Abstract
BackgroundA sustained mismatch between energy intake and exercise energy expenditure (EEE) can lead to Low Energy Availability (LEA), health and performance impairments characteristic of Relative Energy Deficiency in Sport (RED-S). Questionnaires can conveniently identify symptoms and/or LEA/ RED-S risk factors. This study aimed to systematically identify, and critique questionnaires used or developed to measure LEA/ RED-S risk in athletic populations.MethodsA systematic search was conducted using PubMed database. Full text articles were included if: (i) the questionnaire(s) in the study identified LEA and/or RED-S risk; (ii) studies developed questionnaires to identify LEA and/or RED-S risk; (iii) participants belonged to athletic population(s); and (iv) in English.ResultsThirty-three articles met the inclusion criteria and were reviewed, 13 questionnaires were identified. Eight questionnaires had undergone validation procedures, and three questionnaires included questions related to EEE. The most widely used validated questionnaires were Low Energy Availability in Females Questionnaire (LEAF-Q) (48% articles) and Eating Disorder Examination Questionnaire (EDE-Q) (12% articles). The LEAF-Q determines LEA risk from symptoms but cannot be used in males as nearly half of the items (n = 12) relate to menstrual function. The EDE-Q serves as a surrogate marker of LEA risk in both sexes, as it measures a major risk factor of LEA, disordered eating. Better validation is needed for many questionnaires and more are needed to address LEA/RED-S risk in male athletes.ConclusionThese questionnaires may be effective in identifying intentional energy restriction but less valuable in identifying inadvertently failure to increase energy intake with increased EEE.
Highlights
Low Energy Availability (LEA) occurs when an individual fails to consume sufficient energy to cover the exercise energy expenditure (EEE), and maintain basic physiological functions [1]
LEA is related to inadequate dietary energy intake (DEI) and/or high EEE [2], and it’s occurrence is associated with risk factors such as compulsive disordered eating, mismanaged and misinformed eating and compulsive exercising behaviours [2]
The questionnaires identified were categorised into three types: (i) measured LEA symptoms (n = 2); (ii) assessed proxy measures of LEA risk factors (n = 6); or (iii) measured LEA risk factors and symptoms (n = 5)
Summary
Low Energy Availability (LEA) occurs when an individual fails to consume sufficient energy to cover the exercise energy expenditure (EEE), and maintain basic physiological functions [1]. LEA can occur intentionally in a compulsive manner in pursuit of a specific body size or shape. It can arise from mismanaged rational efforts to achieve a certain body size or fatness for athletic competitions which may not include disordered eating behaviours, or alternatively from unintentional dietary inadequacy such as the failure to increase DEI to compensate for an increase in the EEE [3]. A sustained mismatch between energy intake and exercise energy expenditure (EEE) can lead to Low Energy Availability (LEA), health and performance impairments characteristic of Relative Energy Deficiency in Sport (RED-S). This study aimed to systematically identify, and critique questionnaires used or developed to measure LEA/ RED-S risk in athletic populations
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