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Prevalence of Triad–RED–S symptoms in high-level Kenyan male and female distance runners and corresponding control groups

A Correction to this article was published on 24 October 2021

This article has been updated

Abstract

Purpose

This study examined and compared select Triad–RED–S components/risk factors in high-level Kenyan male and female distance runners to corresponding control groups; focusing on examining energy intake (EI), bone indices, and hormonal markers.

Methods

A cross-sectional, observational design was used in which Kenyan male and female (n = 30 and n = 26, respectively) middle- and long-distance runners and corresponding male and female control groups (n = 29 and n = 29, respectively) were examined.

The participant’s bone mineral density (BMD) at the lumbar spine, right femur, and total body were measured using a dual-energy X-ray absorptiometry analysis. Complete blood counts (CBC) were done on the whole blood specimens and hormonal measurements were performed on plasma specimens. In addition, athletes completed metabolic testing to determine maximal oxygen uptakes and 7-day dietary diaries.

Results

Overall daily EI across runners and controls within each sex were low, but not significantly different (p > 0.05). Prevalence of low BMD values (Z score < − 2.0) was comparable across groups in each sex (p > 0.05). CBC measures suggested that both runners and controls were healthy. Finally, slight hormonal differences between runners and their respective controls existed (p < 0.05), but were not clinically meaningful or observed in typical Triad–RED–S-related parameters.

Conclusion

High-level Kenyan male and female runners had low daily EI, but no tendency toward a higher prevalence of low BMD, or Triad–RED–S–related hormonal abnormalities. The occurrence of low EI was not a major risk factor in our athletes; this calls into question whether the current criteria for Triad–RED–S are entirely applicable for athletes of African ethnicity.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Code availability

Not applicable.

Change history

Abbreviations

BMD:

Bone mineral density

BMI:

Body mass index

CBC:

Complete blood count

Cort:

Cortisol

DXA:

Dual-energy X-ray absorptiometry

E2 :

Estradiol

EA:

Energy availability

EI:

Energy Intake

FSH:

Follicle-stimulating hormone

GH:

Growth hormone

HCT:

Hematocrit

HGB:

Hemoglobin

IAAF:

International Association of Athletics Federations (world athletics since October 2019)

IGF-1:

Insulin like growth factor-1

Ins:

Insulin

IOC:

International Olympic Committee

LBM:

Lean body mass

LEA:

Low energy availability

LH:

Luteinizing hormone

LS-BMD:

Lumbar spine bone mineral density

Prol:

Prolactin

RBC:

Red blood cells

RED-S:

Relative energy deficiency in sport

RF-BMD:

Right femur bone mineral density

T3 :

Triiodothyronine

T4 :

Thyroxine

TB-BMD:

Total body bone mineral density.

Testo:

Testosterone

Triad:

Female athlete triad

TSH:

Thyroid-stimulating hormone

VO2 :

Oxygen consumption

VO2max :

Maximal oxygen consumption

WBC:

White blood cells

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Funding

This study was funded by International Association of Athletics Federations.

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Authors

Contributions

MM and ACH conceived and designed research. MM, SS, DWH, RO, ACH and ARL conducted experiments. ACH and LÕ analyzed data and wrote the manuscript. All authors read and approved the manuscript.

Corresponding author

Correspondence to Lauri Õnnik.

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Authors’ have no conflict of interests to declare.

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Communicated by Kirsty Elliott-Sale.

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Õnnik, L., Mooses, M., Suvi, S. et al. Prevalence of Triad–RED–S symptoms in high-level Kenyan male and female distance runners and corresponding control groups. Eur J Appl Physiol (2021). https://doi.org/10.1007/s00421-021-04827-w

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Keywords

  • East Africa
  • Elite athletes
  • Energy intake
  • Bone mineral density
  • Hormones