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Sim A, Tan HQ, Ali Y, Burns SF. Original investigation: manipulating energy availability in male endurance runners: a randomised controlled trial. Appl Physiol Nutr Metab 2024. [PMID: 38713922 DOI: 10.1139/apnm-2024-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
This study investigated the effect of 4 days low energy availability (LEA) on physiological markers and mood states in male endurance runners. Twelve participants (mean (standard deviation); age: 25.8 (3.8) years; fat-free mass (FFM): 52.8 (5.5) kg) completed three 4-day conditions: adequate energy availability (AEA): 45 kcal/kg FFM/day; LEA1: 30 kcal/kg FFM/day; and LEA2: 15 kcal/kg FFM/day, in a randomized order. Participants ran on a treadmill at 65% of V̇O2max until they expended 15 kcal/kg FFM/day of energy. Energy intake was adjusted to achieve the desired energy availability. Pre- and post-measurements of bone turnover, metabolism, testosterone and estradiol (plasma), resting metabolic rate (indirect calorimetry), and mood states (Brunel Mood Scale) were assessed. The results reported a significant decrease in testosterone (condition × time interaction, p = 0.03) occurred on LEA2 (Pre: 23.8 (7.0) nmol/L vs. Post: 20.3 (7.7) nmol/L) compared with AEA (Pre: 22.9 (5.5) nmol/L vs. Post: 23.3 (6.1) nmol/L) or LEA1 (Pre: 23.6 (8.6) nmol/L vs. Post: 20.9 (8.8) nmol/L). Fatigue level significantly increased (condition × time interaction, p = 0.02) in LEA2 (Pre: 3.5 (1.7) vs. Post: 6.5 (2.9)) but did not change in AEA (Pre: 2.8 (1.5) vs. Post: 2.5 (2.7)) or LEA1 (Pre: 2.8(2.4) vs. Post: 2.9 (2.0)). Other measures were unaffected by the interventions. In conclusion, this study suggests that testosterone and fatigue may serve as early indicators of LEA in male runners. However, other physiological markers and mood states appeared largely unaffected, aligning with existing literature indicating minimal disruption of physiological functions during acute LEA in male athletes. Study registration: Australian New Zealand Clinical Trials Registry (Trial No.: 381278).
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Affiliation(s)
- Alexiaa Sim
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, 637616, Singapore
| | - Hui Qing Tan
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, 637616, Singapore
| | - Yusuf Ali
- Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore
| | - Stephen F Burns
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, 637616, Singapore
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O'Leary TJ, Gifford RM, Knight RL, Wright J, Handford S, Venables MC, Reynolds RM, Woods D, Wardle SL, Greeves JP. Sex differences in energy balance, body composition, and metabolic and endocrine markers during prolonged arduous military training. J Appl Physiol (1985) 2024; 136:938-948. [PMID: 38385180 DOI: 10.1152/japplphysiol.00864.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
This study investigated sex differences in energy balance, body composition, and metabolic and endocrine markers during prolonged military training. Twenty-three trainees (14 women) completed 44-wk military training (three terms of 14 wk with 2-wk adventurous training). Dietary intake and total energy expenditure were measured over 10 days during each term by weighed food and doubly labeled water. Body composition was measured by dual-energy X-ray absorptiometry (DXA) at baseline and at the end of each term. Circulating metabolic and endocrine markers were measured at baseline and at the end of terms 2 and 3. Absolute energy intake and total energy expenditure were higher, and energy balance was lower, for men than women (P ≤ 0.008). Absolute energy intake and balance were lower, and total energy expenditure was higher, during term 2 than terms 1 and 3 (P < 0.001). Lean mass did not change with training (P = 0.081). Fat mass and body fat increased from term 1 to terms 2 and 3 (P ≤ 0.045). Leptin increased from baseline to terms 2 and 3 in women (P ≤ 0.002) but not in men (P ≥ 0.251). Testosterone and free androgen index increased from baseline to term 3 (P ≤ 0.018). Free thyroxine (T4) decreased and thyroid-stimulating hormone (TSH) increased from baseline to term 2 and term 3 (P ≤ 0.031). Cortisol decreased from baseline to term 3 (P = 0.030). IGF-I and total triiodothyronine (T3) did not change with training (P ≥ 0.148). Men experienced greater energy deficits than women during military training due to higher total energy expenditure.NEW & NOTEWORTHY Energy deficits are common in military training and can result in endocrine and metabolic disturbances. This study provides first investigation of sex differences in energy balance, body composition, and endocrine and metabolic markers in response to prolonged and arduous military training. Men experienced greater energy deficits than women due to higher energy expenditure, which was not compensated for by increased energy intake. These energy deficits were not associated with decreases in fat or lean mass or metabolic or endocrine function.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
- Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca L Knight
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Jennifer Wright
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Sally Handford
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Michelle C Venables
- Medical Research Council, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
- Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
- Division of Surgery and Interventional Science, UCL, London, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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de Souza LC, Moris JM, Lee KM, Fant KH, Gallucci A, Funderburk LK. Dietary Intake and Menstrual Health among Acrobatics and Tumbling NCAA Division I Student-Athletes. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2024; 43:101-109. [PMID: 37307023 DOI: 10.1080/27697061.2023.2218458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Acrobatics & Tumbling (A&T) is an emerging sport in the National Collegiate Athletic Association that lacks research regarding the dietary intake and health of A&T student-athletes (A&Tsa). This study assessed the dietary intake adequacy, estimated energy availability (EA), self-reported menstrual health, and body composition of A&Tsa. METHODS Twenty-four female A&Tsa participated during week 8 of the preseason (11 top: Age= 20.1 ± 0.9 years; BMI= 22.1 ± 1.7 kg/m2; 13 base: Age= 19.5 ± 1.3 years; BMI= 26.2 ± 2.7 kg/m2). Total energy intake (TEI) and macronutrient intakes were assessed via a paper-based 3-day dietary recall. Resting Metabolic Rate [RMR = 500 + 22 * fat-free mass (FFM)] and energy availability [EA = (TEI - exercise energy expenditure)/FFM)] were estimated; and LEAF-Q assessed menstrual health. Body composition was measured using Dual-Energy X-Ray Absorptiometry. Macronutrient intakes and EA were compared to sports nutrition recommendations (carbohydrate: 6-10 g/kg; protein: 1.2-2.0 g/kg) and the Acceptable Macronutrient Distribution Range (carbohydrate: 45-65%; protein: 10-35%; fat: 20-35%). RESULTS TEI was 1753 ± 467 kcal (top) and 1980 ± 473.8 kcal (base). A total of 20.8% of A&Tsa failed to meet RMR with TEI, with a higher prevalence in the top (-266 ± 219.2 kcal, n = 3) vs. base (-414.3 ± 534.4 kcal, n = 2) A&Tsa. Top and base A&Tsa had both low EA (28.8 ± 13.4 kcals·FFM-1; 23.8 ± 9.5 kcals·FFM-1) and inadequate carbohydrate intake averages (4.2 ± 1.3 g/kg; 3.5 ± 1.1 g/kg, p < 0.001), respectively. A total of 17% of A&Tsa reported secondary amenorrhea, with a higher prevalence in the top (27.3%, n = 3) vs. the base (7.7%, n = 1). CONCLUSION TEI and carbohydrate intake of the majority of A&Tsa were below recommendations. Sports dietitians should encourage and educate A&Tsa about following an adequate diet that meets energy and sports-specific macronutrient needs.
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Affiliation(s)
- Leticia C de Souza
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Jose M Moris
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Katherine M Lee
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Kristin H Fant
- Performance Nutrition (Baylor Athletics), Baylor University, Waco, Texas, USA
| | - Andrew Gallucci
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - LesLee K Funderburk
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
- Department of Human Sciences and Design, Baylor University, Waco, Texas, USA
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Henninger K, Pritchett K, Brooke NK, Dambacher L. Low Energy Availability, Disordered Eating, Exercise Dependence, and Fueling Strategies in Trail Runners. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 16:1471-1486. [PMID: 38288400 PMCID: PMC10824294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Under fueling, disordered eating (DE), exercise dependence (EXD), and high training demands relative to energy intake may increase the risk of low energy availability (LEA) in endurance and ultra-endurance athletes. The purpose of this study was to evaluate the prevalence of LEA risk and relationship with risk of DE, EXD, and fueling habits during training and competition in endurance runners. Trail runners between the age of 18-40 (n = 1,899; males: n = 510, females: n = 1,445) completed a 45-question survey using Qualtrics that included training and racing characteristics, questions regarding carbohydrate intake during training and competition, the Low Energy Availability in Females Questionnaire (LEAF-Q), the Disordered Eating Screen for Athletes (DESA-6), and the Exercise Dependence Scale-21 (EDS-21). Among all runners, 43% of runners were at risk for LEA, 43% were at risk for DE, and 87.3% reported symptoms related to EXD. LEAF-Q scores were positively correlated with EDS-21 (r = 0.33, p < 0.001) and DESA-6 scores (r = 0.29, p < 0.001). From the population, 47.6% of athletes reported taking in less than the recommended carbohydrate guidelines during endurance events lasting > 2.5 hours. In females, athletes at risk for LEA appear less likely to fuel sufficiently than athletes not at risk for LEA (p < 0.001). Risk of LEA, DE, and EXD appears to be high in endurance runners. Furthermore, meeting carbohydrate recommendations during training and competition should be emphasized to avoid negative health outcomes associated with LEA in endurance runners.
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Affiliation(s)
- Keely Henninger
- Professional Trail Runner and Independent Scientist, Portland, OR, USA
| | - Kelly Pritchett
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA
| | - Namrita Kumar Brooke
- Department of Health and Movement Sciences, University of West Florida, Pensacola, FL, USA
| | - Leah Dambacher
- Department of Health Sciences, Central Washington University, Ellensburg, WA, USA
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Peeling P, Sim M, McKay AKA. Considerations for the Consumption of Vitamin and Mineral Supplements in Athlete Populations. Sports Med 2023; 53:15-24. [PMID: 37358750 PMCID: PMC10721676 DOI: 10.1007/s40279-023-01875-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
Vitamins and minerals are of fundamental importance to numerous human functions that are essential to optimise athlete performance. Athletes incur a high turnover of key vitamins and minerals and are therefore dependent on sufficient energy intake to replenish nutrient stores. However, many athletes are poor at servicing their energy replenishment needs, especially female athletes, and although a 'food first approach' to meeting nutrient requirements is the primary goal, it may be important for some athletes to consider a vitamin and/or mineral supplement to meet their daily needs. When working to determine if an athlete requires vitamin or mineral supplements, practitioners should use a robust framework to assess the overall energy requirements, current dietary practices and the biological and clinical status of their athletes. Of note, any supplementation plan should account for the various factors that may impact the efficacy of the approach (e.g. athlete sex, the nutrient recommended dietary intake, supplement dose/timing, co-consumption of other foods and any food-drug interactions). Importantly, there are numerous vitamins and minerals of key importance to athletes, each having specific relevance to certain situations (e.g. iron and B vitamins are significant contributors to haematological adaptation, calcium and vitamin D are important to bone health and folate is important in the female athlete); therefore, the appropriate supplement for a given situation should be carefully considered and consumed with the goal to augment an athlete's diet.
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Affiliation(s)
- Peter Peeling
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, 6009, Australia.
- Western Australian Institute of Sport, Mt Claremont, WA, 6010, Australia.
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, 6067, Australia
- Medical School, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
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Levy SB, Bribiescas RG. Hierarchies in the energy budget: Thyroid hormones and the evolution of human life history patterns. Evol Anthropol 2023; 32:275-292. [PMID: 37584402 DOI: 10.1002/evan.22000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
The evolution of human life history characteristics required dramatic shifts in energy allocation mechanisms compared with our primate ancestors. Thyroid hormones, such as thyroxine (T4) and triiodothyronine (T3), are sensitive to energy balance, and are significant determinants for both tissue-specific and whole-body metabolic rate. Thus, thyroid hormones are in part responsible for setting the body's overall energy budget and likely played an important role in the evolution of human life history patterns. We propose that the dynamics of mammalian T3 production, uptake, and action have evolved so that energy allocation prioritizes the high demands of brain development and functioning, often at the expense of growth and reproduction. This paper explores the role of thyroid hormone dynamics in the evolution of human encephalization, prolonged childhood and adolescence, long lifespans, reproduction, and human aging.
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Affiliation(s)
- Stephanie B Levy
- Department of Anthropology, CUNY Hunter College, New York, New York, USA
- New York Consortium in Evolutionary Primatology, New York, New York, USA
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Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023; 57:1073-1097. [PMID: 37752011 DOI: 10.1136/bjsports-2023-106994] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
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Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Naama Constantini
- Sports Medicine Center, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ida Aliisa Heikura
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anna Melin
- Department of Sport Science - Swedish Olympic Committee Research Fellow, Linnaeus University, Kalmar, Sweden
| | - Anne Marte Pensgaard
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trent Stellingwerff
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
- World Archery, Lausanne, Switzerland
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8
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Martínez-Noguera FJ, Alcaraz PE, Ortolano-Ríos R, Marín-Pagán C. One Season in Professional Cycling Is Enough to Negatively Affect Bone Health. Nutrients 2023; 15:3632. [PMID: 37630821 PMCID: PMC10458969 DOI: 10.3390/nu15163632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Cycling is a very popular sport worldwide, and several studies have already indicated that cycling at various levels has a negative impact on bone health. This is of concern to both performance and health managers of many cycling teams at different levels because of its economic and social impact. Based on the scientific literature, we hypothesize that a single season at the professional level can negatively affect bone health status. The aim of this study was to assess how professional cycling affects bone health markers after one season. Densitometry was used to measure the bone mineral density (BMD), bone mineral content (BMC), bone area (BA), fat mass (FM), fat-free mass (FFM), T-score and Z-score in professional cyclists after one season. After one season at the professional level, cyclists' BMD decreased significantly in the legs, trunk, ribs and pelvis (p ≤ 0.05). BMC decreased in the arms and spine (p ≤ 0.05). BA decreased significantly in the arms and spine (p ≤ 0.05). In addition, a significant decrease in Z-score (p ≤ 0.05) and a decreasing trend in T-score and total BMD (p = 0.06) were observed. One season of professional cycling is enough to negatively affect bone health status.
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Affiliation(s)
- Francisco Javier Martínez-Noguera
- Research Center for High-Performance Sport, University of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.E.A.); (C.M.-P.)
| | - Pedro E. Alcaraz
- Research Center for High-Performance Sport, University of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.E.A.); (C.M.-P.)
| | - Raquel Ortolano-Ríos
- Sports Physiology Department, Faculty of Health Sciences, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain;
| | - Cristian Marín-Pagán
- Research Center for High-Performance Sport, University of Murcia, Campus de los Jerónimos, Guadalupe, 30107 Murcia, Spain; (P.E.A.); (C.M.-P.)
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9
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Leiszler M, Holtz J, Ward C. The Preparticipation Physical Examination for American Football Athletes. HSS J 2023; 19:292-298. [PMID: 37435121 PMCID: PMC10331274 DOI: 10.1177/15563316231174439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 07/13/2023]
Affiliation(s)
| | - Jacob Holtz
- Sports Medicine, South Bend-Notre Dame Sports Medicine Fellowship, South Bend, IN, USA
| | - Cody Ward
- Sports Medicine, University of Notre Dame, Notre Dame, IN, USA
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10
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Siedler MR, De Souza MJ, Albracht-Schulte K, Sekiguchi Y, Tinsley GM. The Influence of Energy Balance and Availability on Resting Metabolic Rate: Implications for Assessment and Future Research Directions. Sports Med 2023; 53:1507-1526. [PMID: 37213050 DOI: 10.1007/s40279-023-01856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
Resting metabolic rate (RMR) is a significant contributor to an individual's total energy expenditure. As such, RMR plays an important role in body weight regulation across populations ranging from inactive individuals to athletes. In addition, RMR may also be used to screen for low energy availability and energy deficiency in athletes, and thus may be useful in identifying individuals at risk for the deleterious consequences of chronic energy deficiency. Given its importance in both clinical and research settings within the fields of exercise physiology, dietetics, and sports medicine, the valid assessment of RMR is critical. However, factors including varying states of energy balance (both short- and long-term energy deficit or surplus), energy availability, and prior food intake or exercise may influence resulting RMR measures, potentially introducing error into observed values. The purpose of this review is to summarize the relationships between short- and long-term changes in energetic status and resulting RMR measures, consider these findings in the context of relevant recommendations for RMR assessment, and provide suggestions for future research.
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Affiliation(s)
- Madelin R Siedler
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Mary Jane De Souza
- Departments of Kinesiology and Physiology, Pennsylvania State University, University Park, PA, USA
| | | | - Yasuki Sekiguchi
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA.
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11
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Armento A, Heronemus M, Truong D, Swanson C. Bone Health in Young Athletes: a Narrative Review of the Recent Literature. Curr Osteoporos Rep 2023; 21:447-458. [PMID: 37289381 PMCID: PMC10248337 DOI: 10.1007/s11914-023-00796-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to discuss the most recent published scientific evidence regarding bone health in the pediatric athlete. RECENT FINDINGS Pediatric athletes commonly suffer from overuse injuries to the physes and apophyses, as well as bone stress injuries, for which magnetic resonance imaging grading of the severity of injuries may be useful in guiding return to sport. Adolescent athletes, particularly those who train indoors and during the winter season, are at risk for vitamin D deficiency, which has important implications for bone mineral density. However, the relationship between vitamin D status and traumatic fracture risk is still unclear. While the female athlete triad is a well-established condition, the current work has led to the recognition of parallel pathophysiology in male athletes, referred to as the male athlete triad. Recent evidence suggests that transdermal 17β-estradiol treatment in amenorrhoeic female athletes is an effective adjunctive treatment to improve bone mineral density in treatment of the female athlete triad. Young athletes are at risk for musculoskeletal injuries unique to the growing skeleton. Optimizing nutritional intake, particularly related to adequate vitamin D intake and prevention of the athlete triad, is critical to optimize bone health in the young athlete.
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Affiliation(s)
- Aubrey Armento
- Department of Orthopedics, University of Colorado School of Medicine, 13123 E. 16th Ave, B060, Aurora, CO 80045 USA
- Sports Medicine Center, Children’s Hospital Colorado, Aurora, CO USA
| | - Marc Heronemus
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Daniel Truong
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Christine Swanson
- Department of Medicine-Endocrinology, Diabetes, and Metabolism, University of Colorado School of Medicine, Aurora, CO USA
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12
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Ito E, Sato Y, Kobayashi T, Soma T, Matsumoto T, Kimura A, Miyamoto K, Matsumoto H, Matsumoto M, Nakamura M, Sato K, Miyamoto T. Low energy availability reduces bone mass and gonadal function in male mice. J Bone Miner Metab 2023; 41:182-192. [PMID: 36914793 DOI: 10.1007/s00774-023-01413-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION In women, the female athlete triad, marked by low energy availability, functional hypothalamic amenorrhea and osteoporosis, is a recognized risk for stress fractures. Stress injuries also occur in men, but by contrast risks and mechanisms underlying them are less characterized. MATERIALS AND METHODS 5 week-old wild-type male mice were fed ad libitum (ad) or subjected to 60% food restriction (FR) for five weeks. In both groups, some mice were allowed access to an exercise wheel in cages to allow voluntary wheel running (ex) and/or treated with active vitamin D analogues. Mice were sacrificed and analyzed at 10 weeks of age. RESULT Male FR mice exhibited significantly reduced testicle weight, serum testosterone levels and bone mass. Such bone losses in FR male mice were enhanced by exercise. Histological analysis revealed that both bone-resorbing and -forming activities were significantly reduced in FR or FR plus exercise (FR + ex) mice, mimicking a state of low bone turnover. Significantly reduced bone mass in FR or FR + ex male mice was significantly rescued by treatment with active vitamin D analogues, with significant restoration of osteoblastic activities. Serum levels of insulin-like growth factor I (IGF-I), which is critical for bone remodeling, were significantly lower in FR versus control male mice. CONCLUSIONS Low energy availability puts men at risk for stress injuries as well, and low energy availability is upstream of gonadal dysfunction and osteoporosis in males. Active vitamin D analogues could serve as therapeutic or preventive options for stress injuries in men.
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Affiliation(s)
- Eri Ito
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yuiko Sato
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tami Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoya Soma
- Division of Oral and Maxillofacial Surgery, Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tatsuaki Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atushi Kimura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Advanced Therapy for Musculoskeletal Disorders II, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Musculoskeletal Reconstruction and Regeneration Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Orthopedic Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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13
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Grandys M, Majerczak J, Frolow M, Chlopicki S, Zoladz JA. Training-induced impairment of endothelial function in track and field female athletes. Sci Rep 2023; 13:3502. [PMID: 36859449 PMCID: PMC9977863 DOI: 10.1038/s41598-023-30165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Professional athletes are often exposed to high training loads that may lead to overfatigue, overreaching and overtraining that might have a detrimental effects on vascular health. We determined the effects of high training stress on endothelial function assessed by the flow-mediated dilation (FMD) and markers of glycocalyx shedding. Vascular examination as well as broad biochemical, hormonal and cardiometabolic evaluation of sprint and middle-distance female runners were performed after 2 months of preparatory training period and compared to age-matched control group of women. Female athletes presented with significantly reduced FMD (p < 0.01) and higher basal serum concentrations of hyaluronan (HA) and syndecan-1 (SDC-1) (p < 0.05 and p < 0.001, respectively), that was accompanied by significantly lower basal serum testosterone (T) and free testosterone (fT) concentrations (p < 0.05) and higher cortisol (C) concentration (p < 0.05). It resulted in significantly lower T/C and fT/C ratios in athletes when compared to controls (p < 0.01). Moreover, fT/C ratio were significantly positively correlated to FMD and negatively to HA concentrations in all studied women. Accordingly, the training load was significantly negatively correlated with T/C, fT/C and FMD and positively with the concentrations of HA and SDC-1. We concluded that young female track and field athletes subjected to physical training developed impairment of endothelial function that was associated with anabolic-catabolic hormone balance disturbances. Given that training-induced impairment of endothelial function may have a detrimental effects on vascular health, endothelial status should be regularly monitored in the time-course of training process to minimalize vascular health-risk in athletes.
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Affiliation(s)
- Marcin Grandys
- Chair of Exercise Physiology and Muscle Bioenergetics, Faculty of Health Sciences, Jagiellonian University Medical College, Ul. Skawinska 8, 31-066, Krakow, Poland.
| | - Joanna Majerczak
- Chair of Exercise Physiology and Muscle Bioenergetics, Faculty of Health Sciences, Jagiellonian University Medical College, Ul. Skawinska 8, 31-066, Krakow, Poland
| | - Marzena Frolow
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland
| | - Stefan Chlopicki
- Jagiellonian Centre for Experimental Therapeutics (JCET), Jagiellonian University, Krakow, Poland.,Department of Experimental Pharmacology, Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Zoladz
- Chair of Exercise Physiology and Muscle Bioenergetics, Faculty of Health Sciences, Jagiellonian University Medical College, Ul. Skawinska 8, 31-066, Krakow, Poland.
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14
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Di Luigi L, Greco EA, Fossati C, Aversa A, Sgrò P, Antinozzi C. Clinical Concerns on Sex Steroids Variability in Cisgender and Transgender Women Athletes. Int J Sports Med 2023; 44:81-94. [PMID: 36174581 DOI: 10.1055/a-1909-1196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In the female athletic community, there are several endogenous and exogenous variables that influence the status of the hypothalamus-pituitary-ovarian axis and serum sex steroid hormones concentrations (e. g., 17β-estradiol, progesterone, androgens) and their effects. Moreover, female athletes with different sex chromosome abnormalities exist (e. g., 46XX, 46XY, and mosaicism). Due to the high variability of sex steroid hormones serum concentrations and responsiveness, female athletes may have different intra- and inter-individual biological and functional characteristics, health conditions, and sports-related health risks that can influence sports performance and eligibility. Consequently, biological, functional, and/or sex steroid differences may exist in the same and in between 46XX female athletes (e. g., ovarian rhythms, treated or untreated hypogonadism and hyperandrogenism), between 46XX and 46XY female athletes (e. g., treated or untreated hyperandrogenism/disorders of sexual differentiation), and between transgender women and eugonadal cisgender athletes. From a healthcare perspective, dedicated physicians need awareness, knowledge, and an understanding of sex steroid hormones' variability and related health concerns in female athletes to support physiologically healthy, safe, fair, and inclusive sports participation. In this narrative overview, we focus on the main clinical relationships between hypothalamus-pituitary-ovarian axis function, endogenous sex steroids and health status, health risks, and sports performance in the heterogeneous female athletic community.
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Affiliation(s)
- Luigi Di Luigi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
| | - Emanuela A Greco
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy.,Department of Science of Movement, Università degli Studi Niccolò Cusano, Rome, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Paolo Sgrò
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
| | - Cristina Antinozzi
- Department of Movement, Human and Health Sciences, Università degli Studi di Roma 'Foro Italico', Rome, Italy
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15
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Miralles-Amorós L, Asencio-Mas N, Martínez-Olcina M, Vicente-Martínez M, Frutos JMGD, Peñaranda-Moraga M, Gonzálvez-Alvarado L, Yáñez-Sepúlveda R, Cortés-Roco G, Martínez-Rodríguez A. Study the Effect of Relative Energy Deficiency on Physiological and Physical Variables in Professional Women Athletes: A Randomized Controlled Trial. Metabolites 2023; 13:metabo13020168. [PMID: 36837787 PMCID: PMC9962361 DOI: 10.3390/metabo13020168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Energy deficits are often observed in athletes, especially in female athletes, due to the high expenditure of sport and strict diets. Low energy availability can cause serious health problems and affect sport performance. The aim of this study was to evaluate the effects of different personalized dietary plans on physiological and physical factors related to energy deficit syndrome in female professional handball players. Twenty-one professional female handball players, aged 22 ± 4 years, 172.0 ± 5.4 cm and 68.4 ± 6.7 kg, divided into three groups (FD: free diet; MD: Mediterranean diet; and AD: high antioxidant diet), participated in this 12-week randomized controlled trial. Energy expenditure through indirect calorimetry, energy availability, 7 day dietary intake analysis, blood pressure, cholesterol, menstrual function, body composition by both anthropometry and bioelectrical impedance, and strength performance were assessed. All participants showed low energy availability (<30 kcal/lean mass per day); despite this, all had eumenorrhea. Significant improvements were found after the intervention in all components of body composition (p < 0.05). In the remaining variables, despite slight improvements, none were significant neither over time nor between the different groups. Low energy availability has been observed in all professional female handball players, which may lead to serious consequences. A longer period of intervention is required to assess the differences between diets and improvements in other parameters.
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Affiliation(s)
- Laura Miralles-Amorós
- Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain
| | - Nuria Asencio-Mas
- Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain
| | - María Martínez-Olcina
- Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain
| | | | - José Manuel García-De Frutos
- Physical Activity and Sport Sciences Department, Faculty of Sport, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
| | - Marcelo Peñaranda-Moraga
- Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain
| | - Lucía Gonzálvez-Alvarado
- Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain
| | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile
| | - Guillermo Cortés-Roco
- Escuela de Educación, Pedagogía en Educación Física, Entrenador Deportivo, Universidad Viña del Mar, Viña del Mar 2520000, Chile
| | - Alejandro Martínez-Rodríguez
- Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- Correspondence:
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16
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Prencipe N, Marinelli L, Varaldo E, Cuboni D, Berton AM, Bioletto F, Bona C, Gasco V, Grottoli S. Isolated anterior pituitary dysfunction in adulthood. Front Endocrinol (Lausanne) 2023; 14:1100007. [PMID: 36967769 PMCID: PMC10032221 DOI: 10.3389/fendo.2023.1100007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and prolactin deficiency. Patients with hypopituitarism suffer from an increased disability and sick days, resulting in lower health status, higher cost of care and an increased mortality. In particular during adulthood, isolated pituitary deficits are not an uncommon finding; their clinical picture is represented by vague symptoms and unclear signs, which can be difficult to properly diagnose. This often becomes a challenge for the physician. Aim of this narrative review is to analyse, for each anterior pituitary deficit, the main related etiologies, the characteristic signs and symptoms, how to properly diagnose them (suggesting an easy and reproducible step-based approach), and eventually the treatment. In adulthood, the vast majority of isolated pituitary deficits are due to pituitary tumours, head trauma, pituitary surgery and brain radiotherapy. Immune-related dysfunctions represent a growing cause of isolated pituitary deficiencies, above all secondary to use of oncological drugs such as immune checkpoint inhibitors. The diagnosis of isolated pituitary deficiencies should be based on baseline hormonal assessments and/or dynamic tests. Establishing a proper diagnosis can be quite challenging: in fact, even if the diagnostic methods are becoming increasingly refined, a considerable proportion of isolated pituitary deficits still remains without a certain cause. While isolated ACTH and TSH deficiencies always require a prompt replacement treatment, gonadal replacement therapy requires a benefit-risk evaluation based on the presence of comorbidities, age and gender of the patient; finally, the need of growth hormone replacement therapies is still a matter of debate. On the other side, prolactin replacement therapy is still not available. In conclusion, our purpose is to offer a broad evaluation from causes to therapies of isolated anterior pituitary deficits in adulthood. This review will also include the evaluation of uncommon symptoms and main etiologies, the elements of suspicion of a genetic cause and protocols for diagnosis, follow-up and treatment.
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17
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Fensham NC, Heikura IA, McKay AKA, Tee N, Ackerman KE, Burke LM. Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability. J Bone Miner Res 2022; 37:1915-1925. [PMID: 35869933 PMCID: PMC9804216 DOI: 10.1002/jbmr.4658] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 01/05/2023]
Abstract
Bone stress injuries are common in athletes, resulting in time lost from training and competition. Diets that are low in energy availability have been associated with increased circulating bone resorption and reduced bone formation markers, particularly in response to prolonged exercise. However, studies have not separated the effects of low energy availability per se from the associated reduction in carbohydrate availability. The current study aimed to compare the effects of these two restricted states directly. In a parallel group design, 28 elite racewalkers completed two 6-day phases. In the Baseline phase, all athletes adhered to a high carbohydrate/high energy availability diet (CON). During the Adaptation phase, athletes were allocated to one of three dietary groups: CON, low carbohydrate/high fat with high energy availability (LCHF), or low energy availability (LEA). At the end of each phase, a 25-km racewalk was completed, with venous blood taken fasted, pre-exercise, and 0, 1, 3 hours postexercise to measure carboxyterminal telopeptide (CTX), procollagen-1 N-terminal peptide (P1NP), and osteocalcin (carboxylated, gla-OC; undercarboxylated, glu-OC). Following Adaptation, LCHF showed decreased fasted P1NP (~26%; p < 0.0001, d = 3.6), gla-OC (~22%; p = 0.01, d = 1.8), and glu-OC (~41%; p = 0.004, d = 2.1), which were all significantly different from CON (p < 0.01), whereas LEA demonstrated significant, but smaller, reductions in fasted P1NP (~14%; p = 0.02, d = 1.7) and glu-OC (~24%; p = 0.049, d = 1.4). Both LCHF (p = 0.008, d = 1.9) and LEA (p = 0.01, d = 1.7) had significantly higher CTX pre-exercise to 3 hours post-exercise but only LCHF showed lower P1NP concentrations (p < 0.0001, d = 3.2). All markers remained unchanged from Baseline in CON. Short-term carbohydrate restriction appears to result in reduced bone formation markers at rest and during exercise with further exercise-related increases in a marker of bone resorption. Bone formation markers during exercise seem to be maintained with LEA although resorption increased. In contrast, nutritional support with adequate energy and carbohydrate appears to reduce unfavorable bone turnover responses to exercise in elite endurance athletes. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nikita C Fensham
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Ida A Heikura
- Canadian Sport Institute Pacific, Victoria, Canada.,Exercise Science, Physical & Health Education, University of Victoria, Victoria, Canada
| | - Alannah K A McKay
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Nicolin Tee
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Kathryn E Ackerman
- Divisions of Sports Medicine and Endocrinology, Boston Children's Hospital, Boston, MA, USA.,Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Louise M Burke
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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18
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von Rosen P, Ekenros L, Solli GS, Sandbakk Ø, Holmberg HC, Hirschberg AL, Fridén C. Offered Support and Knowledge about the Menstrual Cycle in the Athletic Community: A Cross-Sectional Study of 1086 Female Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11932. [PMID: 36231231 PMCID: PMC9564720 DOI: 10.3390/ijerph191911932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Many female athletes perceive that symptoms related to the menstrual cycle such as dysmenorrhea, premenstrual symptoms, amenorrhea or side-effects of hormonal contraceptives negatively impact their training, performance, and general well-being. Knowledge and communication about female athletes' health is therefore important in the sport community. The aims of this study were to explore the level of knowledge and communication about menstrual cycle issues and use of hormonal contraceptives in the athletic community and to describe the kinds of medical support offered to female athletes. A total of 1086 Swedish and Norwegian athletes from 57 different sports responded to a web-based questionnaire. Of these, 58% (n = 627) practiced team sports and 42% (n = 459) individual sports. Twenty-six percent (n = 278) of the athletes perceived their knowledge about female athlete health to be poor/very poor and the knowledge was most often acquired from medical staff. Fifty-three percent (n = 572) of the athletes perceived the knowledge acquired of their coaches as poor/very poor, even though a significantly (p < 0.001) higher proportion of athletes with a female coach (30%, n = 31) rated their coach's knowledge as very good/good, compared to athletes with a male coach (5%, n = 31). Only 11% (n = 116) of the athletes discussed female health issues with their coach. The majority (81%, n = 842) of the athletes partly to strongly agreed that female athlete health is considered a taboo topic in the athletic community. Forty-seven percent (n = 510) of the athletes had access to a physiotherapist, while only three percent (n = 29) had access to a gynecologist. Low perceived knowledge, lack of communication and support demonstrate the need for a multi-professional medical team and enhanced educational efforts focused on female athlete health in the athletic community.
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Affiliation(s)
- Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
| | - Linda Ekenros
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
| | - Guro Strøm Solli
- School of Sport Sciences, UiT—The Arctic University of Norway, 9019 Tromsoe, Norway
- Department of Sports Science and Physical Education, Nord University, 8026 Bodø, Norway
| | - Øyvind Sandbakk
- School of Sport Sciences, UiT—The Arctic University of Norway, 9019 Tromsoe, Norway
- Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Hans-Christer Holmberg
- Department of Health Sciences, Lulea University of Technology, 971 87 Lulea, Sweden or
- Department of Physiology and Pharmacology, Biomedicum C5, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden or
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, 141 52 Huddinge, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden or
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19
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Berryman CE, McClung HL, Sepowitz JJ, Gaffney‐Stomberg E, Ferrando AA, McClung JP, Pasiakos SM. Testosterone status following short-term, severe energy deficit is associated with fat-free mass loss in U.S. Marines. Physiol Rep 2022; 10:e15461. [PMID: 36117330 PMCID: PMC9483439 DOI: 10.14814/phy2.15461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023] Open
Abstract
The objective of this study was to determine metabolic and physiological differences between males with low testosterone (LT) versus those with normal testosterone (NT) following a period of severe energy deficit. In this secondary analysis, 68 male US Marines (mean ± SD, 24.6 ± 2.4 y) were dichotomized by testosterone concentration (< or ≥ 10.5 nmol/L as determined from a single blood sample collected between 0600-0630 after an 8-10 h overnight fast by automated immunoassay) following 7 days of near complete starvation (~300 kcal consumed/d, ~85% energy deficit) during Survival, Evasion, Resistance, and Escape (SERE) training. Dietary intake was assessed before (PRE) SERE. Body composition (dual-energy x-ray absorptiometry and peripheral quantitative computed tomography) and whole-body protein turnover (15 N alanine) were assessed before (PRE) and after (POST) SERE. Mean testosterone concentrations decreased PRE (17.5 ± 4.7 nmol/L) to POST (9.8 ± 4.0 nmol/L, p < 0.0001). When volunteers were dichotomized by POST testosterone concentrations [NT (n = 24) 14.1 ± 3.4 vs. LT (n = 44): 7.5 ± 1.8 nmol/L, p < 0.0001], PRE BMI, total fat mass, trunk fat mass, and testosterone were greater and the diet quality score and total carbohydrate intake were lower in NT compared to LT (p ≤ 0.05). LT lost more fat-free mass and less fat mass, particularly in the trunk region, compared to NT following SERE (p-interaction≤0.044). Whole-body protein synthesis, net balance, and flux decreased and whole-body protein breakdown increased from PRE to POST in both groups (p-time ≤0.025). Following short-term, severe energy deficit, Marines who exhibited low testosterone had greater fat-free mass loss than those who maintained normal testosterone concentrations. Altering body composition and dietary strategies prior to physical training that elicits severe energy deficit may provide an opportunity to attenuate post-training decrements in testosterone and its associated effects (e.g., loss of lean mass, performance declines, fatigue).
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Affiliation(s)
- Claire E. Berryman
- Military Nutrition DivisionUS Army Research Institute of Environmental MedicineNatickMassachusettsUSA
- Oak Ridge Institute for Science and EducationBelcampMarylandUSA
- Department of Nutrition and Integrative PhysiologyFlorida State UniversityTallahasseeFloridaUSA
| | - Holly L. McClung
- Military Nutrition DivisionUS Army Research Institute of Environmental MedicineNatickMassachusettsUSA
| | - John J. Sepowitz
- Military Nutrition DivisionUS Army Research Institute of Environmental MedicineNatickMassachusettsUSA
| | - Erin Gaffney‐Stomberg
- Military Performance DivisionU.S. Army Research Institute of Environmental MedicineNatickMassachusettsUSA
| | - Arny A. Ferrando
- Department of Geriatrics, The Center for Translational Research in Aging & LongevityDonald W. Reynolds Institute of Aging, University of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - James P. McClung
- Military Nutrition DivisionUS Army Research Institute of Environmental MedicineNatickMassachusettsUSA
| | - Stefan M. Pasiakos
- Military Performance DivisionU.S. Army Research Institute of Environmental MedicineNatickMassachusettsUSA
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20
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Energy Availability Over One Athletic Season: An Observational Study Among Athletes From Different Sports. Int J Sport Nutr Exerc Metab 2022; 32:479-490. [PMID: 35894910 DOI: 10.1123/ijsnem.2022-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022]
Abstract
During the athletic season, changes in body composition occur due to fluctuations in energy expenditure and energy intake. Literature regarding changes of energy availability (EA) is still scarce. The aim was to estimate EA of athletes from nonweight and weight-sensitive sports during the athletic season (i.e., preparatory and competitive phase). Eighty-eight athletes (19.1 ± 4.2 years, 21.8 ± 2.0 kg/m2, 27% females, self-reported eumenorrheic) from five sports (basketball [n = 29]; handball [n = 7]; volleyball [n = 9]; swimming [n = 18]; and triathlon [n = 25]) were included in this observational study. Energy intake and exercise energy expenditure were measured through doubly labeled water (over 7 days and considering neutral energy balance) and metabolic equivalents of tasks, respectively. Fat-free mass (FFM) was assessed through a four-compartment model. EA was calculated as EA = (energy intake - exercise energy expenditure)/FFM. Linear mixed models, adjusted for sex, were performed to assess EA for the impact of time by sport interaction. Among all sports, EA increased over the season: basketball, estimated mean (SE): 7.2 (1.5) kcal/kg FFM, p < .001; handball, 14.8 (2.9) kcal/kg FFM, p < .001; volleyball, 7.9 (2.8) kcal/kg FFM, p = .006; swimming, 8.7 (2.0) kcal/kg FFM, p < .001; and triathlon, 9.6 (2.0) kcal/kg FFM, p < .001. Eleven athletes (12.5%) had clinical low EA at the preparatory phase and none during the competitive phase. During both assessments, triathletes' EA was below optimal, being lower than basketballers (p < .001), volleyballers (p < .05), and swimmers (p < .001). Although EA increased in all sports, triathlon's EA was below optimal during both assessments. Risk of low EA might be seasonal and resolved throughout the season, with higher risk during the preparatory phase. However, in weight-sensitive sports, namely triathlon, low EA is still present.
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Winkert K, Steinacker JM, Koehler K, Treff G. High Energetic Demand of Elite Rowing - Implications for Training and Nutrition. Front Physiol 2022; 13:829757. [PMID: 35514350 PMCID: PMC9062098 DOI: 10.3389/fphys.2022.829757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Elite rowers have large body dimensions, a high metabolic capacity, and they realize high training loads. These factors suggest a high total energy requirement (TER), due to high exercise energy expenditure (EEE) and additional energetic needs. We aimed to study EEE and intensity related substrate utilization (SU) of elite rowers during rowing (EEEROW) and other (EEENON-ROW) training. Methods: We obtained indirect calorimetry data during incremental (N = 174) and ramp test (N = 42) ergometer rowing in 14 elite open-class male rowers (body mass 91.8 kg, 95% CI [87.7, 95.9]). Then we calculated EEEROW and SU within a three-intensity-zone model. To estimate EEENON-ROW, appropriate estimates of metabolic equivalents of task were applied. Based on these data, EEE, SU, and TER were approximated for prototypical high-volume, high-intensity, and tapering training weeks. Data are arithmetic mean and 95% confidence interval (95% CI). Results: EEEROW for zone 1 to 3 ranged from 15.6 kcal·min−1, 95% CI [14.8, 16.3] to 49.8 kcal·min−1, 95% CI [48.1, 51.6], with carbohydrate utilization contributing from 46.4%, 95% CI [42.0, 50.8] to 100.0%, 95% CI [100.0, 100.0]. During a high-volume, a high-intensity, or a taper week, TER was estimated to 6,775 kcal·day−1, 95% CI [6,651, 6,898], 5,772 kcal·day−1, 95% CI [5,644, 5,900], or 4,626 kcal∙day−1, 95% CI [4,481, 4,771], respectively. Conclusion: EEE in elite open-class male rowers is remarkably high already during zone 1 training and carbohydrates are dominantly utilized, indicating relatively high metabolic stress even during low intensity rowing training. In high-volume training weeks, TER is presumably at the upper end of the sustainable total energy expenditure. Periodized nutrition seems warranted for rowers to avoid low energy availability, which might negatively impact performance, training, and health.
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Affiliation(s)
- Kay Winkert
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Juergen M Steinacker
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Gunnar Treff
- Division of Sports and Rehabilitation Medicine, Ulm University Medical Center, Ulm, Germany.,Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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22
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Lundy B, Torstveit MK, Stenqvist TB, Burke LM, Garthe I, Slater GJ, Ritz C, Melin AK. Screening for Low Energy Availability in Male Athletes: Attempted Validation of LEAM-Q. Nutrients 2022; 14:nu14091873. [PMID: 35565840 PMCID: PMC9101736 DOI: 10.3390/nu14091873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/06/2023] Open
Abstract
A questionnaire-based screening tool for male athletes at risk of low energy availability (LEA) could facilitate both research and clinical practice. The present options rely on proxies for LEA such screening tools for disordered eating, exercise dependence, or those validated in female athlete populations. in which the female-specific sections are excluded. To overcome these limitations and support progress in understanding LEA in males, centres in Australia, Norway, Denmark, and Sweden collaborated to develop a screening tool (LEAM-Q) based on clinical investigations of elite and sub-elite male athletes from multiple countries and ethnicities, and a variety of endurance and weight-sensitive sports. A bank of questions was developed from previously validated questionnaires and expert opinion on various clinical markers of LEA in athletic or eating disorder populations, dizziness, thermoregulation, gastrointestinal symptoms, injury, illness, wellbeing, recovery, sleep and sex drive. The validation process covered reliability, content validity, a multivariate analysis of associations between variable responses and clinical markers, and Receiver Operating Characteristics (ROC) curve analysis of variables, with the inclusion threshold being set at 60% sensitivity. Comparison of the scores of the retained questionnaire variables between subjects classified as cases or controls based on clinical markers of LEA revealed an internal consistency and reliability of 0.71. Scores for sleep and thermoregulation were not associated with any clinical marker and were excluded from any further analysis. Of the remaining variables, dizziness, illness, fatigue, and sex drive had sufficient sensitivity to be retained in the questionnaire, but only low sex drive was able to distinguish between LEA cases and controls and was associated with perturbations in key clinical markers and questionnaire responses. In summary, in this large and international cohort, low sex drive was the most effective self-reported symptom in identifying male athletes requiring further clinical assessment for LEA.
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Affiliation(s)
- Bronwen Lundy
- Rowing Australia, Canberra, ACT 2600, Australia;
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Monica K. Torstveit
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway; (M.K.T.); (T.B.S.)
| | - Thomas B. Stenqvist
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, 4630 Kristiansand, Norway; (M.K.T.); (T.B.S.)
| | - Louise M. Burke
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
- Correspondence:
| | - Ina Garthe
- Norwegian Olympic Sports Centre, Department of Sports Nutrition, 0806 Oslo, Norway;
| | - Gary J. Slater
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia;
| | - Christian Ritz
- National Institute of Public Health—SDU, 1455 Copenhagen, Denmark;
| | - Anna K. Melin
- Department of Sport Science, Faculty of Social Sciences, Linnaeus University, 351 95 Vaxjo, Sweden;
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Chen Z, Sherk VD, Sharma-Ghimire P, Bemben MG, Bemben DA. Site-Specific Bone Differences and Energy Status in Male Competitive Runners and Road Cyclists. J Clin Densitom 2022; 25:150-159. [PMID: 34952789 DOI: 10.1016/j.jocd.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022]
Abstract
The interaction between mechanical loading and energy availability on bone health in male endurance athletes merits further investigation. The purpose of this study was to compare bone status in male competitive runners and road cyclists and to investigate the influence of energy availability (EA) on bone mineral density (BMD). 18 competitive runners and 19 road cyclists (20-50 years) participated in this study. Areal BMD and body composition were assessed by dual energy x-ray absorptiometry. Volumetric bone variables at the 4% and 66% tibia sites were assessed by peripheral quantitative computed tomography. Energy availability (EA, 7-day dietary and exercise logs) and resting metabolic rate (RMR, open circuit spirometry) were measured as indicators of energy status. Bone loading history, calcium intake, and training history were assessed by questionnaires. After adjusting for age, runners had significantly greater (p < 0.05) areal BMD (femoral neck, left total hip), Z-scores (total body, hips sites), total bone mineral content and trabecular variables (bone mineral content, volumetric BMD, bone strength index) at tibia 4% site, and total volumetric BMD at tibia 66% site than the cyclists (p ≤ 0.05). At the tibia 66% site, cyclists had significantly greater (p < 0.05) total area, periosteal circumference, endosteal circumference, and strength-strain index than runners. Energy variables were similar for runners and cyclists; however, RMR and RMR ratio (measured RMR/predicted RMR) were significantly lower in cyclists (p < 0.001). In conclusion, there were site-specific differences in hip and tibia bone characteristics between runners and cyclists. RMR was associated with several bone outcomes; however, EA was not related to bone health in runners or to dual energy x-ray absorptiometry bone variables in cyclists.
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Affiliation(s)
- Zhaojing Chen
- Department of Kinesiology, California State University, San Bernardino, CA, USA.
| | - Vanessa D Sherk
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Pragya Sharma-Ghimire
- Department of Physical Education and Exercise Science, Lander University, Greenwood, SC, USA
| | - Michael G Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
| | - Debra A Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA
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24
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Jonvik KL, Vardardottir B, Broad E. How Do We Assess Energy Availability and RED-S Risk Factors in Para Athletes? Nutrients 2022; 14:nu14051068. [PMID: 35268044 PMCID: PMC8912472 DOI: 10.3390/nu14051068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/16/2022] Open
Abstract
Low energy availability (LEA) is considered to be the underlying cause of a number of maladaptations in athletes, including impaired physiological function, low bone mineral density (BMD), and hormonal dysfunction. This is collectively referred to as ‘Relative Energy Deficiency in Sport’ (RED-S). LEA is calculated through assessment of dietary energy intake (EI), exercise energy expenditure (EEE) and fat-free mass (FFM). The incidence of LEA in Paralympic athletes is relatively unknown; however, there are legitimate concerns that Para athletes may be at even higher risk of LEA than able-bodied athletes. Unfortunately, there are numerous issues with the application of LEA assessment tools and the criterion for diagnosis within the context of a Para population. The calculation of EEE, in particular, is limited by a distinct lack of published data that cover a range of impairments and activities. In addition, for several RED-S-related factors, it is difficult to distinguish whether they are truly related to LEA or a consequence of the athlete’s impairment and medical history. This narrative review outlines deficits and complexities when assessing RED-S and LEA in Para athletes, presents the information that we do have, and provides suggestions for future progress in this important area of sports nutrition.
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Affiliation(s)
- Kristin L. Jonvik
- Department of Physical Performance, Norwegian School of Sport Sciences, 0806 Oslo, Norway
- Correspondence:
| | - Birna Vardardottir
- Faculty of Health Promotion, Sport and Leisure Studies, University of Iceland, 105 Reykjavik, Iceland;
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Shirley MK, Longman DP, Elliott-Sale KJ, Hackney AC, Sale C, Dolan E. A Life History Perspective on Athletes with Low Energy Availability. Sports Med 2022; 52:1223-1234. [PMID: 35113390 DOI: 10.1007/s40279-022-01643-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 12/19/2022]
Abstract
The energy costs of athletic training can be substantial, and deficits arising from costs unmet by adequate energy intake, leading to a state of low energy availability, may adversely impact athlete health and performance. Life history theory is a branch of evolutionary theory that recognizes that the way the body uses energy-and responds to low energy availability-is an evolved trait. Energy is a finite resource that must be distributed throughout the body to simultaneously fuel all biological processes. When energy availability is low, insufficient energy may be available to equally support all processes. As energy used for one function cannot be used for others, energetic "trade-offs" will arise. Biological processes offering the greatest immediate survival value will be protected, even if this results in energy being diverted away from others, potentially leading to their downregulation. Athletes with low energy availability provide a useful model for anthropologists investigating the biological trade-offs that occur when energy is scarce, while the broader conceptual framework provided by life history theory may be useful to sport and exercise researchers who investigate the influence of low energy availability on athlete health and performance. The goals of this review are: (1) to describe the core tenets of life history theory; (2) consider trade-offs that might occur in athletes with low energy availability in the context of four broad biological areas: reproduction, somatic maintenance, growth, and immunity; and (3) use this evolutionary perspective to consider potential directions for future research.
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Affiliation(s)
- Meghan K Shirley
- Division of GI, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel P Longman
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kirsty J Elliott-Sale
- Musculoskeletal Physiology Research Group, Sport Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Anthony C Hackney
- Department of Exercise and Sport Science, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig Sale
- Musculoskeletal Physiology Research Group, Sport Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Eimear Dolan
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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Oliveira-Junior G, Pinto RS, Shirley MK, Longman DP, Koehler K, Saunders B, Roschel H, Dolan E. The Skeletal Muscle Response to Energy Deficiency: A Life History Perspective. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022. [DOI: 10.1007/s40750-021-00182-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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27
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Moore EM, Drenowatz C, Stodden DF, Pritchett K, Brodrick TC, Williams BT, Goins JM, Torres-McGehee TM. Examination of Athlete Triad Symptoms Among Endurance-Trained Male Athletes: A Field Study. Front Nutr 2021; 8:737777. [PMID: 34901104 PMCID: PMC8664375 DOI: 10.3389/fnut.2021.737777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies examining the physiological consequences associated with deficits in energy availability (EA) for male athletes are sparse. Purpose: To examine male athlete triad components; low energy availability (LEA) with or without an eating disorder risk (ED), reproductive hormone [testosterone (T)], and bone mineral density (BMD) in endurance-trained male athletes during different training periods. Methods: A cross-sectional design with 14 participants (age: 26.4 ± 4.2 years; weight: 70.6 ± 6.4 kg; height: 179.5 ± 4.3 cm; BMI: 21.9 ± 1.8 kg/m2) were recruited from the local community. Two separate training weeks [low (LV) and high (HV) training volumes] were used to collect the following: 7-day dietary and exercise logs, and blood concentration of T. Anthropometric measurements was taken prior to data collection. A one-time BMD measure (after the training weeks) and VO2max-HR regressions were utilized to calculate EEE. Results: Overall, EA presented as 27.6 ± 10.7 kcal/kgFFM·d-1 with 35% (n = 5) of participants demonstrating increased risk for ED. Examining male triad components, 64.3% presented with LEA (≤ 30 kcal/kgFFM·d-1) while participants presented with T (1780.6 ± 1672.6 ng/dl) and BMD (1.31 ±.09 g/cm2) within normal reference ranges. No differences were found across the 2 training weeks for EI, with slight differences for EA and EEE. Twenty-five participants (89.3%) under-ingested CHO across both weeks, with no differences between weeks. Conclusion: Majority of endurance-trained male athletes presented with one compromised component of the triad (LEA with or without ED risk); however, long-term negative effects on T and BMD were not demonstrated. Over 60% of the participants presented with an EA ≤ 30 kcal/kgFFM·d-1, along with almost 90% not meeting CHO needs. These results suggest male endurance-trained athletes may be at risk to negative health outcomes similar to mechanistic behaviors related to EA with or without ED in female athletes.
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Affiliation(s)
- Erin M Moore
- Kinesiology Department, University of Virginia, Charlottesville, VA, United States
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, Linz, University of Upper Austria, Upper Austria, Austria
| | - David F Stodden
- Physical Education, University of South Carolina, Columbia, SC, United States
| | - Kelly Pritchett
- Health Sciences, Central Washington University, Ellensburg, WA, United States
| | - Thaddus C Brodrick
- Exercise Science, Exercise Science Department, University of South Carolina, Columbia, SC, United States
| | - Brittany T Williams
- Exercise Science, Exercise Science Department, University of South Carolina, Columbia, SC, United States
| | - Justin M Goins
- Exercise Science, Exercise Science Department, University of South Carolina, Columbia, SC, United States
| | - Toni M Torres-McGehee
- Exercise Science, Exercise Science Department, University of South Carolina, Columbia, SC, United States
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Nelson LR, Halpern-Felsher BL, Nagata JM, Carlson JL. Clinician practices assessing hypothalamic-pituitary-gonadal axis suppression in adolescents with an eating disorder. Int J Eat Disord 2021; 54:2218-2222. [PMID: 34611918 DOI: 10.1002/eat.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Although extensive literature exists on hypothalamic-pituitary-gonadal (HPG) axis suppression in females with an eating disorder, there are few studies in males. Our study aimed to determine clinician practices for the assessment of HPG axis suppression and to identify differences in practice based on the sex of the patient. METHOD Our 31-item survey queried clinicians about confidence level and practices for assessing HPG suppression in male compared to female patients. RESULTS Findings showed that clinicians (n = 104) were less likely to evaluate HPG suppression in males compared to females, including assessment of sexual maturity rating (p < .050), screening of decreased libido compared to amenorrhea (p < .001) and lab assessment (luteinizing hormone and follicular-stimulating hormone: p < .001; estradiol/testosterone: p < .010; TSH: p < .050). Participants also felt less confident evaluating male patients (p < .001) and requested better screening tools for males (p < .001). DISCUSSION Our data suggest that clinician practices differ based on patient sex and that clinicians request tools for HPG suppression assessment in males. This is the first study examining specific practices and comfort levels of clinicians when assessing HPG axis suppression. Findings suggest that more guidance on the management of male patients may be needed to standardize care and to prevent short and long-term sequela of malnutrition.
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Affiliation(s)
- Lance R Nelson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Bonnie L Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California, USA
| | - Jennifer L Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
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Jurov I, Keay N, Spudić D, Rauter S. Inducing low energy availability in trained endurance male athletes results in poorer explosive power. Eur J Appl Physiol 2021; 122:503-513. [PMID: 34825937 PMCID: PMC8617370 DOI: 10.1007/s00421-021-04857-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022]
Abstract
Purpose Low energy availability in males needs more original research to understand its health and performance consequences. The aim of the study was to induce low energy availability in previously healthy male endurance athletes by reducing energy availability by 25% for 14 consecutive days and measure any potential changes in performance, health, mental state or energy markers. Methods Energy availability was reduced in 12 trained, well-trained and elite endurance athletes by increasing energy expenditure and controlling energy intake. After intervention, health was assessed by blood draw, body composition was measured, energy markers by measuring resting energy expenditure, performance with three specific tests (measuring endurance, agility and explosive power) and two questionnaires were used for psychological assessment (the Three Factor Eating Questionnaire and Well-being questionnaire). Results Reduced energy availability (22.4 ± 6.3 kcal/kg FFM/day) caused significantly lower haemoglobin values (t(12) = 2.652, p = 0.022), there was a tendency for lower iron and IGF-1 (p = 0.066 and p = 0.077, respectively). Explosive power was reduced (t(12) = 4.570, p = 0.001), lactate metabolism was altered and athletes reported poorer well-being (t(12) = 2.385, p = 0.036). Cognitive restriction was correlated with energy availability (r = 0.528, p = 0.039). Conclusion This is the first research providing direct evidence that suboptimal energy availability negatively impacts explosive power before hormonal changes occur in male endurance athletes. It is also the first to show direct association of low energy availability and higher cognitive restriction. We also observed worse well-being and lower haemoglobin values. 25% of energy availability reduction as not enough to elicit changes in resting energy expenditure. Supplementary Information The online version contains supplementary material available at 10.1007/s00421-021-04857-4.
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Affiliation(s)
- Iva Jurov
- Faculty of Sport, University of Ljubljana, Gortanova 22, 1000, Ljubljana, Slovenia.
| | - Nicola Keay
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Darjan Spudić
- Faculty of Sport, University of Ljubljana, Gortanova 22, 1000, Ljubljana, Slovenia
| | - Samo Rauter
- Faculty of Sport, University of Ljubljana, Gortanova 22, 1000, Ljubljana, Slovenia
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Prevalence of Surrogate Markers of Relative Energy Deficiency in Male Norwegian Olympic-Level Athletes. Int J Sport Nutr Exerc Metab 2021; 31:497-506. [PMID: 34489365 DOI: 10.1123/ijsnem.2020-0368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
The syndrome of Relative Energy Deficiency in Sport (RED-S) includes wide-ranging effects on physiological and psychological functioning, performance, and general health. However, RED-S is understudied among male athletes at the highest performance levels. This cross-sectional study aimed to investigate surrogate RED-S markers prevalence in Norwegian male Olympic-level athletes. Athletes (n = 44) aged 24.7 ± 3.8 years, body mass 81.3 ± 15.9 kg, body fat 13.7% ± 5.8%, and training volume 76.1 ± 22.9 hr/month were included. Assessed parameters included resting metabolic rate (RMR), body composition, and bone mineral density by dual-energy X-ray absorptiometry and venous blood variables (testosterone, free triiodothyronine, cortisol, and lipids). Seven athletes (16%) grouped by the presence of low RMR (RMRratio < 0.90) (0.81 ± 0.07 vs. 1.04 ± 0.09, p < .001, effect size 2.6), also showed lower testosterone (12.9 ± 5.3 vs. 19.0 ± 5.3 nmol/L, p = .020) than in normal RMR group. In low RMRratio individuals, prevalence of other RED-S markers (-subclinical-low testosterone, low free triiodothyronine, high cortisol, and elevated low-density lipoprotein) was (N/number of markers): 2/0, 2/1, 2/2, 1/3. Low bone mineral density (z-score < -1) was found in 16% of the athletes, all with normal RMR. Subclinical low testosterone and free triiodothyronine levels were found in nine (25%) and two (5%) athletes, respectively. Subclinical high cortisol was found in 23% of athletes while 34% had elevated low-density lipoprotein cholesterol levels. Seven of 12 athletes with two or more RED-S markers had normal RMR. In conclusion, this study found that multiple RED-S markers also exist in male Olympic-level athletes. This highlights the importance of regular screening of male elite athletes, to ensure early detection and treatment of RED-S.
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31
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Wardle SL, O'Leary TJ, McClung JP, Pasiakos SM, Greeves JP. Feeding female soldiers: Consideration of sex-specific nutrition recommendations to optimise the health and performance of military personnel. J Sci Med Sport 2021; 24:995-1001. [PMID: 34452842 DOI: 10.1016/j.jsams.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/25/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Appropriate nutrition recommendations are required to optimise the health and performance of military personnel, yet limited data are available on whether male and female military personnel have different nutrition requirements. OBJECTIVES To consider the evidence for sex-specific nutrition requirements to optimise the health and performance of military personnel. DESIGN Narrative review. METHODS Published literature was reviewed, with a focus on sex-specific requirements, in the following areas: nutrition for optimising muscle mass and function, nutrition during energy deficit, and nutrition for reproductive and bone health. RESULTS There are limited data on sex differences in protein requirements but extant data suggest that, despite less muscle mass, on average, in women, sex-specific protein feeding strategies are not required to optimise muscle mass in military-aged individuals. Similarly, despite sex differences in metabolic and endocrine responses to energy deficit, current data do not suggest a requirement for sex-specific feeding strategies during energy deficit. Energy deficit impairs health and performance, most notably bone and reproductive health and these impairments are greater for women. Vitamin D, iron and calcium are important nutrients to protect the bone health of female military personnel due to increased risk of stress fracture. CONCLUSIONS Women have an increased incidence of bone injuries, less muscle mass and are more susceptible to the negative effects of energy deficit, including compromised reproductive health. However, there are limited data on sex differences in response to various nutrition strategies designed to improve these elements of health and performance. Future studies should evaluate whether sex-specific feeding recommendations are required.
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Affiliation(s)
- Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
| | - Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, United States of America
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, United States of America
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
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Kontele I, Vassilakou T. Nutritional Risks among Adolescent Athletes with Disordered Eating. CHILDREN-BASEL 2021; 8:children8080715. [PMID: 34438606 PMCID: PMC8394476 DOI: 10.3390/children8080715] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 01/29/2023]
Abstract
In their attempt to achieve the optimum weight or body shape for their activity, athletes frequently use harmful weight-control practices that may lead to the development of disordered eating or eating disorders. These practices are linked to several medical and mental consequences that may be more serious in adolescent athletes, as their bodies must meet both intensive growth demands and training requirements at the same time. Among other consequences, adolescent athletes may be at nutritional risk, due to their high nutrient needs and unhealthy eating behaviors. A literature review was conducted to examine the main nutritional risks and malnutrition issues faced by adolescent athletes that present disordered eating attitudes or eating disorders. Most studies refer to adult elite athletes, however research on adolescent athletes also indicates that the most common nutritional risks that may arise due to disordered eating include energy, macronutrient and micronutrient deficiencies, dehydration and electrolyte imbalances and changes in body composition that may lead to menstrual abnormalities, and decreased bone mass density. Educational programs and early detection of disordered eating and eating disorders are crucial to avoid the emergence and ensure timely management of nutrition-related problems in the vulnerable group of adolescent athletes.
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Within-Day Energy Balance and Metabolic Suppression in Male Collegiate Soccer Players. Nutrients 2021; 13:nu13082644. [PMID: 34444803 PMCID: PMC8398536 DOI: 10.3390/nu13082644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Metabolic suppression due to relative energy deficiency can cause various physiological impairments in athletes. The purpose of this study was to evaluate within-day energy balance (WDEB) and the ratio between measured and predicted resting energy expenditure (REEratio) and to investigate the relationships between the markers of metabolic suppression. Ten male collegiate soccer players completed a 7-day food diary, physical activity, and heart rate records during the training and rest days. Energy intake (EI) and energy expenditure (EE) were analyzed to evaluate WDEB components. Body composition was measured using dual-energy X-ray absorptiometry (DXA), and blood sampling was conducted for hormonal analysis. The REE was measured using the Douglas bag method and predicted using the DXA-predicted method to calculate the REEratio. Participants were categorized into the normal (REEratio ≥ 0.94, n = 5) and suppressed (REEratio < 0.94, n = 5) groups. There were no group differences in the components of WDEB, except diet-induced thermogenesis (DIT), but EI was significantly higher in the normal group than in the suppressed group (7-day total: 3660 ± 347 vs. 3024 ± 491 kcal/day, p = 0.046 and rest days: 3772 ± 463 vs. 2796 ± 800 kcal/day, p = 0.046). Analysis of hormonal markers of metabolic suppression only showed a significant positive association between insulin-like growth factor-1 (IGF-1) and REEratio (r = 0.771, p = 0.009). The relationships between metabolic suppression and the markers of energy deficiency were inconclusive. There are possible associations of insufficient EI and IGF-1 levels with metabolic suppression, and further study is required to understand energy deficiency in male soccer players.
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Stellingwerff T, Heikura IA, Meeusen R, Bermon S, Seiler S, Mountjoy ML, Burke LM. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sports Med 2021; 51:2251-2280. [PMID: 34181189 DOI: 10.1007/s40279-021-01491-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
The symptom similarities between training-overload (with or without an Overtraining Syndrome (OTS) diagnosis) and Relative Energy Deficiency in Sport (RED-S) are significant, with both initiating from a hypothalamic-pituitary origin, that can be influenced by low carbohydrate (CHO) and energy availability (EA). In this narrative review we wish to showcase that many of the negative outcomes of training-overload (with, or without an OTS diagnosis) may be primarily due to misdiagnosed under-fueling, or RED-S, via low EA and/or low CHO availability. Accordingly, we undertook an analysis of training-overload/OTS type studies that have also collected and analyzed for energy intake (EI), CHO, exercise energy expenditure (EEE) and/or EA. Eighteen of the 21 studies (86%) that met our criteria showed indications of an EA decrease or difference between two cohorts within a given study (n = 14 studies) or CHO availability decrease (n = 4 studies) during the training-overload/OTS period, resulting in both training-overload/OTS and RED-S symptom outcomes compared to control conditions. Furthermore, we demonstrate significantly similar symptom overlaps across much of the OTS (n = 57 studies) and RED-S/Female Athlete Triad (n = 88 studies) literature. It is important to note that the prevention of under-recovery is multi-factorial, but many aspects are based around EA and CHO availability. Herein we have demonstrated that OTS and RED-S have many shared pathways, symptoms, and diagnostic complexities. Substantial attention is required to increase the knowledge and awareness of RED-S, and to enhance the diagnostic accuracy of both OTS and RED-S, to allow clinicians to more accurately exclude LEA/RED-S from OTS diagnoses.
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Affiliation(s)
- Trent Stellingwerff
- Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 Interurban Road, Victoria, BC, V9E 2C5, Canada.
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
| | - Ida A Heikura
- Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 Interurban Road, Victoria, BC, V9E 2C5, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stéphane Bermon
- Université Côte d'Azur, LAMHESS Nice, Nice, France
- World Athletics, Health and Science Department, Monte Carlo, Monaco
| | - Stephen Seiler
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- IOC Medical Commission Games Group, Lausanne, Switzerland
| | - Louise M Burke
- Australian Institute of Sport, Bruce, ACT, Australia
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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Matt SA, Barrack MT, Gray VB, Cotter JA, Van Loan MD, Rauh MJ, McGowan R, Nichols JF. Adolescent Endurance Runners Exhibit Suboptimal Energy Availability and Intakes of Key Nutrients. J Am Coll Nutr 2021; 41:551-558. [PMID: 34032561 DOI: 10.1080/07315724.2021.1925994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Backgroud: Despite the evidence of an elevated prevalence of low bone mass in adolescent endurance runners, reports on dietary intake in this population is limited.Objectives: This study aimed to evaluate energy availability (EA) and dietary intake among 72 (n = 60 female, n = 12 male) high school cross-country runners.Methods: The sample consisted of a combined dataset of two cohorts. In both cohorts, the Block Food Frequency Questionnaire (FFQ; 2005 & 2014 versions) assessed dietary intake. Fat free mass was assessed using dual-energy x-ray absorptiometry or bioelectrical impedance analysis.Results: Mean EA was less than recommended (45 kcal/kgFFM/day) among male (35.8 ± 14.4 kcal/kg FFM/day) and female endurance runners (29.6 ± 17.4 kcal/kgFFM/day), with 30.0% of males and 60.0% of females meeting criteria for low EA (<30 kcal/kgFFM/day). Calorie intake for male (2,614.2 ± 861.8 kcal/day) and female (1,879.5 ± 723.6 kcal/day) endurance runners fell below the estimated energy requirement for "active" boys (>3,100 kcal/day) and girls (>2,300 kcal/day). Female endurance runners' relative carbohydrate intake (4.9 ± 2.1 g/kg/day) also fell below recommended levels (6-10 g/kg/day). Male and female endurance runners exhibited below-recommended intakes of calcium, vitamin D, potassium, fruit, vegetables, grains, and dairy. Compared to male endurance runners, female endurance runners demonstrated lower relative intakes of energy (kcal/kg/day), protein (g/kg/day), fat (g/kg/day), fiber, vegetables, total protein, and oils.Conclusion: This study provides evidence of the nutritional risk of adolescent endurance runners and underscores the importance of nutritional support efforts in this population.
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Affiliation(s)
- Samantha A Matt
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Michelle T Barrack
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Virginia B Gray
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Joshua A Cotter
- Department of Kinesiology, California State University Long Beach, Long Beach, California, USA
| | - Marta D Van Loan
- U.S. Department of Agriculture, Agricultural Research Service, Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | - Mitchell J Rauh
- Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Rachel McGowan
- Department of Family and Consumer Sciences, California State University Long Beach, Long Beach, California, USA
| | - Jeanne F Nichols
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.,School of Exercise and Nutritional Sciences, San Diego State University, San Diego, California, USA
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Effects of Low Energy Availability on Bone Health in Endurance Athletes and High-Impact Exercise as A Potential Countermeasure: A Narrative Review. Sports Med 2021; 51:391-403. [PMID: 33346900 PMCID: PMC7900047 DOI: 10.1007/s40279-020-01396-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endurance athletes expend large amounts of energy in prolonged high-intensity exercise and, due to the weight-sensitive nature of most endurance sports, often practice periods of dietary restriction. The Female Athlete Triad and Relative Energy Deficiency in Sport models consider endurance athletes at high-risk for suffering from low energy availability and associated health complications, including an increased chance of bone stress injury. Several studies have examined the effects of low energy availability on various parameters of bone structure and markers of bone (re)modelling; however, there are differences in findings and research methods and critical summaries are lacking. It is difficult for athletes to reduce energy expenditure or increase energy intake (to restore energy availability) in an environment where performance is a priority. Development of an alternative tool to help protect bone health would be beneficial. High-impact exercise can be highly osteogenic and energy efficient; however, at present, it is rarely utilized to promote bone health in endurance athletes. Therefore, with a view to reducing the prevalence of bone stress injury, the objectives of this review are to evaluate the effects of low energy availability on bone health in endurance athletes and explore whether a high-impact exercise intervention may help to prevent those effects from occurring.
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Barrack M, Fredericson M, Dizon F, Tenforde A, Kim B, Kraus E, Kussman A, Singh S, Nattiv A. Dietary Supplement Use According to Sex and Triad Risk Factors in Collegiate Endurance Runners. J Strength Cond Res 2021; 35:404-410. [PMID: 33278271 DOI: 10.1519/jsc.0000000000003848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Barrack, MT, Fredericson, M, Dizon, F, Tenforde, AS, Kim, BY, Kraus, E, Kussman, A, Singh, S, and Nattiv, A. Dietary supplement use according to sex and Triad risk factors in collegiate endurance runners. J Strength Cond Res 35(2): 404-410, 2021-This cross-sectional study evaluated the prevalence in the use of dietary supplements among elite collegiate runners among 2 NCAA Division I cross-country teams. At the start of each season from 2015 to 2017, male and female endurance runners were recruited to complete baseline study measures; the final sample included 135 (male n = 65, female n = 70) runners. Runners completed a health survey, web-based nutrition survey, and Triad risk assessment. The prevalence of dietary supplement use and Triad risk factors, including disordered eating, low bone mass, amenorrhea (in women), low body mass index, and stress fracture history, was assessed. A total of 78.5% (n = 106) runners reported taking 1 or more supplements on ≥4 days per week over the past month, 48% (n = 65) reported use of ≥3 supplements. Products used with highest frequency included multivitamin/minerals 46.7% (n = 63), iron 46.7% (n = 63), vitamin D 34.1% (n = 46), and calcium 33.3% (n = 45). More women, compared with men, used iron (61.4 vs. 30.8%, p < 0.001) and calcium (41.4 vs. 24.6%, p = 0.04); men exhibited higher use of amino acids and beta-alanine (6.2 vs. 0%, p = 0.04). Runners with bone stress injury (BSI) history, vs. no previous BSI, reported more frequent use of ≥3 supplements (61.5 vs. 32.8%, p = 0.001), vitamin D (49.2 vs. 19.4%, p < 0.001), and calcium (47.7 vs. 19.4%, p = 0.001). Low bone mineral density was also associated with higher use of vitamin D and calcium. Most runners reported regular use of 1 or more supplements, with patterns of use varying based on sex, history of BSI, and bone mass.
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Affiliation(s)
- Michelle Barrack
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
| | | | - Francis Dizon
- Department of Family and Consumer Sciences, California State University, Long Beach, Long Beach, California
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Brian Kim
- Departments of Family Medicine and Orthopedic Surgery, University of California, Irvine, Irvine, California; and
| | - Emily Kraus
- Department of Orthopedic Surgery, Stanford University, Stanford, California
| | - Andrea Kussman
- Department of Orthopedic Surgery, Stanford University, Stanford, California
| | - Sonal Singh
- Departments of Family Medicine and Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
| | - Aurelia Nattiv
- Departments of Family Medicine and Orthopedic Surgery, University of California, Los Angeles, Santa Monica, California
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Risk of Low Energy Availability among Female and Male Elite Runners Competing at the 26th European Cross-Country Championships. Nutrients 2021; 13:nu13030873. [PMID: 33800051 PMCID: PMC8000897 DOI: 10.3390/nu13030873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 03/03/2021] [Indexed: 02/08/2023] Open
Abstract
Low energy availability (LEA) causes impaired physiological functioning. Cross-country running is a weight-sensitive sport, making athletes more prone to LEA. We aimed to estimate the prevalence of elite European cross-country athletes at risk of LEA using the LEA in Females Questionnaire (LEAF-Q) and to analyze demographic and physical characteristics that are associated with LEA. Athletes ≥ 18 years competing at the 26th European Cross-Country Championships (n = 602) were invited to complete a questionnaire (sociodemographic, training, anthropometric characteristics, and LEAF-Q). A total of 207 valid surveys were collected (83 females, 22.1 (4.0) years, and 124 males, 22.3 (4.1) years), and 16 surveys were excluded. A high prevalence of athletes at risk of LEA (64.3%) was observed, being higher in females than in males (79.5 and 54.0% respectively, p < 0.001). More than half of athletes (54.1%, n = 112) reported bowel movements once a week or more rarely, while 33 female athletes (41.3%) did not report normal menstruation. Overall, cross-country athletes are at high risk of LEA. Moreover, a high prevalence of gastrointestinal and menstrual impairments was reported. Hence, athletes should be followed by multidisciplinary teams to inform, prevent, and treat LEA and its effects.
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Lee S, Kuniko M, Han S, Oh T, Taguchi M. Association of Low Energy Availability and Suppressed Metabolic Status in Korean Male Collegiate Soccer Players: A Pilot Study. Am J Mens Health 2020; 14:1557988320982186. [PMID: 33356773 PMCID: PMC7768860 DOI: 10.1177/1557988320982186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Low energy availability (EA) can impair physiological function in athletes. The purpose of this study was to investigate EA status, metabolic status, and bone metabolism with biochemical analysis in Korean male soccer players. Twelve male athletes (18–20 years) completed the study. Body composition and bone mineral density were measured using dual energy X-ray absorptiometry (DXA), while VO2 max was determined by an incremental exercise test. Blood samples were taken for bone marker and hormone analyses. Resting energy expenditure (REE) was measured using the Douglas bag method and predicted using the DXA method. Food diaries and heart rates (HR) during training were recorded, and the Profile of Mood States 2 and Eating Attitude Test 26 were completed. Group differences between low EA (LEA <30 kcal/kg FFM/d, n = 5) and high EA (HEA ≥30 kcal/kg FFM/d, n = 7) were evaluated. The mean EA of the all participants was 31.9 ± 9.8 kcal/kg FFM/d with only two participants having an EA above 45 kcal/kg FFM/d. LEA showed suppressed REE (LEA: 26.0 ± 1.7 kcal/kg/d, HEA: 28.8 ± 1.4 kcal/kg/d, p = .011) with a lower REEratio (LEA: 0.91 ± 0.06, HEA: 1.01 ± 0.05, p = .008) as well as a lower insulin-like growth factor 1 (IGF-1) level (LEA: 248.6 ± 51.2 ng/mL, HEA: 318.9 ± 43.4 ng/mL, p = .028) compared to HEA. There were no group differences in bone markers or other hormone levels. Korean male athletes exhibited low EA status with suppressed metabolism, but there was limited evidence on the effect of EA on bone metabolism, endocrine system, and psychological parameters.
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Affiliation(s)
- Sihyung Lee
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Moto Kuniko
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Seungah Han
- Department of Sports and Leisure Studies, Yongin University, Yongin, Gyeonggi, Korea
| | - Taewoong Oh
- Department of Sports and Leisure Studies, Yongin University, Yongin, Gyeonggi, Korea
| | - Motoko Taguchi
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
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Correlations between Basal Trace Minerals and Hormones in Middle and Long-Distance High-Level Male Runners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249473. [PMID: 33348799 PMCID: PMC7765843 DOI: 10.3390/ijerph17249473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 12/16/2022]
Abstract
Several essential trace minerals play an important role in the endocrine system; however, toxic trace minerals have a disruptive effect. The aim of this research was to determine basal concentrations and the possible correlations between trace minerals in plasma and several plasma hormones in runners. Sixty high-level male endurance runners (21 ± 3 years; 1.77 ± 0.05 m; 64.97 ± 7.36 kg) participated in the present study. Plasma hormones were analyzed using an enzyme-linked immunosorbent assay (ELISA) and plasma trace minerals were analyzed with inductively coupled plasma mass spectrometry (ICP-MS). Correlations and simple linear regression were used to assess the association between trace minerals and hormones. Plasma testosterone concentrations were inversely correlated with manganese (r = -0.543; β = -0.410; p < 0.01), selenium (r = -0.292; β = -0.024; p < 0.05), vanadium (r = -0.406; β = -1.278; p < 0.01), arsenic (r = -0.336; β = -0.142; p < 0.05), and lead (r = -0.385; β = -0.418; p < 0.01). Plasma luteinizing hormone (LH) levels were positively correlated with arsenic (r = 0.298; β = 0.327; p < 0.05) and cesium (r = 0.305; β = 2.272; p < 0.05), and negatively correlated with vanadium (r = -0.303; β = -2.467; p < 0.05). Moreover, cortisol concentrations showed significant positive correlations with cadmium (r = 0.291; β = 209.01; p < 0.05). Finally, insulin concentrations were inversely related to vanadium (r = -0.359; β = -3.982; p < 0.05). In conclusion, endurance runners living in areas with high environmental levels of toxic minerals should check their concentrations of anabolic hormones.
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McKay AKA, Pyne DB, Burke LM, Peeling P. Iron Metabolism: Interactions with Energy and Carbohydrate Availability. Nutrients 2020; 12:E3692. [PMID: 33265953 PMCID: PMC7761418 DOI: 10.3390/nu12123692] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
The provision or restriction of select nutrients in an athlete's diet can elicit a variety of changes in fuel utilization, training adaptation, and performance outcomes. Furthermore, nutrient availability can also influence athlete health, with one key system of interest being iron metabolism. The aim of this review was to synthesize the current evidence examining the impact of dietary manipulations on the iron regulatory response to exercise. Specifically, we assessed the impact of both acute and chronic carbohydrate (CHO) restriction on iron metabolism, with relevance to contemporary sports nutrition approaches, including models of periodized CHO availability and ketogenic low CHO high fat diets. Additionally, we reviewed the current evidence linking poor iron status and altered hepcidin activity with low energy availability in athletes. A cohesive understanding of these interactions guides nutritional recommendations for athletes struggling to maintain healthy iron stores, and highlights future directions and knowledge gaps specific to elite athletes.
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Affiliation(s)
- Alannah K. A. McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia;
| | - David B. Pyne
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2617, Australia;
| | - Louise M. Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia;
| | - Peter Peeling
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, WA 6009, Australia;
- Western Australian Institute of Sport, Mt Claremont, WA 6010, Australia
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42
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Areta JL, Taylor HL, Koehler K. Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. Eur J Appl Physiol 2020; 121:1-21. [PMID: 33095376 PMCID: PMC7815551 DOI: 10.1007/s00421-020-04516-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022]
Abstract
Energy availability (EA) is defined as the amount of dietary energy available to sustain physiological function after subtracting the energetic cost of exercise. Insufficient EA due to increased exercise, reduced energy intake, or a combination of both, is a potent disruptor of the endocrine milieu. As such, EA is conceived as a key etiological factor underlying a plethora of physiological dysregulations described in the female athlete triad, its male counterpart and the Relative Energy Deficiency in Sport models. Originally developed upon female-specific physiological responses, this concept has recently been extended to males, where experimental evidence is limited. The majority of data for all these models are from cross-sectional or observational studies where hypothesized chronic low energy availability (LEA) is linked to physiological maladaptation. However, the body of evidence determining causal effects of LEA on endocrine, and physiological function through prospective studies manipulating EA is comparatively small, with interventions typically lasting ≤ 5 days. Extending laboratory-based findings to the field requires recognition of the strengths and limitations of current knowledge. To aid this, this review will: (1) provide a brief historical overview of the origin of the concept in mammalian ecology through its evolution of algebraic calculations used in humans today, (2) Outline key differences from the ‘energy balance’ concept, (3) summarise and critically evaluate the effects of LEA on tissues/systems for which we now have evidence, namely: hormonal milieu, reproductive system endocrinology, bone metabolism and skeletal muscle; and finally (4) provide perspectives and suggestions for research upon identified knowledge gaps.
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Affiliation(s)
- José L Areta
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK.
| | - Harry L Taylor
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Gross C, Joy E. Female Athlete Triad. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Alves J, Toro V, Barrientos G, Bartolomé I, Muñoz D, Maynar M. Hormonal Changes in High-Level Aerobic Male Athletes during a Sports Season. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5833. [PMID: 32806586 PMCID: PMC7460198 DOI: 10.3390/ijerph17165833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study was to determine the possible changes in plasma of several hormones such as Luteinizing Hormone, Testosterone, Cortisol and Insulin in endurance runners during the sports season. Twenty-one high-level male endurance runners (22 ± 3.2 years, 1.77 ± 0.05 m) participated in the study. Basal plasma hormones were measured at four moments during the season (initial, 3, 6 and 9 months), and were analyzed using ELISA (enzyme-linked immunosorbent assay). Testosterone and Luteinizing Hormone (LH) suffered very significant decreases (p < 0.01) at 3 months compared with the beginning and an increase (p < 0.05) at 6 and 9 months compared with 3 months. Insulin level was significantly lower (p < 0.05) at 3, 6 and 9 months compared with the initial test. Insulin and cortisol were associated inversely (r = 0.363; β = -0.577; p = 0.017) and positively (r = 0.202; β = 0.310; p = 0.043), respectively, with the amount of km per week performed by the runners. There was a significant association between km covered at a higher intensity than the anaerobic threshold and I (r = 0.580; β = -0.442; p = 0.000). Our findings indicate that testosterone, LH and insulin were more sensitive to changes in training volume and intensity than cortisol in high-level endurance runners. Basal testosterone and LH concentrations decrease in athletes who perform a high volume of aerobic km in situations of low energy availability.
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Affiliation(s)
- Javier Alves
- Department of Sport Science, Faculty of Education, Pontifical University of Salamanca, C/Henry Collet, 52–70, CP: 37007 Salamanca, Spain;
| | - Víctor Toro
- Department of Physiology, Faculty of Sports Science Faculty, University of Extremadura, University Avenue, s/n CP: 10003 Cáceres, Spain; (V.T.); (I.B.); (D.M.); (M.M.)
| | - Gema Barrientos
- Department of Sport Science, Faculty of Education, Pontifical University of Salamanca, C/Henry Collet, 52–70, CP: 37007 Salamanca, Spain;
| | - Ignacio Bartolomé
- Department of Physiology, Faculty of Sports Science Faculty, University of Extremadura, University Avenue, s/n CP: 10003 Cáceres, Spain; (V.T.); (I.B.); (D.M.); (M.M.)
| | - Diego Muñoz
- Department of Physiology, Faculty of Sports Science Faculty, University of Extremadura, University Avenue, s/n CP: 10003 Cáceres, Spain; (V.T.); (I.B.); (D.M.); (M.M.)
| | - Marcos Maynar
- Department of Physiology, Faculty of Sports Science Faculty, University of Extremadura, University Avenue, s/n CP: 10003 Cáceres, Spain; (V.T.); (I.B.); (D.M.); (M.M.)
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Logue DM, Madigan SM, Melin A, McDonnell SJ, Delahunt E, Heinen M, Corish CA. Self-reported reproductive health of athletic and recreationally active males in Ireland: potential health effects interfering with performance. Eur J Sport Sci 2020; 21:275-284. [PMID: 32212923 DOI: 10.1080/17461391.2020.1748116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: The syndrome of Relative Energy Deficiency in Sport (RED-S) consensus statements recognise that male athletes might have impaired fertility in terms of the Exercise Hypogonodal Male Condition (ExHMC). Thus, the aims of this study were to (1) identify risk of ExHMC in active males in various sports and (2) determine if associations between risk of ExHMC and health problems interfering with training and competition exist. Methods: A questionnaire was distributed online (November 2018-January 2019) using questions derived from the "Androgen Deficiency in the Aging Male Questionnaire" (ADAM-Q) to assess risk of ExHMC. Additional questions were included to collect information on participant demographics, injury and illness history and dietary habits. Logistic regression analyses explored differences between groups. Results: Risk of ExHMC was identified in 23.3% (n = 185) of 794 questionnaire participants. Following multivariate analyses, risk of ExHMC was independently associated with a lower than normal sex drive rating within the last month (OR 7.62, 95%CI 4.99-11.63) and less than three morning erections per week within the last month (OR: 4.67, 95%CI 3.23-6.76). Risk of ExHMC was associated with 15-21 days absence from training or competition during the previous 6 months due to overload injuries in the univariate analysis (OR = 2.69, 95% CI = 1.24-5.84). Conclusion: Risk of ExHMC and associated symptoms in this heterogeneous sample may be indicative of RED-S. Confounding factors such as over-training, medication use, fatigue and psychological stress need to be considered. Identification of male athletes exhibiting physiological symptoms associated with RED-S requires more research.
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Affiliation(s)
- Danielle M Logue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Sport Ireland Institute, Sports Campus Ireland, Dublin, Ireland
| | | | - Anna Melin
- Department of Sports Science, Linnaeus University, Kalmar, Sweden
| | | | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Mirjam Heinen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Hackney AC. Hypogonadism in Exercising Males: Dysfunction or Adaptive-Regulatory Adjustment? Front Endocrinol (Lausanne) 2020; 11:11. [PMID: 32082255 PMCID: PMC7005256 DOI: 10.3389/fendo.2020.00011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
For decades researchers have reported men who engaged in intensive exercise training can develop low resting testosterone levels, alterations in their hypothalamic-pituitary-gonadal (HPG) axis, and display hypogonadism. Recently there is renewed interest in this topic since the International Olympic Committee (IOC) Medical Commission coined the term "Relative Energy Deficiency in Sports" (RED-S) as clinical terminology to address both the female-male occurrences of reproductive system health disruptions associated with exercise. This IOC Commission action attempted to move beyond the sex-specific terminology of the "Female Athlete Triad" (Triad) and heighten awareness/realization that some athletic men do have reproductive related physiologic disturbances such as lowered sex hormone levels, HPG regulatory axis alterations, and low bone mineral density similar to Triad women. There are elements in the development and symptomology of exercise-related male hypogonadism that mirror closely that of women experiencing the Triad/RED-S, but evidence also exists that dissimilarities exist between the sexes on this issue. Our research group postulates that the inconsistency and differences in the male findings in relation to women with Triad/RED-S are not just due to sex dimorphism, but that there are varying forms of exercise-related reproductive disruptions existing in athletic men resulting in them displaying a relative hypogonadism condition. Specifically, such conditions in men may derive acutely and be associated with low energy availability (Triad/RED-S) or excessive training load (overtraining) and appear transient in nature, and resolve with appropriate clinical interventions. However, manifestations of a more chronic based hypogonadism that persists on a more permanent basis (years) exist and is termed the "Exercise Hypogonadal Male Condition." This article presents an up-to-date overview of the various types of acute and chronic relative hypogonadism found in athletic, exercising men and proposes mechanistic models of how these various forms of exercise relative hypogonadism develop.
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Affiliation(s)
- Anthony C. Hackney
- Department of Exercise and Sport Science, Department of Nutrition, Gilling's School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
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