Date of Award

Spring 5-2023

Document Type


Degree Name

Master of Science (MS)

First Advisor

Simone P. Camel


Low bone mineral density is commonly found in female athletes and has been related to the energy adequacy and nutrient density of the athlete’s diet. Insufficient dietary energy intake and/or excessive energy expenditure can lead to low energy availability in female athletes, which has been shown to disrupt endocrine, metabolic, and physiological functions. Psychological distress in competitive athletes may affect dietary choices and patterns. To meet their personal or performance standards/goals, an athlete may go to extremes to achieve those standards/goals, including altering their dietary intake.

This study aimed to evaluate the nutrition-related factors affecting the bone health of collegiate female sports and performance athletes. Specifically, this study explored the associations between diet quality, bone health, low energy availability symptoms, and mental health risks. It was a cross-sectional study that obtained data from female athletes attending NCAA Division I programs in the state of Louisiana, with a subset group of female athletes attending Louisiana Tech University providing additional physical data (BMD measurements & InBody 770). The online questionnaire obtained data to examine diet quality (REAP-S), mental health as measured by the APSQ and BTPS-SF, low energy availability symptoms (LEAF), and bone fracture history. The participant sample included Louisiana Tech University female athletes (n = 44) and non-Louisiana Tech athletes (n = 52), for a total of 96 participants.

Approximately half (54.2%) were White and non-Hispanic and 31.3% were classified as freshmen. The majority (69%) of the female athletes were less than 10 years of age when they began participating in their chosen collegiate sport. Of the 17.1% of the athletes who reported vaping, 73.7% vaped occasionally; two (2.1%) participants stated that they smoked. From the APSQ, 43.5% of the female athletes experienced “very high distress” during their season, while 30.6% of the female athlete tested experienced “high distress”. Correlations from the total sample are: the subscales of the BTPS-SF significantly correlated r (79) = .551, p < .281 with each other, and the 3 subscales of the APSQ positively correlated with the total score of the APSQ, the correlation between the LEAF and the BTPS-SF subscale, Rigid Perfectionism, was significant and positive, r (81) = .305, p < .006, the LEAF questionnaire negatively correlated with the total score of the APSQ and the subscale, Self-Regulation, r (81) = .443, p < .001, the subscale of the APSQ, Self-Regulation, had a positive correlation with the subscale of the BTPS-SF, Rigid Perfectionism, r (82) = .270, p < .014, we found that both subscales correlated with the LEAF, and the total score of the APSQ and its subscales Self-Regulation and Performance has a significant positive correlation with the BTPS-SF subscale, Self-Critical Perfectionism, r (81) = .397, p < .001. The Louisiana Tech University female athletes had the physical measurements. Correlations were run for the sample with physical measurements and the following was found: The correlation between the APSQ and LEAF was significant and positive, r (42) = .245, p < .028, the category of the BTPS-SF, “rigid perfection,” was significant and positive to the SI, T, and Z scores, r (42) = .424, p <.005, Rigid perfectionism also had a significant positive correlation with the LEAF, r (42) = .305, p < 0.06, and there was a positive correlation between the total score of the APSQ and the “self-critical” category of the BTPS-SF, r (42) = .397, p < 0.01. An independent samples t-test was run to compare the diet quality and distress levels in those athletes with a bone fracture history to those without within the subset of Louisiana Tech female athletes (N = 42.. There was a difference between the fracture (M = 28.79, SD = 8.06) and non-fracture (M = 22.71, SD = 8.48) group for the APSQ, the athletes with a history of no fractures (M = 31.61, SD = 4.13) had a higher diet quality (M = 28.43, SD = 3.98) compared to the female athletes with a history of fractures and female athletes with a history of bone fractures (M = 4.18, SD = .59) had a higher average of rigid perfection (M = 3.57, SD = .96)than those with no history of bone fractures.

In summary, we found that mental health status risk was related to diet quality, low energy availability, and bone injury health frequency amongst female collegiate athletes. The more likely a female athlete is to strive to be perfect and is a harsh critic of herself, the higher the distress level of that individual. Nutritional professionals and athletic departments working with female athletes on their campus should consider all aspects of the athlete when treating them, such as mental health, diet quality, symptoms of low energy availability, and history of bone fractures.