Drive for thinness score is a proxy indicator of energy deficiency in exercising women

Appetite ◽  
2007 ◽  
Vol 48 (3) ◽  
pp. 359-367 ◽  
Author(s):  
Mary Jane De Souza ◽  
Rayisa Hontscharuk ◽  
Marion Olmsted ◽  
Gretchen Kerr ◽  
Nancy I. Williams
Keyword(s):  
Drive For Thinness ◽  
Energy Deficiency ◽  
Exercising Women

The Association of a High Drive for Thinness With Energy Deficiency and Severe Menstrual Disturbances: Confirmation in a Large Population of Exercising Women

2011 ◽  
Vol 21 (4) ◽  
pp. 280-290 ◽  
Author(s):  
Jenna C. Gibbs ◽  
Nancy I. Williams ◽  
Jennifer L. Scheid ◽  
Rebecca J. Toombs ◽  
Mary Jane De Souza
Keyword(s):  
Large Population ◽  
Resting Energy Expenditure ◽  
Operational Definition ◽  
Drive For Thinness ◽  
Chi Square ◽  
Energy Deficiency ◽  
College Age ◽  
High Drive ◽  
Exercising Women ◽  
Menstrual Disturbances

A high drive-for-thinness (DT) score obtained from the Eating Disorder Inventory-2 is associated with surrogate markers of energy deficiency in exercising women. The purposes of this study were to confirm the association between DT and energy deficiency in a larger population of exercising women that was previously published and to compare the distribution of menstrual status in exercising women when categorized as high vs. normal DT. A high DT was defined as a score ≥7, corresponding to the 75th percentile for college-age women. Exercising women age 22.9 ± 4.3 yr with a BMI of 21.2±2.2 kg/m2 were retrospectively grouped as high DT (n = 27) or normal DT (n = 90) to compare psychometric, energetic, and reproductive characteristics. Chi-square analyses were performed to compare the distribution of menstrual disturbances between groups. Measures of resting energy expenditure (REE) (4,949 ± 494 kJ/day vs. 5,406 ± 560 kJ/day, p < .001) and adjusted REE (123 ± 16 kJ/LBM vs. 130 ± 9 kJ/LBM, p = .027) were suppressed in exercising women with high DT vs. normal DT, respectively. Ratio of measured REE to predicted REE (pREE) in the high-DT group was 0.85 ± 0.10, meeting the authors’ operational definition for an energy deficiency (REE:pREE <0.90). A greater prevalence of severe menstrual disturbances such as amenorrhea and oligomenorrhea was observed in the high-DT group (χ2 = 9.3, p = .003) than in the normal-DT group. The current study confirms the association between a high DT score and energy deficiency in exercising women and demonstrates a greater prevalence of severe menstrual disturbances in exercising women with high DT.

High Drive For Thinness Is Associated With Severe Energy Deficiency-related Menstrual Disturbances In Exercising Women

2010 ◽  
Vol 42 ◽  
pp. 109-110
Author(s):  
Jenna C. Gibbs ◽  
Nancy I. Williams ◽  
Jennifer L. Scheid ◽  
Rebecca J. Toombs ◽  
Mary Jane De Souza
Keyword(s):  
Drive For Thinness ◽  
Energy Deficiency ◽  
High Drive ◽  
Exercising Women ◽  
Menstrual Disturbances

The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women

Bone ◽  
2008 ◽  
Vol 43 (1) ◽  
pp. 140-148 ◽  
Author(s):  
Mary Jane De Souza ◽  
Sarah L. West ◽  
Sophie A. Jamal ◽  
Gillian A. Hawker ◽  
Caren M. Gundberg ◽  
...  
Keyword(s):  
Bone Metabolism ◽  
Estrogen Deficiency ◽  
Energy Deficiency ◽  
Exercising Women

Elevated PYY is associated with energy deficiency and indices of subclinical disordered eating in exercising women with hypothalamic amenorrhea

Appetite ◽  
2009 ◽  
Vol 52 (1) ◽  
pp. 184-192 ◽  
Author(s):  
Jennifer L. Scheid ◽  
Nancy I. Williams ◽  
Sarah L. West ◽  
Jaci L. VanHeest ◽  
Mary Jane De Souza
Keyword(s):  
Disordered Eating ◽  
Hypothalamic Amenorrhea ◽  
Energy Deficiency ◽  
Exercising Women

Induction of low-T3 syndrome in exercising women occurs at a threshold of energy availability

1994 ◽  
Vol 266 (3) ◽  
pp. R817-R823 ◽  
Author(s):  
A. B. Loucks ◽  
E. M. Heath
Keyword(s):  
Repeated Measures ◽  
Energy Availability ◽  
Free T4 ◽  
Reverse T3 ◽  
Energy Deficiency ◽  
Low T3 ◽  
Significant Difference ◽  
Ergometer Exercise ◽  
Exercising Women ◽  
Early Follicular Phase

To investigate the relationship between energy availability (dietary energy intake minus energy expended during exercise) and thyroid metabolism, we studied 27 untrained, regularly menstruating women who performed approximately 30 kcal.kg lean body mass (LBM)-1.day-1 of supervised ergometer exercise at 70% of aerobic capacity for 4 days in the early follicular phase. A clinical dietary product was used to set energy availability in four groups (10.8, 19.0, 25.0, 40.4 kcal.kg LBM-1.day-1). For 9 days beginning 3 days before treatments, blood was sampled once daily at 8 A.M. Initially, thyroxine (T4) and free T4 (fT4), 3,5,3'-triiodothyronine (T3) and free T3 (fT3), and reverse T3 (rT3) were in the normal range for all subjects. Repeated-measures one-way analysis of variance followed by one-sided, two-sample post hoc Fischer's least significant difference tests of changes by treatment day 4 revealed that reductions in T3 (16%, P < 0.00001) and fT3 (9%, P < 0.01) occurred abruptly between 19.0 and 25.0 kcal.kg LBM-1.day-1 and that increases in fT4 (11%, P < 0.05) and rT3 (22%, P < 0.01) occurred abruptly between 10.8 and 19.0 kcal.kg LBM-1.day-1. Changes in T4 could not be distinguished. If energy deficiency suppresses reproductive as well as thyroid function, athletic amenorrhea might be prevented or reversed by increasing energy availability through dietary reform to 25 kcal.kg LBM-1.day-1, without moderating the exercise regimen.

scholarly journals SAT-008 Do Psychological Factors Influence Exercise Related Amenorrhea?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nancy I Williams ◽  
Nicole C A Strock ◽  
Kristen J Koltun ◽  
Rebecca J Mallinson ◽  
Mary Jane De Souza
Keyword(s):  
Perceived Stress ◽  
Psychological Factors ◽  
Eating Behaviors ◽  
Mood States ◽  
Dysfunctional Attitudes ◽  
Social Approval ◽  
Drive For Thinness ◽  
Daily Stress ◽  
Hypothalamic Amenorrhea ◽  
Exercising Women

Abstract Purpose: The etiology of functional hypothalamic amenorrhea (FHA) can involve both metabolic and psychogenic stressors. The role of metabolic stress has been described in exercising women who develop FHA secondary to chronic energy deficiency attributable to inadequate dietary intake in the face of exercise training. The potential for psychological factors to contribute to exercise-related FHA is unknown. Methods: In our cross-sectional comparison of exercising women ((n=61), exercise ≥2 hours/week, age 18-35 years, BMI 16-25 kg/m2, we tested whether psychological factors discriminated participants who were deemed eumenorrheic or had FHA as confirmed by physical examination, health history, metabolic and endocrine screening, menstrual calendars and daily urinary collection for reproductive hormone metabolites. Body composition, energy balance, and metabolic and endocrine parameters were assessed in addition to psychological factors (Dysfunctional Attitudes Scale, Brief-Resilient Coping, Daily Stress Inventory, Perceived Stress Scale (PSS), Profile of Mood States (POMS), Beck Depression Inventory) and eating behaviors (Eating Disorder Inventory-2, Three-Factor Eating Questionnaire). Results: Exercising women with FHA had a significantly lower BMI (20.2 vs 21.5 m/kg2, p&lt;0.05), less body fat (22.8 vs 25.8%, p&lt;0.05), and a lower fat mass (56.2 vs 58.3 kg, p&lt;0.05), compared to eumenorrheic women. Fasting total triiodothyronine (75.4 vs 89.8 ng/dL, p&lt;0.001), leptin (5.2 vs 9.0 ng/dL, p&lt;0.01), and the ratio of actual to predicted resting metabolic rate (0.84 vs 0.92, p&lt;0.01) were significantly lower in FHA women. FHA women demonstrated a greater drive for thinness (2.9 vs 2.1, p&lt;0.05), greater dietary cognitive restraint (11.3 vs 7.4, p&lt;0.001), and displayed more dysfunctional attitudes, i.e., need for social approval (39.1 vs 33.7, p&lt;0.05) compared to eumenorrheic women but there were no differences in perceived stress, depression, mood states, brief resilient coping, or daily stress (p &gt;0.05). Notably, FHA women displayed a significant positive correlation between need for social approval and indicators of stress (PSS: r=0.50), depression (Beck: r=0.59), and mood (POMS-depression/dejection: r=0.55), which was not apparent in eumenorrheic women. Additionally, EDI-drive for thinness was significantly positively correlated with many of the variables associated with stress (PSS: r=0.47), depression (Beck: r=0.51), dysfunctional attitudes (r=0.55), and mood disorders (POMS-depression-dejection: r= 0.37; tension/anxiety: r=0.44)(all p&lt;0.05). Conclusion: In exercising women, psychological factors do not overtly discriminate reproductive status; however, in women with FHA, there appears to be a higher need for social approval and restrictive eating behaviors may be related to underlying indicators of psychological stress and depression. US DoD PR054531

Discriminating hypothalamic oligomenorrhea/amenorrhea from hyperandrogenic oligomenorrhea/amenorrhea in exercising women

2020 ◽  
Vol 45 (7) ◽  
pp. 707-714 ◽  
Author(s):  
Kristen J. Koltun ◽  
Nancy I. Williams ◽  
Jennifer L. Scheid ◽  
Mary Jane De Souza
Keyword(s):  
Energy Expenditure ◽  
Resting Energy Expenditure ◽  
Urinary Metabolites ◽  
Alternative Mechanism ◽  
Percentage Body Fat ◽  
Energy Deficiency ◽  
Free Androgen Index ◽  
Exercising Women ◽  
Menstrual History ◽  
Resting Energy

The mechanism underlying oligo/amenorrhea in exercising women is often presumed as hypothalamic inhibition secondary to energy deficiency; however, hyperandrogenism may provide an alternative mechanism in some exercising women. Our purpose was to compare reproductive, metabolic, and androgen profiles of exercising women with eumenorrheic, ovulatory menstrual cycles (n = 91), oligo/amenorrhea without evidence of hyperandrogenism (Oligo/Amen; n = 83), and oligo/amenorrhea with evidence of hyperandrogenism (Oligo/Amen-HA; n = 17), and determine the prevalence of oligo/amenorrhea with evidence of hyperandrogenism in exercising women. Self-reported menstrual history and quantification of daily estrogen and progesterone urinary metabolites determined reproductive status. Resting energy expenditure, body composition, and metabolic hormone concentrations determined metabolic status. Serum androgens and calculated free androgen index (FAI) determined androgen status. Groups were similar in age (22.4 ± 0.3 years), height (165.1 ± 0.5 cm), resting energy expenditure (1198.4 ± 12.0 kcal/day), and total triiodothyronine (85.0 ± 1.5 ng/dL) concentration. Oligo/Amen-HA had greater weight (60.0 ± 1.6, 56.1 ± 0.7 kg), body mass index (22.3 ± 0.4, 20.6 ± 0.2 kg/m2), percentage body fat (27.3% ± 1.4%, 24.4% ± 0.6%), fat mass (16.2 ± 1.0, 13.8 ± 0.4 kg), insulin (5.8 ± 0.7, 4.2 ± 0.3 μIU/mL), leptin (12.2 ± 2.3, 6.6 ± 0.7 ng/mL), FAI (6.1 ± 0.3, 1.7 ± 0.1), and luteinizing hormone/follicle-stimulating hormone (1.9 ± 0.3, 1.3 ± 0.2) compared with Oligo/Amen, respectively. In our sample, 17% of those with oligo/amenorrhea had concurrent hyperandrogenism. This study supports that oligo/amenorrhea in some exercising women is related to hyperandrogenism. Novelty Caution must be utilized when discriminating hypothalamic oligo/amenorrhea from hyperandrogenic oligo/amenorrhea. In our sample, 17% of those with presumed hypothalamic oligo/amenorrhea had concurrent hyperandrogenism. Exercise and/or mild energy deficiency may be protective against developing severe hyperandrogenic symptoms.

scholarly journals Indices of Resting Metabolic Rate Accurately Reflect Energy Deficiency in Exercising Women

2020 ◽  
Vol 30 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Nicole C.A. Strock ◽  
Kristen J. Koltun ◽  
Emily A. Southmayd ◽  
Nancy I. Williams ◽  
Mary Jane De Souza
Keyword(s):  
Metabolic Rate ◽  
Alternative Assessment ◽  
Resting Metabolic Rate ◽  
Prediction Equation ◽  
Estimation Methods ◽  
Cross Sectional ◽  
Energy Deficiency ◽  
Exercising Women ◽  
Total Triiodothyronine ◽  
No Gold Standard

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.

The physiology of functional hypothalamic amenorrhea associated with energy deficiency in exercising women and in women with anorexia nervosa

2016 ◽  
Vol 25 (2) ◽  
Author(s):  
Heather C.M. Allaway ◽  
Emily A. Southmayd ◽  
Mary Jane De Souza
Keyword(s):  
Energy Expenditure ◽  
Peptide Yy ◽  
Hormone Secretion ◽  
High Energy ◽  
Drive For Thinness ◽  
Compensatory Mechanisms ◽  
Hypothalamic Amenorrhea ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
Metabolic Alterations

AbstractAn energy deficiency is the result of inadequate energy intake relative to high energy expenditure. Often observed with the development of an energy deficiency is a high drive for thinness, dietary restraint, and weight and shape concerns in association with eating behaviors. At a basic physiologic level, a chronic energy deficiency promotes compensatory mechanisms to conserve fuel for vital physiologic function. Alterations have been documented in resting energy expenditure (REE) and metabolic hormones. Observed metabolic alterations include nutritionally acquired growth hormone resistance and reduced insulin-like growth factor-1 (IGF-1) concentrations; hypercortisolemia; increased ghrelin, peptide YY, and adiponectin; and decreased leptin, triiodothyronine, and kisspeptin. The cumulative effect of the energetic and metabolic alterations is a suppression of the hypothalamic-pituitary-ovarian axis. Gonadotropin releasing hormone secretion is decreased with consequent suppression of luteinizing hormone and follicle stimulating hormone release. Alterations in hypothalamic-pituitary secretion alters the production of estrogen and progesterone resulting in subclinical or clinical menstrual dysfunction.

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