Prevalence of New Zealand High School Athletes at Risk of Low Energy Availability using the LEANZ Questionnaire: A Feasibility Study

Abstract

Background: When energy intake is insufficient to cover the energy cost of exercise and physiological functioning, a state of Low Energy Availability (LEA) is entered. This has negative effects on an athlete’s health and performance, including bone health, menstrual function, immunity, and cardiovascular disease. High school athletes have been found to be at risk of LEA, however, the prevalence of adolescents at risk in New Zealand is unknown. Objective: The aims of this study are to determine if male and female New Zealand high school athletes are at risk of LEA, and provide information on the recruitment logistics and ease of collecting data from high school athletes. Design: Eligible participants aged 16 to 18 years (20 male, nine female) were recruited from high schools around New Zealand who engaged in at least 75 minutes of physical activity per week. Participants attended two clinic visits to provide blood, urine and saliva samples, and completed an anonymous online questionnaire containing 98 questions, including the Low Energy Availability in Females Questionnaire (LEAF-Q) and sections from the Eating Disorder Inventory (EDI-3). Between the clinic visits, participants completed a three-day weighed food record and wore an accelerometer. This study used participant’s LEAF-Q answers to classify them as at risk or not at risk of LEA. Results: For the high school athletes who completed the questionnaire, 43.5% were found to be at risk of LEA. Analysis of the food records and calculated energy expenditure resulted in 52.6% of those who completed the study estimated to be in a state of LEA. Conclusion: This study highlights that adolescent athletes in New Zealand are at risk of LEA. It also highlighted difficulties in accessing and obtaining data from high school athletes. Despite this, the results from this study support the notion that further research into LEA in this population is required, however, all data should be collected in the presence of researchers where possible, and timing of research around school activities needs to be carefully considered.