An Analysis of Female Athlete Triad Components in Elite Para-Athletes

Abstract

The Female Athlete Triad (Triad) is a syndrome defined as the interaction of three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density (BMD). The Triad may also impact males, and may have long term health consequences if unaddressed. Although participation in elite para-sport is rapidly growing, no studies have assessed the prevalence of Triad risk factors in this population. PURPOSE: To evaluate the prevalence of Triad risk factors in an elite para-athlete population and association to sex and para-sport type. METHODS: Subjects were United States para-sport athletes who were training to qualify for the 2016 Summer or the 2018 Winter Paralympic Games. Participants completed an online questionnaire characterizing nutrition, menstrual status (if female), bone health, and awareness of the triad. Responses were analyzed to determine overall prevalence of Triad components, and significant differences based on sex and sport type (leanness vs. non-leanness). RESULTS: A total of 248 (144 male, 104 female) athletes completed the survey. Of these, 137 athletes competed in leanness sports and 109 athletes in non-leanness sports. Of the cohort, 40% (53 male, 45 female) of athletes indicated that they were currently trying to lose weight, and 61% (n = 151; 90 male, 61 female) indicated they were attempting to change their body composition to improve sport performance. Only 3% (1 male, 6 female) of athletes indicated that they had been previously diagnosed with an eating disorder. For pre-menopausal women, 32% (n = 29) reported less than 9 menstrual cycles in the past year. A total of 21% (27 male, 25 female) of athletes reported a history of a bone stress injury, yet 9% (8 male, 13 female) reported a diagnosis of low BMD based on DXA scan. There were no differences in risk factor prevalence between sexes or those competing in leanness versus non-leanness sports. Only 9% of athletes were aware of the Triad. CONCLUSIONS: Elite para-sport athletes have high prevalence of Triad components, regardless of sex or sport type. Awareness of the Triad in athletes is low. While consequences of the Triad in a para-athlete population are poorly understood, screening tools and education to increase awareness are required to optimize overall health of this population.