Table 4

Screening the athlete: ABCDE Assessment

ABCDE AssessmentMeasuresComments
Anthropometric
  • ▸ Stature

  • ▸ Sitting height

  • ▸ Body mass

  • ▸ Body composition

  • ▸ Girth and breadths

  • ▸ BMI

  • ▸ MI

Valid and reliable methods of body composition should be sought (eg, DXA, skinfold assessment using the ISAK standards; 4-component models assessing fat, fat-free and lean tissue mass and total body water; measurement of hydration status using urine specific gravity recommended for all anthropometric assessments)
Careful reflection is required to ascertain whether assessment of body mass and composition may trigger more problems
BMI and MI are measures (indices) for ‘relative body weight’ (ponderosity), but not for body composition
Biochemical
  • ▸ Complete blood count

  • ▸ Complete metabolic panel

  • ▸ Lipid panel

  • ▸ Iron profile

  • ▸ Thyroid function (eg, TSH and T3)

  • ▸ Oestradiol, testosterone, progesterone, prolactin, LH and FSH

  • ▸ Cortisol

  • ▸ 25 (OH) Vitamin D

  • ▸ Urine analysis

  • ▸ Pregnancy test

In females with menstrual dysfunction, prolactin needs to be assessed to rule out pituitary tumour; if ovarian cysts and oligomenorrhoea, androgens should be assessed57
Oestradiol and testosterone should be included in men and women athletes
Clinical
  • ▸ History

  • ▸ Physical examination

  • ▸ Medications

  • ▸ Dietary supplements

Medical history should include DE and EDs. If this is a preparticipation physical examination, then include a general medical history, including menstrual history/status, bone health, history of stress fracture and other injuries, osteoporosis. Screening for DE and EDs with screening tools and/or clinical interview and identification of physical signs and symptoms (see tables 1 and 2)
Dietary
  • ▸ Quantity

  • ▸ Quality

  • ▸ Timing

Energy intake, energy density; macronutrients (expressed in g/kg/d) and micronutrients, fluid balance and hydration (including sweat rate), food restrictions, allergies, intolerance; scary foods; nutrient and fluid timing; carbohydrate availability during intense training; carbohydrate and fibre related to appetite; recovery nutrition; competition preparation and fuelling, travel nutrition and appetite issues during travel or intense training
Dietary assessment methods: consider validity and reliability,58 as well as additional burden and stress on athletes with DE/ED when using diaries and food logs
Energy availability, including the assessment of energy expenditure (see below)
Environmental
  • ▸ Energy expenditure

  • ▸ Annual training plan and peaking

  • ▸ Environmental factors such as cold, heat and altitude

  • ▸ Culture of sport

  • ▸ Travel

  • ▸ Work/school

  • ▸ Family/home

  • ▸ Experience in sports

Total daily energy expenditure, including resting metabolic rate, spontaneous physical activity, exercise energy expenditure; evaluation of training/competition plan in discussion with coach; consideration of environmental factors (eg, training at altitude); leanness/non-leanness sport; countries at risk for inadequate food access and food safety concerns; work/school schedules and time for food preparation, eating, recovery; level of athlete and experience
  • ABCDE, Anthropometric, Biochemical, Clinical, Dietary and Environmental; BMI, body mass index; DE, disordered eating; DXA, dual energy e-ray absorptiometry; EDs, eating disorders; FSH, follicle stimulating hormone; ISAK, International Society for the Advancement of Kinanthropometry; LH, luteinising hormone; MI, mass index; TSH, thyroid stimulating hormone.