Self-reported Eating Behavior Is Correlated With Health Consequences Of Relative Energy Deficiency In Sport

Screening for impairments described by Relative Energy Deficiency in Sport (REDs) is difficult given the syndrome’s non-uniform manifestation and the absence of both diagnostic criteria and validated and accessible methods. The identification of simple yet robust screening tools is warranted. PURPOSE: To explore the relationship between published surrogates of low energy availability (LEA) and health consequences of REDs. METHODS: Female athletes (n = 781) training ≥10 hours/week in a single sport completed an online survey to assess elements of impairments relevant to REDs. Responses above published cut-off scores for the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q) and/or Eating Disorder Screen for Primary Care (ESP), and/or self-reported current or past eating disorder (ED) or disordered eating (DE) were used as surrogates of LEA. Binomial logistic regression models were used to evaluate the relationship between each surrogate of LEA and each REDs health consequence captured by the survey. RESULTS: Athletes were young (mean age: 20 ± 3 yrs), with mean BMI of 22.9 ± 3.7 kg/m2. A total of 60.6% (n = 473) athletes were classified with LEA status based on a positive response to ≥1 LEA surrogate. Self-reported past ED or DE correlated with the greatest number of REDs health consequences, followed by ESP and then self-reported current ED or DE (Table 1). The BEDA-Q correlated with limited REDs health consequences. CONCLUSION: Self-reported past ED or DE is a simple and accessible means of screening for several health consequences described by the REDs model. Positive response to these questions may warrant further clinical investigations to confirm the presence/absence of related impairments. Limited correlation of the BEDA-Q with REDs health consequences may be due to its validation in an adolescent population only. Table 1: Relationship of Published Surrogates of Low Energy Availability (LEA) Status and Health Consequences of Relative Energy Deficiency in Sport (REDs) - REDs Heath Consequences BEDA-Q(n = 296) ESP (n = 67) DE Past (n = 107) DE Current (n = 48) ED Past (n = 67) ED Current (n = 31) Primary amenorrhea 0.885 0.518 0.380 0.640 0.822 0.856 Secondary amenorrhea - past^ 0.095 0.014 0.001 0.533 0.001 0.143 Secondary amenorrhea - current^ 0.168 0.042 <0.001 <0.001 0.001 <0.001 Impaired bone health 0.300 <0.001 <0.001 <0.001 <0.001 <0.001 Anemia - past 0.632 0.079 0.004 0.377 0.098 0.461 Abnormal bruising 0.260 0.132 0.189 0.505 0.366 0.439 Urinary incontinence 0.006 0.007 0.036 0.480 0.005 0.381 Abnormal thyroid function† 0.044 0.001 <0.001 0.025 0.006 0.461 Impaired growth and development 0.582 0.466 0.419 0.387 0.042 0.414 Mental illness 0.017 0.002 <0.001 <0.001 <0.001 <0.001 Impaired cardiovascular function# <0.001 0.324 0.159 <0.001 0.018 0.001 Impaired GI function 0.005 0.003 0.008 <0.001 0.051 0.007 Fecal incontinence 0.247 0.449 0.609 0.144 0.512 0.088 p-values of binomial logistic regression models of surrogates of LEA and reported REDs health consequences. Significance at p < 0.05, bolded text. *n = number of respondents above published cut-offs for risk of LEA (BEDA-Q, ESP) or positive respondents to self-reported current or past DE or ED. BEDA-Q: Brief Eating Disorder in Athletes Questionnaire; ESP: Eating Disorder Screen for Primary Care; DE: disordered eating; ED: eating disorder; GI: gastrointestinal. ^Individuals not on birth control; # temporary factors removed (e.g., influence of viral infection); †existing thyroid issues removed.