Sport-specific prevalence of Relative Energy Deficiency in Sport (REDs) risk among Finnish female national- and international-level athletes

M Wynne-Ellis; A Kuljukka; R S Mikkonen; A C Hackney; I Heikura; J Hulmi; M Valtonen; J K Ihalainen

doi:10.1016/j.jsams.2026.05.003

Sport-specific prevalence of Relative Energy Deficiency in Sport (REDs) risk among Finnish female national- and international-level athletes

J Sci Med Sport. 2026 May 8:S1440-2440(26)00190-8. doi: 10.1016/j.jsams.2026.05.003. Online ahead of print.

Authors

M Wynne-Ellis¹, A Kuljukka², R S Mikkonen², A C Hackney³, I Heikura⁴, J Hulmi², M Valtonen⁵, J K Ihalainen⁶

Affiliations

¹ University of Jyväskylä, Department of Sport Sciences, Finland. Electronic address: miikaw@uef.fi.
² University of Jyväskylä, Department of Sport Sciences, Finland.
³ University of North Carolina, Department of Exercise & Sport Science - Department of Nutrition, USA.
⁴ Canadian Sport Institute-Pacific, Canada; Exercise Science, Physical & Health Education, University of Victoria, Canada.
⁵ Finnish Institute of High-Performance Sport KIHU, Finland.
⁶ University of Jyväskylä, Department of Sport Sciences, Finland; Finnish Institute of High-Performance Sport KIHU, Finland.

PMID: 42177112
DOI: 10.1016/j.jsams.2026.05.003

Abstract

Objectives: To determine the prevalence and sport-specific patterns of Relative Energy Deficiency in Sport risk among Finnish national- and international-level female athletes and active non-athletes.

Design: Cross-sectional comparison of baseline female data from the Athletic Performance and Nutrition cohort, including endurance athletes (number = 50), speed and power athletes (number = 50), team and interval sport athletes (number = 37), and active non-athletes (number = 20).

Methods: Relative Energy Deficiency in Sport risk was assessed using the four-level Relative Energy Deficiency in Sport Clinical Assessment Tool Version 2 framework. Clinical, hormonal, metabolic, and bone-related indicators were examined descriptively. Group differences were tested using analysis of variance, Kruskal-Wallis, and chi-square tests, and odds of risk were estimated using logistic regression.

Results: Overall, 70% of participants were at risk of Relative Energy Deficiency in Sport. Prevalence was 82% among endurance athletes and 65% among non-endurance athletes; endurance athletes had 2.4-fold higher odds of risk. Severe risk occurred in 17.9% of endurance athletes, while no non-athletes were classified in the most severe category. Endurance athletes showed the least favorable indicator profile: 30% reported amenorrhea, 48.9% had low triiodothyronine, and 44% had a low resting metabolic rate ratio. Bone stress injury was reported by 47.6% of endurance athletes and 50% of speed and power athletes, compared with less than 20% in other groups.

Conclusions: Relative Energy Deficiency in Sport risk was highly prevalent across Finnish Tier 3-4 female athletes, especially in endurance, speed, and power sports.

Keywords: Amenorrhea; Athletic injuries; Bone density; Hormones; Low energy availability.