Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q

Bronwen Lundy; Monica K Torstveit; Thomas B Stenqvist; Louise M Burke; Ina Garthe; Gary J Slater; Christian Ritz; Anna K Melin

doi:10.3390/nu14091873

Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q

Nutrients. 2022 Apr 29;14(9):1873. doi: 10.3390/nu14091873.

Authors

Bronwen Lundy^{1

2}, Monica K Torstveit³, Thomas B Stenqvist³, Louise M Burke², Ina Garthe⁴, Gary J Slater⁵, Christian Ritz⁶, Anna K Melin⁷

Affiliations

¹ Rowing Australia, Canberra, ACT 2600, Australia.
² Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia.
³ Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway.
⁴ Norwegian Olympic Sports Centre, Department of Sports Nutrition, 0806 Oslo, Norway.
⁵ School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia.
⁶ National Institute of Public Health-SDU, 1455 Copenhagen, Denmark.
⁷ Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 351 95 Vaxjo, Sweden.

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.

Keywords: EHMC; endurance; questionnaire; testosterone; validation.

MeSH terms

Athletes*
Biomarkers
Dizziness*
Female
Humans
Male
Reproducibility of Results
Sports Nutritional Physiological Phenomena
Surveys and Questionnaires

Substances

Biomarkers

Grants and funding

Although this research project did not receive specific funding, data were collected during a range of projects that were supported by agencies such as the Australian Institute of Sport, Australian Catholic University.