Utilizing the Low Energy Availability in Females Questionnaire (LEAF-Q) to Assess Female Athlete Triad in Collegiate Athletes
DOI:
https://doi.org/10.53646/chwqwb70Keywords:
LEAF-Q, female athletes, female athlete triad, risk of triad, Collegiate Athletes, female collegiate athletesAbstract
BACKGROUND: The female athlete triad has a high prevalence in female athletes and is made up of three components: low energy availability, decreased bone mineral density and menstrual dysfunction. The triad is often recognized in the later stages in endurance sports such as cross country, track, and rowing, which causes significant health issues. The focus of this study is to use the Low Energy Availability in Females Questionnaire (LEAF-Q) to assess risk for the triad amongst all female collegiate endurance and non-endurance athletes, as previous studies have focused solely on endurance athletes.
METHODS: A total of 51 female collegiate athletes attending Nova Southeastern University who compete in basketball, cross country, golf, soccer, softball, swimming, tennis, rowing, and volleyball filled out the LEAF-Q on REDCap in a self-reported format. Athletes who completed the survey were divided into endurance or non-endurance groups. Independent t-tests were utilized to examine differences between endurance and non-endurance athletes for injuries, GI issues, and menstrual scores.
RESULTS: An average score of 8.36 was obtained from the LEAF-Q, with a value greater than or equal to 8 meaning an individual is at risk for the triad. Between the non-endurance athletes versus the endurance athletes, 60.0% of the non-endurance athletes and 58.3% of the endurance athletes were found to be at risk of the triad. No significant differences in injuries per athlete (p = 0.135), GI issues (p = 0.352), and menstrual (p = 0.738) scores were found which means both types of athletes had similar results of being at risk of the triad.
CONCLUSION: According to our findings, non-endurance athletes are at a similar risk of the triad compared to endurance athletes. Further research should be conducted on a larger number of female athletes from a variety of universities to increase the significance of the findings and to further the knowledge of the female athlete triad for athletes, coaches, and parents.
References
1. Nazem TG, Ackerman KE. The female athlete triad. Sports Health. 2012; 4(4):302-311.10.1177/1941738112439685
2. Birch K. Female athlete triad. BMJ. 2005; 330(7485):244-246.10.1136/bmj.330.7485.244
3. Hobart JA, Smucker DR. The female athlete triad. Am Fam Physician. 2000; 61(11):3357-3364, 3367.
4. Patel B, Schneider N, Vanguri P, Issac L. Effects of education, nutrition, and psychology on preventing the female athlete triad. Cureus. 2024; 16(3):e55380.10.7759/cureus.55380
5. Coelho AR, Cardoso G, Brito ME, Gomes IN, Cascais MJ. The female athlete triad/relative energy deficiency in sports (RED-S). Rev Bras Ginecol Obstet. 2021; 43(5):395-402.10.1055/s-0041-1730289
6. Raymond-Barker P, Petroczi A, Quested E. Assessment of nutritional knowledge in female athletes susceptible to the Female Athlete Triad syndrome. J Occup Med Toxicol. 2007; 2:10.10.1186/1745-6673-2-10
7. Ulrich G, Bärtsch P, Friedmann-Bette B. Total haemoglobin mass and red blood cell profile in endurance-trained and non-endurance-trained adolescent athletes. Eur J Appl Physiol. 2011;111(11):2855-2864.10.1007/s00421-011-1920-5.
8. Kaufman M, Nguyen C, Shetty M, Oppezzo M, Barrack M, Fredericson M. Popular dietary trends' impact on athletic performance: a critical analysis review. Nutrients. 2023; 15(16):3511.10.3390/nu15163511
9. Havermale LA. Nutrition knowledge of collegiate athletes in endurance and non-endurance sports. Agric. Food Sci., Med. 2017. https://opensiuc.lib.siu.edu/cgi/viewcontent.cgi?article=2034&context=gs_rp&httpsredir=1&referer=
10. Lodge MT, Ackerman KE, Garay J. Knowledge of the female athlete triad and relative energy deficiency in sport among female cross-country athletes and support staff. J Athl Train. 2021; 57(4):385–392.10.4085/1062-6050-0175.21
11. Melin A, Tornberg ÅB, Skouby S, Faber J, Ritz C, Sjödin A, et al. The leaf questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br. J. Sports Med. 2014; 48(7):540-545.10.1136/bjsports-2013-093240
12. Brown KN, Wengreen HJ, Beals KA. Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches. J Pediatr Adolesc Gynecol. 2014; 27(5):278–282.10.1016/j.jpag.2013.11.014
13. Mukherjee S, Chand V, Wong XX, Choong PP, Lau VS, Wang SC, et al. Perceptions, awareness and knowledge of the female athlete triad amongst coaches – are we meeting the expectations for athlete safety? Int J Sports Sci Coach. 2016; 11(4):545-551.10.1177/1747954116654781
14. Morici G, Gruttad'Auria CI, Baiamonte P, Mazzuca E, Castrogiovanni A, Bonsignore MR. Endurance training: is it bad for you? Breathe (Sheff). 2016;12(2):140-7. 10.1183/20734735.007016.
15. Wilwand M, Pritchett K, Miles M, Pritchett R, Larson A. The prevalence of stress fractures and the associated LEAF-Q responses, self-reported exercise volume and dietary behaviors in female recreational runners. Int J Exerc Sci. 2024; 17(2):1092-1104
16. Gimunová M, Bozděch M, Bernaciková M, Fernandes R, Kumstát M, Paludo A. The relationship between low energy availability, injuries, and bone health in recreational female athletes. PeerJ. 2024; 12:e17533.10.7717/peerj.17533
17. Karlsson E, Alricsson M, Melin A. Symptoms of eating disorders and low energy availability in recreational active female runners. BMJ Open Sport Exerc Med. 2023; 9(3):e001623.10.1136/bmjsem-2023-001623
18. Dambacher L, Pritchett K, Pritchett R, Larson A. Risk of low energy availability, disordered eating, and menstrual dysfunction in female collegiate runners. J Athl Train. 2023; 10.4085/1062-6050-0454.23
19. Meng K, Qiu J, Benardot D, Carr A, Yi L, Wang J, et al. The risk of low energy availability in Chinese elite and recreational female aesthetic sports athletes. J Int Soc Sports Nutr. 2020; 17(1):13.10.1186/s12970-020-00344-x
20. Witkoś J, Błażejewski G, Gierach M. 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. Nutrients. 2023; 15(3):650.10.3390/nu15030650
21. Akman CT, Aydın CG, Ersoy G. The effect of nutrition education sessions on energy availability, body composition, eating attitude and sports nutrition knowledge in young female endurance athletes. Front Public Health. 2024; 12:1289448.10.3389/fpubh.2024.1289448
22. Folscher LL, Grant CC, Fletcher L, Janse van Rensberg DC. Ultra-marathon athletes at risk for the female athlete triad. Sports Med Open. 2015; 1(1):29.10.1186/s40798-015-0027-7
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