Screening for Relative Energy Deficiency in Sport: Detection of Clinical Indicators in Female Endurance Athletes

Paulina Wasserfurth; Robin Halioua; Désirée Toepffer; Zoë Lautz; Helena Engel; Anna Katarina Melin; Monica Klungland Torstveit; Malte Christian Claussen; Karsten Koehler

doi:10.1249/MSS.0000000000003644

Screening for Relative Energy Deficiency in Sport: Detection of Clinical Indicators in Female Endurance Athletes

Med Sci Sports Exerc. 2025 Jan 9. doi: 10.1249/MSS.0000000000003644. Online ahead of print.

Authors

Paulina Wasserfurth¹, Robin Halioua², Désirée Toepffer¹, Zoë Lautz¹, Helena Engel¹, Anna Katarina Melin³, Monica Klungland Torstveit⁴, Malte Christian Claussen, Karsten Koehler¹

Affiliations

¹ Technical University of Munich, Germany; TUM School of Medicine and Health, Department of Health and Sport Sciences, Munich, GERMANY.
² Research Group Sports Psychiatry, Center for Psychiatric Research, Department of Adult Psychiatry and Psychotherapy, Psychiatric University Clinic Zurich, University of Zurich, Zurich, SWITZERLAND.
³ Department of Sport Science, Linnaeus University, Växjö/Kalmar, SWEDEN.
⁴ Department of Sport Science and Physical Education, University of Agder, Kristiansand, NORWAY.

PMID: 39780352
DOI: 10.1249/MSS.0000000000003644

Abstract

Purpose: The purpose was to evaluate the individual and combined use of the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) to detect clinical indicators associated with Relative Energy Deficiency in Sport (REDs).

Methods: In this cross-sectional study, 50 female endurance athletes training ≥4x/week completed the LEAF-Q and BEDA-Q and were assessed for presence of selected REDs indicators. Athletes meeting the criteria for mild or more severe REDs severity/risk according to the International Olympic Committee REDs Clinical Assessment Tool Version 2 (IOC REDs CAT2) were classified as REDs cases. Diagnostic properties of the German versions of the LEAF-Q and BEDA-Q were assessed at different cut-offs using receiver operating characteristics calculations.

Results: Fourteen (28%) athletes were classified as REDs cases. The LEAF-Q had a sensitivity of 79% and a specificity of 50%, with a positive predictive value (PPV) of 38% and negative predictive value (NPV) of 86%. For detection of disordered eating behaviour/eating disorder (DE/ED), the BEDA-Q showed a sensitivity and specificity of 71% and 76%, respectively, with a PPV of 68% and NPV of 79%. Out of 14 REDs cases, nine (64%) scored positive in the LEAF-Q and BEDA-Q. Two athletes (14%) scored positive only in the LEAF-Q and one athlete scored positive only in the BEDA-Q. Two REDs cases remained undetected by both questionnaires.

Conclusions: Among German female endurance athletes, the LEAF-Q and BEDA-Q are good screening tools to detect REDs cases with mild or more severe severity/risk as classified according to the IOC REDs CAT2. Further clinical assessments should be initiated when athletes score positive in at least one of the questionnaires.