The Low Energy Availability in Females Questionnaire (LEAF-Q) as a Useful Tool to Identify Female Triathletes at Risk for Menstrual Disorders Related to Low Energy Availability

Abstract

Background: Nutrition in sport is a priority; it is the basis for maintaining optimal health and a prerequisite for the high performance necessary for competitions. The aim of this study was to assess low energy availability and its possible consequences among female triathletes by using the Low Energy Availability in Females Questionnaire (LEAF-Q). Methods: The study involved 30 female triathetes. The LEAF-Q was used in the study. An analysis of the body composition was carried out with the seca device mBCA 515 medical Body Composition Analyzer. Results: Of the 30 female triathletes studied, 23.3% had a monthly cycle disorder, defined as an amenorrhea state for more than 90 days. No differences were found in injury rates or training days lost to injury due to menstrual disturbances. Menstruation changes were significantly greater due to increases in exercise intensity, frequency, and duration in the group experiencing menstrual disturbances (85.7 [95% CIs: 42.1–99.6] vs. 8.7 [95% CIs: 1.1–28.0]). The menstrual disorder group had a greater incidence of their periods stopping for more than 3 months than the group without menstrual disturbances. Conclusions: The female triathletes did not show abnormalities in body weight or composition, and these were not related to the incidence of menstrual disturbances. However, 20% of the triathletes either had, at the time of the study, or had had in the past monthly cycle disorders that could indicate an immediate risk of low energy availability. The LEAF-Q identified 10% of the triathletes as at risk (score > 8) of low energy availability and the physiological and performance consequences related to relative energy deficiency in sports (RED-S).

Prevalence of Exercise Related Amenorrhea in Females

“…To assess symptoms indicative of insufficient energy intake, the "Low Energy Availability in Female Questionnaire (LEAF-Q)" was employed. This tool, focusing on questions related to injuries, gastrointestinal functions, and reproductive health of athletes, identifies individuals at risk for the Female Athlete Triad with a total score of 8 or higher (15). Additionally, the "Female Athlete Screening Tool (FAST)" was utilized, comprising 33 questions that address daily workout routines, diet plans, and the physical and psychological states of the sportswomen.…”