O3299: Self-Reported Low Energy Availability Risk and Concepts Associated with Relative Energy Deficiency in Sport (REDs) Among Adolescent Female Athletes: An Exploratory Analysis

Background: Relative Energy Deficiency in Sport (REDs) consists of physiologic and performance impairments resulting from low energy availability (LEA; inadequate energy availability to support optimal physiologic functioning after accounting for exercise energy expenditure) and is common among female adolescent athletes. The primary purpose of this investigation was to identify whether potential correlates of REDs (e.g. physical function, psychological health, and dietary habits) were associated with self-reported risk of LEA among adolescent female athletes.

Methods: We conducted a cross-sectional study of female adolescents who were participating in a fall sports season. All participants completed the Low Energy Availability in Females Questionnaire (LEAF-Q), the PROMIS Global Pediatric 25 domain, the Body Appreciation Scale, the Pittsburgh Sleep Quality Index (PSQI), and questions regarding dietary habits and concern about weight. We grouped participants into those at high risk for LEA (LEAF-Q rating ≥8) and those at low risk of LEA (LEAF-Q < 8). We univariably compared high/low LEA risk groups on each outcome, and those that demonstrated potential between-group differences upon univariable screening (defined as p < 0.20) were included as predictor variables in a multivariable linear regression model.

Results: 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 (LEAF-Q rating ≥8; mean=10.3±2.3) and 43 were classified as low risk for LEA (mean LEAF-Q rating=3.0±1.8). There were no significant differences between LEA groups in PROMIS, body appreciation, dietary habits, or weight-related worries (p>0.2). Among the factors included in the multivariable linear regression model (PSQI rating, time between first/last meals, ethnicity, age, and BMI), only a higher PSQI rating (i.e., worse sleep quality) was associated with a higher LEAF-Q rating (i.e., a greater risk of LEA) after adjusting for other factors (Figure 1, β=0.33; 95% CI=0.20, 0.64). The other factors (time between meals, ethnicity, age, and BMI) did not demonstrate a significant association with LEAF-Q ratings (Table 1).

Conclusion: Female adolescent athletes at high risk of 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. There were no significant differences between LEA groups in PROMIS, body appreciation, dietary habits, or weight-related worries. 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. However, further research is needed to determine whether poor sleep contributes to LEA, results from it, or reflects a shared underlying factor.