2011 September | Female Athlete Triad Coalition

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Prevalence of the Female Athlete Triad Syndrome Among High School Athletes

Jeanne F. Nichols, PhD; Mitchell J. Rauh, PhD, PT, MPH; Mandra J. Lawson, MS, RD; Ming Ji, PhD; Hava-Shoshana Barkai, MS. Arch Pediatr Adolesc Med. 2006; 160:137-142

As of recent years, most literature surrounding the female athlete triad subsisted solely in collegiate female athletes. Data regarding high school-aged athletic females was severely lacking. In 2006, Nichols et al performed an observational cross-sectional study to estimate the prevalence of the female athlete triad among high school athletes. One-hundred-seventy female athletes representing eight sports from six high schools in southern California were included in the analysis to determine prevalence of the three aspects of the triad: disordered eating, menstrual status and bone health. Disordered eating and menstrual status were determined by interviewer-assisted questionnaires. Bone mineral density was determined via dual-energy x-ray absorptiometry (DXA) at the spine (L1-L4), hip and total body. Among athletes, 18.2% met criteria for disordered eating, 23.5% met criteria for menstrual irregularity and 21.8% met criteria for low bone mass. Ten of the 170 girls studied (5.9%) met criteria for 2 of the 3 components of the triad and 2 girls (1.2%) met criteria for all 3. In comparison to eumenorrheic athletes (regular menstrual cycles), oligomenorrheic (cycle length of 36-90 days) and amenorrheic (no menses for ≥ 90 days) athletes presented with high dietary restraint (the ability to restrict food intake) and Eating Disorder Examination Questionnaire global scores. As well, in comparison to eumenorrheic athletes, and after controlling for age, age at menarche, BMI, race/ethnicity and sport type, athletes with oligomenorrhea/amenorrhea had lower bone mineral densities at the trochanter (hip). In conclusion, the prevalence of the female athlete triad in high school-aged female athletes showed to be substantial illustrating that these women are at risk for one or more of the components of the triad. Long-term health consequences may be associated with the disordered eating, menstrual irregularities and poor bone health seen in this population. Preparticipation screening to identify these components should be encouraged as a preventive approach to identify high-risk athletes.

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Energy balance in weight stable athletes with and without menstrual disorders

September 2011

S. E. Tomten, A. T. Høstmark in Scand J Med Sci Sports 2006: 16:127–133

Exercising female athletes create an energy deficit with exercise for which they require an increase in energy intake to match expenditure and remain in a state of energy balance. However, reported daily intake is often similar to, or even lower than sedentary women; which creates an energy deficit leading to menstrual dysfunction and related complications such as poor bone health. In a study by Tomten and Hostmark, energy balance, nutritional intake, training activity and total energy expenditure were assessed in female athletes both with and without menstrual dysfunction. Energy balance and nutritional adequacy were assessed in a group of runners with irregular menstrual function (IR, n=10) as well as a group of runners with normal menstrual function (R, n=10). Daily training-related excess energy expenditure and total energy expenditure (TEE) were not different between groups. Daily energy intake (EI) was, however, significantly lower in IR athletes than in the R athletes. EI and TEE were in balance in R athletes; however, a significant negative energy balance was observed in IR athletes. The energy deficit observed in the IR athletes was corroborated by significantly lower levels of free thyroxine in IR athletes, which may indicate a depressed BMR in IR athletes. Mean intakes of carbohydrates and protein were close to recommended guidelines and were not significantly different between groups. The key difference in macronutrient intake was observed in dietary fat that was significantly lower in the IR athletes. Though all athletes were weight stable, an energy deficit was observed in IR athletes, and not in R athletes, primarily due to a lower intake of dietary fat. Fear of gaining weight has been widely accepted as a probable cause for a sub-optimal EI in athletes who depend on a low body mass for success. Decreasing dietary fat intake has been one method by which female athletes lower their EI to maintain low body weights. They may be reluctant to increase food intake in fear of a possible weight gain, even though a higher EI may seem to improve the reproductive function, it may also increase body weight and fat mass.