Screening-based low energy availability risk, disordered eating risk, and their co-occurrence among female volleyball players: a cross-sectional study

Abstract

Low energy availability (LEA) and disordered eating (DE) are important health concerns in female athletes, yet their occurrence and co-occurrence in team-sport contexts, particularly volleyball, remain underexplored. This cross-sectional online survey study examined the proportions of athletes classified as being at risk of LEA and DE overall and across competition levels, and assessed the co-occurrence between the two risk classifications in female volleyball players in Türkiye, using the Low Energy Availability in Females Questionnaire (LEAF-Q) and Eating Attitudes Test-26 (EAT-26). It also examined correlations between EAT-26 total score and LEAF-Q total and domain scores. A total of 213 athletes, recruited via non-probability convenience sampling, completed the LEAF-Q and EAT-26 to assess LEA risk and DE risk, respectively. In this sample, 33.3% of athletes were classified as being at risk of LEA, with no difference across competition levels (p = 0.825). A total of 17.4% were classified as being at risk of DE, with variation across competition levels and the highest proportion among Turkish Women’s Volleyball Second League athletes (p = 0.034). LEA risk and DE risk co-occurred in 10.3% of the sample, and DE risk was associated with higher odds of LEA risk (unadjusted OR = 3.80, 95% CI: 1.82–7.92). EAT-26 total score was positively correlated with LEAF-Q total and gastrointestinal function scores (p < 0.001) and injury history score (p = 0.004), but not menstrual function score (p = 0.133). These results suggest that LEA risk was commonly identified in this sample, DE risk was comparatively less common, and their co-occurrence was only partial, highlighting the value of screening for both risks rather than assuming one from the other.