Low energy availability, often abbreviated as LEA, was widespread among university athletes in a review, with estimates ranging from 41.7% to 100% across the studies examined. The review also found a consistent overlap with disordered-eating indicators, especially cognitive dietary restraint, or persistent efforts to limit food, and drive for thinness. The evidence cannot show whether LEA leads to these problems or the other way around.
The review included 18 studies. Seventeen were cross-sectional, a design that takes a snapshot at one point in time, while one was a prospective cohort study that follows participants over time. Because most of the evidence came from snapshots rather than long-term tracking, the authors could not determine whether LEA came before disordered eating, anxiety or depression, or whether those problems helped lead to it.
The researchers searched SPORTDiscus, Embase, PsychInfo and Medline from inception to May 2024, then updated the search in July 2025. They included studies linking validated mental-health symptom measures with LEA in university athletes.
The numbers varied by sport and measure
LEA was not identified by one common test. Six studies measured energy availability directly, while other studies relied on recognised indicators such as menstrual dysfunction, bone density or injury, or male hormone and sex-drive measures. Among the direct measures, reported prevalence ranged from 40% in soccer players to 100% in cheerleaders, showing how widely the figures varied by sport and method.
The clearest recurring association involved disordered eating. Across the included research, LEA generally co-occurred with disordered-eating risk, with cognitive dietary restraint and drive for thinness repeatedly appearing as key correlates. That finding identifies a pattern shared by the studies, but it does not establish a one-way pathway.
Menstrual dysfunction showed a similar link. Four studies reported significant associations between menstrual dysfunction and disordered-eating risk. One study found higher average scores among athletes with dysfunction than among those without, 17.0 compared with 11.9. The review treats the result as an association, not evidence that either condition caused the other.
Bone findings were more restrained. Disordered-eating symptoms were associated with modest reductions in bone mineral density, a measure of bone mineral content, while severe impairment appeared uncommon in the university-athlete samples studied. Results varied depending on the bone site examined.
The mental-health signal was smaller
Anxiety and depression received much less attention. Three studies examined anxiety and two examined depression, providing preliminary indications of increased prevalence with LEA. The review therefore offers an early warning signal rather than a precise measure of how common either condition is among university athletes.
The review rated the included studies from 6.5 to 8.5 out of 9, describing them as moderate to high quality. But identifying and managing confounding factors, variables that can blur an apparent relationship, were common weaknesses. The evidence base was also concentrated in the United States, where 11 studies were conducted, and the samples mainly comprised women in their late teens and early twenties.
A snapshot, not a timeline
The review's main uncertainty is the direction of the relationship. Its predominantly cross-sectional evidence could not establish whether prolonged LEA preceded disordered eating, anxiety or depression, whether mental-health symptoms preceded LEA, or whether the relationship could run in both directions. The review describes study-level associations and prevalence estimates rather than a pooled effect.
During screening, two reviewers independently examined the first 20% of records and 20% of potentially eligible full texts, resolving disagreements by consensus. One reviewer screened the remaining 80% of records. The review was prospectively registered with PROSPERO in March 2024 under registration number CRD42024513490 and was published online on 21 August 2026.
Paper data and sources
Original title: Exploring the associations between low energy availability and mental health among university athletes: A systematic literature review.
Authors: Siobhan Hegarty, Felicia Ovin, Nicola Keay et al.
Journal/Repository: Journal of sports sciences
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1080/02640414.2026.2717966
Original paper · Full text