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Allaway HCM, Koehler K, Mallinson RJ, Southmayd EA, De Souza MJ, Williams NI. Low Resting Metabolic Rate in Exercise-Associated Amenorrhea is not Due to a Reduced Proportion of Energetically Expensive Tissue Compartments. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000488261.11508.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mallinson RJ, Williams NI, Gibbs JC, Koehler K, Allaway HC, Southmayd EA, De Souza MJ. Cumulative Menstrual Status is an Important Determinant of Femoral Neck Geometry in Exercising Women. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486475.47478.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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78
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Koehler K, Hoerner NR, Gibbs JC, Zinner C, Braun H, De Souza MJ, Schaenzer W. Low energy availability in exercising men is associated with reduced leptin and insulin but not with changes in other metabolic hormones. J Sports Sci 2016; 34:1921-9. [PMID: 26852783 DOI: 10.1080/02640414.2016.1142109] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Low energy availability, defined as low caloric intake relative to exercise energy expenditure, has been linked to endocrine alterations frequently observed in chronically energy-deficient exercising women. Our goal was to determine the endocrine effects of low energy availability in exercising men. Six exercising men (VO2peak: 49.3 ± 2.4 ml · kg(-1) · min(-1)) underwent two conditions of low energy availability (15 kcal · kg(-1) fat-free mass [FFM] · day(-1)) and two energy-balanced conditions (40 kcal · kg(-1) FFM · day(-1)) in randomised order. During one low energy availability and one balanced condition, participants exercised to expend 15 kcal · kg(-1) FFM · day(-1); no exercise was conducted during the other two conditions. Metabolic hormones were assessed before and after each 4-day period. Following both low energy availability conditions, leptin (-53% to -56%) and insulin (-34% to -38%) were reduced (P < 0.05). Reductions in leptin and insulin were independent of whether low energy availability was attained with or without exercise (P > 0.80). Low energy availability did not significantly impact ghrelin, triiodothyronine, testosterone and IGF-1 (all P > 0.05). The observed reductions in leptin and insulin were in the same magnitude as changes previously reported in sedentary women. Further research is needed to understand why other metabolic hormones are more robust against low energy availability in exercising men than those in sedentary and exercising women.
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Li DX, Romans S, De Souza MJ, Murray B, Einstein G. Actigraphic and self-reported sleep quality in women: associations with ovarian hormones and mood. Sleep Med 2015; 16:1217-24. [DOI: 10.1016/j.sleep.2015.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/23/2015] [Indexed: 01/18/2023]
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80
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Lieberman J, De Souza MJ, Koehler K, Williams NI. Exercise Associated Menstrual Disturbances Are Less Likely With Increasing Gynecological Age. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000476397.67335.af] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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81
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Allaway HCM, Williams NI, Gibbs JC, De Souza MJ. The Effect of Energy Status on Distance Running Performance Across a Competitive Season in Female Cross-country Runners. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000476391.36841.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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82
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Metzger CE, Swift S, Baek K, De Souza MJ, Bloomfield SA. Fat and Lean Mass Predict Total Body Bone Mineral Content during Energy Restriction with Exercise. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477562.20283.f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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83
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Southmayd EA, Mallinson RJ, Williams NI, De Souza MJ. Leptin is a Predictor of Volumetric Bone Density in Exercising Women. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478412.62449.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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84
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Hergenroeder AC, De Souza MJ, Anding RH. The Female Athlete Triad: Energy Deficiency, Physiologic Consequences, and Treatment. ADOLESCENT MEDICINE: STATE OF THE ART REVIEWS 2015; 26:116-142. [PMID: 26514035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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85
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Joy E, De Souza MJ, Nattiv A, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G, Barrack M, Burke L, Drinkwater B, Lebrun C, Loucks AB, Mountjoy M, Nichols J, Borgen JS. 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad. Curr Sports Med Rep 2015; 13:219-32. [PMID: 25014387 DOI: 10.1249/jsr.0000000000000077] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The female athlete triad is a medical condition often observed in physically active girls and women and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with one or more of the three triad components, and early intervention is essential to prevent its progression to serious end points that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement presents a set of recommendations developed following the first (San Francisco, CA) and second (Indianapolis, IN) International Symposia on the Female Athlete Triad. This consensus statement was intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the female athlete triad and to provide clear recommendations for return to play. The expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts.
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Reed JL, De Souza MJ, Mallinson RJ, Scheid JL, Williams NI. Energy availability discriminates clinical menstrual status in exercising women. J Int Soc Sports Nutr 2015; 12:11. [PMID: 25722661 PMCID: PMC4342163 DOI: 10.1186/s12970-015-0072-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/03/2015] [Indexed: 11/23/2022] Open
Abstract
Background Conditions of low energy availability (EA) (<30 kcal/kgLBM) have been associated with suppressed metabolic hormones and reductions in LH pulsatility in previously sedentary women during short-term manipulations of energy intake (EI) and exercise energy expenditure (EEE) in a controlled laboratory setting. The purpose of this study was to examine if EA, defined as EA = (EI-EEE)/kgLBM, is associated with disruptions in ovarian function in exercising women. Methods Menstrual status was confirmed with daily measures of urinary reproductive metabolites across 1–3 menstrual cycles or 28-day monitoring periods. EA was calculated for exercise days using EI from 3-day diet logs, EEE from heart-rate monitors and/or exercise logs for a 7-day period, and body composition from DXA. Resting energy expenditure (REE) was measured by indirect calorimetry. Total triiodothyronine (TT3) was measured from a fasting blood sample. Results 91 exercising women (23.1 ± 0.5 years) were categorized clinically as either exercising amenorrheic (ExAmen, n = 30), exercising oligomenorrheic (ExOligo, n = 20) or exercising eumenorrheic (ExEumen, n = 41). The eumenorrheic group was further divided into more specific subclinical groups as either exercising ovulatory (ExOv, n = 20), exercising inconsistent (ExIncon, n = 13), or exercising anovulatory (ExAnov, n = 8). An EA threshold of 30 kcal/kgLBM did not distinguish subclinical menstrual status (χ2 = 0.557, p = 0.46) nor did EA differ across subclinical disturbance groups (p > 0.05). EA was lower in the ExAmen vs. ExEumen (30.9 ± 2.4 vs. 36.9 ± 1.7 kcal/kgLBM, p = 0.04). The ratio of REE/predicted REE was lower in the ExAmen vs. ExEumen (0.85 ± 0.02 vs. 0.92 ± 0.01, p = 0.001) as was TT3 (79.6 ± 4.1 vs. 95.3 ± 2.9 ng/mL, p = 0.002). Conclusions EA did not differ among subclinical forms of menstrual disturbances in a large sample of exercising women, but EA did discriminate clinical menstrual status, i.e., amenorrhea from eumenorrhea.
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Williams NI, Leidy HJ, Hill BR, Lieberman JL, Legro RS, De Souza MJ. Magnitude of daily energy deficit predicts frequency but not severity of menstrual disturbances associated with exercise and caloric restriction. Am J Physiol Endocrinol Metab 2015; 308:E29-39. [PMID: 25352438 PMCID: PMC4281686 DOI: 10.1152/ajpendo.00386.2013] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We assessed the impact of energy deficiency on menstrual function using controlled feeding and supervised exercise over four menstrual cycles (1 baseline and 3 intervention cycles) in untrained, eumenorrheic women aged 18-30 yr. Subjects were randomized to either an exercising control (EXCON) or one of three exercising energy deficit (ED) groups, i.e., mild (ED1; -8 ± 2%), moderate (ED2; -22 ± 3%), or severe (ED3; -42 ± 3%). Menstrual cycle length and changes in urinary concentrations of estrone-1-glucuronide, pregnanediol glucuronide, and midcycle luteinizing hormone were assessed. Thirty-four subjects completed the study. Weight loss occurred in ED1 (-3.8 ± 0.2 kg), ED2 (-2.8 ± 0.6 kg), and ED3 (-2.6 ± 1.1 kg) but was minimal in EXCON (-0.9 ± 0.7 kg). The overall sum of disturbances (luteal phase defects, anovulation, and oligomenorrhea) was greater in ED2 compared with EXCON and greater in ED3 compared with EXCON AND ED1. The average percent energy deficit was the main predictor of the frequency of menstrual disturbances (f = 10.1, β = -0.48, r(2) = 0.23, P = 0.003) even when weight loss was included in the model. The estimates of the magnitude of energy deficiency associated with menstrual disturbances ranged from -22 (ED2) to -42% (ED3), reflecting an energy deficit of -470 to -810 kcal/day, respectively. This is the first study to demonstrate a dose-response relationship between the magnitude of energy deficiency and the frequency of exercise-related menstrual disturbances; however, the severity of menstrual disturbances was not dependent on the magnitude of energy deficiency.
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Allaway HC, Williams NI, Mallinson RJ, Koehler K, De Souza MJ. Reductions in urinary collection frequency for assessment of reproductive hormones provide physiologically representative exposure and mean concentrations when compared with daily collection. Am J Hum Biol 2014; 27:358-71. [DOI: 10.1002/ajhb.22649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 08/25/2014] [Accepted: 10/07/2014] [Indexed: 12/12/2022] Open
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Gibbs JC, Nattiv A, Barrack MT, Williams NI, Rauh MJ, Nichols JF, De Souza MJ. Low bone density risk is higher in exercising women with multiple triad risk factors. Med Sci Sports Exerc 2014; 46:167-76. [PMID: 23783260 DOI: 10.1249/mss.0b013e3182a03b8b] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED The cumulative effect of the female athlete triad (Triad) risk factors on the likelihood of low bone mineral density (BMD) in exercising women is unclear. PURPOSE This study aimed to determine the risk of low BMD in exercising women with multiple Triad risk factors. METHODS We retrospectively examined cross-sectional data from 437 exercising women (mean ± SD age of 18.0 ± 3.5 yr, weighed 57.5 ± 7.1 kg with 24.5% ± 6.1% body fat) obtained at baseline from 4 prospective cohort studies examining Triad risk factors. Questionnaires were completed to obtain information on demographic characteristics, self-reported eating attitudes/behaviors, menstrual function, sport/activity participation, and medication use. Height and body weight were measured. BMD was measured using dual energy x-ray absorptiometry. Low BMD was defined as z-scores of <-1 and ≤-2. Chi-square tests were performed to determine the percentage of women with low BMD who met the criteria for individual (current oligo/amenorrhea, late menarche, low body mass index (BMI), elevated dietary restraint, lean sport/activity participation) or multiple (2, 3, 4, or 5) Triad risk factors. RESULTS Late menarche and low BMI were associated with the highest percentage of low BMD (z-score < -1), 55% and 54%, respectively, and low BMD (z-score ≤-2), 14% and 16%, respectively. The percentage of participants with low BMD (z-score < -1 and ≤-2) increased from 10% to 62% and from 2% to 18%, respectively, as women met the criteria for an increasing number of Triad risk factors. CONCLUSIONS A cumulative number of Triad risk factors were associated with an increased risk of low BMD, suggesting a dose-response association between the number of Triad risk factors and BMD in exercising women. Further research should be conducted to develop a user-friendly algorithm integrating these indicators of risk for low BMD in exercising women (particularly factors associated with low BMI/body weight, menstrual dysfunction, lean sport/activity participation, and elevated dietary restraint).
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De Souza MJ, Williams NI, Nattiv A, Joy E, Misra M, Loucks AB, Matheson G, Olmsted MP, Barrack M, Mallinson RJ, Gibbs JC, Goolsby M, Nichols JF, Drinkwater B, Sanborn C(B, Agostini R, Otis CL, Johnson MD, Hoch AZ, Alleyne JMK, Wadsworth LT, Koehler K, VanHeest J, Harvey P, Weiss Kelly AK, Fredericson M, Brooks GA, O'Donnell E, Callahan LR, Putukian M, Costello L, Hecht S, Rauh MJ, McComb J. Misunderstanding the Female Athlete Triad: Refuting the IOC Consensus Statement on Relative Energy Deficiency in Sport (RED-S). Br J Sports Med 2014; 48:1461-5. [DOI: 10.1136/bjsports-2014-093958] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gibbs JC, Williams NI, Mallinson RJ, Reed JL, Rickard AD, De Souza MJ. Effect of high dietary restraint on energy availability and menstrual status. Med Sci Sports Exerc 2014; 45:1790-7. [PMID: 23954993 DOI: 10.1249/mss.0b013e3182910e11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Dietary restraint (DR) is a key eating behavior associated with menstrual disturbances (MD) in exercising women. However, the association between DR and energy availability (EA) has not been examined. PURPOSES The objective of this study is 1) to compare EA in women when categorized by DR score, to include an evaluation of the frequency of women with low EA, and 2) to compare the distribution of subclinical and clinical MD between DR groups. METHODS Exercising women (23 ± 4 yr; body mass index, 21.1 ± 1.9 kg·m; and exercise volume, 333 ± 198 min·wk) were retrospectively categorized by DR score into two groups: 1) women with high DR (n = 30) and 2) women with normal DR (n = 56). DR scores were obtained from the Three-Factor Eating Questionnaire. High DR score was defined as ≥13. Body composition was measured using dual-energy x-ray absorptiometry. EA was defined as energy intake - exercise energy expenditure per kilogram lean body mass (LBM). Low EA was defined as <30 kcal·kg LBM. Menstrual status was determined using daily urinary samples assayed for reproductive hormones. RESULTS EA was lower in the high DR versus the normal DR group (35.0 ± 12.9 vs 42.0 ± 12.9 kcal·kg LBM, P = 0.018). There was no difference (P = 0.866) in frequency of low EA between DR groups. There was a greater frequency of MD (amenorrhea, oligomenorrhea, anovulation, or luteal phase defect) in the high DR group (21/28, 75.0%) versus the normal DR group (24/47, 51.1%) (χ = 4.2, P = 0.041). CONCLUSION Our findings demonstrate that exercising women with high DR exhibited lower EA and a greater frequency of MD (subclinical and clinical) compared with women with normal DR. However, high DR was not associated with low EA in exercising women.
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Mallinson RJ, De Souza MJ. Current perspectives on the etiology and manifestation of the "silent" component of the Female Athlete Triad. Int J Womens Health 2014; 6:451-67. [PMID: 24833922 PMCID: PMC4014372 DOI: 10.2147/ijwh.s38603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The Female Athlete Triad (Triad) represents a syndrome of three interrelated conditions that originate from chronically inadequate energy intake to compensate for energy expenditure; this environment results in insufficient stored energy to maintain physiological processes, a condition known as low energy availability. The physiological adaptations associated with low energy availability, in turn, contribute to menstrual cycle disturbances. The downstream effects of both low energy availability and suppressed estrogen concentrations synergistically impair bone health, leading to low bone mineral density, compromised bone structure and microarchitecture, and ultimately, a decrease in bone strength. Unlike the other components of the Triad, poor bone health often does not have overt symptoms, and therefore develops silently, unbeknownst to the athlete. Compromised bone health among female athletes increases the risk of fracture throughout the lifespan, highlighting the long-term health consequences of the Triad. The purpose of this review is to examine the current state of Triad research related to the third component of the Triad, ie, poor bone health, in an effort to summarize what we know, what we are learning, and what remains unknown.
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Reed JL, De Souza MJ, Kindler JM, Williams NI. Nutritional practices associated with low energy availability in Division I female soccer players. J Sports Sci 2014; 32:1499-509. [DOI: 10.1080/02640414.2014.908321] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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94
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Koehler K, De Souza MJ, Williams NI. Predictors of Weight Loss During a Controlled Diet and Exercise Intervention in Normal-Weight Women. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000496065.19429.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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95
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Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, Nattiv A. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med 2014; 42:949-58. [PMID: 24567250 DOI: 10.1177/0363546513520295] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Identifying the risk factors associated with a bone stress injury (BSI), including stress reactions and stress fractures, may aid in targeting those at increased risk and in formulating prevention guidelines for exercising girls and women. PURPOSE To evaluate the effect of single or combined risk factors as defined by the female athlete triad-a syndrome involving 3 interrelated spectrums consisting of energy availability, menstrual function, and bone mass-with the incidence of BSIs in a multicenter prospective sample of 4 cohorts of physically active girls and women. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS At baseline, participants' (N = 259; mean age, 18.1 ± 0.3 years) anthropometric characteristics, eating attitudes and behaviors, menstrual function, sports participation or exercise activity, and pathological weight control behaviors were assessed. Dual-energy x-ray absorptiometry (DXA) measured the bone mass of the whole body, total hip, femoral neck, lumbar spine, and body composition. Participants were followed prospectively for the occurrence of injuries; those injuries confirmed by a physician were recorded. RESULTS Twenty-eight participants (10.8%) incurred a BSI. Forty-six percent of those who had ≥12 h/wk of purposeful exercise, a bone mineral density (BMD) Z score <-1.0, and who exhibited 3 to 4 of the following: BMI <21.0 kg/m2, oligo- or amenorrhea, elevated dietary restraint, and/or participation in a leanness sport exercise/activity at baseline, incurred a BSI during the prospective study period. Single factors significantly (P < .05) associated with the development of a BSI included ≥12 h/wk of purposeful exercise (14.7%), BMI <21.0 kg/m2 (15.3%), and low bone mass (BMD Z score <-1.0; 21.0%). The strongest 2- and 3-variable combined risk factors were low BMD (Z score <-1.0) + ≥12 h/wk of exercise, with 29.7% incurring a BSI (odds ratio [OR], 5.1; 95% CI, 2.2-12.1), and ≥12 h/wk of exercise + leanness sport/activity + dietary restraint, with 46.2% incurring a BSI (OR, 8.7; 95% CI, 2.7-28.3). CONCLUSION In the sample, which included female adolescents and young adults participating in competitive or recreational exercise activities, the risk of BSIs increased from approximately 15% to 20% for significant single risk factors to 30% to 50% for significant combined female athlete triad-related risk factor variables. These data support the notion that the cumulative risk for BSIs increases as the number of Triad-related risk factors accumulates.
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Gibbs JC, Williams NI, De Souza MJ. Prevalence of individual and combined components of the female athlete triad. Med Sci Sports Exerc 2014; 45:985-96. [PMID: 23247706 DOI: 10.1249/mss.0b013e31827e1bdc] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The female athlete triad (Triad) is a syndrome linking low energy availability (EA) with or without disordered eating (DE), menstrual disturbances (MD), and low bone mineral density (BMD) in exercising women. The prevalence of Triad conditions (both clinical and subclinical) has not been clearly established.The purpose of this review is to evaluate the studies that determined the prevalence of clinical or subclinical Triad conditions (low EA, DE, MD, and low BMD) in exercising women and in women participating in lean (LS) versus nonlean sports (NLS) using self-report and/or objective measures. METHODS A review of publications using MEDLINE and PubMed was completed. Randomized controlled trials and observational studies that evaluated the prevalence of clinical and subclinical Triad conditions (MD, low BMD, low EA, and DE) in exercising women were included. RESULTS Sixty-five studies were identified for inclusion in this review (n = 10,498, age = 21.8 ± 3.5 yr, body mass index = 20.8 ± 2.6 kg·m; mean ± SD). A relatively small percentage of athletes (0%-15.9%) exhibited all three Triad conditions (nine studies, n = 991). The prevalence of any two or any one of the Triad conditions in these studies ranged from 2.7% to 27.0% and from 16.0% to 60.0%, respectively. The prevalence of all three Triad conditions in LS athletes versus NLS athletes ranged from 1.5% to 6.7% and from 0% to 2.0%, respectively. LS athletes demonstrated higher prevalence rates of MD and low BMD (3.3% vs 1.0%), MD and DE (6.8%-57.8% vs 5.4%-13.5%), and low BMD and DE (5.6% vs 1.0%) than the NLS athletes. CONCLUSIONS Although the prevalence of individual/combined Triad conditions is concerning, our review demonstrates that additional research on the prevalence of the Triad using objective and/or self-report/field measures is necessary to more accurately describe the extent of the problem.
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De Souza MJ, Nattiv A, Joy E, Misra M, Williams NI, Mallinson RJ, Gibbs JC, Olmsted M, Goolsby M, Matheson G. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013. Br J Sports Med 2014; 48:289. [DOI: 10.1136/bjsports-2013-093218] [Citation(s) in RCA: 327] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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VanHeest JL, Rodgers CD, Mahoney CE, De Souza MJ. Ovarian Suppression Impairs Sport Performance in Junior Elite Female Swimmers. Med Sci Sports Exerc 2014; 46:156-66. [DOI: 10.1249/mss.0b013e3182a32b72] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hill BR, De Souza MJ, Wagstaff DA, Williams NI. The impact of weight loss on the 24-h profile of circulating peptide YY and its association with 24-h ghrelin in normal weight premenopausal women. Peptides 2013; 49:81-90. [PMID: 24012997 PMCID: PMC4218746 DOI: 10.1016/j.peptides.2013.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/25/2013] [Accepted: 08/26/2013] [Indexed: 02/05/2023]
Abstract
Peptide YY (PYY) and ghrelin exhibit a reciprocal association and antagonistic physiological effects in the peripheral circulation. Research has yet to clarify the effect of weight loss on the 24h profile of PYY or its association to 24h ghrelin. We sought to determine if diet- and exercise-induced weight loss affects the 24h profile of PYY and its association with 24h ghrelin in normal weight, premenopausal women. Participants (n = 13) were assessed at baseline (BL) and after a 3-month diet and exercise intervention (post). Blood samples obtained q10 min for 24h were assayed for total PYY and total ghrelin q60 min from 0800 to 1000 h and 2000 to 0800 h and q20 min from 1000 to 2000 h. The ghrelin/PYY ratio was used as an index of hormonal exposure. Statistical analyses included paired t-tests and linear mixed effects modeling. Body weight (-1.85 ± 0.67 kg; p = 0.02), and body fat (-2.53 ± 0.83%; p = 0.01) decreased from BL to post. Ghrelin AUC (5252 ± 2177 pg/ml/24h; p=0.03), 24h mean (216 ± 90 pg/ml; p = 0.03) and peak (300 ± 134 pg/ml; p = 0.047) increased from BL to post. No change occurred in PYY AUC (88.2 ± 163.7 pg/ml; p = 0.60), 24h mean (4.8 ± 6.9 pg/ml; p = 0.50) or peak (3.6 ± 6.4 pg/ml; p = 0.58). The 24h association between PYY and ghrelin at baseline (p = 0.04) was weakened at post (p = 0.14); however, the ghrelin/PYY lunch ratio increased (p = 0.01) indicating the potential for ghrelin predominance over PYY in the circulation. PYY and ghrelin are reciprocally associated during a period of weight stability, but not following weight loss. An "uncoupling" may have occurred, particularly at lunch, due to factors that modulate ghrelin in response to weight loss.
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Hill BR, Rolls BJ, Roe LS, De Souza MJ, Williams NI. Ghrelin and peptide YY increase with weight loss during a 12-month intervention to reduce dietary energy density in obese women. Peptides 2013; 49:138-44. [PMID: 24076434 PMCID: PMC4218742 DOI: 10.1016/j.peptides.2013.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 12/23/2022]
Abstract
Reducing dietary energy density (ED) promotes weight loss; however, underlying mechanisms are not well understood. The purpose of this study was to determine if low-ED diets facilitate weight loss through actions on ghrelin and peptide YY (PYY), independent of influences of psychosocial measures. Seventy-one obese women (BMI 30-40 kg/m(2)) ages 22-60 years received counseling to reduce ED. Fasting blood samples were analyzed for total ghrelin and total PYY by radioimmunoassay at months 0, 3, 6, and 12. Restraint, disinhibition, and hunger were assessed by the Eating Inventory. Body weight (-7.8 ± 0.5 kg), BMI (-2.9 ± 0.2 kg/m(2)), body fat (-3.0 ± 0.3%), and ED (-0.47 ± 0.05 kcal/g or -1.97 ± 0.21 kJ/g) decreased from months 0 to 6 (p<0.05) after which no change occurred from months 6 to 12. Ghrelin increased in a curvilinear fashion (month 0: 973 ± 39, month 3: 1024 ± 37, month 6: 1109 ± 44, and month 12: 1063 ± 45 pg/ml, p<0.001) and PYY increased linearly (month 0: 74.2 ± 3.1, month 3: 76.4 ± 3.2, month 6: 77.2 ± 3.0, month 12: 82.8 ± 3.2 pg/ml, p<0.001). ED, body weight, and hunger predicted ghrelin, with ED being the strongest predictor (ghrelin = 2674.8+291.6 × ED-19.2 × BW-15 × H; p<0.05). There was a trend toward a significant association between ED and PYY (PYY = 115.0-43.1 × ED; p = 0.05). Reductions in ED may promote weight loss and weight loss maintenance by opposing increases in ghrelin and promoting increases in PYY.
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