Sérgio Fontinhas. The female athlete triad – Epidemiology,
endocrinology, assessment and nutritional intervention. Main article, AARR, May
1st, 2016.
Abstract
The term
'Female Athlete Triad' refers to a pattern of inter-related symptoms of disordered eating, amenorrhea and osteoporosis
in a number of female athletes. When these three medical conditions are present
the effects are synergetic and cause
a greater negative impact on health than each one alone.
Menstrual disorders are
associated not only with intensive exercise, but also with low body mass and
low body fat. Prolonged
menstrual disorders have a negative effect on the quality and quantity of
plasma lipoproteins, which favors the formation of atherosclerotic lesions.
There is a critical energy availability threshold of 30 kcal/kg LBM,
below which there are several and severe clinical complications. All types of exercise-associated
menstrual cycle
disturbances (EAMD)
can be observed below 30 kcal/kg/LBM.
Since pulsatile secretion of LH depends
on the energy availability, LH pulsatility is disrupted within 5 days when the
EA is reduced by more than 33% from 45 to between 20-30 kcal/kg/LBM. Low EA instigate cortisol release and high cortisol levels are associated
with reproductive disturbances and with a direct effect on bone mineral
density.
There is a significant decreased bone density
(BMD) in athletes suffering from amenorrhea and oligomenorrhea and even after
menstrual cycles are restored bone density can remain significantly lower compared
to the average value. BMD reflects the cumulative history of energy
availability and menstrual status, genetic factors, and exposure to nutritional
and behavioral factors associated with disordered
eating.
Typically, most female athletes only exhibit disordered eating habits rather than an
eating disorder such as anorexia nervosa our bulimia nervosa. Fasting, binge-eating, diet-pills,
laxatives and diuretics are all signs of disordered eating. Such
practices lower the energy availability.
Ultimately the
underlying cause of the menstrual disorder in athletes is an energy imbalance
less than 30 kcal/kg FFM/d. This is most seen in in sports that emphasize leanness or low body weight which may result in disordered eating, and
can potentially be fatal.
Increases
in EA can reverse menstrual disturbances when exercise training persists, but menses resumption in female athletes can take
approximately 6 months or 9–12 weeks, however the mean time to menses recovery could be longer than 1 year.
Athletes of different sports
disciplines have low level of knowledge regarding the potential health effects
of untreated menstrual dysfunctions. Female athletes also do not have sufficient knowledge on sport nutrition
and they use inadequate dietary practice leading to low energy availability and nutrient
deficiencies which can inhibit the reproductive function. Female athlete diets are found to be deficient several
micronutrients and fiber. It may take up to three months of dietary intervention
to change dietary habits of the athlete.
Contents
1. Intro
1.1 Epidemiology of eating disorders
1.2 Epidemiology of amenorrhea
1.1 Epidemiology of eating disorders
1.2 Epidemiology of amenorrhea
2. Endocrinology
2.1 Energy availability and the triad
2.1 Critical threshold of energy availability
2.2 LH pulsatility
2.3. Bone mineral density (BDM)
2.1 Energy availability and the triad
2.1 Critical threshold of energy availability
2.2 LH pulsatility
2.3. Bone mineral density (BDM)
3. Assessing the triad
3.1 Assessing disordered eating
3.2 Assessment of menstrual status
3.3 Energy balance
3.4 Assessment of nutritional status
3.5 Assessment of total energy expenditure and energy availability
3.1 Assessing disordered eating
3.2 Assessment of menstrual status
3.3 Energy balance
3.4 Assessment of nutritional status
3.5 Assessment of total energy expenditure and energy availability
4. Nonpharmacological dietary
intervention
Main article, AARR, May 1st,
2016
3700+ words, 113 references
Full article at www.alanaragonblog.com/aarr
3700+ words, 113 references
Full article at www.alanaragonblog.com/aarr
