Context: Low energy availability, disordered eating, and/or compulsive exercise behaviors may negatively affect health-related quality of life (HRQOL), and this has not been studied specifically in adolescent athletes. Objective: Assess the correlations of HRQOL with energy availability, disordered eating, and compulsive exercise in adolescent athletes. Design: Cross-sectional study. Setting: A single sports medicine center and local athletic partnerships. Patients or Other Participants: Thirteen- to 18-year-old male and female athletes who were actively engaged in at least 1 organized sports team at the time of study participation. Main Outcome Measure(s): Participants completed the Pediatric Quality of Life Inventory (PedsQL), the Eating Disorder Examination Questionnaire, the Compulsive Exercise Test, and 7 days of exercise monitoring (via wrist-worn heart rate activity monitor) and dietary intake reporting to assess energy availability. Results: Sixty-four participants (n = 39 female, mean age = 15.5 ± 1.5 years) completed the study. There were no significant associations between energy availability (ß = -0.07; 95% CI = -0.32, 0.19; P = .56) or Compulsive Exercise Test scores (ß = -0.28; 95% CI = -1.28, 0.72; P = .58) and PedsQL scores, but there was a significant association between Eating Disorder Examination Questionnaire scores (ß = -4.78; 95% CI = -8.53, -0.76; P = .01) and PedsQL scores, after adjusting for participant sex. We observed a significant association between female sex and lower PedsQL scores (ß = -6.43; 95% CI = -12.1, -0.76; P = .03). Conclusions: Adolescent athletes who reported more significant disordered eating behaviors demonstrated worse HRQOL. Female athletes reported worse HRQOL overall compared with male athletes. This highlights the importance of screening and early intervention for disordered eating behaviors to prevent the potential negative impact on HRQOL, as well as the consideration of sex-specific differences regarding HRQOL in adolescent athletes. Key Points More significant disordered eating behaviors, even at a subclinical level, were associated with worse health-related quality of life in male and female adolescent athletes. Clinicians who work with adolescent athletes should be aware of the negative impact disordered eating can have on health-related quality of life, emphasizing the importance of screening and early intervention for disordered eating behaviors in athletes.
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