Female Athlete Triad Research Articles

Examination of the Cumulative Risk Assessment and Nutritional Profiles among College Ballet Dancers

This study examined female collegiate ballet dancers' (n = 28) Female Athlete Triad (Triad) risk via the Cumulative Risk Assessment (CRA) and nutritional profiles (macro- and micronutrients; n = 26). The CRA identified Triad return to play criteria (RTP: Full Clearance, Provisional Clearance, or Restricted/Medical Disqualified) by assessing eating disorder risk, low energy availability, menstrual cycle dysfunction, and low bone mineral density. Seven-day dietary assessments identified any energy imbalances of macro- and micronutrients. Ballet dancers were identified as low, within normal, or high for each of the 19 nutrients assessed. Basic descriptive statistics assessed CRA risk classification and dietary macro- and micronutrient levels. Dancers averaged 3.5 ± 1.6 total score on the CRA. Based on these scores, the RTP outcomes revealed Full Clearance 7.1%, n = 2; Provisional Clearance 82.1%, n = 23; and Restricted/Medical Disqualification 10.7%, n = 3. Dietary reports revealed that 96.2% (n = 25) of ballet dancers were low in carbohydrates, 92.3% (n = 24) low in protein, 19.2% (n = 5) low in fat percent, 19.2% (n = 5) exceeding saturated fats, 100% (n = 26) low in Vitamin D, and 96.2% (n = 25) low in calcium. Due to the variability in individual risks and nutrient requirements, a patient-centered approach is a critical part of early prevention, evaluation, intervention, and healthcare for the Triad and nutritional-based clinical evaluations.

Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs).

Female endurance athletes are considered a high-risk group for developing Relative Energy Deficiency in Sport (REDs). Due to the lack of educational and behavioral intervention studies, targeting and evaluating the effects of the practical daily management of REDs, we developed the Food and nUtrition for Endurance athletes-a Learning (FUEL) program, consisting of 16 weekly online lectures and individual athlete-centered nutrition counseling every other week. We recruited female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47). Fifty athletes with symptoms of REDs and with low risk of eating disorders, with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a 16-week control period (n = 18) (CON). All but one completed FUEL, while 15 completed CON. We found strong evidence for improvements in sports nutrition knowledge, assessed via interviews, and moderate to strong evidence in the ratings concerning self-perceived sports nutrition knowledge in FUEL versus CON. Analyses of the seven-day prospective weighed food record and questions related to sports nutrition habits, suggested weak evidence for improvements in FUEL versus CON. The FUEL intervention improved sports nutrition knowledge and suggested weak evidence for improved sports nutrition behavior in female endurance athletes with symptoms of REDs.

Female Athlete Triad: Lack of Awareness and Subsequent Consequences

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The necessity of female athlete triad education for postpartum women: a case study on insufficient health education

article: The necessity of female athlete triad education for postpartum women: a case study on insufficient health education - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2022 December;181(12):992-8 - Minerva Medica - Journals

The Low Energy Availability in Females Questionnaire (LEAF-Q) as a Useful Tool to Identify Female Triathletes at Risk for Menstrual Disorders Related to Low Energy Availability.

Nutrition in sport is a priority; it is the basis for maintaining optimal health and a prerequisite for the high performance necessary for competitions. The aim of this study was to assess low energy availability and its possible consequences among female triathletes by using the Low Energy Availability in Females Questionnaire (LEAF-Q). The study involved 30 female triathetes. The LEAF-Q was used in the study. An analysis of the body composition was carried out with the seca device mBCA 515 medical Body Composition Analyzer. Of the 30 female triathletes studied, 23.3% had a monthly cycle disorder, defined as an amenorrhea state for more than 90 days. No differences were found in injury rates or training days lost to injury due to menstrual disturbances. Menstruation changes were significantly greater due to increases in exercise intensity, frequency, and duration in the group experiencing menstrual disturbances (85.7 [95% CIs: 42.1-99.6] vs. 8.7 [95% CIs: 1.1-28.0]). The menstrual disorder group had a greater incidence of their periods stopping for more than 3 months than the group without menstrual disturbances. The female triathletes did not show abnormalities in body weight or composition, and these were not related to the incidence of menstrual disturbances. However, 20% of the triathletes either had, at the time of the study, or had had in the past monthly cycle disorders that could indicate an immediate risk of low energy availability. The LEAF-Q identified 10% of the triathletes as at risk (score > 8) of low energy availability and the physiological and performance consequences related to relative energy deficiency in sports (RED-S).

Signs of low energy availability in elite male volleyball athletes but no association with risk of bone stress injury and patellar tendinopathy

ABSTRACT Relative Energy Deficiency in Sport (RED-S) syndrome is associated with undesirable health and performance outcomes. The aetiology of RED-S syndrome is low energy availability (LEA). LEA has been reported in male athletes in various sports, but there is little information in team sports. Therefore, the aims of this study were to assess the point-prevalence of surrogate markers of LEA in elite male volleyball players and examine the association between low and normal total-testosterone (TES) on endocrine markers, resting metabolic rate, bone mineral density (BMD), and history of injury/illness. Using a cross-sectional design, 22 elite male volleyball players underwent anthropometric, dual-energy X-ray absorptiometry (DEXA or DXA) and resting metabolic rate testing, bloodwork, dietary analysis, the three-factor eating questionnaire–R18, injury/illness questionnaire and Victorian Institute of Sport Assessment – patellar tendon questionnaire. The primary finding of this investigation was that 36% of athletes had ≥2 surrogate markers of LEA. Although fasted insulin was lower and cortisol was higher in players with low-total TES, low BMD, low RMR and various other endocrine markers linked to LEA were not observed. More research is required to define surrogate markers of LEA in male athletes. HIGHLIGHTS Thirty-six percent of volleyball players had ≥2 surrogate markers of LEA. The Cunningham, 1991 predictive RMR equation and/or the cut-off point (<0.9) may be unsuitable for detecting energy conservation associated with LEA in large male athletes. There was no association between total-TES and risk of bone stress injury, illness and patellar tendinopathy.

Female athlete triad cross-sectional study of soccer players by level of competition.

[Purpose] To determine the actual status of the Female Athlete Triad (low energy availability, menstrual dysfunction, and bone mineral density loss) in soccer players. [Participants and Methods] The survey was conducted between February 1 and March 1, 2022. It included 115 females between the ages of 12 and 28 registered with the Japan Football Association, from teams at different levels. [Results] Players in the top league did not differ in height and weight but were older and had a better understanding of caloric intake. There were no differences in amenorrhea or history of bone fractures based on league. [Conclusion] Of the female soccer players in the four different levels of competition, only the players in the top league had a better understanding of available energy and took preventive measures against the Female Athlete Triad.

Risks of Overtraining and Compulsive Exercising on Human Health

David Miranda, a physical therapist and the proprietor of Excel Rehabilitation Services in Gonzales, Louisiana, asserts that excessive exercise is harmful to human health and counterproductive. Women who exercise excessively run a higher risk of developing the “female athlete triad,” which includes eating disorders, osteoporosis, and loss of bone mineral density. Intense exercise has been shown to lower libido in men; this may be due to physical exhaustion and low testosterone levels. According to German research that was recently published online in the journal Heart, excessive high-intensity exercise may actually increase the risk of dying from a heart attack or stroke in people who already have heart disease. Too much exercise without adequate recovery might cause low testosterone levels and high amounts of the stress hormone cortisol. Overtraining can increase stress hormone levels, and increase the risk of injury, weariness, and muscle loss. The Wall Street Journal’s article “A Workout Ate My Marriage,” which was published in 2010, describes how spouses grow more estranged from one another as they become fixated on a particular exercise goal, such as extreme weight loss or an Ironman triathlon, at the expense of quality time with loved ones.

Risks of overtraining and compulsive exercising on humanhealth

David Miranda, a physical therapist and the proprietor of Excel Rehabilitation Services in Gonzales, Louisiana,asserts that excessive exercise is harmful to human health and counterproductive. Women who exerciseexcessively run a higher risk of developing the “female athlete triad,” which includes eating disorders, osteoporosis,and loss of bone mineral density. Intense exercise has been shown to lower libido in men; this may be due tophysical exhaustion and low testosterone levels. According to German research that was recently published onlinein the journalHeart, excessive high-intensity exercise may actually increase the risk of dying from a heart attack orstroke in people who already have heart disease. Too much exercise without adequate recovery might cause lowtestosterone levels and high amounts of the stress hormone cortisol. Overtraining can increase stress hormonelevels, and increase the risk of injury, weariness, and muscle loss.The Wall Street Journal’sarticle “A WorkoutAte My Marriage,” which was published in 2010, describes how spouses grow more estranged from one anotheras they become fixated on a particular exercise goal, such as extreme weight loss or an Ironman triathlon, at theexpense of quality time with loved ones.

Identifying the risk of female athlete triad in female athletes involved in aesthetic sport (Rhythmic gymnastics) and non-aesthetic sport (Football) aged between 15-25 years

Identifying the risk of female athlete triad in female athletes involved in aesthetic sport (Rhythmic gymnastics) and non-aesthetic sport (Football) aged between 15-25 years

Female Athlete Triad Recognition and Knowledge of Collegiate Cross-Country Coaches

BACKGROUND: To examine Female Athlete Triad (Triad) recognition and knowledge of collegiate cross-country coaches, as well as team access to Triad-related resources. METHODS: After identifying collegiate women’s cross-country coaches from publicly available records, an internally validated, 44-item survey was emailed to assess Triad recognition and knowledge in order to perform a cross-sectional study. Respondents were grouped by National Collegiate Athletic Association (NCAA) division and geographically based on the location of conference headquarters. Survey responses were analyzed and reported using descriptive statistics where appropriate. Statistical comparisons and contrasts were made using chi-square and Fisher’s exact tests. A significance level of p &lt; .05 was used. RESULTS: A total of 143 NCAA cross-country coaches participated in the survey. Notably, 29% of coaches did not recognize the Triad and close to 40% of responding coaches could not identify any of the three Triad components. A greater number of Division I coaches demonstrated Triad recognition (85.4%) and component knowledge (68.3%) compared to Division II and Division III coaches. Geographic region was associated with respondent Triad recognition (p= .011), but not identification of Triad components (Χ2 = 7.015, p = .135). Access to Triad-related resources was low. Only 51% and 29% of responding teams had access to a registered dietitian or sports psychologist, respectively. CONCLUSION: This study suggests that further Triad education amongst NCAA cross-country coaches is warranted. Future research is needed to illuminate specific strategies to improve Triad knowledge of collegiate cross-country coaches.

Female Athlete Triad Recognition and Knowledge of Collegiate Cross-country Coaches

The Female Athlete Triad (Triad) refers to the triad of low energy availability, impaired menstrual function and low bone density. However each component of the Triad is, in fact, a spectrum with energy availability ranging from normal to low, menstrual function ranging from normal to luteal phase defects and anovulatory cycles to frank functional hypothalamic amenorrhea (FHA, absence of menses) and bone density ranging from normal to low. There is obviously a need to engage coaches in education efforts so they know about the Triad and its components, can pass on this information to their teams, be comfortable discussing dietetic and menstrual issues with female athletes, and recognize Triad symptoms early and bring these to medical attention in a timely fashion. Coaches are in a unique position to educate athletes and prevent the Triad from developing or worsening over time, and to advocate for optimal resources including for the services of a sports dietician and psychologist.

The Impact of Competitive Swimming on Menstrual Cycle Disorders and Subsequent Sports Injuries as Related to the Female Athlete Triad and on Premenstrual Syndrome Symptoms.

The study involved 64 female athletes. The questionnaire utilized in this study was composed by the authors, however some of the questions were based on Low Energy Availability in Females Questionnaire (LEAF-Q). 31.26% of swimmers reported that the menstrual cycle was stopped for more than 3 months, of which 21.88% had a menstrual absence for more than 6 months and 9.38% between 3 months and 6 months. Years of training were a positive predictor of the 'more profuse bleeding'. There was a negative correlation between the disorders of the menstrual cycle, the body weight of the female participants (p < 0.05) and the body mass index (p < 0.01). It was found that with the severity of the degree of disorder in the menstrual cycle, the number of injuries among the surveyed swimmers increased (p < 0.05). The correct body weight of the participants was a positive predictor of the absence of the menstrual cycle disorders among the majority of women practicing swimming. Disorders in the menstrual cycle occurring in a certain percentage of the swimmers positively correlated with the number of injuries recorded among these swimmers. Swimming has been shown to alleviate some of the premenstrual symptoms.

Stress fractures.

Stress fractures (SF) represent 10%-20% of all injuries in sport medicine. An SF occurs when abnormal and repetitive loading is applied on normal bone: The body cannot adapt quickly enough, leading to microdamage and fracture. The etiology is multifactorial with numerous risk factors involved. Diagnosis of SF can be achieved by identifying intrinsic and extrinsic factors, obtaining a good history, performing a physical exam, and ordering laboratory and imaging studies (magnetic resonance imaging is the current gold standard). Relative energy deficiency in sport (RED-S) is a known risk factor. In addition, for women, it is very important know the menstrual status to identify long periods of amenorrhea in the past and the present. Early detection is important to improve the chance of symptom resolution with conservative treatment. Common presentation involves complaints of localized pain, with or without swelling, and tenderness on palpation of bony structures that begins earlier in training and progressively worsens with activity over a 2- to 3-week period. Appropriate classification of SF based on type, location, grading, and low or high risk is critical in guiding treatment strategies and influencing the time to return to sport. Stress injuries at low-risk sites are typically managed conservatively. Studies have suggested that calcium and vitamin D supplementation might be helpful. Moreover, other treatment regimens are not well established. Understanding better the pathophysiology of SFs and the potential utility of current and future bone-active therapeutics may well yield approaches that could treat SFs more effectively.

Menstrual Status and Pregnancy in Former Elite Long-Distance Runners With Menstrual Disorders.

To estimate the ratio of menstrual abnormalities, infertility, and other problems related to pregnancy and childbirth in former long-distance runners. We hypothesized that the female athlete triad during an athletic career affects future fertility and childbearing in former athletes. Cross-sectional study. Participants of the All Japan University Women's Ekiden. Female former athletes who competed at national level were asked to complete the questionnaire; 137 valid responses were obtained. Age at menarche and at the onset of pregnancy, history of amenorrhea and gynecological disorders, and lowest body mass index (BMI) during their athletic career. Menstrual status, history of pregnancy and childbirth, any related infertility treatment and problems, and history of stress fractures. The mean age at menarche was 13.3 ± 2.2 (range, 10-25) years. Five athletes (3.6%) had primary amenorrhea. Eleven of the 137 participants (8.0%) required treatment for infertility. Sixty participants had 121 pregnancies, of which 5 were yet to deliver during the survey. Fifteen of 116 pregnancies (12.9%) ended in miscarriage, induced abortion, or stillbirth. Logistic regression analysis showed that the factors related to "infertility treatment" were age at the onset of pregnancy ( P = 0.047) and higher BMI during their athletic career ( P = 0.032; odds ratio, 2.19). The main factor influencing infertility was an older age at the time of pregnancy, similar to that observed in the general population. Amenorrhea or being underweight during their athletic career was not associated with problems related to conception and childbirth.

Female athlete triad affects rat intestinal morphology and sucrase-isomaltase expression.

Female athletes follow a strict diet and perform rigorous exercise to boost their performance, which induces health issues called the female athlete triad (FAT), defined as the combination of disordered eating, amenorrhoea and low bone mineral density. It is known to have a significant effect on bones. However, its effects on the small intestine, which is responsible for nutrient uptake into the body, remain unclear. In this study, we created an animal model of FAT to examine its effects on digestive and absorptive molecules in the small intestine. Thirty 5-week-old female Sprague-Dawley (sd) rats with an initial body weight of about 147 g were divided into control (Con, n = 7), exercise (Ex, n = 7), food restriction (FR, n = 8) and exercise plus food restriction (FAT, n = 8) groups. The rats were subjected to 4 weeks of wheel running (Ex, FAT) and 50-40 % food restriction (FR, FAT) to examine the effects on bone and typical digestive enzymes and transporters in the jejunum. Two-way ANOVA and the Kruskal-Wallis test were used for statistical analysis of normal and non-normal data, respectively. Four weeks of exercise and food restriction decreased bone weight (vs. other group P < 0·01) and bone breaking power (vs. other group P < 0·01). Villus height decreased in the jejunum (vs. other group P < 0·01), but the expression of typical macronutrients digestive enzyme and absorptive molecules remained unchanged. In contrast, sucrase-isomaltase gene (v. Ex P = 0·02) and protein expression were increased (vs. other group P < 0·05). The study findings show that FAT affects sucrase-isomaltase without histone methylation changes.

Beneficios y limitaciones de la dieta vegana en el requerimiento nutricional de atletas

The vegan diet refers to nutrition based on a wide variety of plant-based food groups (i.e., fruits, vegetables, grains, legumes, nuts and seeds, spices and herbs, mushrooms, and algae) that also excludes all. to all foods of animal origin (ie meat, fish, dairy and eggs). Various scientific studies on the nutritional contribution of the vegan diet in athletes seek to identify the benefits and limitations of a vegan diet in the nutritional requirement of athletes, compared to an omnivore diet. Sports nutrition is essential for optimal physical and mental performance, reduces the risk of illness and injury; That is why it is necessary to consume the macro and micronutrient requirements according to the type and intensity of exercise performed by the athlete. Vegan diets in general provide an optimal basis for vegan athletes to develop their overall potential, from increased intake of complex carbohydrates, dietary fiber, antioxidant vitamins C and E. However, a plant-based diet reduces intake of exclusive nutrients of animal origin. This influences the performance of endurance and strength, even occasions that female athletes develop diseases such as the female athlete triad (FAT) or the Relative Energy Deficiency in Sport (RED-S) if it is not accompanied by supplements of vitamin B12, creatine and proteins. The present bibliographic review aims to show that with an adequate strategic selection and management of food choices, paying special attention to the achievement of energy, macro and micronutrient recommendations, together with adequate supplementation, a vegan diet can satisfy the needs of most athletes satisfactorily.

Female Athlete Triad (FAT) Screening Using LEAF Questionnaire: A Cross-Sectional Study in Indonesia Pencak Silat Athletes

Health information acquired from a health examination or screening is one of the requirements for participating in the Pencak Silat tournament. Unfortunately, the most common health tests cover only vital signs and weight checks. Those tests cannot accurately describe a person's health status, such as digestive and menstrual disorders, common among female athletes due to intensive physical training and the pressure to maintain body weight according to the tournament category. The Female Athlete Triad (FAT) is the name given to this condition. This is the first study to use the LEAF questionnaire to assess the risk of FAT in female Indonesian Pencak Silat athletes. This is an observational study using a cross-sectional design. Data were collected online from 207 participants using a purposive random sampling approach. According to the findings of this study, 53.6% (N = 111) of 207 respondents were at risk of FAT. The risk variables were closely associated with the number of exercise hours per week (P = 0.012) and education level (P = 0.023). The high prevalence of FAT and its high risk indicate the necessity for FAT screening as a requirement for competing in the Pencak Silat tournament and prevention of early osteoporosis and uterine function abnormalities in female Indonesian Pencak Silat athletes. Furthermore, FAT screening on female athletes in all sports is required to prevent the long-term clinical implications of FAT.

Identifying latent classes of Relative Energy Deficiency in Sport (RED-S) consequences in a sample of collegiate female cross country runners

ObjectiveThe purpose of this study was to identify patterns of clustering of the 10 health consequences identified in the Relative Energy Deficiency in Sport (RED-S) framework among collegiate female Cross-Country...

Female athlete triad and relative energy deficiency in sport – endocrine changes and treatment in women

IntroductionFemale athlete triad (FAT) it is a syndrome of three tightly interrelated components: amenorrhea, eating disorder, and osteoporosis. FAT syndrome has been re-evaluated and re-defined and the International Olympic Committee introduced a new relative energy deficiency in sport (RED-S) syndrome.AimThe aim of the study was to review the knowledge on the issues of endocrine changes occurring in FAT and RED-S, and treatment of those conditions on a basis of available literature.Material and methodsThis article was based on a review of the literature search in the electronic databases Medline (PubMed), EBSCO, ClinicalKey, and Willey Online Library, using the terms: ‘female athlete triad,’ ‘relative energy deficiency in sport,’ ‘FAT and RED-S and endocrine changes,’ ‘low energy availability (LEA) and endocrine changes,’ ‘FAT and RED-S and treatment and women’.Results and discussionLEA influences abnormal secretion of gonadotropin-releasing hormone (GnRH) and this leads to the disrupted follicle-stimulating hormone (FSH) and luteinising hormone (LH) secretion. Higher ghrelin levels inhibit secretion of GnRH and of adrenocorticotropic hormone (ACTH), growth hormone (GH), FSH and LH. A high peptide YY (PYY) results in a significant suppression of GnRH secretion. Hypercortisolemia occurring in athletes may directly affect reproductive functions. Lack of estrogen contributes both to disrupted mineralization of bones and to endothelial dysfunction.ConclusionsLow energy levels found in female athletes diagnosed with FAT or RED-S syndrome significantly influence hormonal pathways, disrupting the function of their reproductive system, and this noticeably affects the overall health of sportswomen, influencing endothelial dysfunctions and bone mineral density.