{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:24:08Z","timestamp":1786998248310,"version":"build-2736575974"},"reference-count":17,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>Long-distance \u201cthru-hiking\u201d has extraordinary physical demands and has become increasingly popular. This report describes a man (55 y) who thru-hiked the Pacific Crest Trail in 2021 and was at risk of developing the relative energy deficiency in sport (RED-S) syndrome. Hiking distance was 3767 km over 128 d. Eighty-eight days (69%) were full days of hiking, covering 38\u00b18 km\/d (mean\u00b1SD) in 7.9\u00b11.6 h\/d. Exercise energy expenditure above rest (heart rate vs indirect calorimetry regression method) was 2834\u00b11518 kcal\/d, total energy expenditure was 5702\u00b11323 kcal\/d, and energy intake was 4141 kcal\/d. Body mass decreased by 9%, and fat mass (dual-energy X-ray absorptiometry) decreased by 46%. Energy availability (energy intake minus exercise energy expenditure) was 19.3 kcal\/d\/kg fat-free mass, indicating low energy availability (defined as &lt;30 kcal\/d\/kg). Dual-energy X-ray absorptiometry\u2013measured spine bone mineral density (BMD) decreased by 8.6%, with little to no decrease in total hip (\u22121.0%) and femoral neck (\u22121.5%) BMD. Total cholesterol, low-density lipoprotein cholesterol, and triglycerides increased by 24, 39, and 57%, respectively. Within 8 mo after the hike, BMD and serum lipids nearly or fully returned to baseline. No changes in high-density lipoprotein cholesterol, glycemia, or blood pressure were observed. According to guidelines, these observations are consistent with a moderate risk of RED-S, and a medical evaluation and treatment plan are advisable in order to avoid clinical manifestations (eg, stress fractures, anemia, psychological disturbances). To minimize RED-S risk, it may be prudent for thru-hikers to optimize energy availability by moderating daily hiking distances and\/or increasing food intake.<\/jats:p>","DOI":"10.1016\/j.wem.2023.06.011","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T07:59:51Z","timestamp":1691999991000},"page":"536-542","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Low Energy Availability and Increased Risk of Relative Energy Deficiency in Sport (RED-S) During a 3767-km Thru-Hike on the Pacific Crest Trail: A Case Study"],"prefix":"10.1177","volume":"34","author":[{"given":"Edward P.","family":"Weiss","sequence":"first","affiliation":[{"name":"Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail M.","family":"Frech","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria R.","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"bibr1-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099193"},{"key":"bibr2-j.wem.2023.06.011","unstructured":"Pacific Crest Trail Association. 2600 miler list. https:\/\/www.pcta.org\/discover-the-trail\/thru-hiking-long-distance-hiking\/2600-miler-list\/. Accessed July 3, 2023."},{"key":"bibr3-j.wem.2023.06.011","unstructured":"Appalachian Trail Conservancy. 2000-Milers. https:\/\/appalachiantrail.org\/explore\/hike-the-a-t\/thru-hiking\/2000-milers\/. Accessed July 3, 2023."},{"key":"bibr4-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1038492"},{"key":"bibr5-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e31821ece12"},{"key":"bibr6-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2015.04.003"},{"key":"bibr7-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/33.11.2372"},{"key":"bibr8-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0803720"},{"key":"bibr9-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200939060-00002"},{"key":"bibr10-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01607-6"},{"key":"bibr11-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094873"},{"key":"bibr12-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.14767"},{"key":"bibr13-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1007\/s42000-020-00214-w"},{"key":"bibr14-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13973"},{"key":"bibr15-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.3390\/foods10102273"},{"key":"bibr16-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-200107000-00024"},{"key":"bibr17-j.wem.2023.06.011","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2015.12.006"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603223001175?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1080603223001175?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2023.06.011","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1016\/j.wem.2023.06.011","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1016\/j.wem.2023.06.011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T12:20:55Z","timestamp":1741609255000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1016\/j.wem.2023.06.011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1016\/j.wem.2023.06.011"],"URL":"https:\/\/doi.org\/10.1016\/j.wem.2023.06.011","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"value":"1080-6032","type":"print"},{"value":"1545-1534","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}