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Cited by 70Eating Disorders and BehaviorsNutrition, Health and Food BehaviorHypothalamic control of reproductive hormones

Screening for low energy availability in male athletes: attempted validation of LEAM-Q

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Lundy, Bronwen, Torstveit, Monica K., Stenqvist, Thomas B., Burke, Louise M., Garthe, Ina, Slater, Gary J., Ritz, Christian, Melin, Anna K.·2022·Nutrients
DOI 10.3390/nu14091873PMC PMC9101736
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Abstract

A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.

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  • Two emerging potential indicators of REDs in males are the presence of low libido and decreased morning erections, which have been identified as physiological consequences of LEA.

    “Two emerging potential indicators of REDs in males are the presence of low libido and decreased morning erections, which have been identified as physiological consequences of LEA.[108][109][110][111]”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [108]

    The Results (section 3.3) report that low sex-drive scores distinguished LEA cases from controls, and the Methods (section 2.3) show that the score included questions about morning erections. The paper does not establish decreased morning erections as an independent indicator or demonstrate that either symptom is a physiological consequence caused by LEA. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Lundy, B., Torstveit, M. K., Stenqvist, T. B., Burke, L. M., Garthe, I., Slater, G. J., Ritz, C., & Melin, A. K.
Affiliations
  • Australian Catholic University (AU)
  • University of Agder (NO)
  • Norwegian Olympic Sports Centre, Department of Sports Nutrition, 0806 Oslo, Norway
  • University of the Sunshine Coast (AU)
  • Danish National Institute of Public Health (DK)
  • Linnaeus University (SE)
Corresponding author
Burke, Louise M.
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2022-04-29
Volume
14
Issue
9
Pages
1873
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu14091873
PMC
PMC9101736
OpenAlex
W4225264738
Cited by
70
References
14
Citations by year
2026: 27 · 2025: 11 · 2024: 12 · 2023: 14 · 2022: 3 · 2020: 2 · 2019: 1
FWCI
9.13
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Diva portal (Dalarna University Library) (submittedVersion, other-oa)
  • Figshare (submittedVersion, cc-by)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
low energy availability, male athletes, screening questionnaire, questionnaire validation, sexual desire, dizziness, fatigue, illness, thermoregulation, gastrointestinal symptoms, injuries, recovery, sleep, endurance sports
MeSH terms
Dizziness, Female, Humans, Male, Surveys and Questionnaires, Reproducibility of Results, Biomarkers, Athletes, Sports Nutritional Physiological Phenomena

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