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Wang M, Chee J, Tanaka MJ, Dave Lee YH. Relative Energy Deficiency in Sport (RED-S) and Knee Injuries: Current Concepts for Female Athletes. J ISAKOS 2024:S2059-7754(24)00099-3. [PMID: 38795863 DOI: 10.1016/j.jisako.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/19/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
In athletes, a mismatch between caloric intake and energy expended in exercise can result in Low Energy Availability (LEA). LEA can lead to Relative Energy Deficiency in Sport (RED-S), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of RED-S is higher in females than males. RED-S more comprehensively describes the syndrome originally known as "Female Athlete Triad" (FAT). FAT encompasses the triad of LEA (with or without disordered eating), menstrual dysfunction and low bone mineral density. RED-S includes other physiological derangements such as poor cardiovascular health, abnormalities of metabolic rate, immunity, and protein synthesis. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of RED-S. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendon and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for RED-S if present, for holistic patient care.
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Affiliation(s)
- Mingchang Wang
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288.
| | - Jade Chee
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288.
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA 02114 USA.
| | - Yee Han Dave Lee
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288.
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Tektunalı Akman C, Gönen Aydın C, Ersoy G. The effect of nutrition education sessions on energy availability, body composition, eating attitude and sports nutrition knowledge in young female endurance athletes. Front Public Health 2024; 12:1289448. [PMID: 38550312 PMCID: PMC10973170 DOI: 10.3389/fpubh.2024.1289448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/22/2024] [Indexed: 04/02/2024] Open
Abstract
Nutrition knowledge plays a pivotal role in shaping dietary habits and food choices, particularly in the realm of sports nutrition. This study investigates the effects of a series of nutrition education sessions conducted by a registered dietitian on energy availability, various anthropometric measurements, eating attitudes, and sports nutrition knowledge in young female endurance athletes aged 15-18 years (football, basketball, volleyball) who engage in training for more than 10 h per week (n = 83). Participants were randomly divided into two groups with 45 individuals receiving six physical nutrition education lectures, and the remaining 38 participants receiving no nutrition education. Participants completed the low energy availability in females questionnaire (LEAF-Q), Eating Attitude Test (EAT-26), and Sports Nutrition Knowledge Questionnaire (SNKQ). Energy and nutrient intakes were evaluated through 3-day food records, while exercise energy expenditure was assessed using 3-day activity logs. All of the questionnaires were repeated after 6 months. At baseline, the prevalence of LEA among athletes was determined to be 63.8%. In the intervention group, energy availability (EA) and SNKQ scores increased, and LEAF-Q scores decreased significantly (p < 0.05). However, there was no significant change in EAT-26 scores between the two groups. Energy intake, weight, fat-free mass, and resting metabolic rate have been increased significantly in the intervention group (p < 0,05). These findings suggest that nutrition education proves beneficial in enhancing dietary intake, positively influencing body composition, and improving nutrition knowledge, ultimately contributing to increased energy availability in female athletes over the short term.
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Affiliation(s)
- Cansu Tektunalı Akman
- Department of Nutrition and Dietetics, Institute of Health Sciences, Medipol University, Istanbul, Türkiye
| | - Canan Gönen Aydın
- Department of Sports Medicine, University of Health Sciences, Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Türkiye
| | - Gülgün Ersoy
- Department of Nutrition and Dietetics, Institute of Health Sciences, Medipol University, Istanbul, Türkiye
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Tsukahara Y, Nose-Ogura S, Kinoshita S, Nakamura H, Koshimizu T, Gleason CN, Mason RA, Harada M, Hiraike O, Osuga Y. Differences in screening and treating relative energy deficiency in sport between the United States of America and Japan. J Sports Med Phys Fitness 2024; 64:175-182. [PMID: 38015478 DOI: 10.23736/s0022-4707.23.15302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND The diagnosis and treatment of relative energy deficiency in sport (RED-S) are challenging owing to variations in symptoms and the absence of specific guidelines. This study aimed to investigate differences in the diagnosis and follow-up of RED-S, its consequences, and related factors among sports medicine physicians with different backgrounds in Japan and the USA and examine the differences between the two countries. METHODS An anonymous survey regarding the diagnosis and treatment processes of RED-S was distributed to sports medicine physicians via email. Respondents included 58 sports medicine physicians from the USA and 241 from Japan. RESULTS The findings showed that 77.6% of the US physicians screened athletes for RED-S, whereas 17.5% of their Japanese counterparts did so. Moreover, 98.3% and 36.7% of the US and Japanese physicians, respectively, answered that they screened athletes for eating disorders upon suspicion of low energy availability. Logistic regression analysis revealed that the number of US sports medicine physicians who screened athletes for the female athlete triad (Triad) and RED-S (odds ratio [OR] = 12.78, P<0.001) and adhered to specific criteria for athlete suspension and return-to-play (OR=33.67, P<0.01) was higher than that of their Japanese counterparts. CONCLUSIONS The prevalence of RED-S-related screening and treatment differed between US and Japanese sports medicine physicians. Educating sports medicine physicians about the diagnosis and treatment of athletes with possible signs of RED-S is important in treating female athletes and further investigations are required to identify why the physicians screened/not screened the athletes.
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Affiliation(s)
- Yuka Tsukahara
- Department of Sports Medicine, Tokyo Women's College of Physical Education, Tokyo, Japan
| | - Sayaka Nose-Ogura
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Sakiko Kinoshita
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Hiroe Nakamura
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Takako Koshimizu
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Courtney N Gleason
- School of Medicine, Division of Sports Medicine, Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Rudolph A Mason
- School of Medicine, Division of Sports Medicine, Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
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Kussman A, Choo HJ. Mental Health and Disordered Eating in Athletes. Clin Sports Med 2024; 43:71-91. [PMID: 37949515 DOI: 10.1016/j.csm.2023.07.001] [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] [Indexed: 11/12/2023]
Abstract
Disordered eating (DE) and eating disorders (EDs) are more prevalent in athletes than non-athletes, and can cause devastating health and performance consequences. Although they can affect any athlete, DE/EDs are more common among women and athletes in lean sports, where there is a perceived competitive advantage to being lean. The sports medicine provider plays a crucial role in screening, diagnosis, and treatment of DE/ED. Treatment should involve a multidisciplinary team with a physician, dietitian, and mental health provider. Preventative efforts should seek to educate athletes and their coaches/support staff and should foster a healthy environment, which deemphasizes weight or body image.
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Affiliation(s)
- Andrea Kussman
- Department of Family Medicine, University of Washington.
| | - Hyunwoo June Choo
- Division of Physical Medicine and Rehabilitation, Stanford University Department of Orthopaedics, 450 Broadway, MC 6342, Redwood City, CA 94063, USA
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Torres-McGehee TM, Uriegas NA, Hauge M, Monsma EV, Emerson DM, Smith AB. Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes. J Athl Train 2023; 58:803-812. [PMID: 37459386 DOI: 10.4085/1062-6050-0539.22] [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] [Indexed: 11/16/2023]
Abstract
CONTEXT Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating. OBJECTIVE To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports). DESIGN Cross-sectional study. SETTING Collegiate athletics. PATIENTS OR OTHER PARTICIPANTS National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions. MAIN OUTCOME MEASURE(S) Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores. RESULTS Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037). CONCLUSIONS Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.
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Raffoul A, Turner SL, Salvia MG, Austin SB. Population-level policy recommendations for the prevention of disordered weight control behaviors: A scoping review. Int J Eat Disord 2023; 56:1463-1479. [PMID: 37096990 DOI: 10.1002/eat.23970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The aim of this scoping review was to identify recommendations and gaps in knowledge surrounding the prevention of disordered weight control behaviors (DWCBs) through policy. METHOD A search was conducted in several databases to identify English language articles that described an active policy, recommendation, guideline, or educational curriculum that could be implemented by governments or regulatory bodies to prevent DWCBs or related constructs (e.g., weight stigma, body dissatisfaction). Two researchers independently screened articles with oversight from a third researcher. Data were extracted from the final sample (n = 65) and analyzed qualitatively across all articles and within the domains of education, public policy, public health, industry regulation, and media. RESULTS Only a single empirical evaluation of an implemented policy to reduce DWCBs was identified. Over one-third of articles proposed recommendations relating to industry regulation and media (n = 24, 36.9%), followed by education (n = 21, 32.3%), public policy (n = 19, 29.2%), and public health (n = 10, 15.4%). Recommendations included school-based changes to curricula, staff training, and anti-bullying policies; legislation to ban weight discrimination; policies informed by strategic science; collaboration with researchers from other fields; de-emphasizing weight in health communications; diversifying body sizes and limiting modified images in media; and restricting the sale of weight-loss supplements. DISCUSSION The findings of this review highlight gaps in empirically evaluated policies to reduce DWCBs but also promising policy recommendations across several domains. Although some policy recommendations were supported by empirical evidence, others were primarily based on experts' knowledge, highlighting the need for greater research on population-level DWCBs prevention through policy. PUBLIC SIGNIFICANCE Our scoping review of the evidence on policies for the prevention of disordered weight control behaviors identified several recommendations across the domains of education, public policy, public health, and industry regulation and media. Although few empirical investigations of implemented policies have been conducted, expert recommendations for policies to prevent disordered weight control behaviors among populations are plentiful and warrant future consideration by researchers and policymakers alike.
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Affiliation(s)
- Amanda Raffoul
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha L Turner
- Tan Chingfen Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Meg G Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - S Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Vasiliu O. Current trends and perspectives in the exploration of anorexia athletica-clinical challenges and therapeutic considerations. Front Nutr 2023; 10:1214398. [PMID: 37528996 PMCID: PMC10389266 DOI: 10.3389/fnut.2023.1214398] [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: 04/29/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Elite athletes are exposed to a considerable amount of physical and psychological stress throughout their entire professional life, but the exploration of the consequences of this stressful regimen on mental health is still in its early stages. Eating disorders (EDs), substance use disorders, and behavioral addictions represent only several domains that are worth more investigation in this vulnerable population, in order to find preventative and therapeutic strategies. The exploration of EDs in athletes is important because this population is very vulnerable to the impact that weight and body shape may have on their professional performances, and epidemiological studies support this concern, i.e., the prevalence of EDs in athletes is significantly higher than in the general population. This article is dedicated to the synthesis of available data regarding a specific pathology reported in elite athletes, i.e., anorexia athletica (AA), based on a narrative reviewing methodology. The information about risk factors, pathophysiology, positive and differential diagnosis, epidemiology, structured evaluation, and treatment of AA have been summarized and future research directions have been highlighted. While tentative diagnostic criteria for AA and a self-administered questionnaire exist, its pathophysiology is still insufficiently explored, and the treatment is not based on good-quality trials. According to the retrieved data, more research targeting the physical and mental health of elite athletes, especially those practicing esthetic sports, is needed, in order to implement adequate screening and early intervention programs. Future studies targeting various sub-populations of elite athletes, i.e., esthetic vs. non-esthetic sports, individuals presenting a history of ED vs. those without such a history, and those practicing individual sports vs. team sports are needed to reach the objective of improving the quality of life in this population.
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Dasa MS, Friborg O, Kristoffersen M, Pettersen G, Sagen JV, Sundgot-Borgen J, Rosenvinge JH. Evaluating the Suitability of the Low Energy Availability in Females Questionnaire (LEAF-Q) for Female Football Players. SPORTS MEDICINE - OPEN 2023; 9:54. [PMID: 37439966 DOI: 10.1186/s40798-023-00605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The Low Energy Availability in Females Questionnaire (LEAF-Q) is a screening tool developed to detect endurance athletes and dancers at risk for development of persistent low energy availability (LEA) and the female athlete triad (Triad). This study investigated the applicability of the LEAF-Q in a cohort of sixty professional female football players. METHODS The participants were classified as at risk (≥ 8) or not at risk (< 8) for persistent LEA and the Triad according to their LEAF-Q score, before being compared. Receiver operating curves were then conducted to examine the ability of the overall LEAF-Q and subcategories to correctly determine the presence of clinically defined markers of the Triad. Additionally, Youden's index was calculated to determine the best fitting cut-off values. RESULTS Thirty-two percent of participants were classified as at risk by the LEAF-Q. We found no statistically significant differences between the two groups for any markers associated with persistent LEA. Except for acceptable accuracy in determining menstrual status, all other LEAF-Q components exhibited poor accuracy and predictive values. Youden's index scores imply that increasing the overall and injury cut-off values to ≥ 10 and ≥ 5 respectively, would yield increased performance. CONCLUSIONS Our findings do not support the use of the LEAF-Q for the purpose of detecting LEA and Triad conditions among female football players.
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Affiliation(s)
- Marcus S Dasa
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Oddgeir Friborg
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Morten Kristoffersen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Jørn V Sagen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | | | - Jan H Rosenvinge
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
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Warrick AE, Hassid B, Coleman B, Cansino C, Faustin M. Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport. J Eat Disord 2023; 11:70. [PMID: 37161433 PMCID: PMC10169360 DOI: 10.1186/s40337-023-00800-4] [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: 11/18/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Short and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S. METHODS Our study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution. RESULTS Among 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question. CONCLUSIONS Multidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.
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Affiliation(s)
- Alexandra E Warrick
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Brandon Hassid
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Brandon Coleman
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Catherine Cansino
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, 2521 Stockton Blvd, 4th floor, Sacramento, CA, 95817, USA
| | - Marcia Faustin
- Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y street Suite 3850, Sacramento, CA, 95816, USA.
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Szupiany-Janeczek T, Rutkowski K, Pytko-Polończyk J. Oral Cavity Clinical Evaluation in Psychiatric Patients with Eating Disorders: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4792. [PMID: 36981701 PMCID: PMC10049687 DOI: 10.3390/ijerph20064792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Bulimia nervosa and anorexia nervosa are not the only disorders the symptoms of which may be present in the oral cavity. The assessment of the clinical condition of patients with eating disorder symptoms was aimed at in this study. The study group consisted of 60 patients with diagnoses from categories F4.xx, F5x.x, and F6x.x ICD-10 (International Classification of Diseases, Tenth Revision). Patients were qualified for the study based on the answers provided in the symptom checklists "O". An adequate control group was selected. All patients underwent a dental examination, including the assessment of API (aproximal plaque index) and DMF (decayed missing filled index). Studies have shown that patients with eating disorder symptoms were more likely to have dental erosions (in total, 28.81% of cases). The correlation of erosion with the symptoms of eating disorders was demonstrated for several assessed symptoms present in the symptom checklists "O". Such correlations have not been demonstrated in terms of gingival recession presence. The level of oral hygiene in patients with eating disorders was assessed as sufficient or bad and indicates the need to initiate dental treatment in this group. It is important to correlate the treatment of the underlying mental disease with dental treatment and regular dental checkups.
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Affiliation(s)
- Teresa Szupiany-Janeczek
- Department of Integrated Dentistry, Jagiellonian University Medical College, 31-155 Kraków, Poland
| | - Krzysztof Rutkowski
- Psychotherapy Department, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Jolanta Pytko-Polończyk
- Department of Integrated Dentistry, Jagiellonian University Medical College, 31-155 Kraków, Poland
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Hafstad SM, Bauer J, Harris A, Pallesen S. The prevalence of orthorexia in exercising populations: a systematic review and meta-analysis. J Eat Disord 2023; 11:15. [PMID: 36747235 PMCID: PMC9903632 DOI: 10.1186/s40337-023-00739-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
AIM Orthorexia Nervosa (ON) describes a pathological obsession with proper and high-quality nutrition that is necessary to research further in order to elucidate its prevalence and correlates which may bear implications for prevention and treatment. The aim of this study was to review studies that report the prevalence of ON in people who exercise, calculate an overall prevalence through a random-effects meta-analysis approach and investigate the association of ON prevalence using a random-effects meta-regression. In addition, a sub-group-analysis based on ON-instruments and a sensitivity analysis excluding students samples, were conducted. METHOD Systematic searches were conducted in the following online databases: PubMed, Embase, Web of Science, PsychInfo, CINAHL, Google Scholar and OpenNet. The following search terms were used: Orthore* AND (prevalenc* OR incidenc* OR frequen* OR cut-off OR epidem*). A total of 613 unique hits were reviewed by two blinded authors, and 24 studies were coded and assessed for risk of bias (Holy et.al). The meta-regression included three independent variables (sex, type of sport, and sample size). RESULTS The overall prevalence of ON in the exercising population was 55.3% (95% CI 43.2-66.8). Cochran's Q was 11,436.38 (df = 23, p < 0.0000), and the I2 was 98.4%, indicating high heterogeneity across studies. The sensitivity showed an overall prevalence of 51.3% (95% CI 51.3-70.0). There was a significant difference in prevalence estimates based on the instruments used (Qbet = 33.6, df = 2, p < 0.01). DISCUSSION The overall prevalence of ON in exercising populations was very high. The between-study disparity was large and was partly explained by the ON-instrument administered. One fourth of the studies had a moderate risk of bias. The majority of the studies did not specify relevant demographic information about the sample, and information about the type of sport was frequently missing.
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Affiliation(s)
- Stine Marie Hafstad
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway.
| | - Jonas Bauer
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Post Box 7807, 5020, Bergen, Norway.,Optentia, the Vaal Triangle Campus of the North-West University, Vanderbijlpark, South Africa
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Rupasinghe WAWS, Perera TSH, Silva KDRR, Samita S, Wickramaratne MN. Nutritional intake of sport undergraduates in Sabaragamuwa University of Sri Lanka. BMC Nutr 2023; 9:2. [PMID: 36593516 PMCID: PMC9806877 DOI: 10.1186/s40795-022-00662-0] [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: 08/03/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nutritional intake plays an important role in determining energy availability which is vital to health, wellbeing, and sports performance in an active population. This research assessed the sports undergraduates' nutritional intake compared to the Dietary Guidelines for Americans and nutrition goals provided by WHO. METHODS This study is a quantitative, cross-sectional descriptive study. One hundred and one (n = 101) sports undergraduates aged between 20 to 23 years were recruited and the nutrient intake was assessed using the three-day food diary method and quantified the macro and micronutrients by the food composition database. One sample t-test was performed to compare the mean nutrient intakes with the lowest recommendation values. RESULTS Though most undergraduates were able to meet the dietary requirements in carbohydrates, they were deficient in their protein intake and exceeded in fats intake. Further, both male and female students were deficient in their daily energy intake (1723 kcal, 1607 kcal) and dietary fiber intake (8 g, 11 g). The saturated fat intake was met by all students while 20% of males and 21% of females exceeded the recommendations (< 10%). The micronutrient intake of vitamins such as C, B1, B2, B9, and B12 and minerals such as Calcium, Magnesium, and Potassium, were significantly below the recommendations (p < 0.05) except for vitamin B3 niacin. CONCLUSIONS Providing a nutritionally valuable meal is essentially required to maintain both physical and mental fitness. Our results revealed that the Sri Lankan sport science undergraduates do not have an adequate daily dietary intake of energy, proteins, calcium, magnesium, potassium, and vitamins such as C, B1, B2, B9, and B12.
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Affiliation(s)
- W. A. W. S. Rupasinghe
- grid.440836.d0000 0001 0710 1208Department of Sports Sciences and Physical Education, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka
| | - T. S. H. Perera
- grid.440836.d0000 0001 0710 1208Department of Sports Sciences and Physical Education, Faculty of Applied Sciences, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka
| | - K. D. R. R. Silva
- grid.443386.e0000 0000 9419 9778Department of Applied Nutrition, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Makandura, Gonawila Sri Lanka
| | - S. Samita
- grid.11139.3b0000 0000 9816 8637Department of Crop Science, Faculty of Agriculture, University of Peradeniya, Peradeniya, Sri Lanka
| | - M. Nirmali Wickramaratne
- grid.440836.d0000 0001 0710 1208Department of Biochemistry, Faculty of Medicine, Sabaragamuwa University of Sri Lanka, Hidellana, Rathnapura Sri Lanka
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Kolanowski W, Ługowska K, Trafialek J. The Impact of Physical Activity at School on Eating Behaviour and Leisure Time of Early Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416490. [PMID: 36554365 PMCID: PMC9779581 DOI: 10.3390/ijerph192416490] [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: 11/18/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 05/06/2023]
Abstract
(1) Background: Diet and physical activity (PA) significantly impact health. The aim of this study was to evaluate the impact of long-term increase in organized PA level at school on the eating behaviour and leisure time of early adolescences in the period from the age of 10 to 12. (2) Methods: Children born in 2007 (n = 278) in groups with a standard (control group) and increased level of organized PA at school (4 and 10 h a week) were subjected to an anonymous follow-up survey. The questionnaire included 22 questions related to the eating behaviour and ways and frequency of leisure time PA. The study was conducted in the same groups in three assessment sessions in September 2017, 2018 and 2019. (3) Results: During the course of the study, it was shown improvement of eating behaviour in the increased PA group whereas decline in the standard PA one. The share of children with good and very good scores of eating behaviour decreased in the standard PA group from 56.89% to 54.54% and increased in the increased PA from 58.06% to 60.29%. In the increased PA group children more frequently than standard PA ate vegetables, fruits, fish, poultry meat, wholemeal bakery products, milk, dairy products and drinking tea without sugar, as well as ate breakfast. The standard PA children more frequently than increased PA ate high sugar and/or fat content food as sweets, savoury snacks and drank fizzy drinks as well as fast foods. The frequency of often undertaken leisure time PA increased in the increased PA group from 67% to 74%, while decreased in the standard PA from 58% to 52%. (4) Conclusions: Increase in organized PA at school beneficially influenced early adolescents' eating behaviour and frequency of leisure time PA during 2 years observation. It also increased early adolescents' awareness of healthy diet. Increased PA at school helps shaping healthy lifestyle among early adolescents.
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Affiliation(s)
- Wojciech Kolanowski
- Faculty of Health Sciences, Medical University of Lublin, 20-400 Lublin, Poland
- Correspondence: ; Tel.: +48-603842005
| | - Katarzyna Ługowska
- Faculty of Medical and Health Sciences, Siedlce University, 08-110 Siedlce, Poland
| | - Joanna Trafialek
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
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14
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Koppenburg C, Saxer F, Vach W, Lüchtenberg D, Goesele A. Eating disorder risks and awareness among female elite cyclists: an anonymous survey. BMC Sports Sci Med Rehabil 2022; 14:172. [PMID: 36151580 PMCID: PMC9502946 DOI: 10.1186/s13102-022-00563-6] [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: 05/13/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
Background Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from “normal” weight was depicted. Methods Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score. Results Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m2. In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10–19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index. Conclusion Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00563-6.
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Affiliation(s)
- C Koppenburg
- Department of Sport Sciences, University of Konstanz, Postfach 30, D-78457, Konstanz, Germany.,Crossklinik Basel, Bundesstr. 1, CH-4054, Basel, Switzerland
| | - F Saxer
- Basel Academy for Quality and Research in Medicine, Steinenring 6, CH- 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland.,Novartis Institutes for Biomedical Research, Novartis Campus, CH-4051, Basel, Switzerland
| | - W Vach
- Basel Academy for Quality and Research in Medicine, Steinenring 6, CH- 4051, Basel, Switzerland.
| | - D Lüchtenberg
- Department of Sport Sciences, University of Konstanz, Postfach 30, D-78457, Konstanz, Germany
| | - A Goesele
- Crossklinik Basel, Bundesstr. 1, CH-4054, Basel, Switzerland.,University of Basel, Petersplatz 1, CH-4001, Basel, Switzerland
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15
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Lambert V, Carbuhn A, Culp A, Ketterly J, Twombley B, White D. Interassociation Consensus Statement on Sports Nutrition Models for the Provision of Nutrition Services From Registered Dietitian Nutritionists in Collegiate Athletics. J Athl Train 2022; 57:717-732. [PMID: 36356618 PMCID: PMC9661935 DOI: 10.4085/1062-6050-0157.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Collegiate athletic programs are increasingly adding nutrition services to interdisciplinary sports medicine and sports performance departments in response to scientific evidence highlighting nutrition's integral role in supporting athletic performance and overall health. Registered Dietitian Nutritionists (RDNs) specializing in sports dietetics (ie, sports RDNs) and credentialed Board-certified Specialists in Sports Dietetics (CSSDs) are the preferred nutrition service providers for these programs. Their extensive training and proficiency in medical nutrition therapy, education and behavioral counseling, food-service management, exercise physiology, physical performance, and administration, as defined by the "Standards of Practice and "Standards of Professional Performance" for Registered Dietitian Nutritionists in Sports Nutrition and Human Performance," make these practitioners uniquely qualified to deliver the breadth of care required in the collegiate setting. Therefore, this document, guided by a multidisciplinary panel, introduces 4 sports nutrition models through which any collegiate athletic program can deliver sports RDN-directed nutrition services. In each model, the most effective staffing and scope of service are indicated and reviewed. In addition, recommended organizational structures for sports RDNs are provided that best support the delivery of the model's nutrition services in a variety of collegiate athletic programs and organizational settings. Lastly, future research initiatives and nutrition interventions to help improve the standard of care through these sport nutrition models are explored.
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Affiliation(s)
| | - Aaron Carbuhn
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City
| | - Amy Culp
- Intercollegiate Athletics, University of Texas at Austin
| | - Jennifer Ketterly
- Duke Sports Sciences Institute, Duke University School of Medicine, Durham, NC
| | | | - Dana White
- Athletic Training & Sports Medicine, Quinnipiac University, Hamden, CT
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16
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Lichtenstein MB, Johansen KK, Runge E, Hansen MB, Holmberg TT, Tarp K. Behind the athletic body: a clinical interview study of identification of eating disorder symptoms and diagnoses in elite athletes. BMJ Open Sport Exerc Med 2022; 8:e001265. [PMID: 35813128 PMCID: PMC9214368 DOI: 10.1136/bmjsem-2021-001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 11/15/2022] Open
Abstract
Eating disorders are more prevalent in athletes than in the general population and may have severe consequences for sports performance and health. Identifying symptoms can be difficult in athletes because restrictive eating and slim body images are often idealised in a sports setting. The Eating Disorders Examination Questionnaire (EDE-Q) and the SCOFF (Sick, Control, One stone, Fat and Food) questionnaire (SCOFF) are widely used generic instruments to identify symptoms of eating disorders. This study aimed to investigate the instruments’ validity and explore eating disorder symptoms in a sample of athletes. A sample of 28 athletes (25 females) competing at a national level was interviewed based on the diagnostic criteria for eating disorders. We interviewed 18 athletes with a high score on EDE-Q and 10 with a low score. All interviews were transcribed and analysed from a general inductive approach. We identified 20 athletes with an eating disorder diagnosis, while 8 had no diagnosis. EDE-Q found 90% of the cases, while SCOFF found 94%. EDE-Q found no false-positive cases, while SCOFF found one. The qualitative results showed that most athletes reported eating concerns, restrictive eating, eating control (counting calories), weight concerns, body dissatisfaction (feeling fat and non-athletic), excessive exercise and health problems (eg, pain, fatigue). In conclusion, EDE-Q and SCOFF seem valid instruments to screen athletes’ samples but may fail to find 6%–10% cases with eating disorders. Despite athletic bodies and normal body mass index, many athletes report severe eating problems and dissatisfaction with weight and body appearance. Implementation of regular screening may identify these symptoms at an early stage.
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Affiliation(s)
- Mia Beck Lichtenstein
- Department of Clinical Research, Syddansk Universitet Det Samfundsvidenskabelige Fakultet, Odense, Denmark
| | - Karen Krogh Johansen
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Eik Runge
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Marina Bohn Hansen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Trine Theresa Holmberg
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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17
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Witkoś J, Błażejewski G, Gierach M. An Assessment of the Early Symptoms of Energy Deficiency as a Female Athlete Triad Risk among the Polish National Kayaking Team Using LEAF-Q. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105965. [PMID: 35627502 PMCID: PMC9140911 DOI: 10.3390/ijerph19105965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 12/01/2022]
Abstract
Background: Kayaking is a high intensity sport that demands high levels of aerobic and anaerobic capacity as well as a great deal of strength and endurance. The aim of this study was an assessment of the frequency of occurrence of early low energy availability symptoms using the Low Energy Availability in Females Questionnaire for women belonging to the Polish national kayaking team. Additionally, quantitative measurements of body composition and levels of calcium were performed. Methods: The study involved 33 women who were competitors in the Polish national kayaking team. Results: An analysis of the results in terms of disorders in the monthly cycle in the tested kayakers found that only five competitors, approximately 15% of the entire group, had this type of problem. Between the participants who had disorders of the menstrual cycle and those whose cycle was normal, there was only a statistically significant difference at the level of p < 0.001 in relation to the age of the kayakers. Conclusions: The Low Energy Availability in Females Questionnaire proved to be a useful screening tool, which allowed for the early detection of Female Athlete Triad symptoms in several young female kayakers from the Polish national team.
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Affiliation(s)
- Joanna Witkoś
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, G. Herlinga-Grudzinskiego Street 1, 30-705 Kraków, Poland;
- Correspondence:
| | - Grzegorz Błażejewski
- Faculty of Medicine and Health Science, Andrzej Frycz Modrzewski Krakow University, G. Herlinga-Grudzinskiego Street 1, 30-705 Kraków, Poland;
| | - Marcin Gierach
- Department of Endocrinology and Diabetology, Collegium Medicum, Nicolaus Copernicus University, Skłodowskiej-Curie Street 9, 85-094 Bydgoszcz, Poland;
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18
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Flatt RE, Miller AJ, Foreman T, Shannon J. Considerations for Athletes with Eating Disorders Based on Levels of Care. Curr Sports Med Rep 2022; 21:92-99. [PMID: 35245244 DOI: 10.1249/jsr.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article provides an overview of levels of care for eating disorders (EDs) and considerations that are specific to elite athletes. We discuss the following levels of care in terms of ED pathology and treatment aspects that may be unique to athletes: 1) inpatient and residential care, 2) intensive outpatient and partial hospitalization treatment, and 3) outpatient. Illustrative case studies also are presented to highlight distinctions between levels of care and athlete-specific nuances to treatment approaches and health care teams. Finally, we review aspects of return to play plans for elite athletes with EDs.
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Affiliation(s)
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tonya Foreman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeni Shannon
- Department of Sports Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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19
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Jagim AR, Fields J, Magee MK, Kerksick CM, Jones MT. Contributing Factors to Low Energy Availability in Female Athletes: A Narrative Review of Energy Availability, Training Demands, Nutrition Barriers, Body Image, and Disordered Eating. Nutrients 2022; 14:nu14050986. [PMID: 35267961 PMCID: PMC8912784 DOI: 10.3390/nu14050986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/28/2022] Open
Abstract
Relative Energy Deficiency in sport is experiencing remarkable popularity of late, particularly among female athletes. This condition is underpinned by low energy availability, which is a byproduct of high energy expenditure, inadequate energy intake, or a combination of the two. Several contributing factors exist that may predispose an athlete to low energy availability, and therefore a holistic and comprehensive assessment may be required to identify the root causes. The focus of the current narrative review is to discuss the primary contributing factors as well as known risk factors for low energy availability among female athletes to help practitioners increase awareness on the topic and identify future areas of focus.
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Affiliation(s)
- Andrew R. Jagim
- Sports Medicine, Mayo Clinic Health System, La Crosse, WI 54601, USA
- Exercise & Sport Science Department, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Correspondence: ; Tel.: +1-608-392-5280
| | - Jennifer Fields
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Exercise Science and Athletic Training, Springfield College, Springfield, MA 01109, USA
| | - Meghan K. Magee
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Sport, Recreation, and Tourism Management, George Mason University, Manassas, VA 22030, USA
| | - Chad M. Kerksick
- Exercise & Performance Nutrition Laboratory, Lindenwood University, St. Charles, MO 63301, USA;
| | - Margaret T. Jones
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, Intercollegiate Athletics, George Mason University, Fairfax, VA 22030, USA; (J.F.); (M.K.M.); (M.T.J.)
- Sport, Recreation, and Tourism Management, George Mason University, Manassas, VA 22030, USA
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20
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Smith AB, Gay JL, Monsma EV, Arent SM, Sarzynski MA, Emerson DM, Torres-McGehee TM. Investigation of Eating Disorder Risk and Body Image Dissatisfaction among Female Competitive Cheerleaders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042196. [PMID: 35206381 PMCID: PMC8872421 DOI: 10.3390/ijerph19042196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 12/04/2022]
Abstract
Social agents associated with cheerleading environments are increasingly linked to body image dissatisfaction (BID) and eating disorders (ED). This study examined ED risk across team type, squad type, and position. An additional purpose determined BID in clothing type (daily clothing, midriff uniform, and full uniform), and meta-perceptions from the perspective of peers (MP peers), parents (MP parents), and coaches (MP coaches). Female cheerleaders (n = 268) completed an online survey which included demographics, the Eating Attitudes Test-26, and pathogenic behavior questions. Body image perceptions were assessed by using the Sex-Specific Figural Stimuli Silhouettes. Overall, 34.4% of cheerleaders (n = 268; mean age: 17.9 ± 2.7 years) exhibited an ED risk. Compared to All-Star cheerleaders, college cheerleaders demonstrated significant higher ED risk (p = 0.021), dieting subscale scores (p = 0.045), and laxative, diet pill, and diuretic use (p = 0.008). Co-ed teams compared to all-girl teams revealed higher means for the total EAT-26 (p = 0.018) and oral control subscale (p = 0.002). The BID in clothing type revealed that cheerleaders wanted to be the smallest in the midriff option (p < 0.0001, η2 = 0.332). The BID from meta-perception revealed that cheerleaders felt that their coaches wanted them to be the smallest (p < 0.001, η2 = 0.106). Cheerleaders are at risk for EDs and BID at any level. Regarding the midriff uniform, MP from the perspective of coaches showed the greatest difference between perceived and desired body image.
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Affiliation(s)
- Allison B. Smith
- School of Kinesiology, University of Louisiana at Lafayette, Lafayette, LA 70507, USA
- Correspondence:
| | - Jennifer L. Gay
- Department of Health Promotion & Behavior, University of Georgia, Athens, GA 30602, USA;
| | - Eva V. Monsma
- Department of Physical Education, University of South Carolina, Columbia, SC 29208, USA;
| | - Shawn M. Arent
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (S.M.A.); (M.A.S.); (T.M.T.-M.)
| | - Mark A. Sarzynski
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (S.M.A.); (M.A.S.); (T.M.T.-M.)
| | - Dawn M. Emerson
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Toni M. Torres-McGehee
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA; (S.M.A.); (M.A.S.); (T.M.T.-M.)
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Weight Pressures and Eating Disorder Symptoms among Adolescent Female Gymnasts of Different Performance Levels in Greece. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020254. [PMID: 35204974 PMCID: PMC8870309 DOI: 10.3390/children9020254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 01/12/2023]
Abstract
This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11–17 years old) completed the Eating Attitudes Test (EAT-26), the Weight-Pressures in Sport-Females (WPS-F), the Social Desirability Scale (SDS) and provided information on their training. It was found that 16.3% of competitive gymnasts and 7.4% of non-competitive gymnasts scored ≥20 in EAT-26, indicating disordered eating behavior. Competitive gymnasts scored higher than non-competitive in the total score of EAT-26 (p = 0.027), as well as in the total score of WPS-F, the sport and coaches weight pressures sub-scale and the appearance and performance weight pressures sub-scale (p < 0.001). Multiple regression analyses indicated that sport and coaches weight pressures, appearance and performance weight pressures and body mass index accounted for 30.3% of the variance of EAT-26 in competitive gymnasts, while the appearance and performance weight pressures sub-scale accounted for 16.3% of the variance of EAT-26 in non-competitive gymnasts. Sport and coaches weight pressures are associated with ED in competitive gymnasts, while body appearance and performance demands correlate with ED in female gymnasts irrespective of competitive level.
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Abstract
PURPOSE Early detection of eating disorders (EDs) could improve their prognosis, decrease morbidity and mortality, and prevent the risk of evolution towards a chronic form and somatic, psychiatric and psychosocial complications. The objective of this review was to examine the current scientific data concerning the early detection of EDs, which is one of the facets of secondary prevention. METHOD A scoping literature review was carried out following the PRISMA-ScR criteria, including all articles on ED detection published up to 2021 on PUBMED and PSYCINFO. RESULTS 43 articles were included. Anorexia nervosa and bulimia nervosa were the most widely studied disorders. The articles focused on professionals from the medical field (GPs, psychiatrists, gynaecologists, gastroenterologists and residents), from the paramedical field, from education and sport, and from the general population. The assessments conducted with the professionals receiving interventions aiming to improve detection demonstrated their efficacy. Interventions for ED detection in the general population and at school seemed less efficacious. CONCLUSION The results highlighted some lines of action to be implemented. They pointed towards improving initial and continuing education for professional carers; e-learning could be an interesting solution for continuing education. Improving training with specific instructors, school personnel and sports professionals is also one of the solutions for a better detection of EDs. Specific recommendations could be published for fitness centre professionals to help them to deal with clients suspected of having an ED. Among secondary school students and in the general population, a better dissemination of mental health literacy and the development of mental health first aid programs could help improve early detection. LEVEL OF EVIDENCE Level I: Evidence obtained from systematic reviews.
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23
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Marí-Sanchis A, Burgos-Balmaseda J, Hidalgo-Borrajo R. Eating disorders in sport. Update and proposal for an integrated approach. ENDOCRINOL DIAB NUTR 2022; 69:131-143. [PMID: 35256056 DOI: 10.1016/j.endien.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/24/2021] [Indexed: 06/14/2023]
Abstract
Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.
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Affiliation(s)
- Amelia Marí-Sanchis
- Servicio de Endocrinología y Nutrición, Unidad de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra (CHN), Navarra, Spain; Instituto de Investigación Sanitaria de Navarra (IdisNa), Navarra, Spain.
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Development and Initial Evaluation of the Athlete Eating Psychopathology Observation Questionnaire for Sport Professionals. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2022. [DOI: 10.1123/jcsp.2021-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Eating psychopathology symptoms are common in athletes; however, it is unknown which symptoms are detected and to what extent by sport professionals. This study aimed to develop and evaluate a self-report questionnaire to explore which features of eating psychopathology in athletes are detected by sport professionals, and how observation of these symptoms might vary. Thirty-one questions were developed and 232 sport professionals (56% male) participated in the study. Exploratory Factor Analysis revealed a 20-item, five-factor solution (Negative Affect, Dieting Practices, Fear of Eating in Social Contexts, Bingeing and Purging, and Compulsive Exercise). Participants most frequently reported observing athletes’ dieting practices, while symptoms of a fear of eating in social contexts were observed least frequently. This study has developed and preliminarily tested the Athlete Eating Psychopathology Observation Questionnaire (AEPOQ), which now requires further validation. The findings provide important directions for education initiatives with sport professionals regarding identification of eating psychopathology symptoms.
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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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Morrison AE, Fleming S, Levy MJ. A review of the pathophysiology of functional hypothalamic amenorrhoea in women subject to psychological stress, disordered eating, excessive exercise or a combination of these factors. Clin Endocrinol (Oxf) 2021; 95:229-238. [PMID: 33345352 DOI: 10.1111/cen.14399] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Functional hypothalamic amenorrhoea (FHA) is a common form of secondary amenorrhoea without an identifiable structural cause. Suppression of gonadotrophin-releasing hormone (GnRH) pulsatility results in reduced luteinizing hormone (LH) levels, with subsequent reduction in oestradiol, anovulation and cessation of menstruation. GnRH pulsatility suppression is a recognized complication of psychological stress, disordered eating, low body weight, excessive exercise or a combination of these factors. PATHOPHYSIOLOGY OF FHA Individuals with FHA demonstrate low energy availability (EA), body fat percentage and energy expenditure. Documented adipocytokine changes notably, raised adiponectin, ghrelin, PYY, and decreased leptin, are associated with GnRH suppression. Other endocrine responses seen in this low EA state include low insulin levels, low total T3, increased basal cortisol levels and a reduced response to corticotrophin-releasing hormone (CRH) administration. FHA is associated with raised growth hormone (GH) and low insulin-like growth factor (IGF-1), suggesting relative GH resistance. Kisspeptins are a group of polypeptides, recently discovered to play a major role in the regulation of the reproductive axis through influencing GnRH release. KNDy (kisspeptin/neurokinin B/dynorphin) act on GnRH neurons and a multitude of factors result in their release. IMPLICATIONS FOR FUTURE TREATMENT Management of FHA is imperative to prevent adverse outcomes in bone density, cardiovascular risk profile, psychological well-being and fertility. Outwith modification of nutritional intake and exercise, limited therapeutic strategies are currently available for women with FHA. Advancements in the understanding of the pathophysiological basis of this under-recognized and under-treated clinical entity will aid management and may result in the development of novel therapeutic approaches.
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Affiliation(s)
- Amy E Morrison
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Suzannah Fleming
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Miles J Levy
- Department of Endocrinology, University Hospitals of Leicester, Leicester, UK
- Department of Endocrinology, University of Leicester, Leicester, UK
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Yeargin S, Torres-McGehee TM, Emerson D, Koller J, Dickinson J. Hydration, Eating Attitudes and Behaviors in Age and Weight-Restricted Youth American Football Players. Nutrients 2021; 13:nu13082565. [PMID: 34444723 PMCID: PMC8401195 DOI: 10.3390/nu13082565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 01/17/2023] Open
Abstract
There is a paucity of research examining hydration and nutrition behaviors in youth American football players. A potentially unique risk factor are league restrictions based on weight (WR) or age (AR). The purpose of this study was to examine hydration status between WR and AR leagues. The secondary purpose was to describe eating patterns in players. An observational cohort design with 63 youth football players (10 ± 1 yrs, 148.2 ± 9.4 cm, 44.9 ± 15.3 kg) was utilized. Independent variables were league (AR (n = 36); WR (n = 27)) and activity type (practice (PX = 8); game (GM = 3)). Dependent variables were hydration status (urine osmolality; percent change in body mass (%BM)), eating attitudes (Children’s Eating Attitude Test (ChEAT-26)) and self-reported frequency of meals. On average, players arrived activity mildly hypohydrated (830 ± 296 mOsm/kg) and %BM was minimal (−0.1 ± 0.7%) during events. Players consumed 2 ± 1 meals and 1 ± 1 snack before events. The ChEAT-26 survey reported 21.6% (n = 8) of players were at risk for abnormal eating attitudes. Among these players, eating binges, vomiting, excessive exercise and drastic weight loss were reported. Youth American football players arrived activity mildly hypohydrated and consumed enough fluid during activity to maintain euhydration. Abnormal eating attitudes and the use of unhealthy weight loss methods were reported by some youth American football players.
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Affiliation(s)
- Susan Yeargin
- Exercise Science Department, Arnold School of Public Health University of South Carolina, Columbia, SC 29208, USA;
- Correspondence:
| | - Toni M. Torres-McGehee
- Exercise Science Department, Arnold School of Public Health University of South Carolina, Columbia, SC 29208, USA;
| | - Dawn Emerson
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | | | - John Dickinson
- Palmetto Health/USC Orthopedic Center, Columbia, SC 29203, USA;
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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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Buckley GL, Hall LE, Lassemillante ACM, Belski R. Disordered eating & body image of current and former athletes in a pandemic; a convergent mixed methods study - What can we learn from COVID-19 to support athletes through transitions? J Eat Disord 2021; 9:73. [PMID: 34167589 PMCID: PMC8223527 DOI: 10.1186/s40337-021-00427-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has seen worsened mental health as a result of lockdowns, isolation and changes to sociocultural functioning. The postponement of the Tokyo 2020 Olympics is representative of global cancellations of sporting events, reduced facility access and support restrictions that have affected both current and former athlete's psychological wellbeing. This study aimed to determine whether current (n = 93) and former (n = 111) athletes experienced worsened body image, relationship with food or eating disorder symptomatology during acute COVID-19 transitions. METHODS The study was a Convergent Mixed Methods design whereby qualitative content analysis was collected and analysed simultaneously with quantitative cross-sectional data using the EAT-26 and self-report COVID-19 questions. Data were collected from April until May 2020 to capture data pertaining to transitions related to the pandemic and included individuals across 41 different individual and team sports from club to international competition levels. RESULTS There was a surge in disordered eating in current and former athletes as a result of the early COVID-19 response. Eating disorders were suggested to occur in 21.1% of participants (18% current athletes n = 17, 25% former athletes (n = 26). There was a significant difference between males and females (p = 0.018, r = 0.17), but interestingly no differences between groups from individual vs team sports, type of sporting category (endurance, antigravitational, ball sport, power, technical and aesthetic) or level of competition (club, state, national or international). 34.8% (n = 69) self-reported worsened body image and 32.8% (n = 65) self-reported a worsened food relationship directly from COVID-19. Qualitative analysis indicated that disordered eating occurred predominantly in the form of body preoccupation, inhibitory food control, fear of body composition changes and binge eating. CONCLUSIONS This study indicates that transitions in COVID-19 have worsened food-body relationships in current and former athletes and must be treated as an at-risk time for eating disorder development. We suggest that resources are allocated appropriately to assist athletes to foster psychologically positive food and body relationships through COVID-19 transitions. This study makes practice suggestions in supporting athletes to manage control, seek support, adapt and accept change and promote connection and variety through athletic transitions.
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Affiliation(s)
- Georgina Louise Buckley
- Department of Nursing and Allied Health, Swinburne University of Technology, John St, Hawthorn, Victoria 3122 Australia
- Charles Perkins Centre, Inside Out Institute, Sydney University, John Hopkins Drive, Camperdown, New South Wales 2050 Australia
| | | | - Annie-Claude M. Lassemillante
- Department of Nursing and Allied Health, Swinburne University of Technology, John St, Hawthorn, Victoria 3122 Australia
| | - Regina Belski
- Department of Nursing and Allied Health, Swinburne University of Technology, John St, Hawthorn, Victoria 3122 Australia
- Department of Dietetics, Human Nutrition and Sport, LaTrobe University, Bundoora, Victoria 3083 Australia
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Marí-Sanchis A, Burgos-Balmaseda J, Hidalgo-Borrajo R. Eating disorders in sport. Update and proposal for an integrated approach. ENDOCRINOL DIAB NUTR 2021; 69:S2530-0164(21)00125-7. [PMID: 34148864 DOI: 10.1016/j.endinu.2021.04.004] [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: 12/28/2020] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/15/2022]
Abstract
Eating disorders are a group of conditions which have a huge impact on the health and performance of athletes. The aetiology of eating disorders is multifactorial, being influenced by genetic and environmental factors, but also involving psychological factors and factors specific to the practising of sport. Eating disorders are highly prevalent in sport, particularly in disciplines involving endurance, those that have weight-categories or those where low weight is a competitive advantage and aesthetics are important. Athletes with eating disorders need to be assessed and receive early, comprehensive treatment. Close monitoring of nutritional status is vital, especially with female athletes. Prevention is crucial and plays an invaluable role in this type of disorder, but represents a significant challenge for all professionals who look after athletes. Priority needs to be given to implementing structured nutrition training programmes for the athlete and their entourage to help prevent eating disorders.
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Affiliation(s)
- Amelia Marí-Sanchis
- Servicio de Endocrinología y Nutrición, Unidad de Nutrición Clínica y Dietética, Complejo Hospitalario de Navarra (CHN), Navarra, España; Instituto de Investigación Sanitaria de Navarra (IdisNa), Navarra, España.
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Eating Disorders in Top Elite Beach Handball Players: Cross Sectional Study. CHILDREN-BASEL 2021; 8:children8030245. [PMID: 33810150 PMCID: PMC8004950 DOI: 10.3390/children8030245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 01/12/2023]
Abstract
(1) Background: The preoccupation with the increasing appearance of eating disorders (ED) in athletes continues to grow, especially in athletes who practice team sports. ED severely affects the eating habits of the athletes, who tend to use unhealthy approaches to control their body weight. The development of nutritional education and early interventions by training staff is essential, and these factors are widely perceived as beneficial in sports medicine. This study evaluates the frequency at which beach handball (BH) players develop ED, also comparing the differences by sex and age (junior: adolescents vs. senior: young adults). In addition, the relation between body composition variables and ED was studied. (2) Methods: A descriptive and cross-sectional study was carried out in 69 top elite handball players (36 males and 33 females) from the Spanish National BH Team; who were separated by age (junior: adolescents and senior: young adults). The athletes completed the Eating Attitudes Test in its 26 item version (EAT-26). (3) Results: The prevalence of ED indicated that 11% of females had a high possibility of developing an ED, and 3% of males. Regarding the EAT-26 total score and subscales, no significant differences were found between female and male participants, or between the junior and senior categories. The correlations showed an association between body composition, in terms of body mass index, and the EAT-26 total score in both males and females. In the case of males, the correlation was negative. (4) Conclusions: Although there are no significant differences between sex or categories, it has been found that elite athletes are a population that is at high risk of developing ED.
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Kennedy SF, Kovan J, Werner E, Mancine R, Gusfa D, Kleiman H. Initial validation of a screening tool for disordered eating in adolescent athletes. J Eat Disord 2021; 9:21. [PMID: 33588900 PMCID: PMC7885388 DOI: 10.1186/s40337-020-00364-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Disordered eating (DE) is a growing problem among all athletes, particularly adolescents. To help prevent the progression of DE to a clinical eating disorder (ED), a brief screening tool could offer an efficient method for early identification of DE in athletes and facilitate treatment. The aim of this study is to validate a screening tool for DE that will identify male and female adolescent athletes of all sports and levels of competition who are at risk for DE. The Disordered Eating Screen for Athletes (DESA-6) consists of only 6 items and was designed for use in both male and female athlete populations. METHODS Validation involved two phases: Phase I consisted of screening high school athletes using the Eating Attitudes Test (EAT-26) and the DESA-6; and Phase II included inviting all high school athletes categorized as "at risk" after screening, plus age- and self-reported gender- matched athletes categorized as not "at risk", to complete the same surveys a second time along with clinical interview. Validity and regression analyses were used to compare the DESA-6 to the EAT-26 and EDE 17.0D. RESULTS When comparing to clinical interview, the DESA-6 had a total sensitivity of 92% and specificity of 85.96%, respectively. Upon comparison of concurrent validity, Phase II DESA-6 had a strong significant positive correlation for both males and females when compared to Phase II EDE 17.0D. CONCLUSIONS A brief, easy to administer screening tool for recognizing DE that can be used by physicians, psychologists, athletic trainers, registered dietitians, and other sport/healthcare staff is of utmost importance for early intervention, which can lead to improved treatment outcomes. The DESA-6 is a promising tool for risk assessment of DE in athletes.
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Affiliation(s)
- Samantha F Kennedy
- Department of Psychiatry, Michigan State University, 909 Wilson Rd, Room B119, East Lansing, MI, 48824, USA.
| | - Jeffrey Kovan
- Department of Sports Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Emily Werner
- Department of Kinesiology, Michigan State University, East Lansing, MI, 48824, USA
| | - Ryley Mancine
- Michigan State University College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Donald Gusfa
- Michigan State University College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA
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Walsh M, Crowell N, Merenstein D. Exploring Health Demographics of Female Collegiate Rowers. J Athl Train 2020; 55:636-643. [PMID: 32396472 DOI: 10.4085/1062-6050-132-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Limited information exists about health patterns among female rowers at the collegiate level. Furthermore, the element of weight class (lightweights classified as <130 lb [59 kg]) as a factor in the physical and mental health of female collegiate athletes has not been investigated, despite weight requirements in sport being a risk factor for the female athlete triad. OBJECTIVE To test the hypotheses that (1) components of the female athlete triad were more prevalent in lightweight than in openweight rowers; (2) perceived stress levels were greater in lightweight than in openweight rowers; and (3) rowers who were unable to row due to injury had greater perceived stress levels than uninjured athletes. DESIGN Cross-sectional study. SETTING Twelve collegiate women's rowing programs consisting of 6 National Collegiate Athletic Association Division I openweight and 6 Intercollegiate Rowing Association-level lightweight teams. PATIENTS OR OTHER PARTICIPANTS A total of 158 female collegiate rowers (78 lightweight, 80 openweight). MAIN OUTCOME MEASURE(S) An electronic survey addressing injury history, diet and eating habits and body image (according to the triad screening questionnaire), stress levels (Perceived Stress Scale), and athlete identity (Athlete Identity Measurement Scale) was administered. RESULTS Lightweight rowers reported limiting or carefully controlling foods more frequently than openweight rowers (41.9% to 29.9%, P = .013). A history of an eating disorder was more prevalent among lightweight than openweight rowers (25.7% to 13.0%, P = .048). Prevalences of stress fractures and menstrual irregularities did not differ between weight classes. Lightweight and openweight rowers' scores on the Perceived Stress Scale (16.0 ± 9.9 and 17.3 ± 6.4, respectively) were not different. Injured rowers scored higher on the Perceived Stress Scale (19.4 ± 7.2) than did uninjured rowers (16.6 ± 5.72). CONCLUSIONS Weight class did not contribute to differences in the prevalence of female athlete triad components or perceived stress, although lightweight rowers were more likely to have a history of eating disorder. Injury may be a risk factor for increased stress in this population.
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Prevalence of Eating Disorder Risk and Body Image Dissatisfaction among ROTC Cadets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218137. [PMID: 33158069 PMCID: PMC7663585 DOI: 10.3390/ijerph17218137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/02/2023]
Abstract
Injury risk is multifactorial including non-modifiable and modifiable factors such as nutrition and mental health. The purpose of this study was to estimate eating disorder risk and body image (BI) dissatisfaction among Reserve Officers Training Corps (ROTC) cadets. A total of 102 (male: n = 75, female: n = 27; age: 20 ± 2 years) ROTC cadets self-reported height, current and ideal weight, and completed the Eating Attitudes Test-26 (EAT-26) and self-perceived BI current and perceived sex-specific figural stimuli. The overall eating disorder risk for ROTC cadets was 32.4%. No significant differences were found when comparing sex, ethnicity, or military branch. Overall risk of pathogenic behaviors included 11.8% who reported binge eating; 8.8% who used laxatives, diuretics, or diet pills; 8.8% who exercised for >60 min to control their weight; and 8.8% who lost 9.1 kg or more within the last 6 months. We identified significant interactions (p ≤ 0.01) between sex of the solider, overall perceptions of male and female soldiers, and BI self-perceptions. The ROTC cadets in this study displayed eating disorder risk and BI dissatisfaction, which is concerning for tactical readiness, long-term behavioral health issues, and injury from pathogenic behaviors. Education and quality healthcare are necessary to mitigate the increased risk of eating and BI dissatisfaction within this population.
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Wells KR, Jeacocke NA, Appaneal R, Smith HD, Vlahovich N, Burke LM, Hughes D. The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med 2020; 54:1247-1258. [PMID: 32661127 PMCID: PMC7588409 DOI: 10.1136/bjsports-2019-101813] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2020] [Indexed: 12/13/2022]
Abstract
Identification, evaluation and management of disordered eating (DE) is complex. DE exists along the spectrum from optimised nutrition through to clinical eating disorders (EDs). Individual athletes can move back and forth along the spectrum of eating behaviour at any point in time over their career and within different stages of a training cycle. Athletes are more likely to present with DE than a clinical ED. Overall, there is a higher prevalence of DE and EDs in athletes compared with non-athletes. Additionally, athletes participating in aesthetic, gravitational and weight-class sports are at higher risk of DE and EDs than those in sports without these characteristics. The evaluation and management of DE requires a cohesive team of professional practitioners consisting of, at minimum, a doctor, a sports dietitian and a psychologist, termed within this statement as the core multidisciplinary team. The Australian Institute of Sport and the National Eating Disorders Collaboration have collaborated to provide this position statement, containing guidelines for athletes, coaches, support staff, clinicians and sporting organisations. The guidelines support the prevention and early identification of DE, and promote timely intervention to optimise nutrition for performance in a safe, supported, purposeful and individualised manner. This position statement is a call to action to all involved in sport to be aware of poor self-image and poor body image among athletes. The practical recommendations should guide the clinical management of DE in high performance sport.
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Affiliation(s)
- Kimberley R Wells
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Nikki A Jeacocke
- Performance Services, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Renee Appaneal
- Athlete Availability, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Hilary D Smith
- National Eating Disorders Collaboration, Sydney, New South Wales, Australia
| | - Nicole Vlahovich
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Louise M Burke
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - David Hughes
- AIS Medicine, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
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Chua JYX, Tam W, Shorey S. Research Review: Effectiveness of universal eating disorder prevention interventions in improving body image among children: a systematic review and meta-analysis. J Child Psychol Psychiatry 2020; 61:522-535. [PMID: 31746023 DOI: 10.1111/jcpp.13164] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Increasingly, children are at risk of developing eating disorders. A systematic review and a meta-analysis were conducted to examine the effectiveness of universal eating disorder prevention interventions in improving body image, internalization of appearance ideals, and self-esteem among children aged 5-17 years old. METHODS Nine electronic databases were systematically searched from each database's point of inception to March 2019. The Cochrane Risk of Bias tool assessed each study's risk of bias, while the GRADE approach judged the overall evidence for each review outcome. A meta-analysis was conducted using the random-effect model to obtain standardized mean differences with 95% confidence intervals under the inverse variance method. Heterogeneity was assessed using I2 statistic and Cochran's Q chi-squared test. Publication bias was assessed using funnel plots. RESULTS A total of 24 studies (22 trials) were included in this review. Universal interventions were found to be effective in improving children's body esteem, self-esteem, and internalization of appearance ideals at postintervention and at follow-up timepoints. Subgroup analyses found that girls benefited more from these interventions than boys. Multisessional interventions with an optimal duration of approximately one month were found to be more effective. CONCLUSIONS The findings encourage the incorporation of universal preventive interventions into school curricula to benefit most children. Laypeople such as teachers can deliver these interventions, but content experts should address topics on body dissatisfaction. Due to the low quality of evidence, as accorded by the GRADE approach, current findings should be validated by future research.
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Affiliation(s)
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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American Medical Society for Sports Medicine Position Statement: Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention-Executive Summary. Clin J Sport Med 2020; 30:91-95. [PMID: 32000168 DOI: 10.1097/jsm.0000000000000799] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health (MH) issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and MH providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.
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Cherian KS, Gavaravarapu SM, Sainoji A, Yagnambhatt VR. Coaches' perceptions about food, appetite, and nutrition of adolescent Indian athletes - A qualitative study. Heliyon 2020; 6:e03354. [PMID: 32072052 PMCID: PMC7013178 DOI: 10.1016/j.heliyon.2020.e03354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 01/22/2023] Open
Abstract
Adolescence is a transitional phase of development with the risk of adopting unhealthy behaviours, which is carried on to adulthood. Adolescent athletes tend to resort to unhealthy eating habits resulting in eating disorders and other clinical outcomes. Hence, it forms a crucial age to understand modifiable food habits and provide appropriate counselling. In India, coaches closely monitor the adolescent athletes, even concerning their eating habits due to the lack of multi-disciplinary support staff. Thus, our study aimed to understand the perceptions of coaches towards food, appetite and nutrition of adolescent athletes using In-depth interviews (IDI). Of all 14 coaches at the state-sponsored residential sports centre, 10 consented. The IDI were conducted in a standardized manner and were recorded and transcribed. They were coded manually, using the open and axial coding in the grounded theory approach to determine themes. They considered nutrition as key to performance and consumption of higher animal protein as important. Majority of them considered sprouts, dry fruits, fruits and vegetables as healthy foods, though were unable to define the quantities nor nutrients therein. Coaches considered protein as “important”, while fat as “unhealthy”. They also observed that athletes were avoiding fruits and vegetables, while consuming more rice. Meal timing, fluid and supplement intake were considered essential for international performance, albeit unaware of the specific requirements. Hygiene practices and peer isolation were considered to affect food intake. This lacunae in the nutrition knowledge and the modifiable nutrition practices explored can be targeted by developing a nutrition education and assessment tool for coaches and junior athletes. Further, a long-term engagement of a nutritionist with every sports academy in India is recommended.
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Affiliation(s)
- Keren Susan Cherian
- Department of Work Physiology and Sports Nutrition, MYAS – NIN Department of Sports Science, ICMR – National Institute of Nutrition, Hyderabad, 500007, Telangana, India
| | - Subbarao M. Gavaravarapu
- Media, Communication and Extension Group, ICMR – National Institute of Nutrition, Hyderabad, 500007, Telangana, India
| | - Ashok Sainoji
- Department of Work Physiology and Sports Nutrition, MYAS – NIN Department of Sports Science, ICMR – National Institute of Nutrition, Hyderabad, 500007, Telangana, India
| | - Venkata Ramana Yagnambhatt
- Department of Work Physiology and Sports Nutrition, MYAS – NIN Department of Sports Science, ICMR – National Institute of Nutrition, Hyderabad, 500007, Telangana, India
- Corresponding author.
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Chang C, Putukian M, Aerni G, Diamond A, Hong G, Ingram Y, Reardon CL, Wolanin A. Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement—Executive Summary. Br J Sports Med 2019; 54:216-220. [DOI: 10.1136/bjsports-2019-101583] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Abstract
The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.
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De Souza MJ, Koltun KJ, Williams NI. The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes. Sports Med 2019; 49:125-137. [PMID: 31696452 PMCID: PMC6901401 DOI: 10.1007/s40279-019-01217-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Female Athlete Triad represents three interrelated conditions of (i) low energy availability (energy deficiency), presenting with or without disordered eating, (ii) menstrual dysfunction, and (iii) poor bone health, each of which can exist along a continuum of severity ranging from mild and moderate subclinical health concerns to severe clinical outcomes, including eating disorders, amenorrhea, and osteoporosis. This review provides a brief overview of the Female Athlete Triad, including updating the current thinking regarding energy availability and how it relates to reproductive function, and sets the stage for an initial working model of a similar syndrome in males that will be based on currently available evidence and will later be defined and referred to as a Male Athlete Triad by the newly re-named Female and Male Athlete Triad Coalition. A primary focus of this paper will be on the physiology of each Triad model with an emphasis on low energy availability and its role in reproductive function, with a brief introduction on its effects on bone health in men. From the data reviewed, (i) a specific threshold of energy availability below which menstrual disturbances are induced is not supported; (ii) it appears that the energetic, reproductive, and bone systems in men are more resilient to the effects of low energy availability compared to those of women, requiring more severe energetic perturbations before alterations are observed; and (iii) it appears that recovery of the hypothalamic pituitary gonadal axis can be observed more quickly in men than in women.
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Affiliation(s)
- Mary Jane De Souza
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kristen J. Koltun
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
| | - Nancy I. Williams
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
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Huggins RA, Coleman KA, Attanasio SM, Cooper GL, Endres BD, Harper RC, Huemme KL, Morris RF, Pike Lacy AM, Peterson BC, Pryor RR, Casa DJ. Athletic Trainer Services in the Secondary School Setting: The Athletic Training Locations and Services Project. J Athl Train 2019; 54:1129-1139. [PMID: 31549849 DOI: 10.4085/1062-6050-12-19] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT Previous research from a sample of US secondary schools (n = 10 553) indicated that 67% of schools had access to an athletic trainer (AT; 35% full time [FT], 30% part time [PT], and 2% per diem). However, the population-based statistic in all secondary schools with athletic programs (n = approximately 20 000) is yet to be determined. OBJECTIVE To determine the level of AT services and employment status in US secondary schools with athletics by National Athletic Trainers' Association district. DESIGN Cross-sectional study. SETTING Public and private secondary schools with athletics. PATIENTS OR OTHER PARTICIPANTS Data from all 20 272 US public and private secondary schools were obtained. MAIN OUTCOME MEASURE(S) Data were collected from September 2015 to April 2018 by phone or e-mail communication with school administrators or ATs and by online surveys of secondary school ATs. Employment categories were school district, school district with teaching, medical or university facility, and independent contractor. Data are presented as total number and percentage of ATs. Descriptive statistics were calculated for FT, PT, and no AT services data for public, private, public + private, and employment type by state and by National Athletic Trainers' Association district. RESULTS Of the 20 272 secondary schools, 66% (n = 13 473) had access to AT services, while 34% (n = 6799) had no access. Of those schools with AT services, 53% (n = 7119) received FT services, while 47% (n = 6354) received PT services. Public schools (n = 16 076) received 37%, 32%, and 31%, whereas private schools (n = 4196) received 27%, 28%, and 45%, for FT, PT, and no AT services, respectively. Most of the Athletic Training Locations and Services Survey participants (n = 6754, 57%) were employed by a medical or university facility, followed by a school district, school district with teaching, and independent contractor. Combined, 38% of AT employment was via the school district. CONCLUSIONS The percentages of US schools with AT access and FT and PT services were similar to those noted in previous research. One-third of secondary schools had no access to AT services. The majority of AT employment was via medical or university facilities. These data depict the largest and most updated representation of AT services in secondary schools.
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Affiliation(s)
- Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Kelly A Coleman
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Sarah M Attanasio
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Brad D Endres
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Kasey L Huemme
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Rachel F Morris
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Alicia M Pike Lacy
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University of Buffalo, NY
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Santos-Junior RB, Utter AC, McAnulty SR, Bittencourt Bernardi BR, Buzzachera CF, Franchini E, Souza-Junior TP. Weight loss behaviors in Brazilian mixed martial arts athletes. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00581-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Scott CL, Haycraft E, Plateau CR. Teammate influences and relationship quality are associated with eating and exercise psychopathology in athletes. Appetite 2019; 143:104404. [PMID: 31421196 DOI: 10.1016/j.appet.2019.104404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/02/2019] [Accepted: 08/13/2019] [Indexed: 01/05/2023]
Abstract
Teammates have a powerful influence on athletes' eating attitudes/behaviours, but less is known about the relative importance of teammate influence mechanisms. The primary aim of this study was to explore the relationships and predictive associations between teammate influences (e.g., modelling of teammates' disordered eating; supportive teammate friendships) and athletes' eating and exercise attitudes and behaviours. A further aim was to identify the presence of any gender differences. Athletes (N = 1172, mean age 24 years, n = 727 female) completed a survey exploring multiple teammate influences, eating and exercise attitudes and behaviours, and psychological wellbeing (anxiety, depression, self-esteem). Many significant relationships were identified between teammate influences and eating/exercise psychopathology. Stepwise regression analysis revealed that a perceived pressure from teammates to lose weight/change shape and perceptions that teammates engaged in disordered eating practices were the best predictors of higher eating and exercise psychopathology. Supportive teammate friendships was the best predictor of lower eating psychopathology and higher levels of healthy exercise behaviours. Encouragement/discouragement to eat healthily were also significant predictors. Teammate influences explained more variance in exercise than eating psychopathology, and total variance explained by teammates was higher for females compared to males. Teammates may have a positive and negative influence on the eating and exercise attitudes/behaviours of athletes; however, gender differences are apparent. Understanding teammate influences on the eating and exercise practices of athletes is important for the development of team-based interventions to reduce or prevent disordered eating and exercise. Future research should explore these relationships longitudinally, considering the role of moderating factors (e.g., sport type, stage of season).
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Affiliation(s)
- Charlotte L Scott
- School of Sport, Exercise and Health Sciences, Loughborough University, LE11 3TU, UK
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, LE11 3TU, UK
| | - Carolyn R Plateau
- School of Sport, Exercise and Health Sciences, Loughborough University, LE11 3TU, UK.
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Belval LN, Hosokawa Y, Casa DJ, Adams WM, Armstrong LE, Baker LB, Burke L, Cheuvront S, Chiampas G, González-Alonso J, Huggins RA, Kavouras SA, Lee EC, McDermott BP, Miller K, Schlader Z, Sims S, Stearns RL, Troyanos C, Wingo J. Practical Hydration Solutions for Sports. Nutrients 2019; 11:nu11071550. [PMID: 31324008 PMCID: PMC6682880 DOI: 10.3390/nu11071550] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
Personalized hydration strategies play a key role in optimizing the performance and safety of athletes during sporting activities. Clinicians should be aware of the many physiological, behavioral, logistical and psychological issues that determine both the athlete’s fluid needs during sport and his/her opportunity to address them; these are often specific to the environment, the event and the individual athlete. In this paper we address the major considerations for assessing hydration status in athletes and practical solutions to overcome obstacles of a given sport. Based on these solutions, practitioners can better advise athletes to develop practices that optimize hydration for their sports.
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Affiliation(s)
- Luke N Belval
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA.
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Saitama 359-1192, Japan
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC 27402, USA
| | | | - Lindsay B Baker
- Gatorade Sports Science Institute, Barrington, IL 60010, USA
| | - Louise Burke
- Sports Nutrition, Australian Institute of Sport, Canberra, ACT 2617, Australia
| | | | | | - José González-Alonso
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge UB8 3PH, UK
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Stavros A Kavouras
- Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | - Elaine C Lee
- Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Brendon P McDermott
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA
| | - Kevin Miller
- Department of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, MI 48859, USA
| | - Zachary Schlader
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY 14214, USA
| | - Stacy Sims
- Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton 3216, New Zealand
| | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
| | - Chris Troyanos
- International Institute of Race Medicine, Plymouth, MA 02360, USA
| | - Jonathan Wingo
- Department of Kinesiology, University of Alabama, Tuscaloosa, AL 35487, USA
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Cooper L, Harper R, Wham GS, Cates J, Chafin SJ, Cohen RP, Dompier TP, Huggins RA, Newman D, Peterson B, McLeod TCV. Appropriate Medical Care Standards for Organizations Sponsoring Athletic Activity for the Secondary School-Aged Athlete: A Summary Statement. J Athl Train 2019; 54:741-748. [PMID: 31135211 DOI: 10.4085/1062-6050-544-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To present the appropriate medical care standards for organizations that sponsor athletic activities for secondary school-aged athletes. DATA SOURCES To develop the current standards and identify current best-practices evidence, the task force used a multistep process that included reviewing the existing 2004 Appropriate Medical Care for Secondary School-Aged Athletes consensus points and cross-referencing of National Athletic Trainers' Association (NATA) statements and official documents from the strategic alliance (the NATA, NATA Foundation, Board of Certification, and Commission on Accreditation of Athletic Training Education). Gaps in the recommendations from the 2004 Appropriate Medical Care for Secondary School-Aged Athletes document were identified by the task force, and the new appropriate medical care standards were developed and refined. CONCLUSIONS AND RECOMMENDATIONS Twelve standards, with supporting substandards, were developed that encompassed readiness to participate in activity; facilities; equipment; protective materials; environmental policies; nutrition, hydration, and dietary supplementation; wellness and long-term health; comprehensive emergency action plans; on-site immediate care; on-site therapeutic interventions; psychological concerns; and athletic health care administration. Collectively, these standards describe a comprehensive approach to providing appropriate health care to secondary school-aged athletes and should serve as a framework with which organizations can evaluate and improve the medical care supplied to adolescent athletes.
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Affiliation(s)
| | | | | | | | - Scott J Chafin
- Gregorio, Chafin, Johnson, Poolson, & Tabor, LLC, Shreveport, LA
| | - Randy P Cohen
- Department of Intercollegiate Athletics, University of Arizona, Tucson
| | - Thomas P Dompier
- Department of Athletic Training, Lebanon Valley College, Annville, PA
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Dan Newman
- Department of Athletics, Union High School, Tulsa, OK
| | | | - Tamara C Valovich McLeod
- Athletic Training Programs and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
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Syed-Abdul MM, Soni DS, Wagganer JD. Effects of self-implemented carbohydrate cycling and moderate to high intensity resistance exercise on body fat in body builders. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03762-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Programs on a Diet?: An Examination of Athletic Departments’ Eating Disorder Policies at NCAA Division I Universities. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2018. [DOI: 10.1123/jcsp.2018-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Disordered eating (DE) plays a significant role in the overall health and athletic performance of collegiate athletes. The present study sought to determine how many NCAA Division I Football Bowl Subdivision Institutions have a policy that specifically addresses the prevention and management of DE for their participating athletes and to examine the content of the existing policies. The study searched for policies in the 128 FBS institutions through an online web-search and by contacting athletic department personnel. A total of 33 currently existing policies on athletes with eating disorders (EDs) were found, 13 of which were found online. A documentary analysis was then conducted to determine the type of information that policies include. Sixteen major themes were found throughout the analysis, including themes that related to prevention, risk factors, identification, treatment, referral, and return-to-play guidelines.
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Rosa-Caldwell ME, Todden C, Caldwell AR, Breithaupt LE. Confidence in eating disorder knowledge does not predict actual knowledge in collegiate female athletes. PeerJ 2018; 6:e5868. [PMID: 30397554 PMCID: PMC6211262 DOI: 10.7717/peerj.5868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/03/2018] [Indexed: 11/20/2022] Open
Abstract
Background Eating disorders are serious psychological disorders with long term health impacts. Athletic populations, tend to have higher incidences of eating disorders compared to the general population. Yet there is little known about athletes’ eating disorder knowledge and how it relates to their confidence in their knowledge. Therefore, the purpose of our study was to evaluate collegiate female athletes’ eating disorder (ED) knowledge and confidence in their knowledge. 51 participants were recruited from a National Association of Intercollegiate Athletics (NAIA) university in the mid-west and asked to complete a 30-question exam assessing one’s knowledge of five different categories related to eating disorders. Confidence in the correctness of answers was assessed with a 5-point Likert-scale (1 = very unconfident, 5 = very confident). A one-way ANOVA was used to determine differences between scores on different categories and overall scores. A simple regression analysis was used to determine if confidence or age was predictive in knowledge scores. Results The average score of participants was 69.1%, SD = 10.8% with an average confidence of 3.69/5, SD = 0.33. Athletes scored lowest with regards to Identifying Signs and Symptoms of EDs compared to other sub-scores (p < 0.05). There was no relationship between knowledge and confidence scores. Discussion There is limited ED knowledge among collegiate female athletes. This may be problematic as many athletes appear confident in the correctness of their answers despite these low scores. Coaches should be aware of this lack of knowledge and work with clinical practitioners, such as dieticians, team physicians and athletic trainers to educate and monitor their athletes on eating disorders, specifically signs and symptoms.
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Affiliation(s)
- Megan E Rosa-Caldwell
- Exercise Science Research Center, University of Arkansas at Fayetteville, Fayetteville, AR, United States of America.,Department of Behavioral and Health Sciences, Baker University, Baldwin City, KS, United States of America
| | - Christopher Todden
- Department of Behavioral and Health Sciences, Baker University, Baldwin City, KS, United States of America
| | - Aaron R Caldwell
- Exercise Science Research Center, University of Arkansas at Fayetteville, Fayetteville, AR, United States of America.,Department of Behavioral and Health Sciences, Baker University, Baldwin City, KS, United States of America
| | - Lauren E Breithaupt
- Department of Psychology, George Mason University, Fairfax, VA, United States of America.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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Jeon S, Cho K, Ok G, Lee S, Park H. Weight loss practice, nutritional status, bone health, and injury history: A profile of professional jockeys in Korea. J Exerc Nutrition Biochem 2018; 22:27-34. [PMID: 30343556 PMCID: PMC6199486 DOI: 10.20463/jenb.2018.0021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/18/2018] [Indexed: 01/01/2023] Open
Abstract
[Purpose] The purpose of this study was to investigate the impact of weight loss practices on nutritional status, bone health, and injury history among Korean professional jockeys. [Methods] Forty-three male jockeys completed a questionnaire to assess their weight loss practices. Of these, 10 jockeys were selected for in-depth assessment of their nutritional status, bone health, and injury history. [Results] The questionnaires revealed that 81.4% of jockeys lost weight every week mainly by dieting and/or exercising. None of the jockeys consumed enough food during the weight loss period. Two jockeys were diagnosed with osteopenia and one was diagnosed with osteoporosis. Only history of fracture showed a significant correlation with low bone mineral density. All jockeys had more than one injury experience throughout their career. Fracture was the most common type of injury, occurring during practice and/or competition and caused mainly by difficulties in handling the horses. [Conclusion] Professional jockeys in Korea use extreme weight loss methods. Their repeated periods of poor nutritional intake may result in seriously low bone mineral density, which may aggravate injuries sustained during horse races. Implementation of balanced dietary programs and delivery of health education on weight management are urgently required.
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