{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T05:10:03Z","timestamp":1794546603616,"version":"4.9.1"},"reference-count":49,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/501100004489","name":"Mitacs","doi-asserted-by":"publisher","award":["FR51666, FR51667, FR51668"],"award-info":[{"award-number":["FR51666, FR51667, FR51668"]}],"id":[{"id":"10.13039\/501100004489","id-type":"DOI","asserted-by":"publisher"}]},{"name":"94Forward","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Own the Podium","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Wu Tsai Human Performance Alliance","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"B2ten","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2024,8,7]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This cross-sectional retrospective and prospective study implemented the 2023 International Olympic Committee Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) to determine the current severity of REDs (primary outcome) and future risk of bone stress injuries (BSI, exploratory outcome) in elite athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Female (n=143; 23.3\u00b14.3 years) and male (n=70; 23.1\u00b13.7 years) athletes (performance tier 3 (52%), tier 4 (36%), tier 5 (12%)) participated in a baseline CAT2 (with minor modifications) assessment, including a self-report questionnaire (menstrual function (females), BSI, Eating Disorder Examination Questionnaire (EDE-Q)), bone mineral density (BMD via DXA) and fasted blood analysis (triiodothyronine (T3), testosterone, cholesterol). Athletes were assigned a green, yellow, orange or red light via CAT2. The prospective risk of new self-report of physician-diagnosed BSI was assessed over a subsequent 6\u201324\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>REDs prevalence was 55% green, 36% yellow, 5% orange and 4% red light. The CAT2 identified a greater prevalence of amenorrhoea and BSI and lower T3, testosterone and BMD (p&lt;0.01) in red, orange and yellow (those with REDs) versus green light. ORs for a prospective self-reported BSI (majority physician diagnosed) were greater in orange vs green (OR 7.71, 95% CI (1.26 to 39.83)), in females with severe amenorrhoea (OR 4.6 (95% CI 0.98 to 17.85)), in males with low sex drive (OR 16.0 (95% CI 4.79 to 1038.87)), and athletes with elevated EDE-Q global scores (OR 1.45 (95% CI 0.97 to 1.97)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The CAT2 has high validity in demonstrating current severity of REDs, with increased future risk of self-reported BSI in athletes with a more severe REDs traffic light category.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjsports-2024-108121","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T13:21:10Z","timestamp":1724160070000},"page":"24-35","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Application of the IOC Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) across 200+ elite athletes"],"prefix":"10.1136","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1088-428X","authenticated-orcid":false,"given":"Ida A","family":"Heikura","sequence":"first","affiliation":[{"name":"Canadian Sport Institute Pacific, Victoria, British Columbia, Canada"},{"name":"Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter T P","family":"McCluskey","sequence":"additional","affiliation":[{"name":"Canadian Sport Institute Pacific, Victoria, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Chang","family":"Tsai","sequence":"additional","affiliation":[{"name":"Canadian Sport Institute Pacific, Victoria, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liz","family":"Johnson","sequence":"additional","affiliation":[{"name":"Canadian Sport Institute Pacific, Victoria, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Murray","sequence":"additional","affiliation":[{"name":"Canadian Sport Institute Pacific, Victoria, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8604-2014","authenticated-orcid":false,"given":"Margo","family":"Mountjoy","sequence":"additional","affiliation":[{"name":"Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2626-7785","authenticated-orcid":false,"given":"Kathryn E","family":"Ackerman","sequence":"additional","affiliation":[{"name":"Wu Tsai Female Athlete Program, Boston Children\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Fliss","sequence":"additional","affiliation":[{"name":"Ageing, Nutrition, Exercise, and Muscle Metabolism Lab, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4704-8250","authenticated-orcid":false,"given":"Trent","family":"Stellingwerff","sequence":"additional","affiliation":[{"name":"Canadian Sport Institute Pacific, Victoria, British Columbia, Canada"},{"name":"Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"key":"2025080115045029000_59.1.24.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-5919(20)30338-0"},{"key":"2025080115045029000_59.1.24.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198408023110501"},{"key":"2025080115045029000_59.1.24.3","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2014-093502"},{"key":"2025080115045029000_59.1.24.4","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-099193"},{"key":"2025080115045029000_59.1.24.5","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106994"},{"key":"2025080115045029000_59.1.24.6","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqac044"},{"key":"2025080115045029000_59.1.24.7","doi-asserted-by":"publisher","DOI":"10.3390\/nu6083018"},{"key":"2025080115045029000_59.1.24.8","doi-asserted-by":"publisher","DOI":"10.1007\/BF01623770"},{"key":"2025080115045029000_59.1.24.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1986.03380030082032"},{"key":"2025080115045029000_59.1.24.10","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106932"},{"key":"2025080115045029000_59.1.24.11","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106914"},{"key":"2025080115045029000_59.1.24.12","doi-asserted-by":"crossref","DOI":"10.1136\/bjsports-2015-094873","article-title":"The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT)","volume":"49","author":"Mountjoy","year":"2015","journal-title":"Br J Sports Med"},{"key":"2025080115045029000_59.1.24.13","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106914"},{"key":"2025080115045029000_59.1.24.14","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01435-8"},{"key":"2025080115045029000_59.1.24.15","unstructured":"International Society for Clinical Densitometry . 2023. Available: https:\/\/iscd.org\/official-positions-2023"},{"key":"2025080115045029000_59.1.24.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-106994"},{"key":"2025080115045029000_59.1.24.17","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.2017-0313"},{"key":"2025080115045029000_59.1.24.18","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.2020-0368"},{"key":"2025080115045029000_59.1.24.19","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001711"},{"key":"2025080115045029000_59.1.24.20","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515572142"},{"key":"2025080115045029000_59.1.24.21","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096698"},{"key":"2025080115045029000_59.1.24.22","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1002\/pmrj.12821","article-title":"Low energy availability surrogates associated with lower bone mineral density and bone stress injury site","volume":"14","author":"Holtzman","year":"2022","journal-title":"PM R"},{"key":"2025080115045029000_59.1.24.23","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000000574"},{"key":"2025080115045029000_59.1.24.24","doi-asserted-by":"publisher","DOI":"10.1210\/jc.86.11.5184"},{"key":"2025080115045029000_59.1.24.25","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-016-3887-x"},{"key":"2025080115045029000_59.1.24.26","first-page":"50","article-title":"Decreased bone mineral density and reproductive axis dysfunction: more than oestrogen","volume":"78","author":"DeLoughery","year":"2020","journal-title":"Neth J Med"},{"key":"2025080115045029000_59.1.24.27","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0000000000000077"},{"key":"2025080115045029000_59.1.24.28","doi-asserted-by":"publisher","DOI":"10.1177\/0363546516676262"},{"key":"2025080115045029000_59.1.24.29","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.2021-0323"},{"key":"2025080115045029000_59.1.24.30","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000948"},{"key":"2025080115045029000_59.1.24.31","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-023-01871-8"},{"key":"2025080115045029000_59.1.24.32","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098958"},{"key":"2025080115045029000_59.1.24.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2023.04.003"},{"key":"2025080115045029000_59.1.24.34","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23051"},{"key":"2025080115045029000_59.1.24.35","doi-asserted-by":"crossref","DOI":"10.3390\/nu15051082","article-title":"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)","volume":"15","author":"Fahrenholtz","year":"2023","journal-title":"Nutrients"},{"key":"2025080115045029000_59.1.24.36","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2023-001545","article-title":"Healthy Runner Project: a 7-year, multisite nutrition education intervention to reduce bone stress injury incidence in collegiate distance runners","volume":"9","author":"Fredericson","year":"2023","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025080115045029000_59.1.24.37","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106328"},{"key":"2025080115045029000_59.1.24.38","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520971782"},{"key":"2025080115045029000_59.1.24.39","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000001180"},{"key":"2025080115045029000_59.1.24.40","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-107359"},{"key":"2025080115045029000_59.1.24.41","doi-asserted-by":"publisher","DOI":"10.1123\/ijspp.2021-0451"},{"key":"2025080115045029000_59.1.24.42","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101517"},{"key":"2025080115045029000_59.1.24.43","doi-asserted-by":"crossref","DOI":"10.3389\/fspor.2022.869594","article-title":"Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes","volume":"4","author":"Fahrenholtz","year":"2022","journal-title":"Front Sports Act Living"},{"key":"2025080115045029000_59.1.24.44","doi-asserted-by":"crossref","DOI":"10.1186\/s40337-021-00396-7","article-title":"Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes","volume":"9","author":"Sim","year":"2021","journal-title":"J Eat Disord"},{"key":"2025080115045029000_59.1.24.45","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2018-000439","article-title":"Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes","volume":"5","author":"Torstveit","year":"2019","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025080115045029000_59.1.24.46","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.154.6.807"},{"key":"2025080115045029000_59.1.24.47","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101813"},{"key":"2025080115045029000_59.1.24.48","doi-asserted-by":"publisher","DOI":"10.1123\/ijsnem.10.2.128"},{"key":"2025080115045029000_59.1.24.49","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093240"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2024-108121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T22:05:01Z","timestamp":1754085901000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2024-108121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,20]]},"references-count":49,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12,23]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bjsports-2024-108121"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2024-108121","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,20]]}}}