The IOC consensus statement: To cite: Mountjoy M, Sundgot-Borgen J, Burke L, et al. Br J Sports Med 2014;48:491–497. Margo Mountjoy,1 Jorunn Sundgot-Borgen,2 Kathrin Steffen,2,9 Richard Budgett,9 Louise Burke,3 Arne Ljungqvist9 Abstract Protecting the health of the athlete is a goal of the International Olympic Committee (IOC). The IOC convened an expert panel to update the 2005 IOC Consensus Statement on the Female Athlete Triad. This Consensus Statement replaces the previous and provides guidelines to guide risk assessment, treatment and return-to-play decisions. The IOC expert working group introduces a broader, more comprehensive term for the condition previously known as ‘Female Athlete Triad’. The term ‘Relative Energy Deficiency in Sport’ (RED-S), points to the complexity involved and the fact that male athletes are also affected. The syndrome of RED-S refers to impaired physiological function including, but not limited to, metabolic rate, menstrual function, bone health, immunity, protein synthesis, cardiovascular health caused by relative energy deficiency. The cause of this syndrome is energy deficiency relative to the balance between dietary energy intake and energy expenditure required for health and activities of daily living, growth and sporting activities. Psychological consequences can either precede RED-S or be the result of RED-S. The clinical phenomenon is not a ‘triad’ of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, health and athletic performance. This Consensus Statement also recommends practical clinical models for the management of affected athletes. The ‘Sport Risk Assessment and Return to Play Model’ categorises the syndrome into three groups and translates these classifications into clinical recommendations. Introduction Protecting the health of the athlete is one of the goals of the International Olympic Committee (IOC).1 The Olympic Movement Medical Code, which governs the actions of the IOC Medical Commission and sport organisations, also emphasises the importance of protecting the health of the athlete.2 In 2005, the IOC published the Consensus Statement (Consensus Statement) and the IOC Position Stand (Position Stand)3 on the Female Athlete Triad.4 Based on scientific evidence published in the intervening period, this Consensus Statement serves to update and replace these documents and provide guidelines to the athlete health support team to guide risk assessment, treatment and return-to-play decisions for affected athletes. Relative energy deficiency in sport In the 2005 IOC Consensus Statement,4 the Female Athlete Triad (Triad) was defined as ‘the combination of disordered eating (DE) and irregular menstrual cycles eventually leading to a decrease in endogenous oestrogen and other hormones, resulting in low bone mineral density’(BMD) based on the original scientific evidence of Drinkwater et al.5 In 2007, following progress in scientific understanding, the American College of Sports Medicine redefined the Triad as a clinical entity that refers to the ‘relationship between three interrelated components: energy availability (EA), menstrual function and bone health’. Added was an understanding of the pathophysiology describing the concept that over a period of time, the athlete moves along on a continuous spectrum ranging from the healthy athlete with optimal EA, regular menses and healthy bones to the opposite end of the spectrum characterised by amenorrhoea, low EA and osteoporosis.6 Since 2007, scientific evidence and clinical experience show that the aetiological factor underpinning the Triad is an energy deficiency relative to the balance between dietary nummer 4 | september 2014 | Sport & Geneeskunde 15 Susan Carter,4 Naama Constantini,5 Constance Lebrun,6 Nanna Meyer,7 beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S) Roberta Sherman,8 Pagina 14
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Sport & Geneeskunde nummer 4 | november 2014 Lees publicatie 43Home