Screening for Relative Energy Deficiency in Sport: Detection of Clinical Indicators in Female Endurance Athletes

The purpose was to evaluate the individual and combined use of the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) to detect clinical indicators associated with Relative Energy Deficiency in Sport (REDs).

In this cross-sectional study, 50 female endurance athletes training ≥4× a week completed the LEAF-Q and BEDA-Q and were assessed for presence of selected REDs indicators. Athletes meeting the criteria for mild or more severe REDs severity/risk according to the International Olympic Committee REDs Clinical Assessment Tool Version 2 (IOC REDs CAT2) were classified as REDs cases. Diagnostic properties of the German versions of the LEAF-Q and BEDA-Q were assessed at different cutoffs using receiver operating characteristics calculations.

Fourteen (28%) athletes were classified as REDs cases. The LEAF-Q had a sensitivity of 79% and a specificity of 50%, with a positive predictive value (PPV) of 38% and negative predictive value (NPV) of 86%. For detection of disordered eating behavior/eating disorder, the BEDA-Q showed a sensitivity and specificity of 71% and 76%, respectively, with a PPV of 68% and an NPV of 79%. Out of 14 REDs cases, 9 (64%) scored positive in the LEAF-Q and BEDA-Q. Two athletes (14%) scored positive only in the LEAF-Q, and one athlete scored positive only in the BEDA-Q. Two REDs cases remained undetected by both questionnaires.

Among German female endurance athletes, the LEAF-Q and BEDA-Q are good screening tools to detect REDs cases with mild or more severe severity/risk as classified according to the IOC REDs CAT2. Further clinical assessments should be initiated when athletes score positive in at least one of the questionnaires.