Fueling the Female Athlete: Low Energy Availability, RED-S, and the Nutritional Roots of Pelvic Floor, Bone, and Muscular Health Across the Lifespan

Sports and exercise nutrition in female populations is increasingly recognised as a major determinant of performance, physiological function, and lifelong health. Low energy availability (LEA), in which dietary energy intake is insufficient to support exercise and normal physiological processes, may contribute to Relative Energy Deficiency in Sport (RED-S), affecting metabolic, endocrine, immune, bone, and musculoskeletal systems. Although the female athlete triad and RED-S frameworks have established associations between inadequate fuelling, menstrual dysfunction, and impaired bone health, pelvic floor function remains insufficiently integrated into these models. Pelvic floor dysfunction, including urinary incontinence, is prevalent among female athletes, yet its relationships with energy deficiency, hormonal disruption, connective-tissue health, and training load are not fully understood. Recent research has advanced knowledge of energy availability, bone stress injuries, resistance-training adaptation, sarcopenia, and life-stage-specific nutritional needs, but evidence remains fragmented, often cross-sectional, and limited by surrogate outcomes and underrepresentation of diverse female populations. An integrated, lifespan-oriented approach is needed to clarify mechanisms, improve assessment, and develop effective strategies for protecting health, function, and performance. This Research Topic aims to examine how energy availability and broader nutritional factors influence pelvic floor, bone, and muscular health in girls and women, from recreationally active individuals to elite athletes and across key life stages. It will investigate whether LEA and RED-S are associated with impairments in pelvic floor function, bone strength, muscular fitness, recovery, and physical capacity, with particular attention to clinically meaningful outcomes such as urinary incontinence and bone stress injury. The Research Topic will also consider the influence of menstrual cycling, pregnancy, postpartum recovery, perimenopause, menopause, and ageing on nutritional requirements and tissue vulnerability. Contributions may address mechanisms, risk factors, screening methods, and the effectiveness of nutrition, exercise, education, counselling, supplementation, or combined interventions. The overarching aim is to support evidence-based, sex-specific guidance for clinicians, dietitians, coaches, researchers, and active women. To gather further insights into the relationships between energy availability, nutrition, and pelvic floor, bone, and muscular health across the female lifespan, this Research Topic will consider human studies conducted in athletic, recreational, clinical, and community settings. It will prioritise research integrating nutritional exposures and tissue-level mechanisms with reliable functional, clinical, and performance outcomes. We welcome articles addressing, but not limited to, the following themes:o LEA and RED-S as potential contributors to pelvic floor dysfunction, bone stress injury, impaired muscular adaptation, and reduced physical function.o Nutritional, hormonal, connective-tissue, and mechanical pathways linking LEA or RED-S with urinary incontinence and other pelvic floor outcomes.o The roles of calcium, vitamin D, protein, total energy intake, and dietary patterns in bone health across adolescence, adulthood, perimenopause, and postmenopause.o Fuelling strategies for muscular strength, resistance-training adaptation, recovery, sarcopenia prevention, and lifelong functional capacity.o Menstrual cycling, pregnancy, postpartum recovery, perimenopause, menopause, and ageing as modifiers of nutritional needs and tissue vulnerability.o Screening and assessment of LEA and RED-S using dietary, physiological, endocrine, imaging, and performance-related measures.o Valid and reliable methods for evaluating pelvic floor function, bone health, muscular fitness, and clinically meaningful outcomes in female cohorts.o Nutrition education, counselling, supplementation, and integrated nutrition–exercise interventions in athletic and community settings.o Equity, cultural context, affordability, and access to fuelling and healthcare resources among under-represented or under-resourced populations.o Longitudinal, mechanistic, interventional, and implementation research supporting a unified lifespan model of female health and performance. Topic editors: Tamara Rial Rebullido, Silvia Sole Source: https://www.frontiersin.org/research-topics/84009/fueling-the-female-athlete-low-energy-availability-red-s-and-the-nutritional-roots-of-pelvic-floor-bone-and-muscular-health-across-the-lifespan