Objective To prospectively examine the association between pre-season low energy availability (LEA) risk and injury rates among female adolescents during the subsequent athletic season. Design Prospective cohort. Setting Academic research laboratory. Participants Adolescent female athletes ages 13-18 years. Main outcome measures The Low Energy Availability in Females Questionnaire (LEAF-Q) was completed at a pre-season evaluation including questions related to LEA-indicators (injury history, gastrointestinal symptoms, menstrual function). LEAF-Q scores =8 indicate high LEA risk. Participants then completed weekly surveys assessing subsequent injuries sustained throughout the 9-week athletic season. We calculated an injury rate ratio using Poisson regression with LEAF-Q scores <8 or =8 as the predictor, number of sport-related time-loss injuries as the outcome, adjusting for covariates. Results Fifty-nine participants completed the study (age = 15.9 ± 1.43). Twelve participants sustained 14 injuries during the season. Most injuries were musculoskeletal (93 %; N = 13). Those with LEAF-Q scores =8 had a higher injury rate per athletic exposure vs LEAF-Q scores <8 (rate ratio = 3.41; 95 % confidence interval: 1.12-11.4; p = 0.03). Conclusion Female adolescents at high LEA risk were more likely to sustain an injury than those at low LEA risk during a 9-week season. Pre-season LEA screening may identify individuals at risk for sustaining an in-season, sport-related injury.
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