Prevalence, Severity, and Psychosocial Determinants of Relative Energy Deficiency in Sport (REDs) Among Female Collegiate Athletes in Lahore, Pakistan

Abstract

Background: Relative Energy Deficiency in Sport (REDs) is a syndrome of multiple systems that is caused by chronic low energy availability (LEA). The prevalence of REDs and the psychosocial factors were not studied among female collegiate athletes in Pakistan. Objectives: To evaluate the prevalence of risk of REDs, the psychopathology of eating disorders, the availability of energy, the status of menstrual function and to determine independent factors predicting risk of REDs. Methods: This was a quantitative cross-sectional study of 92 female collegiate athletes (21.4±2.1 years) from five universities of Lahore. The Low Energy Availability in Females Questionnaire (LEAF-Q ≥ 8 = at risk), EDE-Q 6.0, and FHAM (structured questionnaire) were used to assess REDs risk, energy availability (EA), and menstrual function, respectively. Results: REDs risk prevalence was 54.3% (n = 50/92; 95% CI: 43.8–64.4%). The sport with the highest sport-specific prevalence was gymnastics (70.0%) followed by athletics (61.1%). The overall global mean was 2.18 ± 0.91 with 40.2% of these scores being above the clinical cut-off point of 2.3. The average EA was 33.8 ± 9.4 kcal/kg FFM/day (range: 14.2 – 56.8) and 39.1% were deemed to be in the critically low energy expenditure brackets (< 30 kcal/kg FFM/day), approximately following a normal distribution. A higher proportion of participants (38.0%) had irregular periods with this proportion being significantly higher in the athlete at risk group (χ² (1) = 21.84, p < 0.001). Logistic regression analyses revealed that EA (OR = 0.84), EDE-Q global score (OR = 3.84), menstrual irregularity (OR = 4.17), and aesthetic/endurance sport type (OR = 2.63) were independent significant factors (all p ≤ 0.027; Nagelkerke R² = 0.61). Conclusion: Female college students are at risk and have clinically significant prevalence of REDs in Lahore, Pakistan. The major risk determinants are eating disorder psychopathology, low energy availability, menstrual dysfunction and sport type.