Title: Low Energy Availability Association with Food Insecurity Within High School Athletes in Underserved Communities in Los Angeles

Authors: Michael Hernandez, MS IV; Shahrzad Bazargan-Hejazi, PhD CDU Professor of Medical Sociology; Kevin Diaz, MD UCLA-Harbor Sports Medicine Fellow

Background: Proper nutrition for sports and physical activity has been a focal point of athlete health. The term Female Athlete Triad helped describe physically active women who presented with disordered eating, amenorrhea, and osteoporosis. However, the term Relative Energy Deficiency in Sport (RED-S) is now used to capture wider health consequences secondary to low energy availability (LEA). Low Energy Availability in Females Questionnaire (LEAF-Q) has been used to assess LEA. Although the prevalence of disordered eating behavior can tend to be high among those who are screened using the questionnaire, inadequate food availability, including food insecurity (FI) may also contribute to low energy availability. In 2015, 30% of households living in Los Angeles County, reported to be food insecure.

Objective(s): The purpose of this observational study is to evaluate a possible association between food insecurity and low energy availability among high school female athletes within underserved Los Angeles communities. Our hypothesis is that there will be a statistically significant association between food insecurity and low energy availability, controlling for confounding variables. To our knowledge, there are no other studies that look directly into food insecurity as a contributing factor to low energy availability within high school athletes.

Methods: Administration of a 33-item survey that includes the LEAF-Q and Hunger Vital Sign (HVS) to adolescent female athletes. FI (primary predictor variable) measured using the HVS while LEA (primary outcome variable) is measured by LEAF-Q. Linear and adjusted logistic regression models will be used for data analysis.

Results: The COVID-19 pandemic has significantly impacted study progression. Data is currently being collected.

Conclusions: The information gathered from this study could potentially guide clinicians on when to screen at risk female athletes for LEA and provide further resources to help minimize the negative health effects that stem from food insecurity.