Development and Validation of a Risk Assessment Tool for Energy Deficiency in Young Active Females: The Female Energy Deficiency Questionnaire (FED-Q).

Abstract

We aimed to develop and validate a risk assessment tool for energy deficiency in young exercising women using disordered eating subscales and self-reported health-related information. We retrospectively analyzed seven studies in competitive and recreationally active women ( n = 202; age, 21.7 ± 0.3 yr; body mass index, 21.21 ± 0.14 kg·m -2 (mean ± SEM)). Participants completed the Health, Exercise, and Nutrition Survey, the Three-Factor Eating Questionnaire, and the Eating Disorder Inventory-3. Energy deficiency was defined as fasting serum total triiodothyronine (TT 3 ) <73.2 ng·dL -1 . A cutoff of TT 3 <80 ng·dL -1 was also tested. Potential predictors of energy deficiency were as follows: age of menarche, gynecological age, disordered eating, menstrual status, and bone health items (Health, Exercise and Nutrition Survey); dietary cognitive restraint (Three-Factor Eating Questionnaire); and Perfectionism, Body Dissatisfaction, and Drive for Thinness (Eating Disorder Inventory-3). A model set ( n = 152; 21.8 ± 0.3 yr, 21.23 ± 0.16 kg·m -2 ) was used to select predictors, identify interaction terms, and fit 500 random iterations of stepwise logistic regression. Predictors included in ≥475 models were used in a final model and tested on a validation set ( n = 50; 21.6 ± 0.4 yr, 21.15 ± 0.3 kg·m -2 ). The final model included body mass index, number of menstrual cycles in the last 6 months, dietary cognitive restraint, and body dissatisfaction index. The Female Energy Deficiency Questionnaire coefficient detected TT 3 <73.2 ng·dL -1 with 84.2% sensitivity, 80.6% specificity, and 82% accuracy, and TT 3 <80 ng·dL -1 with 85% sensitivity, 83.3% specificity, and 84% accuracy. At present, the Female Energy Deficiency Questionnaire is the only questionnaire that is specifically designed as an indicator of energy deficiency in female athletes across a variety of sports.