title: Energy availability and the female athlete triad in elite endurance athletes.
abstract: The female athlete triad (Triad), links low energy availability (EA), with menstrual dysfunction (MD), and impaired bone health. The aims of this study were to examine associations between EA/MD and energy metabolism and the prevalence of Triad-associated conditions in endurance athletes. Forty women [26.2 ± 5.5 years, body mass index (BMI) 20.6 ± 2.0 kg/m(2), body fat 20.0 ± 3.0%], exercising 11.4 ± 4.5 h/week, were recruited from national teams and competitive clubs. Protocol included gynecological examination; assessment of bone health; indirect respiratory calorimetry; diet and exercise measured 7 days to assess EA; eating disorder (ED) examination; blood analysis. Subjects with low/reduced EA (< 45 kcal/kg FFM/day), had lower resting metabolic rate (RMR) compared with those with optimal EA [28.4 ± 2.0 kcal/kg fat-free mass (FFM)/day vs 30.5 ± 2.2 kcal/kg FFM/day, P < 0.01], as did subjects with MD compared with eumenorrheic subjects (28.6 ± 2.4 kcal/kg FFM/day vs 30.2 ± 1.8 kcal/kg FFM/day, P < 0.05). 63% had low/reduced EA, 25% ED, 60% MD, 45% impaired bone health, and 23% had all three Triad conditions. 53% had low RMR, 25% hypercholesterolemia, and 38% hypoglycemia. Conclusively, athletes with low/reduced EA and/or MD had lowered RMR. Triad-associated conditions were common in this group of athletes, despite a normal BMI range. The high prevalence of ED, MD, and impaired bone health emphasizes the importance of prevention, early detection, and treatment of energy deficiency.
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Melin
authors.affiliation: Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.|Genetic & Molecular Epidemiology (GAME) Unit, Lund University Diabetes Center, Clinical Research Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Å B
authors.initials: ÅB
authors.lastname: Tornberg
authors.affiliation: Endocrinological and Reproductive Unit, Department of Ob/Gyn. Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Skouby
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: S S
authors.initials: SS
authors.lastname: Møller
authors.affiliation: Norwegian School of Sports, Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Sundgot-Borgen
authors.affiliation: Endocrinological and Reproductive Unit, Department of Ob/Gyn. Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Faber
authors.affiliation: Unit for Thrombosis Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sidelmann
authors.affiliation: Endocrinological and Reproductive Unit, Department of Ob/Gyn. Herlev Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Aziz
authors.affiliation: Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Sjödin
mesh_terms: D000328:Adult; D001481:Basal Metabolism; D015519:Bone Density; D002153:Calorimetry, Indirect; D015930:Diet Records; D002149:Energy Intake; D005260:Female; D053716:Female Athlete Triad Syndrome / Q000150:complications / Q000503:physiopathology*; D058869:Gynecological Examination; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications; D006973:Hypertension / Q000503:physiopathology; D007003:Hypoglycemia / Q000097:blood / Q000150:complications; D020738:Leptin / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D008599:Menstruation Disturbances / Q000503:physiopathology; D010807:Physical Endurance / Q000502:physiology*; D055815:Young Adult
chemical_list: D020738:Leptin; D007986:Luteinizing Hormone
keywords: Energy metabolism; amenorrhea; eating disorders; hypercholesterolemia; osteoporosis