Exploring different interventions for Relative Energy Deficiency in Sport (REDs): A systematic review.

Objectives and design: Relative Energy Deficiency in Sport (REDs) is caused by an imbalance in energy intake and expenditure through exercise, which leads to low energy availability. Although awareness of REDs is improving, a synthesis into the available literature to determine the efficacy of different interventions in athletes with REDs is needed. Subsequently, this may inform clinicians and athletes of the most appropriate interventions. Methods: Medline, Embase and Web of Science databases were searched using keywords and their combinations. Two independent reviewers screened the retrieved studies by title, abstract and full text. The Joanna Briggs Institute critical appraisal tool was used to assess risk of bias. Data were extracted into an excel spreadsheet and a narrative synthesis performed. Results: The search retrieved 982 papers, and after screening, 11 were eligible for inclusion, including increase in energy intake (n ​= ​3), increase in energy intake and decrease in energy expenditure (n ​= ​1), dietary approaches (n ​= ​1), education and counselling (n ​= ​5) and hormonal intervention (n ​= ​1). Increasing energy intake enabled return of menses, yet did not significantly increase bone mineral density. Dietary approaches significantly improved body image, tension, vigour and depression. Nutrition education improved bone health, energy availability, and eating behaviours in athletes, while hormonal interventions had limited effects on bone mineral density. Conclusion: Increasing energy intake is essential in the management of REDs and may be more effective when used alongside education and hormonal treatment. Future research is needed to allow better analysis of the efficacy of interventions due to the limited research available.