Association Between the Female Athlete Triad and Endothelial Dysfunction in Dancers

Objective: To determine the prevalence of the 3 components of the female athlete triad [disordered eating, menstrual dysfunction, low bone mineral density (BMD)] and their relationships with brachial artery flow-mediated dilation in professional dancers. Design: Prospective study. Setting: Academic institution in the Midwest. Participants: Twenty-two professional ballet dancers volunteered for this study. Interventions: The prevalence of the female athlete triad and its relationship to endothelial dysfunction. Main Outcome Measures: Subjects completed questionnaires to assess disordered eating and menstrual status/history. They also completed a 3-day food record and wore an accelerometer for 3 days to determine energy availability. Serum baseline thyrotropin, prolactin, and hormonal concentrations were obtained. Bone mineral density and body composition were measured with a GE Lunar Prodigy dual-energy X-ray absorptiometry. Endothelial function was determined as flow-mediated vasodilation measured by high-frequency ultrasound in the brachial artery. An increase in brachial diameter Results: Seventeen dancers (77%) had evidence of low/negative energy availability. Thirty-two percent had disordered eating (EDE-Q score). Thirty-six percent had menstrual dysfunction and 14% were currently using hormone contraception. Twenty-three percent had evidence of low bone density (Z-score \u3c -1.0). Sixty-four percent had abnormal brachial artery flow-mediated dilation ( Conclusions: Endothelial dysfunction was correlated with reduced BMD, menstrual dysfunction, and low serum estrogen. These findings may have profound implications for cardiovascular and bone health in professional women dancers

Urinary Perchlorate and Thyroid Hormone Levels in Adolescent and Adult Men and Women Living in the United States

BACKGROUND: Perchlorate is commonly found in the environment and known to inhibit thyroid function at high doses. Assessing the potential effect of low-level exposure to perchlorate on thyroid function is an area of ongoing research. OBJECTIVES: We evaluated the potential relationship between urinary levels of perchlorate and serum levels of thyroid stimulating hormone (TSH) and total thyroxine (T(4)) in 2,299 men and women, ≥ 12 years of age, participating in the National Health and Nutrition Examination Survey (NHANES) during 2001–2002. METHODS: We used multiple regression models of T(4) and TSH that included perchlorate and covariates known to be or likely to be associated with T(4) or TSH levels: age, race/ethnicity, body mass index, estrogen use, menopausal status, pregnancy status, premenarche status, serum C-reactive protein, serum albumin, serum cotinine, hours of fasting, urinary thiocyanate, urinary nitrate, and selected medication groups. RESULTS: Perchlorate was not a significant predictor of T(4) or TSH levels in men. For women overall, perchlorate was a significant predictor of both T(4) and TSH. For women with urinary iodine < 100 μg/L, perchlorate was a significant negative predictor of T(4) (p < 0.0001) and a positive predictor of TSH (p = 0.001). For women with urinary iodine ≥ 100 μg/L, perchlorate was a significant positive predictor of TSH (p = 0.025) but not T(4) (p = 0.550). CONCLUSIONS: These associations of perchlorate with T(4) and TSH are coherent in direction and independent of other variables known to affect thyroid function, but are present at perchlorate exposure levels that were unanticipated based on previous studies

Estimating body composition in adolescent sprint athletes : comparison of different methods in a 3 years longitudinal design

A recommended field method to assess body composition in adolescent sprint athletes is currently lacking. Existing methods developed for non-athletic adolescents were not longitudinally validated and do not take maturation status into account. This longitudinal study compared two field methods, i.e., a Bio Impedance Analysis (BIA) and a skinfold based equation, with underwater densitometry to track body fat percentage relative to years from age at peak height velocity in adolescent sprint athletes. In this study, adolescent sprint athletes (34 girls, 35 boys) were measured every 6 months during 3 years (age at start = 14.8 +/- 1.5yrs in girls and 14.7 +/- 1.9yrs in boys). Body fat percentage was estimated in 3 different ways: 1) using BIA with the TANITA TBF 410; 2) using a skinfold based equation; 3) using underwater densitometry which was considered as the reference method. Height for age since birth was used to estimate age at peak height velocity. Cross-sectional analyses were performed using repeated measures ANOVA and Pearson correlations between measurement methods at each occasion. Data were analyzed longitudinally using a multilevel cross-classified model with the PROC Mixed procedure. In boys, compared to underwater densitometry, the skinfold based formula revealed comparable values for body fatness during the study period whereas BIA showed a different pattern leading to an overestimation of body fatness starting from 4 years after age at peak height velocity. In girls, both the skinfold based formula and BIA overestimated body fatness across the whole range of years from peak height velocity. The skinfold based method appears to give an acceptable estimation of body composition during growth as compared to underwater densitometry in male adolescent sprinters. In girls, caution is warranted when interpreting estimations of body fatness by both BIA and a skinfold based formula since both methods tend to give an overestimation

Reproductive dysfunction and associated pathology in women undergoing military training

Evidence from civilian athletes raises the question of whether reproductive dysfunction may be seen in female soldiers as a result of military training. Such reproductive dysfunction consists of impaired ovulation with or without long term subfertility. We critically review pertinent evidence, which points towards reduced energy availability as the most likely explanation for exercise-induced reproductive dysfunction. Evidence also suggests reproductive dysfunction is mediated by activation of the hypothalamic-pituitary-adrenal axis and suppression of the hypothalamic-pituitary-gonadal axis, with elevated ghrelin and reduced leptin likely to play an important role. The observed reproductive dysfunction exists as part of a female athletic triad, together with osteopenia and disordered eating. If this phenomenon was shown to exist with UK military training this would be of significant concern. We hypothesise that the nature of military training and possibly field exercises may contribute to greater risk of reproductive dysfunction among female military trainees compared with exercising civilian controls. We discuss the features of military training and its participants, such as energy availability, age at recruitment, body phenotype, type of physical training, psychogenic stressors, altered sleep pattern and elemental exposure as contributors to reproductive dysfunction. We identify lines of future research to more fully characterise reproductive dysfunction in military women, and suggest possible interventions which, if indicated, could improve their future wellbeing

Nutrition Strategies for Triathlon

Contemporary sports nutrition guidelines recommend that each athlete develop a personalised, periodised and practical approach to eating that allows him or her to train hard, recover and adapt optimally, stay free of illness and injury and compete at their best at peak races. Competitive triathletes undertake a heavy training programme to prepare for three different sports while undertaking races varying in duration from 20 min to 10 h. The everyday diet should be adequate in energy availability, provide CHO in varying amounts and timing around workouts according to the benefits of training with low or high CHO availability and spread high-quality protein over the day to maximise the adaptive response to each session. Race nutrition requires a targeted and well-practised plan that maintains fuel and hydration goals over the duration of the specific event, according to the opportunities provided by the race and other challenges, such as a hot environment. Supplements and sports foods can make a small contribution to a sports nutrition plan, when medical supplements are used under supervision to prevent/treat nutrient deficiencies (e.g. iron or vitamin D) or when sports foods provide a convenient source of nutrients when it is impractical to eat whole foods. Finally, a few evidence-based performance supplements may contribute to optimal race performance when used according to best practice protocols to suit the triathlete’s goals and individual responsiveness

Recreational Female CrossFit Athletes and Low Energy Availability

CrossFit is a demanding sport in which athletes perform constantly varied, functional movements at a high intensity, therefore requiring an adequate energy availability to avoid negative health and performance consequences. The purpose of this study was to assess risk of low energy availability (low EA) (phase 1) among recreational, female CrossFit athletes and measure and calculate energy availability using a 7-day dietary to measure energy intake (EI) and exercise energy expenditure (ExEE) (phase 2). In phase 1, using the LEAF-Q (Low Energy Availability in Females Questionnaire), 49% of survey respondents (n=149) were found to be at risk of low EA. Of the 167 participants interested in phase 2 per the survey in phase 1, 83 completed at least one day of the EI and ExEE record, and 67 completed all 7 days. The athletes in phase 2 did not meet EI recommendations set forth by the International Society of Sports Nutrition (ISSN), 30% of participants were below 30 kcals.kgFFM-1.d-1, and the average energy availability among participants was 34.1 ± 12.3 kcals.kgFFM-1.d-1. EA was correlated to ExEE, EI, and carbohydrate and fat intake. Currently, CrossFit nutrition recommendations fall short when compared to those of the ISSN. CrossFit athletes and coaches should become familiar with the signs, symptoms, and implications of low EA and its resulting syndrome, RED-S (Relative Energy Deficiency in Sport)

Disponibilidad de energía, disfunción menstrual y salud ósea en el deporte: una revisión de la tríada de la atleta femenina

[EN] Introduction: The female athlete triad (FAT) is a serious health-related problem that threatens women who exercise. This condition is an interrelated multifactorial syndrome which includes low energy availability, menstrual cycle disturbances and decreased bone mineral density. Objective: To review the major components of the FAT and their relationships, as well as strategies for diagnosis and treatment. Methods: Articles related to the topic were reviewed through PubMed and SportDiscus databases. Results: Interrelationship between components of the FAT may result in clinical manifestations, including eating disorders, amenorrhea and osteoporosis. Clinical conditions are not always exhibited simultaneously. Prevention is important to minimize complications. Diagnosis and treatment is complicated and often must involve an interdisciplinary therapeutic approach. Conclusions: Understanding of the disease may be facilitated by a unified framework focusing on energy deficiency. Preventive or early interventions require to increase energy availability through a higher total energy intake or a decrease in energy expenditure trough excessive physical exercise. A healthy lifestyle, and support by parents and coaches should be included. Psychotherapy may be necessary when eating disorders are present.[ES] Introducción: La tríada de la atleta femenina es un importante problema de salud que amenaza a las mujeres que practican ejercicio. Este trastorno constituye un síndrome multifactorial e interrelacionado que incluye una baja disponibilidad de energía, alteraciones del ciclo menstrual y disminución de la densidad mineral ósea. Objetivo: Revisar los componentes de la tríada de la atleta femenina y sus interacciones, así como las estrategias de diagnóstico y tratamiento. Métodos: Se revisaron artículos relacionados con el tema en las bases de datos Pubmed y Sportdiscus. Resultados: La interrelación entre los componentes de la tríada de la atleta femenina puede resultar en manifestaciones clínicas, que incluyen trastornos de la conducta alimentaria, amenorrea y osteoporosis. Estas manifestaciones no siempre se presentan de forma simultánea. La prevención es importante para minimizar las complicaciones. El diagnostico y el tratamiento son complicados y pueden requerir a menudo un abordaje terapéutico multidisciplinar. Conclusiones: El conocimiento de la enfermedad puede facilitarse por el desarrollo de un marco unificado centrado en la deficiencia de energía. Las intervenciones preventivas y tempranas requieren un incremento de la disponibilidad de energía a través de un mayor aporte energético o una reducción del gasto asociado a un ejercicio físico excesivo. Debe incluirse un estilo de vida saludable y el apoyo por parte de padres y entrenadores. La psicoterapia puede ser necesaria si se presentan trastornos alimentarios.S

The female athlete triad in student track and field athletes

Objectives: To explore the female athlete triad components in university track and field athletes, as well as calculate estimated energy availability.Design: Cross-sectional descriptive study design.Setting and subjects: Sixteen volunteer, white, female track and field athletes were recruited from North-West University.Outcome measures: Athletes completed a demographic, health and sport questionnaire; pathogenic body weight control questionnaire; menstrual history questionnaire; four 24-hour dietary recalls and one three-day diet and exercise record form. Body composition and bone mineral density (BMD) were assessed with dual energy X-ray absorptiometry. The bulimia, drive for thinness and body dissatisfaction subscales of the Eating Disorder Inventory, and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire, was used to measure disordered eating behaviour. Estimated energy availability was calculated using a three-day dietary and exercise record form completed by the athlete on three heavy training days.Results: In the total group, 25% had menstrual pattern changes, 62.5% disordered eating behaviour, 73.3% (11/15) low estimated energy availability, and 12.5% reported stress fractures during the past two years. The average estimated energy availability was 18.5 (14.1-40.9) kcal/kg fat-free mass/day. Diet or fat-burning pills were the most popular pathogenic weight-control measures used by 37.5% athletes. Athletes with menstrual pattern changes had lower spine [1.043 (0.975-1.059) vs. 1.166 (1.090-1.234) g/cm2, p-value = 0.043] and femoral neck [0.905 ± 0.045 vs. 1.025 ± 0.027 g/cm2, p-value = 0.042) BMD. Altogether, 87.5% athletes presented with various components of.Conclusion: More than two thirds of this group of student track and field athletes had low estimated energy availability and more than three quarters were classified with various combinations of the components of the female athlete triad.Keywords: disordered eating, bone mineral density, energy availability, menstrual cycl

THE FEMALE ATHLETE TRIAD

Prepoznajući pozitivne strane redovite tjelesne aktivnosti, Američko društvo za sportsku medicinu (ACSM) potiče djevojke i žene da se uključe u razne sportske aktivnosti radi očuvanja i unaprjeđenja zdravlja. No, 1992. godine u sportovima koje naglašavaju vitku građu tijela prepoznat je skup međusobno povezanih kliničkih entiteta uključujući amenoreju, poremećaj hranjenja i osteoporozu koji je kasnije definiran kao trijas sportašica. Iako postoji puno radova na temu trijasa sportašica, relativno je malen broj članaka koji donose rezultate u svjetlu novih stajališta o pojedinim dijelovima trijasa sportašica. Upravo je zato cilj ovog rada iznijeti nove smjerniceAmeričkog društva za sportsku medicinu i Međunarodnog društva za kliničku denzitometriju (ISCD) kojima je revidiran pojam trijasa sportašica. Trenutno poimanje trijasa sportašica predstavlja međusobno povezane pojmove raspoložive energije, menstruacijskog ciklusa i mineralne gustoće kostiju koji se klinički manifestiraju od blažih poremećaja do izrazito teških stanja kao što su poremećaji hranjenja, amenoreja i osteoporoza. Kao glavni pokretač Trijasa smatra se nepravilna prilagodba prehrambenih navika u ovisnosti o trajanju i intenzitetu tjelesne aktivnosti ne samo kod sportašica nego i kod osoba koje se rekreativno bave sportom. U ovom članku donosimo pregled epidemiologije, kliničke slike te metoda dijagnosticiranja i mogućnosti liječenja trijasa sportašica kao i njegovih pojedinih komponenti. Posebno se razmatra i mogućnost postojanja sličnih poremećaja kod muškaraca.Recognizing the positive sides of exercising on a regular basis, the American College of Sports Medicine (ACSM) encourages girls and women to engage in various sport activities to preserve and improve their health. However, in 1992 in sports that emphasize a slim body figure, an association of symptoms including amenorrhea, eating disorders and osteoporosis was recognized. Later it was defined as the Female athlete triad. Although there is a large amount of articles on this subject, a relatively small number of articles bring results on the new points of view of certain parts of the Female athlete triad. That is why the goal of this article is to introduce new guidelines from the American College of Sports and the International Society for Clinical Densitometry (ISCD) which changed the concept of the Female athlete triad. The current comprehension of the Female athlete triad is presented as related notions of available energy, menstrual cycle and bone mineral density which clinically manifest from mild disorders to severe conditions such as eating disorder, amenorrhea and osteoporosis. The main trigger of the Triad is considered to be irregular adjustment of eating habits due to the length and intensity of the physical activity, not only in professional athletes but also in amateurs. In this article we also discuss the epidemiology, clinical picture, diagnostic methods and therapy options of the Female athlete triad and all of its components. Finally, the possibility that a similar association of disorders exists in male athletes will also be discussed