The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad

Melin, Anna; Tornberg, Åsa; Skouby, Sven O.; Faber, Jens; Ritz, Christian; Sjödin, Anders; Sundgot‐Borgen, Jorunn

doi:10.1136/bjsports-2013-093240

Cited by 253 publications

(342 citation statements)

References 27 publications

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“…For example, in a primary-care population the Eating Disorder Examination Questionnaire (EDE-Q) demonstrated acceptable sensitivity (80%) and specificity (80%). 8 Furthermore, the Low Energy Availability in Female Athletes (LEAF) 9 did not fit the inclusion criteria of this CAT as it was designed to identify female athletes with or without eating disorders who have persistent low energy availability and female athlete triad conditions. Although the LEAF is slightly lower than the acceptable sensitivity criterion, it correctly classified individuals not at risk for the triad 90% of the time.…”

Section: Implications For Practice Education and Future Researchmentioning

confidence: 99%

“…Although the LEAF is slightly lower than the acceptable sensitivity criterion, it correctly classified individuals not at risk for the triad 90% of the time. 9 Thus, the EDE-Q and LEAF are alternative screening tools for clinicians screening nonathletes or patients who may be at risk for the triad.…”

Section: Implications For Practice Education and Future Researchmentioning

confidence: 99%

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The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

Wagner¹,

Erickson²,

Tierney³

et al. 2016

Journal of Sport Rehabilitation

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Clinical Scenario: Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need. Focused Clinical Question: Should screening tools be used to detect eating disorders in female athletes? Summary of Key Findings: The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values. Clinical Bottom Line: There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder. Strength of Recommendation: There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.

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Section: Implications For Practice Education and Future Researchmentioning

confidence: 99%

Section: Implications For Practice Education and Future Researchmentioning

confidence: 99%

The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

Wagner¹,

Erickson²,

Tierney³

et al. 2016

Journal of Sport Rehabilitation

View full text Add to dashboard Cite

show abstract

“…Recently, Melin et al [39] proposed the LEAF Questionnaire (Low Energy Availability in Female Questionnaire), which is composed of questions regarding dietary habits and health problems, including the reproductive functions of female athletes. This procedure seems to be of importance, since it has been found that dietary interventions have the potential to restore menses in female athletes [2, 7, 21, 36].…”

Section: Energy Availability In Female Athletesmentioning

confidence: 99%

“…Moreover, Williams et al [62] demonstrated that the frequency of menstrual disturbances is markedly affected by the magnitude of the daily energy deficit, and is significantly greater for a 42% than for an 8% energy deficiency. Since the time of these earlier studies until now, intense research has focused on analysing the dietary habits of female athletes and their energy availability [39,47,48,53,61].…”

Section: Energy Availability In Female Athletesmentioning

confidence: 99%

Female athletes and health

Malara

Lutosławska

2016

Biomedical Human Kinetics

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SummaryIt is well documented that regular physical activity has a beneficial effect on human health by affecting the metabolic processes that are of fundamental importance in the body's functions, such as insulin sensitivity and glucose disposal, as well as lipid and lipoprotein turnover. On the other hand, there is a wealth of studies which indicate that strenuous, regular physical activity, such as that performed by high performance athletes, may be detrimental for the athletes' health especially in women. This review focuses on the factors that contribute to health problems in female athletes, named the female athlete triad, which includes excessive dieting, menstrual dysfunctions (anovulatory menstrual cycles, oligomenorrhea, amenorrhea) and a low bone mineral density (BMD). As a result of these factors, women who participate in sports, especially those focused on leanness, need special attention and education from health professionals, coaches and the athletes themselves to prevent the detrimental effects of an inadequate energy supply against high energy demands.

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“…Furthermore, it is well documented that low energy availability impacts negatively on menstrual function (Loucks et al, 2011). Melin et al (2014) have shown that self-reported menstrual dysfunction has a high specificity and sensitivity for clinically verified menstrual dysfunction. Therefore, the FCWM Questionnaire included a series of questions designed to investigate the association between menstrual cycle regularity, magnitude of BW change and current BW.…”

Section: Discussionmentioning

confidence: 99%

Physiques that perform: The interaction between body composition management, performance and calcium homeostasis in female cyclists

Haakonssen¹

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Body composition of female cyclists is believed to have an impact on performance. The central aim of this thesis was to address social, technical and health related issues around body composition management in this population. The first study (Chapter 3) examined the satisfaction of elite female cyclists with their body weight in the context of race performance, the magnitude of body weight manipulation and the association of these variables with menstrual function. Female competitors in the Australian National Road Cycling Championships (n = 32) and the Oceania Championships (n = 5) completed a questionnaire designed to identify attitudes towards body weight as it relates to performance, the magnitude of body weight change and the techniques used to manipulate body weight. All but one cyclist reported that female cyclists are a weight conscious population and 54% reported having a desire to change body weight at least once weekly. Of the cyclists surveyed, 62% reported that their current body weight was not ideal for performance. The perceived ideal body weight was (mean ± SD) 1.6 ± 1.6 kg (2.5 ± 2.5%) less than their current weight and 73% reported their career lowest body weight was either 'beneficial' or 'extremely beneficial' for performance. A majority (65%) of the cyclists reported successfully reducing body weight in the previous 12 mo with a mean loss of 2.4 ± 1.0 kg (4.1 ± 1.9%). The most common weight loss technique was reduced energy intake (76%). Five cyclists (14%) had been previously diagnosed as having an eating disorder by a physician. Of the 18 athletes not using a hormonal contraceptive, 11 reported menstrual dysfunction (oligomenorrhea or amenorrhea). The first study showed that elite female cyclists are a weight conscious population who may not be satisfied with their body weight leading into a major competition and in some cases, are frequently weight conscious.The purpose of the second study (Chapter 4) was to describe normative values and seasonal changes for body composition in female road and track endurance cyclists. In order to better understand changes in energy balance (EB) when body composition is being manipulated, measures of energy intake (EI) as well as energy expenditure (EE) require accurate measurement. Study four (Chapter 6) validated the use of commercially available power meters (Schoberer Resistance Measurement, Jülich, Germany; SRM) for estimating EE during variable intensity cycling. Female road cyclists (n = 9) completed a gross efficiency test (GE test = 4 min at ~45%, ~55%, ~65% and ~75% maximal aerobic power; MAP) before and after 10.5 min of either constant (CON) or variable (VAR) intensity cycling averaging ~55% MAP. Gross efficiency (GE) measured pre-, post-and during CON and VAR cycling was compared. Total EE for 10.5 min of VAR cycling was estimated using indirect calorimetry (CAL) and compared to estimates based on mechanical power (SRM) using each athlete's mean GE (GE IND ). There was no effect of VAR on GE tests . The difference between GE (mean ± ...

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The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad

Abstract: Borgen, J. (2014). The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad.

Cited by 253 publications

References 27 publications

The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

The Diagnostic Accuracy of Screening Tools to Detect Eating Disorders in Female Athletes

Female athletes and health

Physiques that perform: The interaction between body composition management, performance and calcium homeostasis in female cyclists

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