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 seven studies in competitive and recreationally active women (n = 202; age, 21.7 ± 0.3 yr; body mass index, 21.21 ± 0.14 kg·m-2 (mean ± SEM)). Participants completed the Health, Exercise, and Nutrition Survey, the Three-Factor Eating Questionnaire, and the Eating Disorder Inventory-3. Energy deficiency was defined as fasting serum total triiodothyronine (TT3) <73.2 ng·dL-1. A cutoff of TT3 <80 ng·dL-1 was also tested. Potential predictors of energy deficiency were as follows: age of menarche, gynecological age, disordered eating, menstrual status, and bone health items (Health, Exercise and Nutrition Survey); dietary cognitive restraint (Three-Factor Eating Questionnaire); and Perfectionism, Body Dissatisfaction, and Drive for Thinness (Eating Disorder Inventory-3). A model set (n = 152; 21.8 ± 0.3 yr, 21.23 ± 0.16 kg·m-2) was used to select predictors, identify interaction terms, and fit 500 random iterations of stepwise logistic regression. Predictors included in >=475 models were used in a final model and tested on a validation set (n = 50; 21.6 ± 0.4 yr, 21.15 ± 0.3 kg·m-2). Results The final model included body mass index, number of menstrual cycles in the last 6 months, dietary cognitive restraint, and body dissatisfaction index. The Female Energy Deficiency Questionnaire coefficient detected TT3 <73.2 ng·dL-1 with 84.2% sensitivity, 80.6% specificity, and 82% accuracy, and TT3 <80 ng·dL-1 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.
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