Table 1 Questionnaires used in the assessment of Low Energy Availability (LEA) and Relative Energy Deficiency in Sport (RED-S)
| Questionnaires | Validated in population | No. of items | Cut-off scores | Used as surrogate markers for | Validity and Reliability |
|---|---|---|---|---|---|
| Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) [20] | Adolescent female elite athletes | 9 | An overall weighted score ≥ 0.27 indicates eating disorder [20] |
Risk factors of LEA • Eating disorder screening ° Eating behaviours ° Weight concern ° Shape concern |
Validated against EDI-2 Sensitivity: 82.1% (95% CI, 76.6–87.6) Specificity: 84.6% (95% CI, 79.4–89.8) Cronbach α: 0.8 1[20] |
| Eating Disorder Examination Questionnaire (EDE-Q) [21] | Non-active males and females | 28 | Dietary restraint score ≥ 3 and presence of ≥1 pathologic behaviour indicated LEA [22] |
Risk factors of LEA • Eating disorder screening ° Shape, weight, eating concern and dietary restraint ° Disordered eating behaviours ▪ Binge-eating, lost control of eating, overeating, vomiting, laxatives usage, compulsive exercise |
Sensitivity: 83% Specificity: 96% Positive predictive value: 56% [23] Cronbach α: 0.93 [24] Test-retest reliability Spearman’s rho > 0.86 [25] |
| Eating Disorder Inventory (EDI) – Drive for Thinness (DT) score [26] | Females | 7 | ≥7 considered high [26] |
Risk factors of LEA • Eating disorder screening ° Excessive concern with dieting, preoccupation with weight and fear of weight gain |
Sensitivity: 86% Specificity: 80% [27] Cronbach α: > 0.80 [28] Test-retest reliability: 0.75–0.94 [29] |
| Eating Disorder Screening for Primary Care (ESP) [20] | Primary care patients for eating disorders and university students | 4 | ≥3 in abnormal responses indicated LEA [30] |
Risk factors of LEA • Eating disorder screening ° Eating behaviours ° Weight concern ° Family & self-report history of eating disorder |
Sensitivity: 100% (95% CI, 90–100%) Specificity: 71% (95% CI, 0.0–0.15) [20] |
| Female Athlete Triad Risk Scale [31] | Not validated | 6 | ≥3 indicated risk of Triad [31] |
Risk factors and symptoms of LEA • Triad risk screening ° Eating behaviours ° Menstrual function ° Bone injury history | – |
| Female Athlete Triad Screening Questionnaire [32] | Not validated | 12 | Any positive answer to any questions indicated need for further measurements |
Risk of factors and symptoms of LEA • Screening for Triad risk ° Disordered eating/ eating disorders ° Body image questions ° Menstrual history ° Bone Health | – |
| Low Energy Availability in Females Questionnaire (LEAF-Q) [16] | Female endurance athletes | 25 | ≥8 indicated LEA [16] |
Symptoms of LEA • LEA risk screening ° Menstrual function ° Injury ° Illness frequency ° Gastrointestinal function |
Sensitivity: 78% Specificity: 90% Test re-test reliability: 0.79 Cronbach α: ≥ 0.71 [16] |
| Meal attitudes and body weight questions [33] | Not validated | 2 |
Indicated to be at LEA when responses are: - Frequently lose weight intentionally - Consume less than 2 meals a day [33] |
Risk factors of LEA • Screening for Triad risk ° Frequency of meals per day ° Body weight | – |
| RED-S risk measurement for cyclists [34] | Not validated | 3 |
Indicated to be at LEA when ≥1 response on: - > 5% of body weight loss in the last month - > 14 days of missed training or competition because of illness, - > 20 missed days of training or competition because of injury [34] |
Symptoms of LEA • Screening for RED-S risk ° Loss of body mass ° Injury and illness history | – |
| RED-S Specific Screening Tool (RST) (female and male versions) [35] |
Female version: Middle and high-school female soccer players Male version: Not validated | 25–31 |
Risk of RED-S Females < 16 years old/ non-menstruating and males (all ages): - Low < 100 - Moderate 101–400 - High > 400 Females > 16 years old - Low < 150 - Moderate < 150–500 - High > 500 [35] |
Risk factors and symptoms of LEA • Screening for RED-S risk ° Menstrual function ° Activity levels ° Nutrition and diet ° Injury ° Physiological effects ° Psychological effects ° Factors that affect bone mineral density | Female version: Validated against Pre-Participation Gynaecological Examination Survey (r = 0.697, p < 0.001) |
| Sport-specific Energy Availability Questionnaire and Interview (SEAQ-I) [17] | Male road cyclists | 6 | – |
Risk factors and symptoms of LEA • Screening for LEA risk ° Weight change ° Nutrition change ° Fuelling around training (e.g. weekly fasted rides) ° Bone injury history ° Illness history ° Medication history | Content validity measured by clinical sports endocrinologist, a sports research scientist, a registered sports performance dietician, competitive male cyclists and coaches |
| Three-Factor Eating Questionnaire (TFEQ) – Dietary cognitive restraint [36] | Non-obese and obese males and females | 51 | ≥14 is considered as elevated |
Risk factors of LEA • Dietary restraint |
Sensitivity: 72% Specificity: 70.1% [37] Internal consistency: 0.93 [36] Cronbach α: 0.71 [37] |
| Triad consensus panel screening questions by the Female Athlete Coalition [19] | Not validated | 11 | – |
Risk factors and symptoms of LEA • Screening for Triad risk ° Menstrual function ° Weight concern ° Eating behaviours ° Eating disorder history ° Bone function | – |