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

Abstract

PURPOSE 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. METHODS We retrospectively analyzed 7 studies in competitive and recreationally active women [n = 202, age 21.7 ± 0.3 years, body mass index (BMI) 21.21 ± 0.14 kg/m2, (mean ± SEM)]. Participants completed the Health, Exercise and Nutrition Survey (HENS), the Three-Factor Eating Questionnaire (TFEQ), and the Eating Disorder Inventory-3 (EDI-3). Energy deficiency was defined as fasting serum total triiodothyronine (TT3) <73.2 ng/dL. A cut-off of TT3 < 80 ng/dL was also tested. Potential predictors of energy deficiency were: age of menarche, gynecological age, disordered eating, menstrual status, and bone health items (HENS); dietary cognitive restraint (TFEQ); and Perfectionism, Body Dissatisfaction, and Drive for Thinness (EDI-3). A model set (n = 152; 21.8 ± 0.3 years, 21.23 ± 0.16 kg/m2) was used to select predictors, identify interaction terms, and fit 500 random iterations of stepwise logistic regression. Predictors included in ≥450 models were used in a final model and tested on a validation set (n = 50; 21.6 ± 0.4 years, 21.15 ± 0.3 kg/m2). RESULTS The final model included BMI; number of menstrual cycles in the last 6 months, dietary cognitive restraint, and body dissatisfaction index. The FED-Q coefficient detected TT3 < 73.2 ng/dL with 84.2% sensitivity, 80.6% specificity, and 82% accuracy, and TT3 < 80 ng/dL with 85% sensitivity, 83.3% specificity, and 84% accuracy. CONCLUSIONS 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.