Low energy availability (LEA) describes a complex state of insufficient energy intake to support normal physiological function, after exercise energy expenditure has been accounted for. LEA is a common challenge in athletes and can stem from a range of causes. The aim of this study was to compare the occurence of disordered eating (DE) as well as other less studied traits, e.g. exercise addiction (EA) and muscle dysmorphia (MD), in Icelandic female athletes considered at risk of LEA vs not.

Elite and sub-elite female athletes (n=60, age 24.1±7.8) from various sport disciplines completed the Low Energy Availability in Female Questionnaire (LEAF-Q), Eating Disorder Examination – Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI), and Muscle Dysmorphic Disorder Inventory (MDDI).

Average total LEAF-Q score was 7.8±4.7 and 46.7% had a score ≥8 (considered at risk of LEA). According to the other questionnaires 20% were at risk for EA, 13.3% for MD and 11.7% for DE. Athletes at risk of LEA had higher EAI (21.6±3.5 vs 18.2±4.5, p=0.002), EDE-QS (8.6±6.9 vs. 4.5±5.5, p=0.014) and MDDI scores (31.9±7.6 vs. 27.1±7.5, p=0.017) compared to those not at risk. The proportion of athletes at risk of EA was higher in the group at risk of LEA vs not (32.1 vs 9.4%, p=0.023) but observed differences in MD (21.4% vs. 6.3%, p=0.084) and DE (17.9 vs. 6.3%, p=0.162) risk proportions were not significant.

The results provide evidence that exercise addiction and muscle dysmorphia, and associated health behaviors, are factors to consider when assessing risk of LEA.