Document Type

Thesis

Date of Degree Completion

Spring 2026

Degree Name

Master of Science (MS)

Department

Health Sciences

Committee Chair

Dr. Kelly Pritchett

Second Committee Member

Dr. Michelle Barrack

Third Committee Member

Dr. Robert Pritchett

Abstract

ABSTRACT

LOW ENERGY AVAILABILITY AND DIETARY FACTORS IN HIGH SCHOOL RUNNERS

By

Natalie Elizabeth Allik

June 2026

Context: Low energy availability (LEA) is associated with adverse health and performance outcomes in athletes and may be particularly concerning during adolescence when growth and bone development are ongoing. Although inadequate carbohydrate (CHO) intake has been proposed as a contributor to LEA, limited research has examined this relationship in adolescent endurance athletes. Objective: To examine dietary intake, bone mineral density (BMD), and eating disorder (ED) risk in adolescent distance runners with and without LEA. Methods: Eighteen adolescent distance runners (15.7 ± 1.2 years; 7 males, 11 females) completed baseline assessments including anthropometrics, dual-energy X-ray absorptiometry (DXA), a 24-hour dietary recall, the Athlete Nutrition Screening Survey (ANSS), and the Eating Disorder Examination Questionnaire (EDE-Q). Energy availability (EA) was calculated using dietary intake, estimated exercise energy expenditure, and DXA-derived fat-free mass. Participants were classified as LEA or adequate EA based on established EA thresholds. Results: Athletes with LEA reported significantly lower energy intake (1729.9 ± 681.8 vs. 2581.9 ± 530.5 kcal·day⁻¹, p = 0.035), CHO intake (215.5 ± 89.7 vs. 355.0 ± 119.8 g·day⁻¹, p = 0.020), CHO intake relative to body mass (3.66 ± 1.38 vs. 6.79 ± 2.29 g·kg⁻¹·day⁻¹, p = 0.004), fat intake relative to body mass (p = 0.015), and dietary fiber intake (p = 0.035). Iron, folate, zinc, and potassium intake were also lower in athletes with LEA (all p < 0.05). CHO intake relative to body mass demonstrated a strong positive association with EA (ρ = 0.845, p < 0.001) and independently predicted LEA status (OR = 0.329, 95% CI: 0.117–0.930, p = 0.036). No significant differences were observed in BMD or EDE-Q scores between groups. Conclusions: Lower CHO intake was strongly associated with LEA in adolescent distance runners and independently predicted LEA status. Athletes with LEA also demonstrated poorer overall nutrient adequacy, suggesting a pattern of underfueling rather than isolated nutrient deficiencies. These findings support the importance of adequate CHO intake and nutrition education in adolescent endurance athletes.

Keywords: low energy availability; carbohydrate intake; adolescent athletes; endurance running; relative energy deficiency in sport; bone mineral density

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