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Cited by 435Eating Disorders and BehaviorsLower Extremity Biomechanics and PathologiesHypothalamic control of reproductive hormones

The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad

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Melin, Anna, Tornberg, Åsa B, Skouby, Sven, Faber, Jens, Ritz, Christian, Sjödin, Anders, Sundgot-Borgen, Jorunn·2014·British Journal of Sports Medicine
DOI 10.1136/bjsports-2013-093240
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Abstract

Background: Low energy availability (EA) in female athletes with or without an eating disorder (ED) increases the risk of oligomenorrhoea/functional hypothalamic amenorrhoea and impaired bone health, a syndrome called the female athlete triad ( Triad ). There are validated psychometric instruments developed to detect disordered eating behaviour (DE), but no validated screening tool to detect persistent low EA and Triad conditions, with or without DE/ED, is available. Aim: The aim of this observational study was to develop and test a screening tool designed to identify female athletes at risk for the Triad . Methods: Female athletes (n=84) with 18–39 years of age and training ≥5 times/week filled out the Low Energy Availability in Females Questionnaire (LEAF-Q), which comprised questions regarding injuries and gastrointestinal and reproductive function. Reliability and internal consistency were evaluated in a subsample of female dancers and endurance athletes (n=37). Discriminant as well as concurrent validity was evaluated by testing self-reported data against measured current EA, menstrual function and bone health in endurance athletes from sports such as long distance running and triathlon (n=45). Results: The 25-item LEAF-Q produced an acceptable sensitivity (78%) and specificity (90%) in order to correctly classify current EA and/or reproductive function and/or bone health. Conclusions: The LEAF-Q is brief and easy to administer, and relevant as a complement to existing validated DE screening instruments, when screening female athletes at risk for the Triad , in order to enable early detection and intervention.

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Crossref · 10.1136/bjsports-2013-093240

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  • The LEAF-Q serves as a complementary screening tool alongside established Disordered Eating assessments in identifying athletes at risk for the Female Athlete Triad.

    “Moreover, the LEAF-Q not only detects LEA, but also serves as a complementary screening tool alongside established Disordered Eating (DE) assessments in the identification of athletes at risk for the Female Athlete Triad [27].”

    From Low Energy Availability and Relative Energy Deficiency in Sport: A Systematic Review and Meta-analysis (2025) · cites this paper as [27]

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Authors
Melin, A., Tornberg, Å. B., Skouby, S., Faber, J., Ritz, C., Sjödin, A., & Sundgot-Borgen, J.
Affiliations
  • University of Copenhagen (DK)
  • Lund University (SE)
Corresponding author
Melin, Anna
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2014-02-21
Volume
48
Issue
7
Pages
540-545
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2013-093240
OpenAlex
W2135307207
Cited by
435
References
6
Citations by year
2026: 68 · 2025: 56 · 2024: 64 · 2023: 61 · 2022: 43 · 2021: 45 · 2020: 31 · 2019: 19 · 2018: 20 · 2017: 14 · 2016: 5 · 2015: 3 · 2014: 5
FWCI
10.65
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Lunds Universitet
  • Herlev Hospital
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
female athlete triad, low energy availability, eating disorders, oligomenorrhea, bone health, female athletes, endurance athletes, dancers, screening tool development, menstrual function
MeSH terms
Adolescent, Adult, Female, Humans, Surveys and Questionnaires, Sensitivity and Specificity, Risk Assessment, Female Athlete Triad Syndrome, Young Adult, Self Report

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