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"It's something that's probably often overlooked,'' Dr Black, of the University of Otago human nutrition department, said yesterday.
Dr Black was the first of three authors in a recent collaborative study which pointed out that poor nutrition could "negatively affect everything from bone to reproductive health''.
Accordingly, more attention should be paid to the specific nutritional needs of female athletes, she said.
"Coaches, parents and athletes need to be aware of signs of low energy intakes, such as increased injury or illness, and seek advice where needed,'' she said.
Dr Black and colleagues from Waikato University and High Performance Sport New Zealand, Dr Stacy Sims and Dane Baker, respectively, undertook a literature review about low energy availability (LEA).
LEA is when available energy in the body is too low for best physiological functioning, leading to altered hormonal profiles and eventually "total loss of menstruation''.
LEA had "significant negative impacts on bone, endocrine, immunological, cardiovascular, gastrointestinal, reproductive, and psychological health'', and caused long-term decreases in athletic performance, the study said.
"The focus of LEA research and practice should be on prevention instead of prevalence -start early and develop good nutrition, training and body image habits to carry through.''
The researchers' findings, just published in the US-based Strength and Conditioning Journal, show reported prevalence of LEA varies from 2% (club level endurance athletes) to 77% (professional ballet dancers).
Despite the "severe negative health and performance consequences'', awareness of LEA was "pretty low''.
Athletes and coaches could avoid LEA by understanding the different nutrient requirements across stages of the menstrual cycle; promoting recovery by eating after exercising; and optimising energy-dense foods and promoting liquid-based recovery options.
One way the industry was helping educate on this issue was via High Performance Sport New Zealand's Women's Health in Sport: A Performance Advantage project, she said.