Leanness Sports Research Articles

Association of Competitive Adolescent Athletes from Lean and Non-Lean Sports Physical, Social and Psychological Characteristics with Adherence to Mediterranean Diet.

Mediterranean diet (MD) is regarded as one of the healthier dietary patterns which is recommended for athletes. This study aims to investigate the adherence to the Mediterranean diet (AMD) and associated beliefs in a large, diverse sample of competitive adolescent athletes from various sports, including both lean and non-lean sports. Additionally, the study examines factors important regarding intention to AMD within the Theory of Planned Behavior (TPB). In the study took part 711 adolescents (357 male, aged = 14.93 ± 1.38, and 354 female, aged = 14.85 ± 1.35) athletes. The level of AMD was not a significant different between lean (mean = 4.98, SD = ±3.90) and non-lean (mean = 4.77, SD = ±3.68) sport. According to the sport type the 35% of lean sport athletes demonstrated low AMD, 34.1% moderate adherence and 30.9% a high degree. The non lean athletes demonstrated low AMD in 36.3%, moderate adherence 33% and high degree in 30.7%. The results of the mediation analysis indicated a significant mediation effect of intention in the relationship between TPB variables and MD. Based on the results of the study the type of sport does not play a role in the AMD, which, as in the general population, is low. Also validate the TPB and underscore the significance of targeting individuals' intentions to promote positive dietary behaviors.

Association of LEAF-Q and EDE-QS scores with cholesterol levels in Finnish female athletes

ObjectiveLow energy availability (LEA) is common in athletes. Disturbances in sex hormone levels due to insufficient energy availability have been suggested to influence cholesterol metabolism and impact the overall risk...

An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes.

Background/Objectives: Several systematic reviews and meta-analyses have been conducted to date indicating a high prevalence of disordered eating in elite athletes and associated risk factors. However, the substantial time burden associated with locating and comparing these reviews, which are varied in methodology and sampling focus, may be a barrier for informing policy and best practice as well as directing future research. This umbrella review aimed to provide a summary of evidence across published reviews regarding the prevalence and risk factors for disordered eating (including body image concerns and eating disorders) in elite athletes. Methods: Five databases (CINAHL, PsycINFO, MEDLINE, Scopus, and SPORTDiscus) were systematically searched for peer-reviewed systematic reviews and meta-analyses that met the following inclusion criteria: (1) investigated prevalence and risk factors for disordered eating, (2) included a sample of elite athletes, and (3) available in English. The included studies underwent data extraction and risk of bias assessment using the AMSTAR 2. Results: The initial search identified 1828 articles that were screened for title and abstract and then full text, leaving 24 systematic reviews (including 10 meta-analyses). Disordered eating was prevalent across elite athletes, including males and females and across sport type. Elite athletes were at elevated risk for disordered eating and eating disorders but at lower risk for body image concerns versus non-athlete controls. Several risk factors were identified, including female gender, competing in lean sports, and experiencing career changes. Few reviews or meta-analyses examined perceived pressures within the sporting environment, and most had substantial risk of bias concerns. Conclusions: Elite athletes are at risk for the spectrum of disordered eating, and all should be considered for primary prevention and screening. Further research is needed regarding sport-specific versus general pressures and mediators of risk to better inform interventions.

The association between overuse and musculoskeletal injuries and the female athlete triad in Division I collegiate athletes.

Although the female athlete triad (Triad) has been associated with increased risk of bone-stress injuries (BSIs), limited research among collegiate athletes has addressed the associations between the Triad and non-BSI injuries. To elucidate the relationship between Triad and both BSI and non-BSI in female athletes. Retrospective cohort study. Primary and tertiary care student athlete clinic. National Collegiate Athletic Association Division I female athletes at a single institution. Participants completed a pre-participation questionnaire and dual-energy x-ray absorptiometry, which was used to generate a Triad cumulative risk assessment score (Triad score). The number of overuse musculoskeletal injuries that occurred while the athletes were still competing collegiately were identified through chart review. BSI and non-BSI were treated as count variables. The association between BSI, non-BSI, and Triad score was measured using Poisson regression to calculate rate ratios. Of 239 athletes, 43% of athletes (n = 103) sustained at least one injury. Of those, 40% (n = 95) sustained at least one non-BSI and 10% (n = 24) sustained at least one BSI over an average follow-up 2.5 years. After accounting for sport type (non-lean, runner, other endurance sport, or other lean advantage sport) and baseline age, we found that every additional Triad score risk point was associated with a significant 17% increase in the rate of BSI (rate ratio [RR] 1.17, 95% confidence interval [CI] 1.03-1.33; p = .016). However, Triad score was unrelated to non-BSI (1.00, 95% CI 0.91-1.11; p = .99). Compared with athletes in non-lean sports (n = 108), athletes in other lean advantage sports (n = 30) had an increased rate of non-BSI (RR: 2.09, p = .004) whereas distance runners (n = 46) had increased rates of BSI (RR: 7.65, p < .001) and non-BSI (RR: 2.25, p < .001). Higher Triad score is associated with an increased risk of BSI but not non-BSI in collegiate athletes.

Determinants of menstrual dysfunction in the female athlete triad: A cross-sectional study in Italian athletes.

BackgroundIn 1992 the American College of Sports Medicine first described the Female Athlete Triad. The Triad is a metabolic injury involving three distinct clinical traits: low energy availability, with possible eating disorder, low bone mineral density and menstrual dysfunction (MD). Although the estimated prevalence of the Triad is low (1.2 %), single factors are common in female athletes, at all competitive levels and ages. Even though the Triad was described over two decades ago, the interrelation of the three diagnostics components is still debated: additional evidence is required to improve the multidisciplinary treatment approach for this complex condition. MD is one of the first signs of energy impairment. The present study aims at investigating MD determinants and predictors in female athletes, to allow an early diagnosis of the Triad and to implement adequate preventive strategies. Materials and methodsAn original structured questionnaire was composed to detect the presence of MD risk factors. Included participants were active female athletes within reproductive age range (15–40 years old). Anthropometric parameters and training-related factors, possibly affecting the regularity of the menstrual cycle, were investigated. ResultsRespondents were 288 female athletes. Among them, 73.3 % were under 25 years of age; 6.6 % resulted underweight; 30.6 % reported to follow a meal plan/diet and 13.9 % declared to be a smoker. Lean sports were practiced by 30.6 % of responders. Body-weight congruence was detected in in 79.9 % of participants, whereas overestimation of body image was found in 16.3 % of athletes. Irregular menstrual cycle, a possible MD predictor, was present in 33.0 % of athletes, with 41.1 % practicing some lean sport (p = 0.007). Also, overestimation of body image suggested an increased risk of menstrual irregularity (p = 0.001). BMI <18.5 or BMI >30 could also act as risk factor, although significance was not fully obtained (p = 0.053). Overall, practice of lean sports and overestimation of body image appeared good determinants of increased menstrual irregularity (AOR 2.02 and 3.83, respectively). ConclusionsMenstrual irregularity in female athletes can be considered an early predictor of MD: risk is further increased in athletes of lean sports and reporting an overestimation of self-perceived body image. Screenings and awareness programs should specifically address female athletes, because of their vulnerable-group profile. In order to define a standardized at-risk profile for Triad onset and sequelae likelihood, evaluation of menstrual regularity should especially be considered, in conjunction with the assessment of other indicators of energy availability (e.g. TEE, lean and fat mass, BMC). Testing for sport-derived stress and disordered eating attitudes is also recommended. Preventive strategy should involve the proactive engagement of sport clubs and periodic competitive sport medical assessment.

Observational study on the eating behavior of a heterogeneous group of young athletes

Eating Disorders represent one of the fastest-growing mental health problems in the world. While a diagnosis of an eating disorder can only be made after careful psychiatric evaluation, the detection of “at-risk” individuals can be conducted through screening programs that use tools such as the Eating Attitude Test (EAT-26), a test used to measure the symptoms and concerns characteristic of eating disorders. This observational study was designed to evaluate the presence of at-risk individuals, using the EAT-26, among young athletes in “lean sports”, young athletes in non-”lean sports”, young non-athlete sportspeople, and young people who did not practice any sports. In addition, the presence of a correlation between the risk of developing eating disorders, gender, and age was also investigated. The results identified a prevalence of risk of 13% among study participants. None of the subjects who did not engage in any physical activity obtained a test score that could be considered at risk. Furthermore, no correlation was found between gender and the scores obtained. These results should be taken into consideration to emphasize the importance of nutritional intervention by expert and qualified personnel within various sports societies, in order to prevent the development of these pathologies and at the same time increase and improve performance.

Contraception, female cycle disorders and injuries in Swiss female elite athletes-a cross sectional study.

Aim: The national Olympic committee of Switzerland has conducted an online survey among female elite athletes with a focus on cycle disorders, contraception, and injuries in 2021. Methods: A total of 1,092 female elite athletes from 107 different sports were asked to answer the questionnaire. A descriptive analysis was carried out to determine location parameters and create frequency tables. Results: The questionnaire was completed by 408 athletes (37.4%) from 92 different sports. 43.4% participated in a lean sport. 57.1% reported no injuries, 32.6% one injury, and 10.2% two or more injuries per year. A considerable proportion reported being affected by primary amenorrhoea (10.8%). Primary amenorrhoea occurred significantly more often in female athletes with a BMI lower than 21.7kg/m2 (15.2%) than in athletes with a BMI above 21.7kg/m2 (7.4%, p = 0.021). Considering contraception, 25.8% of female athletes were currently using an oral contraceptive pill. The proportion of female athletes not using contraception at all or using non-hormonal contraceptive methods was high at 54.4%. In lean sports, significantly more athletes used no or non-hormonal contraceptives (p < 0.05). Conclusion: Among top Swiss female athletes, a considerable proportion used non-hormonal or no contraceptives. This trend was more evident in lean sports. Delayed menarche and cycle irregularities were common among female athletes, especially among athletes with high training volumes as well as a BMI below 21.7kg/m2. This orienting survey underlines the importance of specialized gynecological care for elite female athletes.

Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background

BackgroundEating disorders negatively influence athletes’ health and performance. To achieve a high level of performance and conform to cultural expectations regarding an athletic body type, female athletes often restrict their diets, which can lead to eating disorders. In addition to factors related to the sports environment, adolescent athletes are subject to changes caused by the maturation process. Therefore, the same factors may have different effects on eating disorder risk among adolescent and adult athletes. This study examined the relationship between eating disorder risk, specific aspects of the sports environment (sport type, level of competition [national and international], and training background), and individual aspects (body satisfaction and body mass index) in two groups of athletes: adolescents and adults.MethodsThe sample included 241 highly trained female athletes aged 12–30 years (M = 20.68, SD = 4.45) recruited from different sports clubs in Poland. The subgroup of adolescents consisted of 82 athletes, while the number of adult athletes was 159. The Eating Attitudes Test questionnaire was used to assess the eating disorder risk among the athletes. Body satisfaction was measured using the Feelings and Attitudes Toward Body Scale incorporated into the Body Investment Scale.ResultsEating disorder risk was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes. Significant associations between eating disorder risk and the studied variables were noted only among adolescent athletes. Univariate logistic regression analysis revealed that the occurrence of eating disorder risk was associated with participation in lean non-aesthetic sports (OR = 11.50, 95% CI: 3.58–37.09). Moreover, eating disorder risk was associated with athletes’ lower body satisfaction (OR = 0.80, 95% CI: 0.70–0.92). Body mass index was not included in the final regression model.ConclusionsThe study indicated that eating disorder risk in adolescent female athletes was related to sport type and body satisfaction. The findings showed that, in adolescent athletes, eating disorder risk was the most associated with practicing lean non-aesthetic sports. Coaches and athletes should be aware that eating disorder risk increases among individuals with a lower body image.

When Appearance Social Comparison Benefits Women’s Body Satisfaction: Examining the Effects of Viewing Lean Sports

ABSTRACT While media representations of female athletes in lean sports often lead to negative body image perceptions in female audiences, media images depicting athletes playing sports may generate positive responses with respect to body image. Derived from the two lines of scholarship in sports media effects, this between-subjects, online experiment tests the effects of viewing images of female athletes playing lean sports (gymnastics, diving, artistic swimming, figure skating, and cheerleading). Results showed that female viewers (N = 625) engaged in greater appearance social comparison after viewing the images of female athletes playing lean sports (versus the control images), which in turn, was positively associated with their body satisfaction. Different levels of thinness and muscularity of female athletes in the media images did not significantly affect female viewers’ appearance social comparison or body satisfaction. Notably, post hoc analyses revealed several different findings across three age groups of women audiences (young adults, middle-aged adults, and older adults). Overall, this study sheds light on the positive impact of appearance social comparison after viewing lean sports. Furthermore, the findings indicate the importance of focusing on athlete performance in media practice in relation to lean sports.

Tarsal Navicular Bone Stress Injuries: A Multicenter Case Series Investigating Clinical Presentation, Diagnostic Approach, Treatment, and Return to Sport in Adolescent Athletes

Background: Tarsal navicular bone stress injuries (BSIs) are considered “high risk” because of prolonged healing times and higher rates of nonunion in adult populations but, to our knowledge, have not been comprehensively examined in adolescent athletes. Purpose: To describe the characteristics of tarsal navicular BSIs in adolescents. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of patients aged 10 to 19 years with a radiographically diagnosed tarsal navicular BSI was performed at 8 academic centers over a 9-year study period. Age, sex, body mass index (BMI), primary sport, physical examination findings, imaging, treatment, surgical technique, return-to-sport time, and complications were analyzed. Results: Among 110 patients (mean age, 14.7 ± 2.7 years; 65% female), common primary sports were cross-country/track and field (29/92 [32%]) and gymnastics/dance (25/92 [27%]). Grade 4 BSIs were identified in 44% (48/110) of patients, with fracture lines present on radiography or magnetic resonance imaging. Nonoperative treatment (mean age, 14.4 ± 2.6 years), consisting of protected weightbearing and either a protective boot (69/88 [78%]) or a cast (19/88 [22%]), was trialed in all patients and was successful in 94 patients (85%). Operative treatment (mean age, 17.1 ± 1.4 years) was ultimately pursued for 16 patients (15%). Patients who required surgery had a higher BMI and a higher percentage of fracture lines present on imaging (nonoperative: 36/94 [38%]; operative: 14/16 [88%]). The median time to return to weightbearing, running, and full sport was significantly longer in duration for the operative group than the nonoperative group (P <.05). Complications associated with surgery included 1 case each of delayed union, nonunion, and painful implants, the latter of which required secondary surgery. Conclusion: Adolescent tarsal navicular BSIs were identified most commonly in female patients in leanness sports. Adolescents who required surgery were more likely to be older, have higher BMIs, and have grade 4 BSIs, and they returned to sport within a median of 5 months after single- or double-screw fixation with a low risk of postoperative complications. A better understanding of the presenting signs and symptoms and appropriate diagnostic imaging of navicular BSIs may lead to an earlier diagnosis and improved outcomes.

Elite lean athletes at sports high schools face multiple risks for mental health concerns and are in need of psychosocial support.

The combined demands on an adolescence in an elite sports high school can negatively affect mental health (eg, stress, burnout, depression, anxiety). Late adolescence is also when elite-striving athletes typically transition from junior-to-senior level programs. In addition, adolescent elite lean sports athletes have an increased risk of suffering from abnormal eating pathology. The purpose of this study was to investigate the perceived psychosocial needs that young, elite-striving lean sports athletes in sports high schools find essential for their sports careers and transition from junior-to-senior level sports. Eight Swedish elite-striving lean sports athletes (2 men and 6 women; median age 17.0 years, range: 16-18 years) participated in this study and sports represented were athletics (n = 1), gymnastics (n = 3), and wrestling (n = 4). Semi-structured interviews were performed, and data was analyzed by thematic analysis. Results showed integration, both in the present situation and for the future, as an overarching theme perceived as essential for a successful elite sports career over time. Three additional themes were also identified: (a) Psychosocial stress (combined performance demands, diminished social life, sports-related body weight demands, taboo talking about eating disorders, injuries), (b) Protective psychosocial factors (social support and psychological safety, communication and coordination school and sports, self-care/health behaviors), and (c) support needs junior-to-senior transition (career advice and mentorship, individualized support). As a result, elite-striving, lean sports athletes attending sports high schools need additional support to excel in their academic and athletic endeavors. Sports developmental programs continue to provide inadequate support before and during the junior-to-senior level transition. Similarly, despite the continued calls for reducing the stigma of mental health, athletes in sports schools still encounter barriers from coaches and peers, making the subject taboo, particularly surrounding eating pathologies.

Exploring the mental health of circus artists: Circus factors, psychological resilience, and demographics predict disordered eating and exercise addictions

There are similarities in the performance demands of circus and other performance domains such as leanness sports and dance, yet little is known about the mental health of circus artists. We explored self-reported disordered eating and exercise addictions in a sample of 500 circus artists. The sample consisted of aerial acrobats (71%), floor acrobats (13%), object manipulators (9%), and equilibrists (6%) who participate in circus at a range of performance levels (amateur 50%, part/full-time professional 41%, student 6%, retired 3%). Similar to elite athletes in leanness sports, approximately 36% of the circus artists in our sample were classified as ‘at risk’ of an eating disorder. A binomial logistic regression model suggested that being ‘at risk’ of an eating disorder was negatively related to participants’ age and trait resilience, positively related to exercise addictions, and differences among circus categories were found (i.e., higher among equilibrium and aerial acrobatics). Using a Bayesian estimation procedure, a linear regression model suggested that exercise addiction scores were positively related to participants’ weekly training time and being ‘at risk’ for an eating disorder, negatively associated with their years of experience in circus, and differences between circus categories (high levels in equilibrium) and modality of engagement in circus (higher levels among amateurs) were identified. Consequently, these exploratory study findings indicate that a complex interaction of factors might impact the development of disordered eating and exercise addictions among circus artists. Implications for discipline-specific and experience-specific interventions to address these maladaptive behaviours are discussed.

Self-Reported Restrictive Eating, Eating Disorders, Menstrual Dysfunction, and Injuries in Athletes Competing at Different Levels and Sports.

The purpose of this study was to investigate the prevalence of self-reported restrictive eating, current or past eating disorder, and menstrual dysfunction and their relationships with injuries. Furthermore, we aimed to compare these prevalences and associations between younger (aged 15–24) and older (aged 25–45) athletes, between elite and non-elite athletes, and between athletes competing in lean and non-lean sports. Data were collected using a web-based questionnaire. Participants were 846 female athletes representing 67 different sports. Results showed that 25%, 18%, and 32% of the athletes reported restrictive eating, eating disorders, and menstrual dysfunction, respectively. Higher rates of lean sport athletes compared with non-lean sport athletes reported these symptoms, while no differences were found between elite and non-elite athletes. Younger athletes reported higher rates of menstrual dysfunction and lower lifetime prevalence of eating disorders. Both restrictive eating (OR 1.41, 95% CI 1.02–1.94) and eating disorders (OR 1.89, 95% CI 1.31–2.73) were associated with injuries, while menstrual dysfunction was associated with more missed participation days compared with a regular menstrual cycle (OR 1.79, 95% CI 1.05–3.07). Our findings indicate that eating disorder symptoms and menstrual dysfunction are common problems in athletes that should be managed properly as they are linked to injuries and missed training/competition days.

Development and validation of the Eating Disorders Screen for Athletes (EDSA): A brief screening tool for male and female athletes

ObjectivesTo develop and validate the Eating Disorders Screen for Athletes (EDSA), a brief eating disorders screening tool for use in both male and female athletes. Methods: Data from Division I athletes at a Midwestern university (N = 434) were used to conduct exploratory factor analysis (EFA) by gender. Data from athletes competing at various levels at universities across the United States (N = 862) were then used to conduct confirmatory factor analysis (CFA) and receiver operator characteristic (ROC) curve analysis by gender. Athletes from a range of lean and non-lean sports were included. Gender-specific empirically derived cut-offs on the Eating Disorder Examination-Questionnaire were used to classify high eating disorder risk for ROC curve analysis. Measurement invariance by gender, level of competition, and sport type was also examined. Results: A six-item, one-factor structure for the EDSA was supported by EFA and CFA in both genders, and internal consistency was good for both male (α = 0.80) and female athletes (α = 0.86). ROC curve analyses indicated that the EDSA was highly accurate in predicting eating disorder risk status and identified a score of 3.33 as the optimal cut-off for both male (sensitivity = 0.96, specificity = .80) and female athletes (sensitivity = 0.96, specificity = .64). Results also supported strong measurement invariance for the EDSA by gender, level of competition (Division I versus club), and sport type (lean versus non-lean). Conclusions: The EDSA shows promise as a brief screening tool to identify male and female athletes at risk for eating disorders.

Self-reported eating disorder risk in lean and non-lean NCAA Collegiate Athletes.

The purpose of this present study was to examine gender differences in overall scores on the Eating Attitudes Test (EAT-26) in National Collegiate Athletic Association (NCAA) college athletes in "lean" sports versus "non-lean" sports. Using a self-report survey design, this study examined eating disorder risk in 121 NCAA college athletes, using the EAT-26. We expected that female athletes and athletes in "lean" sports would report higher scores on the EAT-26. There was a significant effect of sport type (lean vs. non-lean) on eating attitudes and behaviors, with those in non-lean sports reporting higher scores, on average, on the attitudinal measure and those in lean sports reporting, on average, higher scores on the behavioral measure. There was an interaction between gender and sport type (lean vs. non-lean) on eating attitudes and behaviors. Male athletes in non-lean sports had the highest overall average scores on the attitudinal portion of the EAT-26, and males in lean sports had the lowest scores. However, on the EAT-26 behavioral portion, men in lean sports reported significantly higher scores than did men in non-lean sports. Female athletes, regardless of sport type, reported similar scores on both the EAT- 26 attitudinal and behavioral sections. Our findings suggest that athletes, regardless of sport type and gender, may be affected by eating disorder symptomatology. Gender differences may be smaller in athletic populations than previously thought. Sport type may affect whether disordered eating symptomatology presents as attitudinal or behavioral in nature, especially in male athletes. Descriptive study, Level V.

Prevalence of female athlete triad in Bulgaria

As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad as first described in 1992 by the American College of Sports Medicine consisted of disordered eating, amenorrhea, and osteoporosis; the definition was updated in 2007 to include a spectrum of dysfunction related to energy availability, menstrual function, and bone mineral density. For this review, a comprehensive search of databases—MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus, from earliest inclusive dates to January 2013—was conducted by an experienced librarian with input from the authors. Controlled vocabulary supplemented with keywords such as female athlete triad, amenorrhea, oligomenorrhea, fracture, osteopenia, osteoporosis, bone disease, anorexia, bulimia, disordered eating, low energy availability was used to search for articles on female athlete triad. Articles addressing the prevalence, screening, and management of the female athlete triad were selected for inclusion in the review. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, and recommended screening and management guidelines. The lack of efficacy of current screening of athletes is highlighted. Low energy availablity, from either dietary restriction or increased expenditure, plays a pivotal role in development of the triad. Athletes involved in “lean sports” (those that emphasize weight categories or aesthetics, such as ballet, gymnastics, or endurance running) are at highest risk. Treatment is centered on restoring energy availability to reverse adverse changes in the metabolic milieu. Prevention and early recognition of triad disorders are crucial to ensure timely intervention. Caregivers and physicians of female athletes must remain vigilant in education, recognition, and treatment of athletes at risk.

Biological significance of chromium III for the human organism

Currently, chromium is probably the most controversial transition metal. In recent publications it is clearly stated that it is not an essential micronutrient and should be considered to have a pharmacological effect. Conflicting scientific reports along with a huge amount of dietary supplements, as well as dietary and sports nutrients available on the market have prompted the authors to investigate the available information on the range of possible application, efficacy and safety of products containing salts or chelates of chromium III. The authors reviewed articles in electronic databases for the years 1959-2016, and selected works describing the biochemical, physiological and toxic properties of chromium salts and chelates and the range of possible applications in medicine, dietetics and sport. A critical analysis of reports dealing with the effect of chromium on the carbohydrate and lipid metabolism, body composition, lean body mass and sports performance was carried out. The authors indicated papers analyzing the mechanism of action of chromium in the cognitive and affective disorders. Much attention has been paid to the safety use of chromium III supplements. There are still some unsolved issues. In the field of toxicology, a limited number of reports about environmental exposure to trivalent chromium in the workplace draws our attention. In the field of biochemical research, there is still a need to clarify the mechanism of psychiatric and endocrinological activity, especially in conjunction with the immune system. Med Pr 2018;69(2):211-223.

Factors Associated with Disordered Eating Behaviors among Triathletes

CONTEXTAlthough there is little data currently available concerning the primary factors associated with disordered eating behaviors among triathletes, these athletes may be at greater risk. Sports medicine professionals are in a unique position to identify athletes with disordered eating risks.METHODSThe purpose of this cross-sectional survey study was to identify the prevalence of disordered eating attitudes and behaviors among a national convenience sample of triathletes. A secondary purpose was to identify “triathlon-specific factors” and “competitive athlete-factors” potentially associated with disordered eating behaviors. The authors hypothesized that certain triathlon-specific factors and competitive athlete factors would be associated with increased rates of self-reported disordered eating behaviors.RESULTSIn a respondent sample of 1,033 adults, multiple competitive athlete factors were associated with a higher risk for disordered eating, whereas triathlon-specific factors were not.CONCLUSIONSIn this study sample, disordered eating was not specifically associated with triathlon-specific factors. Rather, disordered eating behaviors were found to be more often associated with associated competitive athlete factors, particularly in the many leanness sports such as running.

Menstrual Dysfunction in Females Presenting to a Pediatric Sports Medicine Practice

ABSTRACT This study aimed to determine the prevalence of menstrual dysfunction (MD) among injured female athletes presenting to a pediatric primary care sports medicine clinic and to examine the influence of type of injury (acute or overuse) and type of sports participation (i.e., lean build sports [LBS], non–lean build sports [NLBS], or combination [CBS]) on the likelihood of experiencing MD to recommend better screening practices for these athletes. Demographics and menstrual history were collected from females (10–18 yr) presenting with a new musculoskeletal injury, along with type of injury and participation in LBS (n = 156), NLBS (n = 243), or CBS (n = 92). Logistic regression models were used to determine the odds of MD, adjusting for age and body mass index. Of 491 females who met inclusion criteria for the study, 15.9% reported MD. Females experiencing MD were likely to be older at menarche (12.3 vs 11.9, P = 0.006), with a similar body mass index (P = 0.244). Female athletes experiencing an acute or overuse injury had a similar risk of experiencing MD (adjusted odds ratio [AOR] = 1.40, 95% CI = 0.85–2.28). Females who participated in LBS were as likely as those who participated in NLBS to have MD (AOR = 1.52, 95% CI = 0.86–2.66). However, participation in NLBS or CBS tended to protect injured females from MD as compared with sole LBS participation (AOR = 0.77, 95% CI = 0.46–1.29), although the relationship was not statistically significant. MD is prevalent in adolescent female athletes presenting with musculoskeletal injuries; however, it is not associated with the type of injury or type of sport in which the athlete participates. All adolescent females presenting with musculoskeletal injury should be screened for MD.

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

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.