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Female soccer players have been identified as presenting with low energy availability (LEA), though the prevalence of LEA may be overestimated given inaccuracies associated with self‐reporting dietary intakes. Accordingly, we aimed to quantify total daily energy expenditure (TDEE) via the doubly labelled water (DLW) method, energy intake (EI) and energy availability (EA). Adolescent female soccer players (n = 45; 16 ± 1 years) completed a 9–10 day ‘training camp’ representing their national team. Absolute and relative TDEE was 2683 ± 324 and 60 ± 7 kcal kg−1 fat free mass (FFM), respectively. Mean daily EI was lower (P < 0.01) when players self‐reported using the remote food photography method (RFPM) (2047 ± 383 kcal day−1) over a 3‐day period versus DLW derived EI estimates accounting for body mass (BM) changes (2545 ± 518 kcal day−1) over 7–8 days, representing a mean daily Δ of 499 ± 526 kcal day−1 and 22% error when using the RFPM. Estimated EA was different (P < 0.01) between methods (DLW: 48 ± 14 kcal kg−1 FFM, range: 22–82; RFPM: 37 ± 8 kcal kg−1 FFM, range: 22–54), such that prevalence of LEA (<30 kcal kg−1 FFM) was lower in DLW compared with RFPM (5% vs. 15%, respectively). Data demonstrate the potential to significantly underestimate EI when using self‐report methods. This approach can therefore cause a misrepresentation and an over‐prevalence of LEA, which is the underlying aetiology of ‘relative energy deficiency in sport’ (REDs). What is the central question of this study? Do self‐reported dietary intakes (via remote food photography method, RFPM) overestimate low energy availability (LEA) prevalence in female soccer players compared with energy intake evaluation from the doubly labelled water (DLW) method? What is the main finding and its importance? Estimated energy availability is greater with the DLW method compared with RFPM, such that the prevalence of LEA is greater when self‐reporting dietary intakes. Accordingly, data demonstrate the potential to misrepresent the prevalence of LEA, an underlying factor in the aetiology of ‘relative energy deficiency in sport’ (REDs).

Previous studies demonstrate that “under-fuelling” (i.e., reduced carbohydrate (CHO) and energy intake (EI) in relation to recommended guidelines) is prevalent within adult female soccer players, the consequence of which may have acute performance and chronic health implications. However, the dietary practices of adolescent female soccer players, a population who may be particularly at risk for the negative aspects of low energy availability (LEA), are not well documented. Accordingly, we aimed to quantify EI and CHO intake, physical loading and estimated energy availability (EA) in elite national team adolescent female soccer players (n = twenty-three; age, 17.9 ± 0.5 years) during a 10-day training and game schedule comprising two match days on day six (MDa) and nine (MDb). The players self-reported their EI via the remote food photography method, whilst the physical loading and associated exercise energy expenditure were assessed via GPS technology. The relative CHO intake was significantly greater (all p < 0.05) on the day before the first match (MD-1a) (4.1 ± 0.8 g·kg−1), on the day before the second match (MD-1b) (4.3 ± 1.1 g·kg−1), MDa (4.8 ± 1.2 g·kg−1) and MDb (4.8 ± 1.4 g·kg−1) in comparison to most other days (<4 g·kg−1). The mean daily measured EA over the 10-day period was 34 ± 12 kcal·kg FFM−1·day−1 (with six players, i.e., 34%, presenting LEA), though, when adjusting the energy intake for potential under-reporting, these values changed substantially (44 ± 14 kcal·kg FFM−1·day−1, only one player was classed as presenting LEA). Such data suggest that the prevalence of LEA amongst female team sport athletes may be over-estimated. Nonetheless, players are still likely under-fuelling for the work required in relation to the daily CHO recommendations (i.e., >6 g·kg−1) for intensive training and game schedules. These data provide further evidence for the requirement to create and deliver targeted player and stakeholder education and behaviour change interventions (especially for younger athletes) that aim to promote increased daily CHO intake in female soccer players.

It has been recommended that women aged 40–49 years with a significant family history of breast cancer should be offered annual mammography screening (http://www.nice.org.uk). An observational study known as FH01 (http://www.screeningservices.org/btw/fh01/index.asp) is evaluating this policy in a cohort of 6000 women at moderately increased risk of breast cancer due to family history. The main aims are to assess the likely impact on breast cancer mortality and cost-effectiveness. Measuring these outcomes is challenging in an environment where a randomized trial is not feasible and there is no natural comparison group. In this paper, we present some approaches to estimating effectiveness and the planned analyses. These involve comparison of disease stage and likely consequent breast cancer mortality in the cohort offered screening with that estimated in the absence of screening. The estimation uses observed outcomes in external populations and estimated outcomes for the hypothetical situation where screening had not taken place.