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Relative polycythemia — Clinical Guidelines

Overview

Relative Energy Deficiency in Sport (RED-S) refers to impaired physiological function resulting from inadequate energy availability relative to the body's needs for health and performance, affecting both male and female athletes 4.

Diagnosis

Key Diagnostic Criteria:

- Low energy availability (EA) due to inadequate caloric intake relative to energy expenditure 3. - Presence of at least one RED-S-related consequence such as bone stress injury, amenorrhea, or performance impairments 2.

Recommended Tests:

- Assessment of dietary intake and energy expenditure 2. - Monitoring of menstrual function, bone health markers, and performance metrics 2 4.

Grading:

- No specific grading system mentioned in the abstracts 2 4.

Management

First-Line Treatments:

- Increase energy availability through dietary modifications to ensure adequate caloric intake 2 4. - Reduce excessive exercise volume if contributing to energy deficiency 2 4.

Adjunctive Treatments:

- Individualized nutrition counseling and structured educational programs (e.g., FUEL program) 1. - Specific medical interventions (e.g., hormonal support) may be considered based on individual deficits 2 4.

Special Populations

Pregnancy: Not specifically addressed in the provided abstracts 1 2 3 4.

Pediatrics: Not specifically addressed in the provided abstracts 1 2 3 4.

Elderly: Not specifically addressed in the provided abstracts 1 2 3 4.

Comorbidities: Management should consider overlapping conditions, though specific guidance is lacking 2 4.

Key Recommendations

Prioritize Increasing Energy Availability: Focus on enhancing dietary intake or reducing energy expenditure to restore balance between intake and expenditure (Evidence: Strong 2 4).

Implement Structured Educational Programs: Utilize evidence-based educational interventions like the FUEL program to improve nutritional knowledge and behavior (Evidence: Moderate 1).

Early Detection and Intervention: Screen athletes at risk for RED-S to prevent long-term health consequences, despite limited validated screening tools (Evidence: Expert opinion 2).

References

1 Fahrenholtz IL, Melin AK, Garthe I, Hollekim-Strand SM, Ivarsson A, Koehler K et al.. Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs). Nutrients 2023. link 2 Johnston K. Sports Medicine: Relative Energy Deficiency in Sport. FP essentials 2022. link 3 Areta JL, Taylor HL, Koehler K. Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. European journal of applied physiology 2021. link 4 Mountjoy M, Sundgot-Borgen J, Burke L, Carter S, Constantini N, Lebrun C et al.. The IOC consensus statement: beyond the Female Athlete Triad--Relative Energy Deficiency in Sport (RED-S). British journal of sports medicine 2014. link 5 Simon SD. Understanding the odds ratio and the relative risk. Journal of andrology 2001. link

Relative polycythemia