Disordered eating and the female athlete triad

Disordered eating- and exercise-related behaviors and cognitions during the first year college transition

ObjectiveDuring the college transition, vulnerability to disordered eating and exercise behaviors and cognitions may increase. We studied how behaviors and cognitions change differentially over time, in the context of gender, athletic participation, and contingencies of self-worth. Participants: 229 diverse, first-year students at a competitive liberal arts college. Methods: Three-wave longitudinal study employing surveys before, during, and following the first semester, using linear mixed model analyses. Results: There were changes over time in one measure of disordered exercise-related cognitions and exercise frequency; disordered eating showed no significant changes over time. Athletic participation and basing a lower amount of self-worth on appearance were protective against subclinical disordered cognitions and behaviors; gender was not predictive. Conclusion: Health personnel should consider athletic participation and contingencies of self-worth when assessing students' risk for ED symptoms, in both genders. Early interventions may be useful, as changes were observed within the first three months of college.

Disordered Eating Attitudes, Anxiety, Self-Esteem and Perfectionism in Young Athletes and Non-Athletes

Eating disorders are associated with short and long-term consequences that can affect sports performance. The purposes of this study were to investigate whether female athletes, particularly gymnasts and footballers, exhibit more eating problems compared to female non-athletes, and to identify individual personality characteristics including anxiety, self-esteem, and perfectionism as possible contributors to eating disorder risk. In a sample of 120 participants, 80 adolescent female athletes were compared to a control condition of 40 non-athletes (mean age 17.2 ± 2.82). Participants responded to a questionnaire package to investigate the presence of disordered eating (SCOFF) and psychological variables in relation to disordered eating symptoms or eating disorder status. Subsequently, anthropometric measures were obtained individually by trained staff. There were statistically significant differences between conditions. One of the most important results was the score in SCOFF (Mann-Whitney = 604, p < 0.05; Cohen's d = 0.52, r = 0.25), being higher in control than in the gymnast condition. These results suggest that non-athlete female adolescents show more disturbed eating behaviours and thoughts than female adolescents from aesthetic sport modalities and, therefore, may have an enhanced risk of developing clinical eating disorders.

Prevalence of Disordered Eating Among International Sport Lead Rock Climbers

Disordered eating (DE) is characterized as a range of irregular eating patterns or behaviors, which may lead to pathological eating or a clinical eating disorder diagnosis. DE patterns are associated with a variety of negative health outcomes. The prevalence of DE is highest in female athletes who participate in aesthetic or weight dependent sports. Elite rock climbers tend to be strong, small and lean, but the prevalence of DE in rock climbers is unknown. The purpose of the present study was to assess DE prevalence in a large group of international rock climbers and to explore the relationship between sport rock climbing ability and DE. A web-based survey assessed both DE (Eating Attitudes Test-26) and climbing ability based on the International Rock Climbing Research Association's position statement on comparative grading scales. The survey was distributed to international climbing communities; 810 individuals attempted the survey; 604 completed all questions; 498 identified as sport lead climbers. The majority of sport lead climbers were lower grade/intermediate (57.8%), compared to advanced (30.7%) and elite/higher elite (11.4%), and male (76.9%). Forty-three sport lead climbers reported a score of 20 or above on the EAT-26 indicating an 8.6% prevalence of DE in this sample. Male climbers had a DE prevalence of 6.3% (24 of 383) and female climbers more than doubled that with 16.5% (19 of 115). Chi-square analysis revealed that DE was associated with climbing ability level [χ2 (2, n = 498, 8.076, p = 0.02)], and when analyzed by sex, only the female climbers had a significant relationship of DE with climbing ability [χ2 (2, n = 115, 15.640, p = 0.00)]. These findings suggest sport lead rock climbers are not immune to DE and that the risk is elevated in female climbers, particularly at the elite/high elite climbing ability level. Our research indicates further investigations are warranted to determine if and how disordered eating behaviors affect health and performance of adult rock climbers.

Training session intensity affects plasma redox status in amateur rhythmic gymnasts

PURPOSE

The aim of this study was to examine systemic responses of oxidant/antioxidant status following 2 training sessions of different intensity in amateur rhythmic gymnasts.

METHODS

Before the experimental training, 10 female gymnasts performed a gradually increased exercise test to assess maximal heart rate, maximal oxygen consumption, and anaerobic threshold. They executed 2 intermittent training sessions separated by 48 h of recovery (48 h-post R): the first was performed at low-moderate intensity (LMI) and the second at high intensity (HI). Blood samples were collected immediately pre- and post-training and 48 h-post R. Hydroperoxide level (OxL) and total antioxidant capacity (TAC) were photometrically measured.

RESULTS

OxL was significantly higher in post-training and 48 h-post R following HI than the same conditions after an LMI session (HI vs. LMI post-training: 381.10 ± 46.17 (mean ± SD) vs. 344.18 ± 27.94 Units Carratelli (U.CARR); 48 h-post R: 412.21 ± 26.61 vs. 373.80 ± 36.08 U.CARR). There was no change in TAC between the 2 training sessions investigated. In LMI training, OxL significantly decreased in post-training and increased to reach the baseline at 48 h-post R, whereas TAC increased only at 48 h-post R. In HI training, OxL significantly increased to reach a high oxidative stress 48 h-post R, whereas TAC was lower in post-training than pre-training.

CONCLUSION

The pattern of OxL and TAC levels implies different regulation mechanisms by HI and LMI training sessions. High oxidative stress induced by an HI protocol might be associated with both insufficient TAC and recovery time at 48 h necessary to restore redox balance.

A Comparison of the Nutrient Intakes of Macronutrient-Based Dieting and Strict Dieting Bodybuilders

The purpose of this study was to provide a descriptive assessment of the nutritional habits of competitive bodybuilders and compare the nutrient intakes of macronutrient-based dieting and strict dieting individuals. Data from 41 subjects (30 males and 11 females) were used in analyses. Participants completed a comprehensive food frequency questionnaire, and diets were analyzed using a computer system. Males consumed an average of 2,577.2 kcal (SD = 955.1), with an average fat intake of 83.6 g (SD = 41.3), an average carbohydrate intake of 323.3 g (SD = 105.2), and an average protein intake of 163.4 g (SD = 70.4). There were no significant differences between male macronutrient-based dieting and strict dieting bodybuilders when mean intakes were compared for all nutrients, including the macronutrients, selected vitamins and minerals, dietary fiber, added sugars, and saturated fat. Females in this study consumed an average of 1,794 kcal (SD = 453.1), with an average fat intake of 58.3 g (SD = 23.1), a mean carbohydrate intake of 217.8 g (SD = 85.9), and an average protein intake of 103.8 g (SD = 35.7). For females, macronutrient-based dieters consumed significantly greater amounts of several nutrients, including protein, vitamin E, vitamin K, and vitamin C. Over half of individuals from all groups consumed less than the recommended amounts of several of the micronutrients. Based on this information, it is recommended that competitive bodybuilders should be advised to take their micronutrition into greater consideration.

Promotion of Healthy Weight-Control Practices in Young Athletes

Children and adolescents may participate in sports that favor a particular body type. Some sports, such as gymnastics, dance, and distance running, emphasize a slim or lean physique for aesthetic or performance reasons. Participants in weight-class sports, such as wrestling and martial arts, may attempt weight loss so they can compete at a lower weight class. Other sports, such as football and bodybuilding, highlight a muscular physique; young athletes engaged in these sports may desire to gain weight and muscle mass. This clinical report describes unhealthy methods of weight loss and gain as well as policies and approaches used to curb these practices. The report also reviews healthy strategies for weight loss and weight gain and provides recommendations for pediatricians on how to promote healthy weight control in young athletes.

Perceptions of body weight and nutritional practices among male and female National Collegiate Athletic Association Division II athletes

OBJECTIVE

This study investigated body weight and nutritional behavior perceptions among Division II collegiate athletes.

PARTICIPANTS

The sample was composed of 155 collegiate athletes who responded to a survey.

METHODS

Data were self-reported by athletes via questionnaire. Independent-sample t tests were used to identify significant gender differences related to body weight perceptions, nutritional practices, and ideal weight difference (IWD). An alpha level of .05 was used to determine statistical significance.

RESULTS

Mean ± SD female and male IWD was -6.8 ± 8.8 and 1.3 ± 12.3 lbs, respectively (p < .001). Significant differences in level of agreement regarding perceived body weight effects on performance and dietary practices existed between genders.

CONCLUSIONS

Significant gender differences may exist regarding body weight perceptions and nutritional practices among collegiate athletes. Deliverance of gender-specific educational information about proper nutritional practices is warranted. To properly tailor interventions to specific sports, research with larger sample sizes is needed.

The female athlete triad

Context:

The female athlete triad (the triad) is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density; it is relatively common among young women participating in sports. Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team.

Evidence Acquisition:

Articles from 1981 to present found on PubMed were selected for review of major components of the female athlete triad as well as strategies for diagnosis and treatment of the conditions.

Results:

The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. While no specific drug intervention has been shown to consistently improve bone mineral density in this patient population, maximizing energy availability and optimizing vitamin D and calcium intake are recommended.

Conclusions:

Treatment requires a multidisciplinary approach involving health care professionals as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.

Psychological factors related to eating disordered behaviors: a study with Portuguese athletes

This study analyzes eating disordered behaviors in a sample of Portuguese athletes and explores its relationship with some psychological dimensions. Two hundred and ninety nine athletes (153 male, 51.2%) practicing collective (65.2%) or individual sports (34.8%) were included. The assessment protocol included the Eating Disorder Examination Questionnaire (EDE-Q) (Fairburn & Beglin, 1994); the Sport Condition Questionnaire (Bruin et al., 2007; Hall et al., 2007); the Sport Anxiety Scale (Smith et al., 2006); the Task and Ego Orientation in Sport Questionnaire (Duda, 1992; Duda & Whitehead, 1998); the Cognitive Evaluation of Sport-Threat Perceptions (Cruz, 1994; Lazarus, 1991); and the Self-Presentation Exercise Questionnaire (Gammage et al., 2004). Results revealed that: i) no case of clinical significance was detected in the four dimensions of the EDE-Q simultaneously; ii) females scored higher on the EDE-Q Global Score, and athletes with the better sport results scored higher on the Restraint subscale; iii) athletes with a higher desire to weigh less scored higher on the EDE-Q Global Score; iv) athletes with lower scores on EDE-Q displayed more positive results on the psychological measures; v) several psychological dimensions were identified as predictors of eating disordered behaviors. In conclusion, the prevalence of eating disordered behaviors was negligible in this study, yet the relationship of this problem with personal, sport and psychological factors was evident.

The adolescent female athlete: current concepts and conundrums

The adolescent female athlete has become a common part of the sports environment at all levels from childhood play to professional adult sports. This article considers various issues common to this athlete to help clinicians care for their patients. Basic sports physiology is reviewed and then specific conditions are considered, including iron deficiency anemia, stress urinary incontinence, breast issues (ie, pain, asymmetry, galactorrhea, injury), the female athlete triad (ie, menstrual dysfunction, abnormal eating patterns, and osteopenia or osteoporosis), and injuries. Clinical conundrums are considered including the difficulty in caring for a dedicated athlete whose intense love of her sport may lead to menstrual and bone loss complications. The knowledgeable clinician in the twenty-first century can be of considerable help to the female athlete who is at and beyond puberty.

Physique Anxiety and Disordered Eating Correlates in Female Athletes: Differences in Team and Individual Sports

As female athletes participating in physique-salient sports report similar levels of social physique anxiety (SPA) and disordered eating symptoms compared with those in nonphysique salient sports, alternative factors contributing to disordered eating require consideration, specifically participation in sport type (team vs. individual). This study examined SPA and disordered eating correlates in female athletes (N= 137) in two sport types (team sports and individual sports). Individual sport athletes exhibited higher SPA,F(1, 135) = 22.03,p< .001; dieting, Brown and Forsythe’sF(1, 57.05) = 43.79,p< .001; and bulimic behavior, Brown and Forsythe’sF(1, 59.92) = 13.45,p= .001 than team sport athletes. SPA and sport type together predicted 44% of dieting and 22% of bulimic symptom variance, suggesting that individual-sport athletes with higher SPA experienced greater disordered eating. Involvement in individual sports where physique is more open to social evaluation may contribute to dieting and bulimic symptoms among female athletes.

National athletic trainers' association position statement: preventing, detecting, and managing disordered eating in athletes

OBJECTIVE

To present recommendations for the prevention, detection, and comprehensive management of disordered eating (DE) in athletes.

BACKGROUND

Athletes with DE rarely self-report their symptoms. They tend to deny the condition and are often resistant to referral and treatment. Thus, screenings and interventions must be handled skillfully by knowledgeable professionals to obtain desired outcomes. Certified athletic trainers have the capacity and responsibility to play active roles as integral members of the health care team. Their frequent daily interactions with athletes help to facilitate the level of medical surveillance necessary for early detection, timely referrals, treatment follow-through, and compliance.

RECOMMENDATIONS

These recommendations are intended to provide certified athletic trainers and others participating in the health maintenance and performance enhancement of athletes with specific knowledge and problem-solving skills to better prevent, detect, and manage DE. The individual biological, psychological, sociocultural, and familial factors for each athlete with DE result in widely different responses to intervention strategies, challenging the best that athletics programs have to offer in terms of resources and expertise. The complexity, time intensiveness, and expense of managing DE necessitate an interdisciplinary approach representing medicine, nutrition, mental health, athletic training, and athletics administration in order to facilitate early detection and treatment, make it easier for symptomatic athletes to ask for help, enhance the potential for full recovery, and satisfy medicolegal requirements. Of equal importance is establishing educational initiatives for preventing DE.

The Female Athlete Triad and Cardiovascular Dysfunction

In the past 35 years, a significant increase has occurred in sports participation by women. An estimated 3 million girls and young women compete in American high school sports. Women who participate in sports and fitness programs are generally healthier and have higher self-esteem. However, an increase has also been seen in gender-specific injuries and medical problems. The female athlete triad is a syndrome of separate but interrelated conditions of disordered eating, amenorrhea, and osteoporosis. Athletic amenorrhea is known to have a hormonal profile similar to menopause characterized by decreased circulating estrogens. Menopause is known to be associated with osteoporosis and accelerated cardiovascular disease. Although enhanced risk for cardiovascular disease is theoretically possible, it has not been explored in the young athletic population. Premature cardiovascular disease first manifests as endothelial dysfunction, which can be examined noninvasively with ultrasound. This article discusses disordered eating, amenorrhea, osteoporosis, and the potential for heightened cardiovascular risk in young athletic women.

Impact of fatness, fitness, and ethnicity on the relationship of nocturnal ghrelin to 24-hour luteinizing hormone concentrations in adolescent girls

CONTEXT

Ghrelin is related to energy balance that regulates food intake.

OBJECTIVE

The aim was to explore whether ghrelin would be linked to differences in fitness in adolescent girls, whose menstrual cycles are sensitive to changes in energy balance.

METHODS

A total of 72 girls, ages 14-21 yr, including five with amenorrhea, were studied in the follicular phase. LH was sampled every 10 min over 24-h, and ghrelin was measured hourly between 2300 and 0300 h. Body composition was measured by dual x-ray absorptiometry. Fitness was characterized by reported frequency of exercise per week and by maximal oxygen consumption with "high" vs. "low" fitness groups defined from maximal oxygen consumption norms for this population. Data were analyzed with SAS software (SAS Institute Inc., Cary, NC).

RESULTS

Ghrelin was related to percent body fat (P = 0.038; R(2) 0.07), weekly exercise (P = 0.032; R(2) 0.07), and 24-h mean LH (P = 0.002; R(2) 0.13). The ghrelin relationship with LH was more pronounced in the low-fitness group. In multiple regression models, 24-h LH was an independent predictor of ghrelin after adjusting for percent body fat, fitness, exercise, or age. Ghrelin was higher in Caucasian girls than in African-American girls after adjusting for covariates at 0200 h (P = 0.017).

CONCLUSIONS

Twenty-four-hour LH is an independent predictor of nighttime ghrelin concentrations in postpubertal adolescent girls. Diverging patterns in ghrelin may reflect differences in exercise patterns and/or may be influenced by ethnicity. These data introduce ghrelin as a biomarker of individual differences in energy balance during the menstrual cycle and across ethnicities.

Adolescents involved in weight-related and power team sports have better eating patterns and nutrient intakes than non-sport-involved adolescents

OBJECTIVE

To examine eating habits and energy and nutrient intake among adolescents participating in weight-related and power team sports and non-sport-involved adolescents.

DESIGN

Data were drawn from Project EAT (Eating Among Teens), which was conducted with 4,746 adolescents from 31 middle and high schools in the Minneapolis/St Paul metropolitan area.

SETTING

Urban secondary schools.

SUBJECTS

Adolescents reporting participation in a weight-related sport, a power team sport, or no consistent participation in a sport.

MAIN OUTCOME MEASURES

Meal and snack frequency, mean energy and nutrient intake, and mean physical activity.

STATISTICAL ANALYSES PERFORMED

Analyses were conducted by sex across the three groups. General linear models were used to compare mean energy and nutrient intake, composite nutrient adequacy, and mean physical activity across the three groups. Percentages of youth meeting nutrient recommendations were compared across the three groups using chi(2) tests.

RESULTS

For both males and females, youth involved in weight-related sports ate breakfast more frequently than non-sport-involved peers (females: 3.6 and 3.2 times per week, respectively, P<0.01; males: 4.7 and 3.7 times per week, respectively, P<0.01). Weight-related and power team sport-involved youth also had higher mean protein, calcium, iron, and zinc intakes than non-sport-involved peers. However, adolescent females had low calcium intake, regardless of sports involvement (weight-related sports 1,091 mg/day, power team sports 1,070 mg/day, and non-sport-involved 1,028 mg/day, P<0.05).

CONCLUSIONS

Sport-involved adolescents have better eating habits and nutrient intake than their non-sport-involved peers. However, they are still in need of nutrition interventions, particularly around calcium intake.

Promotion of healthy weight-control practices in young athletes

Children and adolescents are often involved in sports in which weight loss or weight gain is perceived as an advantage. This policy statement describes unhealthy weight-control practices that may be harmful to the health and/or performance of athletes. Healthy methods of weight loss and weight gain are discussed, and physicians are given resources and recommendations that can be used to counsel athletes, parents, coaches, and school administrators in discouraging inappropriate weight-control behaviors and encouraging healthy methods of weight gain or loss, when needed.

Use of the preparticipation physical examination form to screen for the female athlete triad in Canadian interuniversity sport universities

OBJECTIVE

The purpose of this study was to survey universities affiliated with Canadian Interuniversity Sport on existing screening protocols for the female athlete triad, and to identify any potential areas for improvement of this system.

DESIGN

Surveys were faxed or e-mailed to Canadian Interuniversity Sport-affiliated universities in Canada, and preparticipation physical examination (PPE)/medical history forms from each institution were analyzed.

SETTING

The Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario.

PARTICIPANTS

In 2000, of the 48 universities, 35 responded (73.0% response rate). In 2002, 39 of 49 universities responded (79.6%).

MAIN OUTCOME MEASUREMENTS

Although the majority of institutions surveyed implement a PPE form (80.0% in 2000, 87.2% in 2002), only 70.6% to 75.0% of these institutions actually conduct a follow-up when deemed necessary. However, the number of forms including a specific female section increased from 46.4% in 2000 to 61.8% in 2002. Also encouraging is the percentage of universities attempting to increase awareness of the triad disorders (33.3% in 2002 vs. 14.3% in 2000). It is interesting to note that in over half of the institutions surveyed both years, the athletic therapist or trainer is responsible for analyzing the completed PPE forms.

CONCLUSIONS

This study has shown substantial improvement from 2000 to 2002 in the development of the PPE across Canada, even in a relatively short period of 2 years. However, this study also demonstrates the lack of uniformity within Canada of the PPE forms. There remains a need to improve the PPE form to target a section of the form specifically to female athletes, or else cases may be missed. The triad is also not found solely in sports where leanness is associated with better performance. Better efforts need to made to increase awareness of the triad and its risks among female athletes, as well as provide educational opportunities for athletic therapists, who are the first line of intervention in many cases.

CLINICAL RELEVANCE

The key to successful prevention and intervention is education. This study demonstrates the need for education for all people directly involved with the athlete, and the need to work together to promote a healthy and realistic body image and increase awareness of the female athlete triad among athletes.

Early identification and interventions for female athlete triad

The diagnosis of female athlete triad is based on three criteria: (a) disordered eating, (b) amenorrhea, and (c) osteopenia. Prevention involves increasing awareness of this problem in athletes, parents, and coaches. Routine and opportunistic screening for risk factors by health care providers will increase early detection in athletes. Appropriate evaluation and treatment will decrease the consequences of this disorder. Consequences include stress fractures, development of eating disorders, and lower peak bone mass resulting in increased risk of osteoporosis later in life. A primary care case manager who provides motivation and support along with a multidisciplinary approach to treatment is recommended. This approach includes nutritional, exercise, and psychological therapies and possibly supplements and medication for optimal results.

Preparticipation physical examination: selected issues for the female athlete

OBJECTIVE

The purpose of this article was to examine the preparticipation examination (PPE) with regard to the female athlete. Ever-increasing participation of women in competitive sport has created a requirement for more gender-specific sport medicine knowledge. In particular, physicians and other health care professionals should be aware of the triad of disordered eating, amenorrhea (and other menstrual dysfunction), and osteoporosis (or altered bone mineral density) collectively described as the female athlete triad. Suggested additions to the standard PPE may help identify athletes at risk. DATA SOURCES/METHODS: A literature search was carried out using MEDLINE for years 1966 to 2003, with keywords female athlete triad, PPE, female athlete, eating disorders, amenorrhea, and osteoporosis. Further studies were identified through reference lists.

RESULTS

Better recognition and prevention of these problems is essential. At present, there is little evidence-based information available to guide the practicing clinician in this area. It remains to be determined which methods are the most sensitive and specific for detecting the triad disorders, as well as the most economical and time-efficient.

CONCLUSIONS

The PPE offers an excellent opportunity to screen for these entities, as well to initiate early treatment. It is recommended that a standardized form (or part of the form) be developed for the female athlete.

Eating disorders in children and adolescents

Anorexia nervosa and bulimia nervosa are common disorders in the pediatric population. This article is designed to help the clinician develop a detailed understanding of these disorders as they affect children and adolescents. The etiology, diagnosis, complications, and treatment of these eating disorders are discussed. The special circumstances of diabetes mellitus, athletics, and the interface with the obese patient also are covered. The need to correctly identify a patient with the disorder, perform the appropriate testing, and organize the most appropriate treatment is required from virtually every primary care practitioner.

Effects of estrogen replacement on metabolic factors that influence physical performance in female hypogonadism

There is a lack of knowledge regarding the effects of estrogens on physical performance. This is related, in part, to the challenge of isolating the effects of estrogens from those of progestins, because levels of both hormones fluctuate across the menstrual cycle, both decline during the menopausal transition, and the administration oh hormones to hypogonadal women typically involves a combination of estrogens and progestins. Some research findings suggest that fluctuations in estrogen levels acutely influence factors that may affect physical performance, such as substrate utilization or maximal aerobic power, but solid evidence is lacking. The simple observation that hypogonadism is not uncommon among elite athletes in some sports suggests that estrogen deficiency does not have a major negative impact on athletic performance. However, chronic hypogonadism may ultimately lead to impaired performance by menas that are not necessarily obvious. For example, chronic estrogen deficiency has potent, deleterious effects on the skeleton that can increase risk for stress fracture and may limit the ability to sustain a high level of physical training. Estrogen deficiency also appears to promote fat accumulation and may accelerate the loss of fat-free mass, and both of these changes in body composition could impair physical performance. There is evidence that hormone replacement attenuates the negative effects of hypogonadism on body composition and bone density, and that effects are mediated primarily by estrogens rather than progestins. Further research is necessary to broaden the understanding of the role of the estrogens in physical performance.

Eating disorder and menstrual dysfunction screening, education, and treatment programs

To describe the nature, scope, and perceived effectiveness of selected National Collegiate Athletic Association (NCAA) Division 1 programs for the screening, education, and treatment of eating disorders (ED) and menstrual dysfunction (MD).

METHODS

Surveys were mailed to the team physician or the head athletic trainer of all NCAA Division 1 schools currently supporting at least two of the following women's sports: cross-country/track, swimming, and gymnastics. The survey contained closed- and open-ended questions to ascertain the types of ED and MD screening, education, and treatment programs and their perceived effectiveness.

RESULTS

A total of 170 surveys were sent, and 81% were returned. Although 79% of schools reported screening for MD, only 24% used a comprehensive menstrual history questionnaire. An MD treatment protocol was used by 33% of schools, and 7% reported withholding those with MD from athletic participation. Screening for ED was reported by 60% of schools, but less than 6% used a structured interview or a validated ED questionnaire. Athletes with confirmed ED were withheld from athletic participation by 21% of the schools; athletes with suspected ED were withheld by 9%. Education about ED and MD was made available to athletes by 73% of the schools, and 61% of the schools made this education available to coaches. However, less than 41% of schools made such education a requirement. Thirty-five percent of respondents perceived their MD screening programs to be successful or very successful, compared with 26% for ED screening programs.

CONCLUSIONS

These results indicate a pressing need for more standardized ED and MD screening, prevention, and treatment programs among NCAA Division 1 schools. At the very least, all NCAA-member institutions should implement mandatory ED and MD education for all athletes and athletic personnel.

Sports dentistry and dental traumatology

Sports dentistry had its origins in the 1980s. More recently, the Academy for Sports Dentistry joined forces with the International Association of Dental Traumatology in cosponsoring the World Congress on Sports Dentistry and Dental Traumatology. It is the intent of the present paper to introduce readers to the arena of sports dentistry, suggest future areas for collaborative research, and stimulate authors to submit high quality, scientifically based manuscripts on sports dentistry to Dental Traumatology.

Amenorréia e osteoporose em adolescentes atletas

A participação feminina no esporte foi crescendo ao longo dos anos. Trabalhos científicos têm mostrado os benefícios trazidos por esta prática para a saúde da mulher, mas quando se trata de esporte competitivo podem surgir problemas. A complicação mais comum descrita pela literatura é a "tríade da atleta", a qual envolve três processos: o distúrbio alimentar, a amenorréia e a osteoporose. A amenorréia atinge, nos Estados Unidos, até 66% das atletas de competição, e algumas de suas possíveis causas são: perda de peso, excesso de treino, quantidade insuficiente de gordura corporal, perda de estoques específicos de gordura corporal e dieta inadequada. Como conseqüência da amenorréia, a esportista pode desenvolver osteoporose precoce. Não se sabe ao certo a porcentagem de atletas com osteopenia, mas há indícios de que a falta de estrógeno, a dieta inadequada e o consumo insuficiente de cálcio serem fatores que as predispõem a desenvolver a doença.

Female athlete triad

OBJECTIVE

To describe the components of female athlete triad, the proposed mechanisms that may relate to its causation, and some screening and treatment options that may be used by the clinician who encounters this clinical entity in patients.

DATA SOURCES

A qualitative review of the literature was performed.

RESULTS

This article provides the clinician with current information relevant to understanding and recognizing female athlete triad in at-risk patients. The components of the triad-amenorrhea, disordered eating, and osteoporosis-are interrelated in multifactorial etiology, pathogenesis, and consequences. Proposed causal factors include inadequate nutrition, menstrual status, training intensity and frequency, body size and composition, and psychological and physiological stress. There should be a high index of suspicion in all females athletes for the presence of and/or increased risk for female athlete triad. An increased awareness of the existence of the problem and its presenting signs and symptoms is the key to screening for this syndrome. The most efficacious treatment lies in its prevention.

CONCLUSIONS

Female athlete triad is an interrelated, multifactorial syndrome comprised of disordered eating, amenorrhea, and osteoporosis. It is a common entity among female athletes. Prevention, early detection, and early treatment are absolutely essential to maintain the athletes health into maturity and to prevent the serious consequences of this triad. The long-term effects of some triad components are still unknown.

The female athlete. Before and beyond puberty

As the twentieth century progressed, the female athlete became an accepted participant of sports at all levels. This article reviews various aspects of female sports participation. After an historical perspective, selected comments are provided on psychologic and physiologic aspects. Concepts of adolescent gynecology are reviewed, including breast and menstrual problems and pregnancy. Other areas reviewed include iron deficiency anemia, stress urinary incontinence, and sports injuries in female athletes.

Gender-related differences in elite gymnasts: the female athlete triad

High-intensity training can alter the normal pattern of pubertal development in elite gymnasts. We investigated sex hormones, the ob gene product leptin, body composition, nutrition, and eating habits in female and male elite gymnasts from national cadres to elucidate gender-related differences. Serum leptin levels were decreased, particularly in pubertal girls, and did not show the normal developmental pattern. After leptin levels were transformed into standard deviation scores, mainly pubertal female gymnasts had significantly lower values than normal controls of the same gender, pubertal stage, and body mass index. The percentage of body fat was reduced compared with a normal age-matched population in both genders but to a higher degree in female gymnasts. When leptin standard deviation scores were based on percent body fat instead of body mass index, mean values were still significantly decreased compared with those of normal controls: -1.05 in girls (P < 0.001) and -0.60 in boys (P = 0.025). In both genders, total energy consumption and nutritional intake were insufficient, although to a lesser extent in male gymnasts. Pubertal development is influenced to a different degree in female and male elite gymnasts. In contrast to their male counterparts, high-intensity training takes place during the sensitive phase of pubertal maturation in female gymnasts. Whereas the girls displayed low estrogen levels, hypoleptinemia, reduced body fat mass, insufficient caloric intake, and retarded menarche, the pubertal development of male gymnasts remained almost unaltered.

The female athlete triad: a terrible trio implications for primary care

PURPOSE

To describe the components of the female athlete triad, including definitions and clinical criteria for diagnosis, methods of screening, and treatment options.

DATA SOURCES

Selected scientific literature; standard diagnostic guidelines.

CONCLUSIONS

The female athlete triad is a cascading event consisting of disordered eating, amenorrhea, and osteoporosis. This disorder can occur in any sport but is seen most often in events that emphasize thinness and appearance such as gymnastics, ballet, and diving. It can often go unrecognized and result in irreversible bone loss and possible death.

IMPLICATIONS FOR PRACTICE

Primary care nurse practitioners (NPs) may be the first health care professionals encountering these females; they need to recognize the risk factors and institute a multidisciplinary approach to treatment. The treatment team should be composed of the patient, the NP, a dietitian, a psychologist, psychiatrist, or psychiatric nurse specialist, and the patient's family, coaches, and trainers.

Exercise-related female reproductive dysfunction

Clinical or biochemical abnormalities of gonadal function, consisting of delayed puberty, luteal phase deficiency, oligo-amenorrhea or anovulation, occur in girls and women participating in strenuous sports. The evidence of a causal relationship between athletic activity and menstrual dysfunction has led to increased interest, also because the number of women who practice sports has increased rapidly. The pathogenesis of exercise-related female reproductive dysfunction (ERFRD) is not completely clarified. The heterogeneity of sports practice, the role of overtraining and other factors, as adequate calorie balance or the assumption of exogenous steroids, could play a primary role in the comprehension of the pathogenic mechanisms of reproductive dysfunction. The interest of physicians about ERFRD is also due to the consequences of reduced gonadal function on women's health. Apart from some short-term transient effects (i.e. on muscle, genito-urinary tract or behavior), hypoestrogenemia can induce long-term deleterious effects, as premature osteoporosis and lifelong impairment of skeletal structure. In view of the possible short-term (infertility) and long-term (osteoporosis) consequences of ERFRD, correct physical training and adequate diet approach are mandatory to prevent or to revert neuroendocrine abnormalities so frequently reported in girls and women participating in recreational or competitive athletic activities.