The Utility of the Low Energy Availability in Females Questionnaire to Detect Markers Consistent With Low Energy Availability-Related Conditions in a Mixed-Sport Cohort

2021 ◽  
pp. 1-11
Author(s):  
Margot A. Rogers ◽  
Michael K. Drew ◽  
Renee Appaneal ◽  
Greg Lovell ◽  
Bronwen Lundy ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Confidence Interval ◽  
Bone Mineral ◽  
Reproductive Hormones ◽  
Low Energy ◽  
Energy Availability ◽  
Mineral Density ◽  
Predictive Values ◽  
Menstrual Dysfunction ◽  
Low Energy Availability

The Low Energy Availability in Females Questionnaire (LEAF-Q) was validated to identify risk of the female athlete triad (triad) in female endurance athletes. This study explored the ability of the LEAF-Q to detect conditions related to low energy availability (LEA) in a mixed sport cohort of female athletes. Data included the LEAF-Q, SCOFF Questionnaire for disordered eating, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, Mini International Neuropsychiatric Interview, blood pressure, and blood metabolic and reproductive hormones. Participants were grouped according to LEAF-Q score (≥8 or <8), and a comparison of means was undertaken. Sensitivity, specificity, and predictive values of the overall score and subscale scores were calculated in relation to the triad and biomarkers relevant to LEA. Fisher’s exact test explored differences in prevalence of these conditions between groups. Seventy-five athletes (18–32 years) participated. Mean LEAF-Q score was 8.0 ± 4.2 (55% scored ≥8). Injury and menstrual function subscale scores identified low bone mineral density (100% sensitivity, 95% confidence interval [15.8%, 100%]) and menstrual dysfunction (80.0% sensitivity, 95% confidence interval [28.4%, 99.5%]), respectively. The gastrointestinal subscale did not detect surrogate markers of LEA. LEAF-Q score cannot be used to classify athletes as “high risk” of conditions related to LEA, nor can it be used as a surrogate diagnostic tool for LEA given the low specificity identified. Our study supports its use as a screening tool to rule out risk of LEA-related conditions or to create selective low-risk groups that do not need management as there were generally high negative predictive values (range 76.5–100%) for conditions related to LEA.

scholarly journals Low Energy Availability Is Difficult to Assess but Outcomes Have Large Impact on Bone Injury Rates in Elite Distance Athletes

2018 ◽  
Vol 28 (4) ◽  
pp. 403-411 ◽  
Author(s):  
Ida A. Heikura ◽  
Arja L.T. Uusitalo ◽  
Trent Stellingwerff ◽  
Dan Bergland ◽  
Antti A. Mero ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Effect Size ◽  
Reproductive Function ◽  
Low Energy ◽  
Energy Availability ◽  
Mineral Density ◽  
Low Testosterone ◽  
And Training ◽  
Low Energy Availability

We aimed to (a) report energy availability (EA), metabolic/reproductive function, bone mineral density, and injury/illness rates in national/world-class female and male distance athletes and (b) investigate the robustness of various diagnostic criteria from the Female Athlete Triad (Triad), Low Energy Availability in Females Questionnaire, and relative energy deficiency in sport (RED-S) tools to identify risks associated with low EA. Athletes were distinguished according to benchmarks of reproductive function (amenorrheic [n = 13] vs. eumenorrheic [n = 22], low [lowest quartile of reference range;n = 10] versus normal testosterone [n = 14]), and EA calculated from 7-day food and training diaries (< or >30 kcal·kg−1fat-free mass·day−1). Sex hormones (p < .001), triiodothyronine (p < .05), and bone mineral density (females,p < .05) were significantly lower in amenorrheic (37%) and low testosterone (40%; 15.1 ± 3.0 nmol/L) athletes, and bone injuries were ∼4.5-fold more prevalent in amenorrheic (effect size = 0.85, large) and low testosterone (effect size = 0.52, moderate) groups compared with others. Categorization of females and males using Triad or RED-S tools revealed that higher risk groups had significantly lower triiodothyronine (female and male Triad and RED-S:p < .05) and higher number of all-time fractures (male Triad:p < .001; male RED-S and female Triad:p < .01) as well as nonsignificant but markedly (up to 10-fold) higher number of training days lost to bone injuries during the preceding year. Based on the cross-sectional analysis, current reproductive function (questionnaires/blood hormone concentrations) appears to provide a more objective and accurate marker of optimal energy for health than the more error-prone and time-consuming dietary and training estimation of EA. This study also offers novel findings that athlete health is associated with EA indices.

The Female Athlete Triad

2018 ◽  
pp. 288-301
Author(s):  
Jennifer L. Carlson ◽  
Katherine B. Hill
Keyword(s):  
Bone Mineral Density ◽  
Disordered Eating ◽  
Female Athlete ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Menstrual Dysfunction ◽  
Bone Acquisition ◽  
Low Energy Availability

In 2007, the female athlete triad was redefined to include (1) low energy availability with or without disordered eating; (2) menstrual dysfunction; and (3) decreased bone mineral density. Components of the triad are common during adolescence, a critical period for bone acquisition and growth, but the prevalence varies among athlete populations based on several factors. Screening for the triad should be a routine part of the preparticipation physical examination of adolescent athletes, and new recommendations exist for the screening and management of athletes at risk for complications from the triad. Awareness and education are critical for prevention and early intervention.

scholarly journals Risk of Low Energy Availability in National and International Level Paralympic Athletes: An Exploratory Investigation

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 979
Author(s):  
Kelly Pritchett ◽  
Alicia DiFolco ◽  
Savannah Glasgow ◽  
Robert Pritchett ◽  
Katy Williams ◽  
...  
Keyword(s):  
At Risk ◽  
National Level ◽  
Relative Energy ◽  
Low Energy ◽  
Assessment Tools ◽  
Energy Availability ◽  
Mineral Density ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
Low Energy Availability

(1) Background: The purpose of this study was to examine the symptoms of low energy availability (LEA) and risk of relative energy deficiency in sport (RED-S) symptoms in para-athletes using a multi-parameter approach. (2) Methods: National level para-athletes (n = 9 males, n = 9 females) completed 7-day food and activity logs to quantify energy availability (EA), the LEA in Females Questionnaire (LEAF-Q), dual energy X-ray absorptiometry (DXA) scans to assess bone mineral density (BMD), and hormonal blood spot testing. (3) Results: Based on EA calculations, no athlete was at risk for LEA (females < 30 kcal·kg−1 FFM·day−1; and males < 25 kcal·kg−1 FFM·day−1; thresholds for able-bodied (AB) subjects). Overall, 78% of females were “at risk” for LEA using the LEAF-Q, and 67% reported birth control use, with three of these participants reporting menstrual dysfunction. BMD was clinically low in the hip (<−2 z-score) for 56% of female and 25% of male athletes (4) Conclusions: Based on calculated EA, the risk for RED-S appears to be low, but hormonal outcomes suggest that RED-S risk is high in this para-athlete population. This considerable discrepancy in various EA and RED-S assessment tools suggests the need for further investigation to determine the true prevalence of RED-S in para-athlete populations.

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

2018 ◽  
Vol 28 (4) ◽  
pp. 412-418 ◽  
Author(s):  
Sarah Staal ◽  
Anders Sjödin ◽  
Ida Fahrenholtz ◽  
Karen Bonnesen ◽  
Anna Katarina Melin
Keyword(s):  
Bone Mineral Density ◽  
At Risk ◽  
Disordered Eating ◽  
Surrogate Marker ◽  
Low Energy ◽  
Energy Availability ◽  
Mineral Density ◽  
Energy Deficiency ◽  
Ballet Dancers ◽  
Low Energy Availability

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.

scholarly journals Circulating Alpha-Tocopherol Levels, Bone Mineral Density, and Fracture: Mendelian Randomization Study

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1940
Author(s):  
Karl Michaëlsson ◽  
Susanna C. Larsson
Keyword(s):  
Bone Mineral Density ◽  
Confidence Interval ◽  
Bone Mineral ◽  
Genetic Variants ◽  
Mendelian Randomization ◽  
Alpha Tocopherol ◽  
European Ancestry ◽  
Mineral Density ◽  
Standard Deviation Increase ◽  
A Genome

Recent cohort studies indicate a potential role of the antioxidant α-tocopherol in reducing bone loss and risk of fractures, especially hip fractures. We performed a Mendelian randomization investigation of the associations of circulating α-tocopherol with estimated bone mineral density (eBMD) using heel ultrasound and fractures, identified from hospital records or by self-reports and excluding minor fractures. Circulating α-tocopherol was instrumented by three genetic variants associated with α-tocopherol levels at p < 5 × 10−8 in a genome-wide association meta-analysis of 7781 participants of European ancestry. Summary-level data for the genetic associations with eBMD in 426,824 individuals and with fracture (53,184 cases and 373,611 non-cases) were acquired from the UK Biobank. Two of the three genetic variants were strongly associated with eBMD. In inverse-variance weighted analysis, a genetically predicted one-standard-deviation increase of circulating α-tocopherol was associated with 0.07 (95% confidence interval, 0.05 to 0.09) g/cm2 increase in BMD, which corresponds to a >10% higher BMD. Genetically predicted circulating α-tocopherol was not associated with odds of any fracture (odds ratio 0.97, 95% confidence interval, 0.91 to 1.05). In conclusion, our results strongly strengthen a causal link between increased circulating α-tocopherol and greater BMD. Both an intervention study in those with a low dietary intake of α-tocopherol is warranted and a Mendelian randomization study with fragility fractures as an outcome.

scholarly journals Bone metabolism, bone mineral density and low-energy fractures 10 years after Roux-en-Y gastric bypass

Bone ◽  
2019 ◽  
Vol 127 ◽  
pp. 436-445 ◽  
Author(s):  
Ingvild Kristine Blom-Høgestøl ◽  
Stephen Hewitt ◽  
Monica Chahal-Kummen ◽  
Cathrine Brunborg ◽  
Hanne Løvdal Gulseth ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Gastric Bypass ◽  
Bone Metabolism ◽  
Bone Mineral ◽  
Low Energy ◽  
Mineral Density

scholarly journals SOSTOYaNIE MINERAL'NOY PLOTNOSTI KOSTNOY TKANI U ZhENShchIN, PERENESShIKh MALOTRAVMATIChNYE PERELOMY V VOZRASTE 50 LET I STARShE

2012 ◽  
Vol 15 (2) ◽  
pp. 9-12
Author(s):  
O V Dobrovol'skaya ◽  
N V Demin ◽  
N V Toroptsova
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Bone Mineral ◽  
Vertebral Fractures ◽  
High Frequency ◽  
Low Energy ◽  
Mineral Density ◽  
Wrist Fractures ◽  
History Of ◽  
The Mean

This study was aimed to evaluate the bone mineral density (BMD) in women at the age of 50 years and older with the his tory of fracture(s) after a low-energy trauma. For this purpose the osteodensitometry of three areas was performed in 173 women with different low-traumatic fractures. Osteoporosis and osteopenia were found in 77% and 21% of patients respectively. Osteoporosis at least in one of three areas was revealed in 80% of women with hip fracture, in 77% of women with wrist fractures, in 73% of patients with humeral fractures, in 86% women after vertebral fractures and in 62% of patients with ankle fractures. Moreover, in these subgroups the osteoporosis in two areas of three was found in 38%, 23%, 30%, 33% and 24% of cases respectively. Osteoporosis in all three areas was detected more frequently in women with wrist fractures (in 39% of cases). The high frequency of osteoporosis in women with the history of low-traumatic fractures argues the need of an adequate antiosteoporotic treatment without mandatory verification of the reduced BMD by the mean of the osteodensitometry.

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