Author(s): FENUTA, A., BUCHANAN C, COTE AT, Institution: TRINITY WESTERN UNIVERSITY , Country: CANADA, Abstract-ID: 1877

INTRODUCTION:
Relative energy deficiency in sport (RED-S), resulting from chronic low energy availability, is associated with negative health outcomes (e.g. menstrual and immune dysfunction, compromised bone health, etc) and reduced performance. More common in female athletes, most research has focused on individual and endurance sports. We explored the association of female athlete health knowledge and the prevalence of RED-S in Canadian university team sport athletes.
METHODS:
University team sport female athletes (N=97; 19.8±1.7 years; BC, Canada) completed an online survey during pre-season (Aug-Sept 2025) assessing confidence (0=not at all to 100=completely confident) and knowledge responding to female athlete health questions and RED-S risk (LEAF-Q screening tool). LEAF-Q focuses on symptoms linked to low energy availability affecting physiological function across three domains (injuries, gastrointestinal function, and menstrual function). Scores were summed across all sections (0-25) with ≥8 vs. <8 identifying athletes at risk vs. not at risk for RED-S. Data is mean±SD.
RESULTS:
On average, athletes were not confident (32.7±24.6/100; range=0-90) answering the health questions with an average knowledge score of 42.3% [14.4±6.3/34 (range=1-31)]. Most athletes had heard of RED-S prior to study participation (72.2%; first-year: 86.7%>returning: 65.2%, p=0.030) and 55.8% identified low energy availability as the primary cause of RED-S. 67% of female athletes (80% first-year vs. 62.1% returning) were at risk for RED-S (LEAF-Q scores: means: overall=9.3±3.8, not at risk=5.2±1.5 vs. at risk=11.3±2.8; overall range=2-18). There was no significant difference in LEAF-Q scores between hormonal (36%) vs. non-hormonal (64%) contraceptive users (10.1±4.2 vs. 8.9±3.5, p=0.163) or between first-year and returning athletes (10.0±2.6 vs. 9.0±4.2, p=0.194). There were no significant differences in confidence (28.0%±23.0% vs. 34.2%±24.8%, p=0.250) or knowledge (13.4±6.2 vs. 15.0±6.4, p=0.256) scores between first-year and returning athletes. While there was a positive correlation between confidence and knowledge (r=0.55, p<0.001), there was no significant correlation between confidence or knowledge and LEAF-Q scores (all p>0.05).
CONCLUSION:
A significant proportion of intermittent or skill-based team sport athletes may be at risk for RED-S requiring further clinical evaluation. Additional education is warranted given the low confidence and knowledge scores related to female athlete health reported by these athletes. Multi-domain standardized screening procedures should be considered to facilitate detection of RED-S particularly a) for hormonal contraceptive users given LEAF-Q may underestimate risk and b) given the lack of association between knowledge and LEAF-Q scores. Pre-season provides an opportunity for early intervention and education prior to the added demands of academics and the competitive season for university athletes.