Author(s): YUNCAI, F., XIAOTONG, L., Institution: BEIJING RESEARCH INSTITUTE OF SPORTS SCIENCE, Country: CHINA, Abstract-ID: 612

INTRODUCTION:
Artistic swimming requires stringent physique control and high training loads, increasing susceptibility to low energy availability (LEA) and relative energy deficiency in sport (RED-S). LEA/RED-S is associated with menstrual dysfunction, gastrointestinal disturbances, higher injury risk, and impaired performance. Data on LEA/RED-S screening in elite Asian aesthetic athletes remain limited. This cross-sectional study aimed to: (i) estimate potential LEA risk in elite female artistic swimmers using the LEAF-Q; (ii) compare outcomes by competitive level; (iii) examine associations between body-weight fluctuation and LEA risk.
METHODS:
29 elite female artistic swimmers (mean age: 19.9±4.1 years; mean training experience: 12.3±4.6 years) were enrolled, comprising 19 national-level and 10 first-class athletes. The primary tool was the validated LEAF-Q, which assesses injury history, gastrointestinal function, and menstrual function over the preceding month.A total score≥8 defined a screen-positive result for LEA risk, with subscale thresholds of >2 for injury, >2 for gastrointestinal, and >4 for menstrual dysfunction. Additionally, a battery of supplementary questionnaires was administered to capture associated behaviors and states, including detailed dietary restriction practices, body image dissatisfaction using a standardized scale, and emotional status screened via a validated depression inventory. Data were analyzed using descriptive statistics, independent samples t-tests for group comparisons, and Pearson correlation analysis (significance set at p<0.05).The study was conducted in accordance with the latest revision of the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Sport University (No.2025027H).
RESULTS:
 The mean LEAF-Q total score was 7.4±3.7. The overall prevalence of screen-positive LEA risk was 34.5% (9/29). Menstrual dysfunction (subscale score >4) was the most prevalent indicator (33.3%). National-level athletes demonstrated significantly greater weight fluctuation and higher LEAF-Q total scores compared to first-class athletes (p<0.05). Weight fluctuation was positively correlated with LEAF-Q total score (r=0.42, p<0.05). Supplementary data revealed that 45% of athletes engaged in frequent dietary restriction, 35% reported body image dissatisfaction, and 25% showed mild-to-moderate depressive tendencies.
CONCLUSION:
This study indicates a high prevalence (34.5%) of potential LEA/RED-S risk among elite female artistic swimmers in China, with menstrual dysfunction being predominant. Significant associations were identified with weight fluctuation, restrictive dietary behaviors, and psychological factors. Routine screening with the LEAF-Q, combined with integrated assessment of nutritional and psychological status, is essential for implementing targeted interventions to protect athlete health and optimize performance.