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Ihalainen JK, Mikkonen RS, Ackerman KE, Heikura IA, Mjøsund K, Valtonen M, Hackney AC. Beyond Menstrual Dysfunction: Does Altered Endocrine Function Caused by Problematic Low Energy Availability Impair Health and Sports Performance in Female Athletes? Sports Med 2024:10.1007/s40279-024-02065-6. [PMID: 38995599 DOI: 10.1007/s40279-024-02065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 07/13/2024]
Abstract
Low energy availability, particularly when problematic (i.e., prolonged and/or severe), has numerous negative consequences for health and sports performance as characterized in relative energy deficiency in sport. These consequences may be driven by disturbances in endocrine function, although scientific evidence clearly linking endocrine dysfunction to decreased sports performance and blunted or diminished training adaptations is limited. We describe how low energy availability-induced changes in sex hormones manifest as menstrual dysfunction and accompanying hormonal dysfunction in other endocrine axes that lead to adverse health outcomes, including negative bone health, impaired metabolic activity, undesired outcomes for body composition, altered immune response, problematic cardiovascular outcomes, iron deficiency, as well as impaired endurance performance and force production, all of which ultimately may influence athlete health and performance. Where identifiable menstrual dysfunction indicates hypothalamic-pituitary-ovarian axis dysfunction, concomitant disturbances in other hormonal axes and their impact on the athlete's health and sports performance must be recognized as well. Given that the margin between podium positions and "losing" in competitive sports can be very small, several important questions regarding low energy availability, endocrinology, and the mechanisms behind impaired training adaptations and sports performance have yet to be explored.
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Affiliation(s)
- Johanna K Ihalainen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland.
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland.
| | - Ritva S Mikkonen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, 40014, Jyväskylä, Finland
- Sports Technology Unit, Faculty of Sport and Health Sciences, University of Jyväskylä, Vuokatti, Finland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ida A Heikura
- Canadian Sport Institute-Pacific, Victoria, BC, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Katja Mjøsund
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
- National Olympic Training Centre Helsinki, Helsinki, Finland
| | - Maarit Valtonen
- Finnish Institute of High Performance Sport KIHU, Jyväskylä, Finland
| | - Anthony C Hackney
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kuikman MA, McKay AKA, Minahan C, Harris R, Elliott-Sale KJ, Stellingwerff T, Smith ES, McCormick R, Tee N, Skinner J, Ackerman KE, Burke LM. Effect of Menstrual Cycle Phase and Hormonal Contraceptives on Resting Metabolic Rate and Body Composition. Int J Sport Nutr Exerc Metab 2024; 34:207-217. [PMID: 38653456 DOI: 10.1123/ijsnem.2023-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/17/2024] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women's Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise.
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Affiliation(s)
- Megan A Kuikman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Clare Minahan
- Griffith Sports Science, Griffith University, Gold Coast, QLD, Australia
- Female Performance and Health Initiative, Australian Institute of Sport, Canberra, ACT, Australia
| | - Rachel Harris
- Female Performance and Health Initiative, Australian Institute of Sport, Canberra, ACT, Australia
- Perth Orthopaedic and Sports Medicine Research Institute, West Perth, WA, Australia
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Pacific Institute for Sport Excellence, Victoria, BC, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ella S Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Rachel McCormick
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Nicolin Tee
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | | | - Kathryn E Ackerman
- Female Athlete Program, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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Hiromatsu C, Goto K. Energy Availability and Interstitial Fluid Glucose Changes in Elite Male Japanese Triathletes during Training Camp: A Case Study. Nutrients 2024; 16:2048. [PMID: 38999796 PMCID: PMC11243290 DOI: 10.3390/nu16132048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
This study explored the impact of varying energy availability (EA) on the 24-h interstitial fluid glucose concentration (IGC) in five elite male Japanese triathletes at a training camp. Measurements of IGC, energy and macronutrient intake, and exercise energy expenditure (EEE) through metabolic equivalents (METs) from training logs were conducted. Three subjects were evaluated over two 4-day periods, and two subjects over one 4-day period. Findings revealed significant correlations of daily mean nocturnal IGC with daily EA (r = 0.553, p = 0.001) and energy intake (EI) (r = 0.595, p < 0.001). However, no significant correlation was found between mean daily nocturnal IGC and EEE (r = -0.278, p = 0.124). Daytime IGC was ≥110 mg/dL for >50% of the time in all subjects, except on 1 day in one subject, and never fell <70 mg/dL. Therefore, daily EA may influence nocturnal IGC in elite male triathletes, although high daytime IGC levels were maintained without hypoglycemia.
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Affiliation(s)
- Chiyori Hiromatsu
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga 525-8577, Japan
| | - Kazushige Goto
- Graduate School of Sports and Health Science, Ritsumeikan University, Shiga 525-8577, Japan
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Hutson MJ, O'Donnell E, McConnell K, Chauntry AJ, Blagrove RC. Energy availability modulates regional blood flow via estrogen-independent pathways in regularly menstruating young women. Eur J Appl Physiol 2024:10.1007/s00421-024-05497-0. [PMID: 38809480 DOI: 10.1007/s00421-024-05497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE This study aimed to investigate the impact of short-term low energy availability (LEA) on vascular function in young, regularly menstruating women. METHODS Participants were 19 women, aged 22.9 ± 4.2 years, with body mass index 18-30 kg·m2. They were divided into two groups and completed two conditions in a crossover design: a 3-day control condition (CON) with an energy availability of 45 kcals·kgFFM-1·day-1 and a 3-day LEA condition of 15 kcals·kgFFM-1 day-1. Assessments were conducted during the early follicular phase of the menstrual cycle. Outcome measures included forearm blood flow (FBF), heart rate, blood pressure, arterial stiffness, resting energy expenditure (REE), metabolic blood markers and body composition. RESULTS Significant time-by-condition interactions were found for resting FBF (p = .004), REE (p = .042), triiodothyronine (p = .006), β-hydroxybutyrate (p = .002) and body mass (p < .001). Resting FBF was 1.43 ± 1.01 and 1.31 ± 0.61 (arbitrary units) at pre and post, respectively, in LEA and 1.52 ± 0.7 and 1.76 ± 0.57 at pre and post in CON. The LEA condition led to a decrease in triiodothyronine (pre: 1.54 ± 0.28, post: 1.29 ± 0.27 ng ml-1), REE (pre: 1588 ± 165, post: 1487 ± 160 kcals day-1) and body mass (pre: 61.4 ± 7.5, post: 59.6 ± 7.3 kg). Changes in resting FBF were significantly correlated with changes in REE in the LEA condition (r = 0.53; p = 0.02). CONCLUSION Short-term LEA modifies regional blood flow and this might contribute to the observed decreased in REE. Findings emphasize the need for careful management of energy availability in populations at risk of LEA.
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Affiliation(s)
- Mark J Hutson
- Faculty of Life and Health Sciences, School of Sport, Ulster University, Coleraine, BT52 1SA, UK.
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
| | - Kyle McConnell
- Faculty of Life and Health Sciences, School of Sport, Ulster University, Coleraine, BT52 1SA, UK
| | - Aiden J Chauntry
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard C Blagrove
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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Melin AK, Areta JL, Heikura IA, Stellingwerff T, Torstveit MK, Hackney AC. Direct and indirect impact of low energy availability on sports performance. Scand J Med Sci Sports 2024; 34:e14327. [PMID: 36894187 DOI: 10.1111/sms.14327] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
Low energy availability (LEA) occurs inadvertently and purposefully in many athletes across numerous sports; and well planned, supervised periods with moderate LEA can improve body composition and power to weight ratio possibly enhancing performance in some sports. LEA however has the potential to have negative effects on a multitude of physiological and psychological systems in female and male athletes. Systems such as the endocrine, cardiovascular, metabolism, reproductive, immune, mental perception, and motivation as well as behaviors can all be impacted by severe (serious and/or prolonged or chronic) LEA. Such widely diverse effects can influence the health status, training adaptation, and performance outcomes of athletes leading to both direct changes (e.g., decreased strength and endurance) as well as indirect changes (e.g., reduced training response, increased risk of injury) in performance. To date, performance implications have not been well examined relative to LEA. Therefore, the intent of this narrative review is to characterize the effects of short-, medium-, and long-term exposure to LEA on direct and indirect sports performance outcomes. In doing so we have focused both on laboratory settings as well as descriptive athletic case-study-type experiential evidence.
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Affiliation(s)
- Anna K Melin
- Department of Sport Science, Faculty of Social Sciences, Swedish Olympic Committee Research Fellow, Linnaeus University, Växjö/Kalmar, Sweden
| | - José L Areta
- School of Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Ida A Heikura
- Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Trent Stellingwerff
- Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Monica Klungland Torstveit
- Department of Sport Science and Physical Education, Faculty of Health and Sport Science, University of Agder, Kristiansand, Norway
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
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O'Neill JER, Corish CA, Horner K. Accuracy of Resting Metabolic Rate Prediction Equations in Athletes: A Systematic Review with Meta-analysis. Sports Med 2023; 53:2373-2398. [PMID: 37632665 PMCID: PMC10687135 DOI: 10.1007/s40279-023-01896-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Resting metabolic rate (RMR) prediction equations are often used to calculate RMR in athletes; however, their accuracy and precision can vary greatly. OBJECTIVE The aim of this systematic review and meta-analysis was to determine which RMR prediction equations are (i) most accurate (average predicted values closest to measured values) and (ii) most precise (number of individuals within 10% of measured value). DATA SOURCES A systematic search of PubMed, CINAHL, SPORTDiscus, Embase, and Web of Science up to November 2021 was conducted. ELIGIBILITY CRITERIA Randomised controlled trials, cross-sectional observational studies, case studies or any other study wherein RMR, measured by indirect calorimetry, was compared with RMR predicted via prediction equations in adult athletes were included. ANALYSIS A narrative synthesis and random-effects meta-analysis (where possible) was conducted. To explore heterogeneity and factors influencing accuracy, subgroup analysis was conducted based on sex, body composition measurement method, athlete characteristics (athlete status, energy availability, body weight), and RMR measurement characteristics (adherence to best practice guidelines, test preparation and prior physical activity). RESULTS Twenty-nine studies (mixed sports/disciplines n = 8, endurance n = 5, recreational exercisers n = 5, rugby n = 3, other n = 8), with a total of 1430 participants (822 F, 608 M) and 100 different RMR prediction equations were included. Eleven equations satisfied criteria for meta-analysis for accuracy. Effect sizes for accuracy ranged from 0.04 to - 1.49. Predicted RMR values did not differ significantly from measured values for five equations (Cunningham (1980), Harris-Benedict (1918), Cunningham (1991), De Lorenzo, Ten-Haaf), whereas all others significantly underestimated or overestimated RMR (p < 0.05) (Mifflin-St. Jeor, Owen, FAO/WHO/UNU, Nelson, Koehler). Of the five equations, large heterogeneity was observed for all (p < 0.05, I2 range: 80-93%) except the Ten-Haaf (p = 0.48, I2 = 0%). Significant differences between subgroups were observed for some but not all equations for sex, athlete status, fasting status prior to RMR testing, and RMR measurement methodology. Nine equations satisfied criteria for meta-analysis for precision. Of the nine equations, the Ten-Haaf was found to be the most precise, predicting 80.2% of participants to be within ± 10% of measured values with all others ranging from 40.7 to 63.7%. CONCLUSION Many RMR prediction equations have been used in athletes, which can differ widely in accuracy and precision. While no single equation is guaranteed to be superior, the Ten-Haaf (age, weight, height) equation appears to be the most accurate and precise in most situations. Some equations are documented as consistently underperforming and should be avoided. Choosing a prediction equation based on a population of similar characteristics (physical characteristics, sex, sport, athlete status) is preferable. Caution is warranted when interpreting RMR ratio of measured to predicted values as a proxy of energy availability from a single measurement. PROSPERO REGISTRATION CRD42020218212.
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Affiliation(s)
- Jack Eoin Rua O'Neill
- Institute for Sport and Health and School of Public Health, Physiotherapy and Sport Science, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin 4, Ireland
| | - Katy Horner
- Institute for Sport and Health and School of Public Health, Physiotherapy and Sport Science, University College Dublin, Belfield, Dublin 4, Ireland
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Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023; 57:1073-1097. [PMID: 37752011 DOI: 10.1136/bjsports-2023-106994] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
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Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Naama Constantini
- Sports Medicine Center, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ida Aliisa Heikura
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anna Melin
- Department of Sport Science - Swedish Olympic Committee Research Fellow, Linnaeus University, Kalmar, Sweden
| | - Anne Marte Pensgaard
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trent Stellingwerff
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
- World Archery, Lausanne, Switzerland
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Hutson MJ, O'Donnell E, Brooke-Wavell K, James LJ, Raleigh CJ, Carson BP, Sale C, Blagrove RC. High-impact jumping mitigates the short-term effects of low energy availability on bone resorption but not formation in regularly menstruating females: A randomized control trial. Scand J Med Sci Sports 2023; 33:1690-1702. [PMID: 37365858 DOI: 10.1111/sms.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
Low energy availability (LEA) is prevalent in active individuals and negatively impacts bone turnover in young females. High-impact exercise can promote bone health in an energy efficient manner and may benefit bone during periods of LEA. Nineteen regularly menstruating females (aged 18-31 years) participated in two three-day conditions providing 15 (LEA) and 45 kcals kg fat-free mass-1 day-1 (BAL) of energy availability, each beginning 3 ± 1 days following the self-reported onset of menses. Participants either did (LEA+J, n = 10) or did not (LEA, n = 9) perform 20 high-impact jumps twice per day during LEA, with P1NP, β-CTx (circulating biomarkers of bone formation and resorption, respectively) and other markers of LEA measured pre and post in a resting and fasted state. Data are presented as estimated marginal mean ± 95% CI. P1NP was significantly reduced in LEA (71.8 ± 6.1-60.4 ± 6.2 ng mL-1 , p < 0.001, d = 2.36) and LEA+J (93.9 ± 13.4-85.2 ± 12.3 ng mL-1 , p < 0.001, d = 1.66), and these effects were not significantly different (time by condition interaction: p = 0.269). β-CTx was significantly increased in LEA (0.39 ± 0.09-0.46 ± 0.10 ng mL-1 , p = 0.002, d = 1.11) but not in LEA+J (0.65 ± 0.08-0.65 ± 0.08 ng mL-1 , p > 0.999, d = 0.19), and these effects were significantly different (time by condition interaction: p = 0.007). Morning basal bone formation rate is reduced following 3 days LEA, induced via dietary restriction, with or without high-impact jumping in regularly menstruating young females. However, high-impact jumping can prevent an increase in morning basal bone resorption rate and may benefit long-term bone health in individuals repeatedly exposed to such bouts.
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Affiliation(s)
- Mark J Hutson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Emma O'Donnell
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Lewis J James
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Conor J Raleigh
- Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| | - Brian P Carson
- Department of Physical Education & Sport Sciences, University of Limerick, Limerick, Ireland
| | - Craig Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Richard C Blagrove
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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9
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Siedler MR, De Souza MJ, Albracht-Schulte K, Sekiguchi Y, Tinsley GM. The Influence of Energy Balance and Availability on Resting Metabolic Rate: Implications for Assessment and Future Research Directions. Sports Med 2023; 53:1507-1526. [PMID: 37213050 DOI: 10.1007/s40279-023-01856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
Resting metabolic rate (RMR) is a significant contributor to an individual's total energy expenditure. As such, RMR plays an important role in body weight regulation across populations ranging from inactive individuals to athletes. In addition, RMR may also be used to screen for low energy availability and energy deficiency in athletes, and thus may be useful in identifying individuals at risk for the deleterious consequences of chronic energy deficiency. Given its importance in both clinical and research settings within the fields of exercise physiology, dietetics, and sports medicine, the valid assessment of RMR is critical. However, factors including varying states of energy balance (both short- and long-term energy deficit or surplus), energy availability, and prior food intake or exercise may influence resulting RMR measures, potentially introducing error into observed values. The purpose of this review is to summarize the relationships between short- and long-term changes in energetic status and resulting RMR measures, consider these findings in the context of relevant recommendations for RMR assessment, and provide suggestions for future research.
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Affiliation(s)
- Madelin R Siedler
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Mary Jane De Souza
- Departments of Kinesiology and Physiology, Pennsylvania State University, University Park, PA, USA
| | | | - Yasuki Sekiguchi
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Grant M Tinsley
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA.
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10
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Iraki J, Paulsen G, Garthe I, Slater G, Areta JL. Reliability of resting metabolic rate between and within day measurements using the Vyntus CPX system and comparison against predictive formulas. Nutr Health 2023; 29:107-114. [PMID: 34931931 PMCID: PMC10009490 DOI: 10.1177/02601060211057324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: To detect longitudinal changes of resting metabolic rate (RMR) resulting from the effects of energetic stress, reliable RMR measurements are crucial. The Vyntus CPX is a new automated indirect calorimetry system for which RMR reliability has not been determined. Additionally, its agreement with common predictive RMR formulas is unknown. Aim: To determine the within and between-day reliability of RMR measurements using the Vyntus CPX system and its agreement with predictive RMR formulas. Methods: Young (31 ± 7 years) healthy participants (n = 26, 12 females, 14 males) completed three measurements of RMR, two consecutive measures on the same day, one the day before/after, all under standardised conditions. Reliability was assessed with pairwise comparisons of between-day at the same time (BDST), within day consecutive measurements (WDCM) and between-day different time (BDDT), for parameters of reliability (mean change (MC), intraclass correlation (ICC) and typical error of measurement (TEM)). Measured RMR values (kcal/day) were compared against predictive values of 4 common formulas. Results: Parameters of reliability (mean, (95% confidence interval)) were: -BDST: MC, 0.2(-2.3-2.7)% (p = 0.67); ICC, 0.92(0.84-0.97); TEM, 4.5(3.5-6.2)%. -WDCM: MC, -2.5(-6.2-1.3)% (p = 0.21); ICC, 0.88(0.74-0.88); TEM, 7.0(5.4-9.8)%. -BDDT: MC, -1.5(-4.8-1.9)% (p = 0.57); ICC, 0.90(0.76-0.95); TEM, 6.1(4.8-8.5)%. RMRratios (measured/predicted) were: 1.04 ± 0.14 (Nelson, p = 0.13), 1.03 ± 0.10 (Mifflin, p = 0.21), 0.98 ± 0.09 (Harris-benedict, p = 0.30), 0.95 ± 0.11 (Cunningham1980, p = 0.01), 1.00 ± 0.12 (Cunningham1991, p = 0.90) and 0.96 ± 0.13 (DXA, p = 0.03). Conclusions: The Vyntus CPX is reliable and measured RMR values agreed with four predictive formulas but are lower than Cunningham1980 and DXA RMR estimates for this population.
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Affiliation(s)
- J Iraki
- Iraki Nutrition, Lørenskog, Norway
| | - G Paulsen
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
| | - I Garthe
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
| | - G Slater
- School of Health and Behavioural Sciences, 5333University of the Sunshine Coast, Queensland, Australia
| | - J L Areta
- Research institute for Sport and Exercise Sciences, 4589Liverpool John Moores University, Liverpool, UK
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11
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Markers of Low Energy Availability in Overreached Athletes: A Systematic Review and Meta-analysis. Sports Med 2022; 52:2925-2941. [PMID: 35819582 DOI: 10.1007/s40279-022-01723-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Overreaching is the transient reduction in performance that occurs following training overload and is driven by an imbalance between stress and recovery. Low energy availability (LEA) may drive underperformance by compounding training stress; however, this has yet to be investigated systematically. OBJECTIVE The aim of this study was to quantify changes in markers of LEA in athletes who demonstrated underperformance, and exercise performance in athletes with markers of LEA. METHODS Studies using a ≥ 2-week training block with maintained or increased training loads that measured exercise performance and markers of LEA were identified using a systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Changes from pre- to post-training were analyzed for (1) markers of LEA in underperforming athletes and (2) performance in athletes with ≥ 2 markers of LEA. RESULTS From 56 identified studies, 14 separate groups of athletes demonstrated underperformance, with 50% also displaying ≥ 2 markers of LEA post-training. Eleven groups demonstrated ≥ 2 markers of LEA independent of underperformance and 37 had no performance reduction or ≥ 2 markers of LEA. In underperforming athletes, fat mass (d = - 0.29, 95% confidence interval [CI] - 0.54 to - 0.04; p = 0.02), resting metabolic rate (d = - 0.63, 95% CI - 1.22 to - 0.05; p = 0.03), and leptin (d = - 0.72, 95% CI - 1.08 to - 0.35; p < 0.0001) were decreased, whereas body mass (d = - 0.04, 95% CI - 0.21 to 0.14; p = 0.70), cortisol (d = - 0.06, 95% CI - 0.35 to 0.23; p = 0.68), insulin (d = - 0.12, 95% CI - 0.43 to 0.19; p = 0.46), and testosterone (d = - 0.31, 95% CI - 0.69 to 0.08; p = 0.12) were unaltered. In athletes with ≥ 2 LEA markers, performance was unaffected (d = 0.09, 95% CI - 0.30 to 0.49; p = 0.6), and the high heterogeneity in performance outcomes (I2 = 84.86%) could not be explained by the performance tests used or the length of the training block. CONCLUSION Underperforming athletes may present with markers of LEA, but overreaching is also observed in the absence of LEA. The lack of a specific effect and high variability of outcomes with LEA on performance suggests that LEA is not obligatory for underperformance.
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12
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Case Study: Improving Energy Status in a Wheelchair Athlete With Suppressed Resting Energy Expenditure. Int J Sports Physiol Perform 2022; 17:1151-1154. [PMID: 35606095 DOI: 10.1123/ijspp.2021-0336] [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: 07/09/2021] [Revised: 04/03/2022] [Accepted: 04/03/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Wheelchair athletes experience a reduction in fat-free mass due to the underlying condition and/or muscle disuse. This leads to a lower resting energy expenditure (REE), as well as a lower energy expenditure during exercise or daily activities. Traditional markers of low energy availability (LEA), including amenorrhea and low bone mineral density, are often inconclusive in wheelchair athletes. This case study provides data from a professional female wheelchair badminton player with multiple sclerosis who presented with a reduced measured-to-predicted REE ratio (REEratio), a common indicator of LEA in able-bodied athletes. Furthermore, a nutrition and exercise intervention was conducted to restore REE. METHODS REE and body composition were measured using indirect calorimetry and dual-energy X-ray absorptiometry, respectively. The predicted REE of the REEratio was calculated using 2 separate approaches. An REEratio <0.9 was considered an indicator for LEA. A nutrition and exercise intervention was implemented to normalize REE and induce weight loss through increased meal frequency, a 200- to 400-kcal/d increase in energy intake, and added endurance exercise. RESULTS The athlete (33 y, 78 kg, 154 cm) initiallly showed an REEratio of 0.65 to 0.70, which increased to 1.00 to 1.09 after 1 year. The athlete lost 11.8 kg, almost exclusively (11 kg) in the form of fat mass. The athlete reported reduced fatigue and higher perceived fitness. CONCLUSION The nutrition and exercise intervention successfully restored energy status, induced sustainable weight loss, and reduced fatigue in a wheelchair athlete with multiple sclerosis with presumed LEA. Methods to assess LEA in this population require further validation.
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Martin A, Fox D, Murphy CA, Hofmann H, Koehler K. Tissue losses and metabolic adaptations both contribute to the reduction in resting metabolic rate following weight loss. Int J Obes (Lond) 2022; 46:1168-1175. [PMID: 35181758 PMCID: PMC9151388 DOI: 10.1038/s41366-022-01090-7] [Citation(s) in RCA: 8] [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: 07/08/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To characterize the contributions of the loss of energy-expending tissues and metabolic adaptations to the reduction in resting metabolic rate (RMR) following weight loss. METHODS A secondary analysis was conducted on data from the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy study. Changes in RMR, body composition, and metabolic hormones were examined over 12 months of calorie restriction in 109 individuals. The contribution of tissue losses to the decline in RMR was determined by weighing changes in the size of energy-expending tissues and organs (skeletal muscle, adipose tissue, bone, brain, inner organs, residual mass) assessed by dual-energy X-ray absorptiometry with their tissue-specific metabolic rates. Metabolic adaptations were quantified as the remaining reduction in RMR. RESULTS RMR was reduced by 101 ± 12 kcal/d as participants lost 7.3 ± 0.2 kg (both p < 0.001). On average, 60% of the total reduction in RMR were explained by energy-expending tissues losses, while 40% were attributed to metabolic adaptations. The loss of skeletal muscle mass (1.0 ± 0.7 kg) was not significantly related to RMR changes (r = 0.14, p = 0.16), whereas adipose tissue losses (7.2 ± 3.0 kg) were positively associated with the reduction in RMR (r = 0.42, p < 0.001) and metabolic adaptations (r = 0.31, p < 0.001). Metabolic adaptations were correlated with declines in leptin (r = 0.27, p < 0.01), triiodothyronine (r = 0.19, p < 0.05), and insulin (r = 0.25, p < 0.05). CONCLUSIONS During weight loss, tissue loss and metabolic adaptations both contribute to the reduction in RMR, albeit variably. Contrary to popularly belief, it is not skeletal muscle, but rather adipose tissue losses that seem to drive RMR reductions following weight loss. Future research should target personalized strategies addressing the predominant cause of RMR reduction for weight maintenance.
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Affiliation(s)
- Alexandra Martin
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Darius Fox
- grid.24434.350000 0004 1937 0060Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE USA
| | - Chaise A. Murphy
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Hande Hofmann
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Karsten Koehler
- grid.6936.a0000000123222966Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
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14
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Jürimäe J, Karvelyte V, Remmel L, Tamm AL, Purge P, Gruodyte-Raciene R, Kamandulis S, Maasalu K, Gracia-Marco L, Tillmann V. Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity. J Pediatr Endocrinol Metab 2021; 34:755-761. [PMID: 33851796 DOI: 10.1515/jpem-2020-0662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Sclerostin is an important regulator of bone mass involving the Wnt/β-catenin signalling pathway. Relatively few studies have investigated the relationships of circulating sclerostin levels with adiposity-related and muscle-related biochemical factors in individuals with increased energy metabolism. The aim of this study was to investigate the associations of circulating sclerostin with adipokines, myokines, osteokines and body composition values in lean adolescent females with increased physical activity. METHODS A total of 73 adolescent females who were physically active and aged 14-18 years old participated in the study. Sclerostin, leptin, resistin, tumour necrosis factor (TNF)-α, interleukin (IL)-6, irisin, osteocalcin, C-terminal telopeptide of type I collagen (CTx), insulin-like growth factor (IGF)-1 and insulin were obtained from fasting blood samples. Body composition was measured by dual-energy X-ray absorptiometry (DXA) and analyzed for body fat mass, lean body mass, bone mineral content and muscle mass. RESULTS Serum sclerostin (117.9 ± 60.3 pg/mL) was correlated with age, age at menarche, body fat, muscle mass, training activity, leptin, TNF-α, irisin, osteocalcin, CTx and IGF-1. Multivariate linear regression analysis demonstrated that fat mass (β = 0.434; p = 0.001), leptin (β = -0.308; p = 0.015), irisin (β = 0.227; p = 0.024) and CTx (β = 0.290; p = 0.031) were the most important predictors of serum sclerostin concentration. CONCLUSIONS Bone-derived sclerostin is associated with specific adipokine, myokine and osteokine values in lean adolescent females with increased physical activity. These results suggest that the interactions between bone, adipose and muscle tissues could also be associated with circulating sclerostin concentrations.
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Affiliation(s)
- Jaak Jürimäe
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Liina Remmel
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Priit Purge
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | | | - Katre Maasalu
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Luis Gracia-Marco
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Vallo Tillmann
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
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15
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Ishizu T, Torii S, Taguchi M. Habitual Dietary Status and Stress Fracture Risk Among Japanese Female Collegiate Athletes. J Am Coll Nutr 2021; 41:481-488. [PMID: 34125657 DOI: 10.1080/07315724.2021.1920068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the present study was to identify the habitual dietary intake and stress fractures history among sport types and to determine the factors related to the risk of stress fractures among Japanese female collegiate athletes. METHODS This study involved 589 Japanese female collegiate athletes. We investigated habitual dietary intake (food frequency questionnaire), eating attitude (EAT-26), demographics, training status, participation in sports events, history of injury in their career, and menstrual status using a self-reported questionnaire. A multivariate logistic regression analysis was conducted to determine the risk factors associated with stress fractures. RESULTS Thirty percent of the total participants had a history of stress fractures, although most participants had no risk of eating disorders. Most Japanese female collegiate athletes consumed less than the dietary reference intake levels for the general Japanese female population aged 18-29 years and the athletes' dietary guideline for key bone-health nutrients such as calcium and vitamin D. The multivariate logistic regression analysis revealed body mass index (BMI; OR, 0.91; 95% CI, 0.82-0.99) and energy intake (EI; OR, 0.99; 95% CI, 0.99-0.99) as significant and independent factors in the history of stress fractures among Japanese female collegiate athletes (p = 0.047 and p = 0.039, respectively). CONCLUSIONS Japanese female collegiate athletes failed to meet energy and nutrient recommendations; BMI and EI were significantly associated with stress fractures, a diet that includes an appropriate amount of energy is essential.
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Affiliation(s)
- Tatsuya Ishizu
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Motoko Taguchi
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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16
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Ihalainen JK, Löfberg I, Kotkajuuri A, Kyröläinen H, Hackney AC, Taipale-Mikkonen RS. Influence of Menstrual Cycle or Hormonal Contraceptive Phase on Energy Intake and Metabolic Hormones-A Pilot Study. ENDOCRINES 2021; 2:79-90. [PMID: 33959726 PMCID: PMC8096184 DOI: 10.3390/endocrines2020008] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Sex hormones are suggested to influence energy intake (EI) and metabolic hormones. This study investigated the influence of menstrual cycle (MC) and hormonal contraceptive (HC) cycle phases on EI, energy availability (EA), and metabolic hormones in recreational athletes (eumenorrheic, NHC = 15 and monophasic HC-users, CHC = 9). In addition, 72-h dietary and training logs were collected in addition to blood samples, which were analyzed for 17β-estradiol (E2), progesterone (P4), leptin, total ghrelin, insulin, and tri-iodothyronine (T3). Measurements were completed at four time-points (phases): Bleeding, mid-follicular (FP)/active 1, ovulation (OVU)/active 2, mid-luteal (LP)/inactive in NHC/CHC, respectively. As expected, E2 and P4 fluctuated significantly in NHC (p < 0.05) and remained stable in CHC. In NHC, leptin increased significantly between bleeding and ovulation (p = 0.030) as well as between FP and OVU (p = 0.022). No group differences in other measured hormones were observed across the MC and HC cycle. The mean EI and EA were similar between phases, with no significant differences observed in macronutrient intake over either the MC or HC. While the MC phase might have a small, but statistically significant effect on leptin, the findings of the present study suggest that the MC or HC phase does not significantly alter ad libitum EI or EA in recreational athletes.
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Affiliation(s)
- Johanna K. Ihalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Ida Löfberg
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Anna Kotkajuuri
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Heikki Kyröläinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Anthony C. Hackney
- Department of Exercise & Sport Science-Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Ritva S. Taipale-Mikkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylä, Finland
- Sports Technology Unit, Faculty of Sport and Health Sciences, University of Jyväskylä, 88610 Vuokatti, Finland
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17
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The Impact of Low Energy Availability on Nonexercise Activity Thermogenesis and Physical Activity Behavior in Recreationally Trained Adults. Int J Sport Nutr Exerc Metab 2021; 31:329-336. [PMID: 34021097 DOI: 10.1123/ijsnem.2021-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/18/2022]
Abstract
Energy availability describes the amount of dietary energy remaining for physiological functionality after the energy cost of exercise is deducted. The physiological and hormonal consequences of low energy availability (LEA) are well established, but the impact of LEA on physical activity behavior outside of exercise and, specifically, nonexercise activity thermogenesis (NEAT) has not been systematically examined. The authors conducted a secondary analysis of a repeated-measures crossover study in which recreationally trained young men (n = 6, 25 ± 1.0 years) underwent two 4-day conditions of LEA (15 kcal·kg fat-free mass-1 ·day-1) with and without endurance exercise (LEA + EX and LEA EX) and two energy-balanced control conditions (CON + EX and CON EX). The duration and intensity of physical activity outside of prescribed exercise were assessed using the SenseWear Pro3 armband. LEA did not alter NEAT (p = .41), nor time spent in moderate to vigorous (p = .20) and low-intensity physical activity (p = .17). However, time spent in low-intensity physical activity was lower in LEA + EX than LEA - EX (13.7 ± 0.3 vs. 15.2 ± 0.3 hr/day; p = .002). Short-term LEA does not seem to impact NEAT per se, but the way it is attained may impact physical activity behavior outside of exercise. As the participants expended similar amounts of energy during NEAT (900-1,300 kcal/day = 12.5-18.0 kcal·kg fat-free mass-1·day-1) and prescribed exercise bouts (15.0 kcal·kg fat-free mass-1·day-1), excluding it as a component of energy expenditure may skew the true energy available for physiological functionality in active populations.
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18
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Heikura IA, Stellingwerff T, Areta JL. Low energy availability in female athletes: From the lab to the field. Eur J Sport Sci 2021; 22:709-719. [PMID: 33832385 DOI: 10.1080/17461391.2021.1915391] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Decades of laboratory research have shown impairments to several body systems after only 4-5 days of strictly controlled consistent low energy availability (LEA); where energy availability (EA) = Energy Intake (EI) - Exercise Energy Expenditure (EEE)/Fat-Free Mass. Meanwhile, cross-sectional reports exist on the interrelatedness of LEA, menstrual dysfunction and impaired bone health in females (the Female Athlete Triad). These findings have demonstrated that LEA is the key underpinning factor behind a broader set of health and performance outcomes, recently termed as Relative Energy Deficiency in Sport (RED-S). There is utmost importance of early screening and diagnosis of RED-S to avoid the development of severe negative health and performance outcomes. However, a significant gap exists between short-term laboratory studies and cross-sectional reports, or clinically field-based situations, of long-term/chronic LEA and no definitive, validated diagnostic tests for RED-S exist. This review aims to highlight methodological challenges related to the assessment of the components of EA equation in the field (e.g. challenges with EI and EEE measures). Due to the uncertainty of these parameters, we propose the use of more chronic "objective" markers of LEA (i.e. blood markers). However, we note that direct extrapolations of laboratory-based outcomes into the field are likely to be problematic due to potentially poor ecological validity and the extreme variability in most athlete's daily EI and EEE. Therefore, we provide a critical appraisal of the scientific literature, highlighting research gaps, and a potential set of leading objective RED-S markers while working in the field.HIGHILIGHTS Direct application of short-term laboratory-based findings in the field is problematic.Calculation of energy availability (EA) in the field is methodologically challenging and prone to errors.The use of several biomarkers may allow the detection of early exposure to low EA in the female athlete.
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Affiliation(s)
- Ida A Heikura
- Canadian Sport Institute - Pacific, Victoria, Canada.,Exercise Science, Physical & Health Education, University of Victoria British Columbia, Victoria, Canada
| | - Trent Stellingwerff
- Canadian Sport Institute - Pacific, Victoria, Canada.,Exercise Science, Physical & Health Education, University of Victoria British Columbia, Victoria, Canada
| | - Jose L Areta
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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19
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Dipla K, Kraemer RR, Constantini NW, Hackney AC. Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females. Hormones (Athens) 2021; 20:35-47. [PMID: 32557402 DOI: 10.1007/s42000-020-00214-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/20/2020] [Indexed: 12/26/2022]
Abstract
The purpose of this review is to present a different perspective of the relative energy deficiency syndrome, to improve understanding of associated endocrine alterations, and to highlight the need for further research in this area. The term "female athlete triad" was coined over 25 years ago to describe three interrelated components: disordered eating, menstrual dysfunction, and low bone mass. The syndrome's etiology is attributed to energy intake deficiency relative to energy expenditure required for health, function, and daily living. Recently, it became clear that there was a need to broaden the term, as the disorder is not an issue of only three interrelated problems but of a whole spectrum of insults resulting from low energy availability (LEA; i.e., insufficient energy availability to cover basic physiological demands) that can potentially affect any exerciser, irrespective of gender. The new model, termed relative energy deficiency in sport (RED-S), has received greater scrutiny in sports medicine due to its effects on both health and performance in athletes of both sexes. RED-S results from low-energy diets (intentional or unintentional) and/or excessive exercise. Energy deficiency reduces hypothalamic pulsatile release of gonadotropin-releasing hormone, this impairing anterior pituitary release of gonadotropins. In women, reduced FSH and LH pulsatility produces hypoestrogenism, causing functional hypothalamic amenorrhea and decreased bone mass. In men, it reduces testosterone and negatively affects bone health. Moreover, LEA alters other hormonal pathways, causing physiological consequences, such as alteration of the thyroid hormone signaling pathways, leptin levels, carbohydrate metabolism, the growth hormone/insulin-like growth factor-1 axis, and sympathetic/parasympathetic tone. This review explains and clarifies the effects of RED-S in both sexes.
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Affiliation(s)
- Konstantina Dipla
- Department of Sports Science, Exercise Physiology and Biochemistry Laboratory, Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Robert R Kraemer
- Department of Kinesiology and Health Studies, Exercise Physiology Laboratory, Southeastern Louisiana University, Hammond, LA, USA.
| | - Naama W Constantini
- Heidi Rotberg Sport Medicine Center, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
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20
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A Review of Nonpharmacological Strategies in the Treatment of Relative Energy Deficiency in Sport. Int J Sport Nutr Exerc Metab 2021; 31:268-275. [PMID: 33465762 DOI: 10.1123/ijsnem.2020-0211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 11/18/2020] [Indexed: 11/18/2022]
Abstract
Relative energy deficiency in sport (RED-S) can result in negative health and performance outcomes in both male and female athletes. The underlying etiology of RED-S is low energy availability (LEA), which occurs when there is insufficient dietary energy intake to meet exercise energy expenditure, corrected for fat-free mass, leaving inadequate energy available to ensure homeostasis and adequate energy turnover (optimize normal bodily functions to positively impact health), but also optimizing recovery, training adaptations, and performance. As such, treatment of RED-S involves increasing energy intake and/or decreasing exercise energy expenditure to address the underlying LEA. Clinically, however, the time burden and methodological errors associated with the quantification of energy intake, exercise energy expenditure, and fat-free mass to assess energy availability in free-living conditions make it difficult for the practitioner to implement in everyday practice. Furthermore, interpretation is complicated by the lack of validated energy availability thresholds, which can result in compromised health and performance outcomes in male and female athletes across various stages of maturation, ethnic races, and different types of sports. This narrative review focuses on pragmatic nonpharmacological strategies in the treatment of RED-S, featuring factors such as low carbohydrate availability, within-day prolonged periods of LEA, insufficient intake of bone-building nutrients, lack of mechanical bone stress, and/or psychogenic stress. This includes the implementation of strategies that address exacerbating factors of LEA, as well as novel treatment methods and underlying mechanisms of action, while highlighting areas of further research.
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21
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Markers of Energy Metabolism Affect Lactate Metabolism and Aerobic Performance in Competitive Female Cyclists. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
(1) Background: Low energy availability (LEA) has negative effects on performance, but mechanisms, timing, and other circumstances of these effects are not yet established. We aim to assess the performance-related effects of low energy availability in competitive female cyclists with a detailed approach to within-day energy availability (WDEB). (2) Methods: Female competitive cyclists (n = 8) completed the measurement of body composition, resting energy expenditure, and incremental testing; they reported diary logs and used accelerometers for energy availability (EA) calculation. Based on the Low Energy Availability in Females (LEAF) questionnaire, performance and energy parameters were compared between cyclists with risk for relative energy deficiency in sport (RED-S; the LEAF+ group) and cyclists without any risk (LEAF−). (3) Results: 87.5% had EA <30 kcal/kg. EA and energy balance in LEAF– were significantly different from LEAF+ cyclists (U = 0.00, z = −2.00, p < 0.05 and U = 0.00, z = −2.00, p < 0.05, respectively). We found significant correlations between WDEB−300 and EA (−0.736, p = 0.037) and energy balance (−0.732, p = 0.039). In addition, relative power output was correlated with mRMR/pRMR (−0.763, p = 0.046). (4) Conclusions: This study is the first to show that WDEB−300 in competitive female cyclists is greater in cyclists with risk for RED-S. Increased time in a catabolic state was correlated to worse anaerobic capacity in incremental testing. Measuring mRMR/pRMR might be useful as it was negatively associated with aerobic performance.
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22
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Areta JL, Taylor HL, Koehler K. Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. Eur J Appl Physiol 2020; 121:1-21. [PMID: 33095376 PMCID: PMC7815551 DOI: 10.1007/s00421-020-04516-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/23/2020] [Indexed: 12/21/2022]
Abstract
Energy availability (EA) is defined as the amount of dietary energy available to sustain physiological function after subtracting the energetic cost of exercise. Insufficient EA due to increased exercise, reduced energy intake, or a combination of both, is a potent disruptor of the endocrine milieu. As such, EA is conceived as a key etiological factor underlying a plethora of physiological dysregulations described in the female athlete triad, its male counterpart and the Relative Energy Deficiency in Sport models. Originally developed upon female-specific physiological responses, this concept has recently been extended to males, where experimental evidence is limited. The majority of data for all these models are from cross-sectional or observational studies where hypothesized chronic low energy availability (LEA) is linked to physiological maladaptation. However, the body of evidence determining causal effects of LEA on endocrine, and physiological function through prospective studies manipulating EA is comparatively small, with interventions typically lasting ≤ 5 days. Extending laboratory-based findings to the field requires recognition of the strengths and limitations of current knowledge. To aid this, this review will: (1) provide a brief historical overview of the origin of the concept in mammalian ecology through its evolution of algebraic calculations used in humans today, (2) Outline key differences from the ‘energy balance’ concept, (3) summarise and critically evaluate the effects of LEA on tissues/systems for which we now have evidence, namely: hormonal milieu, reproductive system endocrinology, bone metabolism and skeletal muscle; and finally (4) provide perspectives and suggestions for research upon identified knowledge gaps.
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Affiliation(s)
- José L Areta
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK.
| | - Harry L Taylor
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom St Campus, Liverpool, L3 3AF, UK
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
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Black KE, Baker DF, Sims ST. Nutritional Needs of the Female Athlete: Risk and Prevention of Low Energy Availability. Strength Cond J 2020. [DOI: 10.1519/ssc.0000000000000464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Strock NCA, De Souza MJ, Williams NI. Eating behaviours related to psychological stress are associated with functional hypothalamic amenorrhoea in exercising women. J Sports Sci 2020; 38:2396-2406. [PMID: 32619140 DOI: 10.1080/02640414.2020.1786297] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Functional hypothalamic amenorrhoea (FHA) can occur due to the independent or combined effects of psychogenic and energetic stressors. In exercising women, research has primarily focused on energy deficiency as the cause of FHA while psychological stressors have been ignored. To assess both psychological and metabolic factors associated with FHA in exercising women, we performed across-sectional comparison of 61 exercising women (≥2 hours/week, age 18-35 years, BMI 16-25kg/m2), who were eumenorrheic or amenorrhoeic confirmed by daily urine samples assayed for reproductive hormone metabolites. Psychological factors and eating behaviours were assessed by self-report questionnaires. Exercising women with FHA had lower resting metabolic rate (p=0.023), T3 (p<0.001), T4 (p=0.013), leptin (p=0.002), higher peptide YY (p<0.001), greater drive for thinness (p=0.017), greater dietary cognitive restraint (p<0.001), and displayed dysfunctional attitudes, i.e., need for social approval (p=0.047) compared to eumenorrheic women. Amenorrhoeic women displayed asignificant positive correlation between the need for social approval and drive for thinness with indicators of stress, depression, and mood, which was not apparent in eumenorrheic women. In exercising women with FHA, eating behaviours are positively related to indicators of psychological stress and depression.
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Affiliation(s)
- Nicole C A Strock
- 109 Noll Laboratory, Penn State University, University Park , PA.,Women's Health and Exercise Laboratory, Penn State University,University Park , PA
| | - Mary Jane De Souza
- Women's Health and Exercise Laboratory, Penn State University,University Park , PA
| | - Nancy I Williams
- Women's Health and Exercise Laboratory, Penn State University,University Park , PA
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Koltun KJ, Williams NI, De Souza MJ. Female Athlete Triad Coalition cumulative risk assessment tool: proposed alternative scoring strategies. Appl Physiol Nutr Metab 2020; 45:1324-1331. [PMID: 32502379 DOI: 10.1139/apnm-2020-0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We (i) identified alternative scoring strategies for the Female Athlete Triad Coalition cumulative risk assessment (CRA) tool to be utilized when particular risk factors (bone mineral density (BMD), oligomenorrhea/amenorrhea) cannot be determined; (ii) objectively defined dietary restriction for use in the CRA tool; and (iii) explored proxy measures of energy deficiency. This cross-sectional investigation of exercising women (n = 166) utilized an existing database derived from multiple studies designed to assess health, exercise, and menstrual function. Data from the screening/baseline period of each study included: anthropometrics, dual-energy X-ray absorptiometry, disordered eating questionnaires, descriptive data, and proxy measures of energy deficiency (total triiodothyronine (TT3) and ratio of measured-to-predicted resting metabolic rate (mRMR/pRMR)). Substituting delayed menarche for BMD was the best-fit replacement resulting in 15 (9%) participants being categorized in different clearance categories. When menstrual status cannot be assessed, such as during hormonal contraceptive use, low energy availability (EA) determined using self-report and disordered eating questionnaires was the best substitution, resulting in 34 (20%) participants being categorized in different clearance categories. Based on original clearance categorizations, the provisional group had lower TT3 (78.3 ± 2.2 ng/dL; 92.7 ± 2.7 ng/dL) and Harris-Benedict mRMR/pRMR (0.85 ± 0.01; 0.90 ± 0.01) than the full group. Until an updated risk assessment tool is developed, delayed menarche can substitute for low BMD and low EA for oligomenorrhea/amenorrhea. Novelty This investigation addresses previous limitations of the Triad CRA tool. Disordered eating questionnaires can be used to objectively identify dietary restriction for the low EA risk factor. When a risk factor cannot be assessed, delayed menarche can substitute for low BMD and low EA for oligomenorrhea/amenorrhea.
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Affiliation(s)
- Kristen J Koltun
- Women's Health and Exercise Lab, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, PA 16803, USA.,Women's Health and Exercise Lab, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, PA 16803, USA
| | - Nancy I Williams
- Women's Health and Exercise Lab, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, PA 16803, USA.,Women's Health and Exercise Lab, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, PA 16803, USA
| | - Mary Jane De Souza
- Women's Health and Exercise Lab, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, PA 16803, USA.,Women's Health and Exercise Lab, Department of Kinesiology, College of Health and Human Development, The Pennsylvania State University, PA 16803, USA
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26
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Characterizing the resting metabolic rate ratio in ovulatory exercising women over 12 months. Scand J Med Sci Sports 2020; 30:1337-1347. [DOI: 10.1111/sms.13688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 04/11/2020] [Indexed: 12/20/2022]
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Longstrom JM, Colenso-Semple LM, Waddell BJ, Mastrofini G, Trexler ET, Campbell BI. Physiological, Psychological and Performance-Related Changes Following Physique Competition: A Case-Series. J Funct Morphol Kinesiol 2020; 5:jfmk5020027. [PMID: 33467243 PMCID: PMC7739261 DOI: 10.3390/jfmk5020027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 01/21/2023] Open
Abstract
The purpose of this case-series was to evaluate the physiological, psychological and performance-related changes that occur during the postcompetition period. Participants included three male (34.3 ± 6.8 years, 181.6 ± 8.9 cm) and four female (29.3 ± 4.9 years, 161.4 ± 6.0 cm) natural physique athletes. Body composition (fat mass (FM) and fat-free mass (FFM); Skinfold), resting metabolic rate (RMR; indirect calorimetry), total body water (TBW; bioelectrical impedance analysis), sleep quality (PSQI; Pittsburgh Sleep Quality Index), quality of life measures (RAND SF36), menstrual irregularities, and knee extension performance were assessed 1-2 weeks prior to competition, and 4 weeks and 8-10 weeks postcompetition. Blood hormones (free triiodothyronine; T3, free thyroxine; T4, and leptin) were assessed at 1-2 weeks prior to competition and 8-10 weeks postcompetition. Participants tracked daily macronutrient intake daily for the duration of the study. Group-level data were analyzed using exploratory, one-tailed, nonparametric statistical tests. Bodyweight, FM, bodyfat%, RMR, and blood hormones (T3, T4, and leptin) increased significantly (p < 0.05) at the group level. Relative (%Δ) increases in fat mass were associated with △RMR (τ = 0.90; p = 0.001) and △leptin (τ = 0.68; p = 0.02), and △leptin was associated with △RMR (τ = 0.59; p = 0.03). The time course for recovery appears to vary substantially between individuals potentially due to strategies implemented postcompetition.
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Indices of Resting Metabolic Rate Accurately Reflect Energy Deficiency in Exercising Women. Int J Sport Nutr Exerc Metab 2020; 30:14-24. [DOI: 10.1123/ijsnem.2019-0199] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/24/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
Energy deficiency in exercising women can lead to physiological consequences. No gold standard exists to accurately estimate energy deficiency, but measured-to-predicted resting metabolic rate (RMR) ratio has been used to categorize women as energy deficient. The purpose of the study was to (a) evaluate the accuracy of RMR prediction methods, (b) determine the relationships with physiological consequences of energy deficiency, and (c) evaluate ratio thresholds in a cross-sectional comparison of ovulatory, amenorrheic, or subclinical menstrual disturbances in exercising women (n = 217). Dual-energy X-ray absorptiometry (DXA) and indirect calorimetry provided data on anthropometrics and energy expenditure. Harris–Benedict, DXA, and Cunningham (1980 and 1991) equations were used to estimate RMR and RMR ratio. Group differences were assessed (analysis of variance and Kruskal–Wallis tests); logistic regression and Spearman correlations related ratios with consequences of energy deficiency (i.e., low total triiodothyronine; TT3). Sensitivity and specificity calculations evaluated ratio thresholds. Amenorrheic women had lower RMR (p < .05), DXA ratio (p < .01), Cunningham1980 (p < .05) and Cunningham1991 (p < .05) ratio, and TT3 (p < .01) compared with the ovulatory group. Each prediction equation overestimated measured RMR (p < .001), but predicted (p < .001) and positively correlated with TT3 (r = .329–.453). A 0.90 ratio threshold yielded highest sensitivity for Cunningham1980 (0.90) and Harris–Benedict (0.87) methods, but a higher ratio threshold was best for DXA (0.94) and Cunningham1991 (0.92) methods to yield a sensitivity of 0.80. In conclusion, each ratio predicted and correlated with TT3, supporting the use of RMR ratio as an alternative assessment of energetic status in exercising women. However, a 0.90 ratio cutoff is not universal across RMR estimation methods.
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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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Tinsley GM, Trexler ET, Smith-Ryan AE, Paoli A, Graybeal AJ, Campbell BI, Schoenfeld BJ. Changes in Body Composition and Neuromuscular Performance Through Preparation, 2 Competitions, and a Recovery Period in an Experienced Female Physique Athlete. J Strength Cond Res 2019; 33:1823-1839. [PMID: 30036283 DOI: 10.1519/jsc.0000000000002758] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Tinsley, GM, Trexler, ET, Smith-Ryan, AE, Paoli, A, Graybeal, AJ, Campbell, BI, and Schoenfeld, BJ. Changes in body composition and neuromuscular performance through preparation, two competitions, and a recovery period in an experienced female physique athlete. J Strength Cond Res 33(7): 1823-1839, 2019-This prospective case study evaluated an experienced female figure competitor during contest preparation, 2 competitions, and a recovery period. Twelve laboratory sessions were conducted over 8 months. At each visit, body composition was assessed by 4-compartment model, resting metabolic rate (RMR) by indirect calorimetry, and neuromuscular performance by peak force and rate of force development (RFD) on a mechanized squat device. Caloric intake ranged from 965 to 1,610 kcal·d (16.1-24.8 kcal·kg·BM; 18.2-31.1 kcal·kg·FFM), with varying macronutrient intakes (CHO: 0.3-4.8 g·kg; PRO: 1.7-3.0 g·kg; and FAT: 0.2-0.5 g·kg). Body fat was reduced from 20.3 to 12.2% before the first competition and declined to 11.6% before the second competition. Fat-free mass increased by 2.1% before the first competition and peaked at 4.6% above baseline in the recovery period. Resting metabolic rate decreased from 1,345 kcal·d at baseline to a low value of 1,119 kcal·d between competitions. By the end of recovery, RMR increased to 1,435 kcal·d. Concentric and eccentric peak forces declined by up to 19% before the first competition, experienced perturbations in the inter-competition and recovery periods, and remained 5-8% below baseline at study termination. Similarly, RFD decreased by up to 57% before the first competition, was partially recovered, but remained 39% lower than baseline at study termination. Despite favorable body composition changes, neuromuscular performance was impaired during and after the competitive season in an experienced female physique competitor.
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Affiliation(s)
- Grant M Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, Texas
| | - Eric T Trexler
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Abbie E Smith-Ryan
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina
| | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Austin J Graybeal
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, Texas
| | - Bill I Campbell
- College of Education, University of South Florida, Tampa, Florida
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31
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De Souza MJ, Koltun KJ, Strock NCA, Williams NI. Rethinking the concept of an energy availability threshold and its role in the Female Athlete Triad. CURRENT OPINION IN PHYSIOLOGY 2019. [DOI: 10.1016/j.cophys.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Ostendorf DM, Melanson EL, Caldwell AE, Creasy SA, Pan Z, MacLean PS, Wyatt HR, Hill JO, Catenacci VA. No consistent evidence of a disproportionately low resting energy expenditure in long-term successful weight-loss maintainers. Am J Clin Nutr 2018; 108:658-666. [PMID: 30321282 PMCID: PMC6186213 DOI: 10.1093/ajcn/nqy179] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background Evidence in humans is equivocal in regards to whether resting energy expenditure (REE) decreases to a greater extent than predicted for the loss of body mass with weight loss, and whether this disproportionate decrease in REE persists with weight-loss maintenance. Objectives We aimed to1) determine if a lower-than-predicted REE is present in a sample of successful weight-loss maintainers (WLMs) and 2) determine if amount of weight loss or duration of weight-loss maintenance are correlated with a lower-than-predicted REE in WLMs. Design Participants (18-65 y old) were recruited in 3 groups: WLMs (maintaining ≥13.6 kg weight loss for ≥1 y, n = 34), normal-weight controls [NCs, body mass index (BMI; in kg/m2) similar to current BMI of WLMs, n = 35], and controls with overweight/obesity (OCs, BMI similar to pre-weight-loss maximum BMI of WLMs, n = 33). REE was measured (REEm) with indirect calorimetry. Predicted REE (REEp) was determined via 1) a best-fit linear regression developed with the use of REEm, age, sex, fat-free mass, and fat mass from our control groups and 2) three standard predictive equations. Results REEm in WLMs was accurately predicted by equations developed from NCs and OCs (±1%) and by 3 standard predictive equations (±3%). In WLMs, individual differences between REEm and REEp ranged from -257 to +163 kcal/d. A lower REEm compared with REEp was correlated with amount of weight lost (r = 0.36, P < 0.05) but was not correlated with duration of weight-loss maintenance (r = 0.04, P = 0.81). Conclusions We found no consistent evidence of a significantly lower REE than predicted in a sample of long-term WLMs based on predictive equations developed from NCs and OCs as well as 3 standard predictive equations. Results suggest that sustained weight loss may not always result in a substantial, disproportionately low REE. This trial was registered at clinicaltrials.gov as NCT03422380.
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Affiliation(s)
- Danielle M Ostendorf
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO,Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Address correspondence to DMO (e-mail: )
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Denver, CO
| | - Ann E Caldwell
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Seth A Creasy
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Zhaoxing Pan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Paul S MacLean
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Holly R Wyatt
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - James O Hill
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Victoria A Catenacci
- Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO,Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Prevalence of Indicators of Low Energy Availability in Elite Female Sprinters. Int J Sport Nutr Exerc Metab 2018; 28:490-496. [PMID: 29757049 DOI: 10.1123/ijsnem.2017-0397] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Low energy availability (LEA), and subsequent relative energy deficiency in sport, has been observed in endurance, aesthetic, and team sport athletes, with limited data on prevalence in athletes in short-burst activities such as sprinting. We examined prevalence of signs and symptoms of LEA in elite female sprinters at the start of the training season (PRE), and at the end of a 5-month indoor training period (POST). Four of 13 female sprinters (31%) presented at PRE testing with at least one primary (amenorrhea, low bone mineral density, low follicle-stimulating hormone, luteinizing hormone, or estradiol, resting metabolic rate ≤29 kcal/kg fat-free mass, Low Energy Availability in Females Questionnaire score ≥8) and one secondary indicator of LEA (fasting blood glucose <4 mmol/L, free triiodothyronine <3.5 pmol/L, ferritin <25 μg/L, low-density lipoprotein cholesterol >3.0 mmol/L, fasting insulin <20 pmol/L, low insulin-like growth factor-1, systolic blood pressure <90 mmHg, and/or diastolic blood pressure <60 mmHg). At POST, seven out of 13 athletes (54%) presented with at least one primary and one secondary indicator of LEA, three of whom had also presented with indicators of LEA at PRE. Five out of 13 (39%) athletes had previous stress fracture history, though this was not associated with current indicators of LEA (PRE: r = .52, p = .07; POST: r = -.07, p = .82). In conclusion, elite female sprinters may present with signs and symptoms of LEA, even after off-season rest. Medical and coaching staff should be aware of the signs and symptoms of LEA and relative energy deficiency in sport and should include appropriate screening and intervention strategies when working with sprinters.
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Low RMRratio as a Surrogate Marker for Energy Deficiency, the Choice of Predictive Equation Vital for Correctly Identifying Male and Female Ballet Dancers at Risk. Int J Sport Nutr Exerc Metab 2018; 28:412-418. [DOI: 10.1123/ijsnem.2017-0327] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ballet dancers are reported to have an increased risk for energy deficiency with or without disordered eating behavior. A low ratio between measured (m) and predicted (p) resting metabolic rate (RMRratio < 0.90) is a recognized surrogate marker for energy deficiency. We aimed to evaluate the prevalence of suppressed RMR using different methods to calculate pRMR and to explore associations with additional markers of energy deficiency. Female (n = 20) and male (n = 20) professional ballet dancers, 19–35 years of age, were enrolled. mRMR was assessed by respiratory calorimetry (ventilated open hood). pRMR was determined using the Cunningham and Harris–Benedict equations, and different tissue compartments derived from whole-body dual-energy X-ray absorptiometry assessment. The protocol further included assessment of body composition and bone mineral density, blood pressure, disordered eating (Eating Disorder Inventory-3), and for females, the Low Energy Availability in Females Questionnaire. The prevalence of suppressed RMR was generally high but also clearly dependent on the method used to calculate pRMR, ranging from 25% to 80% in males and 35% to 100% in females. Five percent had low bone mineral density, whereas 10% had disordered eating and 25% had hypotension. Forty percent of females had elevated Low Energy Availability in Females Questionnaire score and 50% were underweight. Suppressed RMR was associated with elevated Low Energy Availability in Females Questionnaire score in females and with higher training volume in males. In conclusion, professional ballet dancers are at risk for energy deficiency. The number of identified dancers at risk varies greatly depending on the method used to predict RMR when using RMRratio as a marker for energy deficiency.
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Woods AL, Rice AJ, Garvican-Lewis LA, Wallett AM, Lundy B, Rogers MA, Welvaert M, Halson S, McKune A, Thompson KG. The effects of intensified training on resting metabolic rate (RMR), body composition and performance in trained cyclists. PLoS One 2018; 13:e0191644. [PMID: 29444097 PMCID: PMC5812577 DOI: 10.1371/journal.pone.0191644] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 01/09/2018] [Indexed: 11/26/2022] Open
Abstract
Background Recent research has demonstrated decreases in resting metabolic rate (RMR), body composition and performance following a period of intensified training in elite athletes, however the underlying mechanisms of change remain unclear. Therefore, the aim of the present study was to investigate how an intensified training period, designed to elicit overreaching, affects RMR, body composition, and performance in trained endurance athletes, and to elucidate underlying mechanisms. Method Thirteen (n = 13) trained male cyclists completed a six-week training program consisting of a “Baseline” week (100% of regular training load), a “Build” week (~120% of Baseline load), two “Loading” weeks (~140, 150% of Baseline load, respectively) and two “Recovery” weeks (~80% of Baseline load). Training comprised of a combination of laboratory based interval sessions and on-road cycling. RMR, body composition, energy intake, appetite, heart rate variability (HRV), cycling performance, biochemical markers and mood responses were assessed at multiple time points throughout the six-week period. Data were analysed using a linear mixed modeling approach. Results The intensified training period elicited significant decreases in RMR (F(5,123.36) = 12.0947, p = <0.001), body mass (F(2,19.242) = 4.3362, p = 0.03), fat mass (F(2,20.35) = 56.2494, p = <0.001) and HRV (F(2,22.608) = 6.5212, p = 0.005); all of which improved following a period of recovery. A state of overreaching was induced, as identified by a reduction in anaerobic performance (F(5,121.87) = 8.2622, p = <0.001), aerobic performance (F(5,118.26) = 2.766, p = 0.02) and increase in total mood disturbance (F(5, 110.61) = 8.1159, p = <0.001). Conclusion Intensified training periods elicit greater energy demands in trained cyclists, which, if not sufficiently compensated with increased dietary intake, appears to provoke a cascade of metabolic, hormonal and neural responses in an attempt to restore homeostasis and conserve energy. The proactive monitoring of energy intake, power output, mood state, body mass and HRV during intensified training periods may alleviate fatigue and attenuate the observed decrease in RMR, providing more optimal conditions for a positive training adaptation.
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Affiliation(s)
- Amy L Woods
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia.,Department of Physiology, Australian Institute of Sport, Bruce ACT, Australia
| | - Anthony J Rice
- Department of Physiology, Australian Institute of Sport, Bruce ACT, Australia
| | - Laura A Garvican-Lewis
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia.,Department of Physiology, Australian Institute of Sport, Bruce ACT, Australia.,Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alice M Wallett
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia.,Department of Physiology, Australian Institute of Sport, Bruce ACT, Australia
| | - Bronwen Lundy
- Department of Nutrition, Australian Institute of Sport, Bruce ACT, Australia
| | - Margot A Rogers
- Department of Nutrition, Australian Institute of Sport, Bruce ACT, Australia
| | - Marijke Welvaert
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia
| | - Shona Halson
- Department of Physiology, Australian Institute of Sport, Bruce ACT, Australia
| | - Andrew McKune
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia.,Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kevin G Thompson
- Research Institute for Sport and Exercise, University of Canberra, Bruce ACT, Australia
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De Souza MJ, Koltun KJ, Etter CV, Southmayd EA. Current Status of the Female Athlete Triad: Update and Future Directions. Curr Osteoporos Rep 2017; 15:577-587. [PMID: 29027102 DOI: 10.1007/s11914-017-0412-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review provides an update on the primary clinical sequelae of the Female Athlete Triad. RECENT FINDINGS Scientific advancements have contributed to improve understanding of Triad-related conditions, including leptin's role as a potential neuroendocrine link between energy status and reproductive function. Use of finite element analysis of HRpQCT imaging has provided a more accurate assessment of bone geometry and bone strength and may be clinically relevant. New perspectives aimed at developing and implementing a multi-disciplinary, personalized approach in the prevention and early treatment of triad-related symptoms are provided. The Female Athlete Triad is a multi-dimensional condition that affects active women across the lifespan. Energy availability impacts reproductive function and bone with implications for health and performance. Understanding the contributions of each individual component as well as their interconnected effects is necessary for progression and expansion of the Triad literature.
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Affiliation(s)
- Mary Jane De Souza
- Department of Kinesiology and Physiology Women's Health and Exercise Lab, 104 Noll Laboratory, College of Health and Human Development, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Kristen J Koltun
- Department of Kinesiology Women's Health and Exercise Lab, College of Health and Human Development, The Pennsylvania State University, University Park, USA
| | - Clara V Etter
- Department of Kinesiology Women's Health and Exercise Lab, College of Health and Human Development, The Pennsylvania State University, University Park, USA
| | - Emily A Southmayd
- Department of Kinesiology Women's Health and Exercise Lab, College of Health and Human Development, The Pennsylvania State University, University Park, USA
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Southmayd EA, Mallinson RJ, Williams NI, Mallinson DJ, De Souza MJ. Unique effects of energy versus estrogen deficiency on multiple components of bone strength in exercising women. Osteoporos Int 2017; 28:1365-1376. [PMID: 28032184 DOI: 10.1007/s00198-016-3887-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/14/2016] [Indexed: 12/15/2022]
Abstract
UNLABELLED Many female athletes are energy and/or estrogen deficient, but the independent effects on bone health have not been isolated. Energy deficiency was detrimental at the tibia while estrogen deficiency was detrimental at the radius. Nutrition must be considered alongside menstrual recovery when addressing compromised bone health in female athletes. INTRODUCTION The purpose of this study was to describe volumetric bone mineral density (vBMD), bone geometry, and estimated bone strength in exercising women (n = 60) grouped according to energy status (energy replete (EnR: n = 30) vs. energy deficient (EnD: n = 30)) and estrogen status (estrogen replete (E2R: n = 33) vs. estrogen deficient (E2D: n = 27)), resulting in four distinct groups: EnR + E2R (n = 17), EnR + E2D (n = 13), EnD + E2R (n = 16), EnD + E2D (n = 14). METHODS Energy status was determined using the ratio of measured to predicted resting energy expenditure (mREE/pREE). Estrogen status was based on self-reported menstrual status confirmed by daily evaluation of urinary estrone-1-glucoronide (E1G), pregnanediol glucuronide (PdG), and luteinizing hormone (LH). Eumenorrheic women were considered E2R, amenorrheic women were E2D, and oligomenorrheic women were categorized based on history of menses in the past year. Bone was assessed using peripheral quantitative computed tomography (pQCT). RESULTS EnD women exhibited lower total vBMD, trabecular vBMD, cortical area, and BSI at the distal tibia and lower total vBMD, smaller cortical area and cortical thickness, and larger endosteal circumference at the proximal tibia compared to EnR women (p < 0.042). E2D women had lower total and cortical vBMD, larger total and trabecular area, and lower BSI at the distal radius and lower cortical vBMD at the proximal radius compared to E2R women (p < 0.023). Energy and estrogen interacted to affect total and trabecular area at the distal tibia (p < 0.021). CONCLUSIONS Efforts to correct energy deficiency, which in turn may promote reproductive health, are warranted in order to address the unique contributions of energy status versus estrogen status to bone health.
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Affiliation(s)
- E A Southmayd
- Women's Health and Exercise Lab, Department of Kinesiology, Pennsylvania State University, University Park, State College, PA, 16802, USA.
| | - R J Mallinson
- Women's Health and Exercise Lab, Department of Kinesiology, Pennsylvania State University, University Park, State College, PA, 16802, USA
| | - N I Williams
- Women's Health and Exercise Lab, Department of Kinesiology, Pennsylvania State University, University Park, State College, PA, 16802, USA
| | - D J Mallinson
- School of Social and Behavioral Sciences, Stockton University, 101 Vera King Farris Drive, Galloway, NJ, 08205, USA
| | - M J De Souza
- Women's Health and Exercise Lab, Department of Kinesiology, Pennsylvania State University, University Park, State College, PA, 16802, USA
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