Risk of low energy availability (LEA) in New Zealand national team and U20 female football representatives : a thesis presented in partial fulfilment of the requirements for the degree of Masters in Health Science (Sport and Exercise), Massey University, Albany, New Zealand

Background: The rates of low energy availability (LEA) seen among female footballers in collegiate, professional and youth environments range from 12% to 66%. Studies in female footballers are limited, and no research has yet looked at the prevalence of LEA in a cohort of international players. Due to the negative consequences associated with a state of LEA, research is needed for a more thorough investigation into possible prevalence rates and the associated risk factors of LEA within the international New Zealand female football environment. Objectives: Identify the number of national team and U20 female football players at risk of LEA in New Zealand, the factors (age, years training in national environment, nutrition knowledge, occupation) that increase the risk of LEA and the prevalent symptoms (sleep, mood, disordered eating) of those that are at risk of LEA. Methods: 22 members of the New Zealand U20 and full national women’s football teams (age 20.8 ± 3.5 years) participated in this study. Participants completed an online questionnaire that was composed of five independent validated surveys to assess LEA risk (LEAF-Q), eating disorders/disordered eating risk (EDE-Q), sleep quality (ASS-Q), nutrition knowledge (ASNK-Q) and mood (POMS-Q). Results: 59.1% (n = 13) of our participants were identified as being at risk of LEA. Players who reported menstrual disturbances (amenorrhea or oligomenorrhea) were 2.25 times more likely to be at risk of LEA than those who did not report a menstrual disturbance. Menstrual status was significantly associated with risk of LEA (R = -0.46, P = 0.030). Players at risk of LEA had significantly higher (p = 0.027) POMS-Q score’s (109.4 ± 24.4) than participants not at risk of LEA (89.0 ± 11.7). POMS-Q was significantly and positively associated with LEA score (r = 0.46, p = 0.032). Player’s spending >5 hours per week on non-football related training (gym, fitness, speed etc.) were 1.6 times more likely to be at risk of LEA compared to players who spent <5 hours on non-football related training. Players who were not full-time and had an additional occupation were 1.9 times more likely to be identified as being at risk of LEA compared to full-time players in the New Zealand squad. Players who had moderate and/or severe clinical sleep problems were 1.7 times more likely to be identified as being at risk of LEA, however the player’s sleep score was not predicative of LEA risk. There was no significant relationship between nutritional knowledge or disordered eating behaviours and risk of LEA. However, players who were identified as being at risk of LEA scored significantly higher on the negative mood subscales including anger (p < 0.001), depression (p < 0.001) and confusion (p = 0.037) compared to players who were not identified as being at risk of LEA. As a result, POMS-Q (p = 0.032) and menstrual status (p = 0.030) were the only two variables that showed significance in being able to predict the risk of LEA in our participant cohort. Conclusion: This study confirms that a significant proportion (59.1%) of players in the New Zealand national and U20 female football team are at risk of LEA. The positive and predictive relationship observed between mood disturbances, menstrual status and risk of LEA may suggest that regular monitoring of mood and menstrual cycle health could potentially be used for the early identification of LEA in national level female footballers in New Zealand