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.

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.

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 Analysis of female athlete triad in adolescent female Bharatanatyam dancer using low energy availability questionnaire

2021 ◽  
Vol 8 (8) ◽  
pp. 4024
Author(s):  
Sharayu S. Tambe ◽  
Anjali S. Puntambekar
Keyword(s):  
Female Athlete ◽  
Musculoskeletal Injuries ◽  
Low Energy ◽  
Primary Amenorrhea ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Negative Consequences ◽  
Menstrual Dysfunction ◽  
Validated Questionnaire ◽  
Low Energy Availability

Background: The aim of this study was to assess adolescent Bharatanatyam female dancers for female athlete triad (FAT) which includes low energy availability (LEA), musculoskeletal injury profile, gastrointestinal function and menstrual dysfunction using in females LEAF questionnaire.Methods: The approval was taken from the institutional review board of K. J. Somaiya college of physiotherapy. A pre-designed, pre-validated, questionnaire was distributed in the google form layout, among population according to the inclusion and exclusion criteria; asking for consent to confirm their willingness to participate voluntarily. After confirmation, the participants were directed to complete the LEAF questionnaire, maintaining their confidentiality. Data collected was analyzed using descriptive statistics.Results: A total of 82 participants took part in this study. The cumulative incidence of musculoskeletal injuries is about 50%. 35.4% of population experienced gaseous or bloated abdomen apart from menstrual function and 32.9% experienced cramps or stomach ache which were not related to menses. 7.3% of population reported primary amenorrhea, 35.8% reported secondary amenorrhea and 18.6% reported oligomenorrhea. Thus, overall, 34.5% population reported all the components of FAT.Conclusions: Prevalence of LEA in Bharatanatyam female dancers was reported amongst which prevalence of musculoskeletal injuries was high amongst the participants followed by menstrual dysfunction. LEA might have been interpreted as a usual or needed procedure to achieve better performance in past, but now it is recognized that it may lead to several negative consequences. Therefore, timely screening of dancers along with adequate training protocol will help alleviate LEA.

scholarly journals The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes

2019 ◽  
Vol 49 (S2) ◽  
pp. 125-137 ◽  
Author(s):  
Mary Jane De Souza ◽  
Kristen J. Koltun ◽  
Nancy I. Williams
Keyword(s):  
Bone Health ◽  
Female Athlete ◽  
Reproductive Function ◽  
Low Energy ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Male Athlete ◽  
Menstrual Dysfunction ◽  
Working Model ◽  
Low Energy Availability

Abstract The Female Athlete Triad represents three interrelated conditions of (i) low energy availability (energy deficiency), presenting with or without disordered eating, (ii) menstrual dysfunction, and (iii) poor bone health, each of which can exist along a continuum of severity ranging from mild and moderate subclinical health concerns to severe clinical outcomes, including eating disorders, amenorrhea, and osteoporosis. This review provides a brief overview of the Female Athlete Triad, including updating the current thinking regarding energy availability and how it relates to reproductive function, and sets the stage for an initial working model of a similar syndrome in males that will be based on currently available evidence and will later be defined and referred to as a Male Athlete Triad by the newly re-named Female and Male Athlete Triad Coalition. A primary focus of this paper will be on the physiology of each Triad model with an emphasis on low energy availability and its role in reproductive function, with a brief introduction on its effects on bone health in men. From the data reviewed, (i) a specific threshold of energy availability below which menstrual disturbances are induced is not supported; (ii) it appears that the energetic, reproductive, and bone systems in men are more resilient to the effects of low energy availability compared to those of women, requiring more severe energetic perturbations before alterations are observed; and (iii) it appears that recovery of the hypothalamic pituitary gonadal axis can be observed more quickly in men than in women.

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.

Characterization of Risk Quantification Differences Using Female Athlete Triad Cumulative Risk Assessment and Relative Energy Deficiency in Sport Clinical Assessment Tool

2019 ◽  
Vol 29 (6) ◽  
pp. 569-575 ◽  
Author(s):  
Bryan Holtzman ◽  
Adam S. Tenforde ◽  
Allyson L. Parziale ◽  
Kathryn E. Ackerman
Keyword(s):  
Female Athlete ◽  
Assessment Tool ◽  
Cumulative Risk ◽  
Relative Energy ◽  
Risk Level ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Energy Deficiency ◽  
Low Energy Availability

This study’s objective was to identify differences in risk for low energy availability and athletic clearance level by comparing scores on Female Athlete Triad Cumulative Risk Assessment (Triad CRA) and Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT). A total of 1,000 female athletes aged 15–30 years participating in ≥4 hr of physical activity/week for the previous ≥6 months completed an extensive survey assessing health, athletic history, family disease history, and specific Triad/RED-S risk factors. Retrospective chart review ascertained laboratory and bone mineral density measures. Triad CRA and RED-S CAT were used to assign each athlete’s risk level (low, moderate, and high), and case-by-case comparison measured the level of agreement between the tools. We hypothesized that the tools would generally agree on low-risk athletes and that the tools would be less aligned in the specific elevated risk level (moderate or high). Most of the sample was assigned moderate or high risk for Triad CRA and RED-S CAT (Triad: 54.7% moderate and 7.9% high; RED-S: 63.2% moderate and 33.0% high). The tools agreed on risk for 55.5% of athletes. Agreement increased to 64.3% when only athletes with bone mineral density measurements were considered. In conclusion, Triad CRA and RED-S CAT provide consensus on the majority of athletes at elevated (moderate or high) risk for low energy availability, but have less agreement on the specific risk level assigned.

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.

scholarly journals The female athlete triad: a current concepts review

2016 ◽  
Vol 23 (2) ◽  
Author(s):  
C George
Keyword(s):  
Bone Mineral Density ◽  
At Risk ◽  
Bone Mineral ◽  
Female Athlete ◽  
Well Being ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Mineral Density ◽  
Menstrual Function ◽  
Positive Effects

Female athletic participation continues to grow throughout the world. This has many positive effects on health and well-being, but it has also led to a unique set of health problems. The female athlete triad was first described in 1992 by the American College of Sports Medicine, consisting of disordered eating, amenorrhoea and osteoporosis. An updated position stand was released in 2007 that modified the components of the triad to energy availability, menstrual function and bone mineral density. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, diagnosis and treatment. Each of the components of the triad exists on a continuum from healthy to pathological. Low energy availability, from either dietary restriction or increased expenditure, is the factor that leads to the pathological states of menstrual function and bone mineral density. Athletes especially at risk are those in sports requiring leanness or low body weight. Prevention and early recognition of triad disorders is crucial to ensure timely intervention and treatment. Treatment is centered on restoring energy availability to adequate levels (30 kcal.kg-1.d-1) to re-establish normal metabolic functioning. All those who work with female athletes must remain vigilant in the education, recognition and treatment of athletes at risk. Continued research and knowledge of the triad disorders aids the development of prevention and treatment strategies to allow women to continue to enjoy the benefits of regular exercise and physical activity throughout their lives.

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