Self-Reported Low Energy Availability Risk and Correlates of Relative Energy Deficiency in Sport (REDs) Among Adolescent Female Athletes: An Exploratory Analysis

Abstract

Relative Energy Deficiency in Sport (REDs) consists of physiologic and performance impairments resulting from low energy availability (LEA) and is common among female adolescent athletes. To identify health outcomes associated with self-reported LEA risk among adolescent female athletes. Cross-sectional study Female adolescent athletes participating in a high school fall sports season. We grouped participants into those at high and low risk for LEA based on Low Energy Availability in Females Questionnaire (LEAF-Q) scores (LEAF-Q≥8 and <8). LEAF-Q, PROMIS Global Pediatric 25 domain, Body Appreciation Scale, Pittsburgh Sleep Quality Index (PSQI), and questions regarding dietary habits and concerns about weight. A total of 69 female adolescents enrolled and completed all assessments. Of these participants, N=26 (38%) were classified as being at high risk for LEA and 43 were classified as low risk for LEA. There were no significant differences between LEA groups on PROMIS domains, body appreciation ratings, dietary habits, or weight-related worries (p>0.2). Several factors were different between groups and included in the multivariable linear regression model (PSQI rating, time between first/last meals, ethnicity, age, BMI). A higher PSQI rating was associated with a higher LEAF-Q rating after adjusting for covariates (β=0.33, 95% CI: 0.02, 0.64; p=0.04). The additional variables (time between meals, ethnicity, age, and BMI) did not demonstrate a significant association with LEAF-Q ratings in the multivariable regression model. Female adolescent athletes at high risk for LEA reported worse sleep quality than those at low risk for LEA. This finding aligns with the proposed association of sleep disturbance and LEA in the REDs conceptual model. Healthcare providers should monitor sleep quality in female adolescent athletes at high risk for LEA and promote optimal sleep hygiene and consistency in this population.