Author(s): WASSERFURTH, P., HALIOUA, R., LAUTZ, Z., TOEPFFER, D., ENGEL, H., CLAUSSEN, M., KOEHLER, K., Institution: TECHNICAL UNIVERSITY OF MUNICH , Country: GERMANY, Abstract-ID: 1345

INTRODUCTION:
Secondary prevention of Relative Energy Deficiency in Sport (REDs) requires the (successful) identification of athletes with problematic low energy availability (LEA). The newly established International Olympic Committee REDs Clinical Assessment Tool-Version 2 (IOC REDs CAT2) enables stratification of athletes into severity/risk categories based on clinical markers associated with LEA. The Low Energy Availability in Females Questionnaire (LEAF-Q) is a commonly used screening tool for LEA in female endurance athletes, but the agreement between the LEAF-Q and the IOC REDs CAT2 is currently unknown. Therefore, we aimed to evaluate whether female endurance athletes who score positive in the LEAF-Q also show clinical indicators of REDs.
METHODS:
In this cross-sectional study, 50 female endurance athletes (28±5 years, BMI: 21.2±1.9 kg/m2, 21.5±5.1% body fat) who trained ≥ 4x/week completed the LEAF-Q and were assessed for the presence of primary, secondary and potential REDs indicators. As a part of this, participants completed a clinical interview to evaluate disordered eating (DE) and eating disorders (ED). Athletes who met at least two of the following criteria were categorized as REDs case: amenorrhea or oligomenorrhea, presence of DE or ED, low free triiodothyronine (fT3). Athletes with none or only one indicator served as controls. Diagnostic properties of the LEAF-Q were assessed using receiver operating characteristics calculations.
RESULTS:
In total, 14 athletes (28%) were classified as REDs cases. REDs cases showed a higher prevalence of amenorrhea (64.3% vs. 5.6%, p<0.001), DE/EDs (78.6% vs. 27.7%, p=0.002) and low fT3 (50.0% vs. 2.8%, p<0.001). To detect “mild” or more severe REDs risk, the LEAF-Q had a sensitivity of 78.6% and specificity was 50.0%, with a positive predictive value (PPV) of 37.9% and negative predictive value (NPV) of 85.7%. With the exception of DE, which was significantly more common in athletes who scored positive in the LEAF-Q (55.2% vs. 23.8%, p=0.042), there were no differences in primary, secondary or potential indicators between athletes scoring above or below the LEAF-Q cut-off (total score ≥8).
CONCLUSION:
Among German female endurance athletes the LEAF-Q is a good screening tool to successfully identify athletes who meet criteria of “mild” or more severe REDs risk, as classified according to the IOC REDs CAT2. However, the low PPV highlights the need to perform individual-specific assessment of REDs severity/risk for athletes who score positive in the LEAF-Q.