Risk, Knowledge, and Awareness of Relative Energy Deficiency in Sport (RED-S) in Elite Female Volleyball Players

BACKGROUND: Relative energy deficiency in sport (RED-S) is a condition caused by low energy availability (LEA) and is associated with adverse health and performance outcomes in athletes. Although volleyball involves considerable physical stress and repetitive jumping, little is known about RED-S knowledge and risk of LEA in elite female volleyball players. HYPOTHESIS: Elite female volleyball athletes have limited awareness of RED-S, and athletes at risk for LEA according to the LEAF-Q are more likely to be injured. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Elite female volleyball athletes competing in the Turkish Women's Elite Volleyball League during the 2024-2025 season were recruited. Participants completed an online survey including demographic information, the Low Energy Availability in Females Questionnaire (LEAF-Q), and items assessing knowledge, awareness, and support-seeking behaviors related to RED-S. Athletes were classified as "at risk" for LEA using a LEAF-Q cutoff score of ≥8. Associations between LEAF-Q risk status and injury history during the previous year were analyzed. RESULTS: A total of 148 athletes participated. The mean LEAF-Q score was 5.50 ± 3.48, and 25% of athletes were classified as at risk for LEA according to the LEAF-Q. Most athletes (92.6%) reported never having heard of RED-S or the Female Athlete Triad. Athletes identified as at risk by the LEAF-Q were significantly more likely to have sustained an injury in the previous year than athletes not at risk (odds ratio, 7.86; 95% CI, 3.03-20.41). CONCLUSION: Elite female volleyball athletes demonstrated low knowledge of RED-S, while a substantial proportion were identified as at risk for LEA. LEA risk was associated strongly with injury history, supporting the clinical relevance of LEAF-Q screening in this population. CLINICAL RELEVANCE: Routine LEAF-Q screening combined with sport-specific education may facilitate early identification of athletes who may require further clinical evaluation for LEA-related problems and may inform prevention-oriented support strategies in elite female volleyball players.