothyronine, and 44% had a low resting metabolic rate ratio. Bone stress injury was reported by 47.6% of endurance athletes and 50% of speed and power athletes, compared with less than 20% in other groups. CONCLUSIONS: Relative Energy Deficiency in Sport risk was highly prevalent across Finnish Tier 3-4 female athletes, especially in endurance, speed, and power sports.