Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women

Papageorgiou, Maria; Martín, Daniel; Colgan, Hannah; Cooper, Simon B.; Greeves, Julie P.; Tang, Jonathan; Fraser, William D.; Elliott‐Sale, Kirsty J.; Sale, Craig

doi:10.1016/j.bone.2018.06.016

Cited by 43 publications

(60 citation statements)

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“…In the fasted state, studies of longer periods of continuous energy restriction have observed a dose-response decrease in markers of bone formation (P1CP) when energy availability was restricted to 10, 20 or 30 kcal kg LBM −1 day −1 for 5 days, but N-terminal telopeptide (NTX; a marker of bone resorption) was only increased in the 10 kcal kg LBM −1 day −1 condition [12]. Similarly, Papageorgiou et al [11] showed a decrease in a marker of bone formation (P1NP), but no change in a marker of bone resorption (CTX) after restricting energy availability to 15 kcal kg LBM −1 day −1 for 3 days. In combination with the current study, these studies suggest that the length of energy restriction or the total energy deficit created is important when considering the effect on bone formation and resorption.…”

Section: Discussionmentioning

confidence: 85%

“…Energy restriction is a risk factor for stress fracture incidence [9,10], bone metabolism is markedly disrupted by 3-5 days of energy restriction (i.e. 10-30 kcal kg LBM −1 day −1 ), as evidenced by reductions in plasma markers of bone formation but without a corresponding decrease in bone resorption markers [11,12]. Whilst these studies clearly demonstrate the potential for sustained moderate-severe energy restriction to impair bone health, typically, intermittent energy restriction involves shorter periods (1-2 days) of limited energy intake (~ 10-15 kcal kg LBM −1 day −1 ) but interspersed with refeeding periods [6].…”

Section: Introductionmentioning

confidence: 99%

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Severely restricting energy intake for 24 h does not affect markers of bone metabolism at rest or in response to re-feeding

et al. 2020

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Purpose Intermittent energy restriction commonly refers to ad libitum energy intake punctuated with 24 h periods of severe energy restriction. This can improve markers of metabolic health but the effects on bone metabolism are unknown. This study assessed how 24 h severe energy restriction and subsequent refeeding affected markers of bone turnover. Methods In a randomised order, 16 lean men and women completed 2, 48 h trials over 3 days. On day 1, participants consumed a 24 h diet providing 100% [EB: 9.27 (1.43) MJ] or 25% [ER: 2.33 (0.34) MJ] of estimated energy requirements. On day 2, participants consumed a standardised breakfast (08:00), followed by an ad libitum lunch (12:00) and dinner (19:30). Participants then fasted overnight, returning on day 3. Plasma concentrations of C-terminal telopeptide of type I collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP) and parathyroid hormone (PTH) were assessed as indices of bone metabolism after an overnight fast on days 1-3, and for 4 h after breakfast on day 2. Results There were no differences between trials in fasting concentrations of CTX, P1NP or PTH on days 1-3 (P > 0.512). During both trials, consuming breakfast reduced CTX between 1 and 4 h (P < 0.001) and PTH between 1 and 2 h (P < 0.05), but did not affect P1NP (P = 0.773) Postprandial responses for CTX (P = 0.157), P1NP (P = 0.148) and PTH (P = 0.575) were not different between trials. Ad libitum energy intake on day 2 was greater on ER [12.62 (2.46) MJ] than EB [11.91 (2.49) MJ]. Conclusions Twenty-four hour severe energy restriction does not affect markers of bone metabolism.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Severely restricting energy intake for 24 h does not affect markers of bone metabolism at rest or in response to re-feeding

et al. 2020

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“…An outstanding body of work led by Prof. Anne Loucks encompassed several rigorously executed clinical trials and established that energy availability, and not stress of exercise, was the underlying cause of these and other endocrine dysregulations in females (Tables 2, 3). Further work by us (Areta et al 2014(Areta et al , 2020Koehler et al 2016b;Murphy and Koehler 2020;Smiles et al 2015) and others (Ishibashi et al 2020;Kojima et al 2020;Papageorgiou et al 2017Papageorgiou et al , 2018 expanded this area to other physiological systems of interest in both sexes. The current section summarises this research grouped in endocrine systems and tissues, organised hierarchically in (1) General endocrine response (leptin, hypothalamic-pituitary-thyroid axis, and Growth hormone-Insulin-like growth-factor axis and cortisol) (Table 2); (2) hypothalamic-pituitary-gonadal axis (Table 3); (3) Bloodborne metabolic substrates, (4) bone metabolism (Table 4), and, (5) skeletal muscle responses (Table 5), all of which is summarised in a figure (Fig.…”

Section: Endocrine Metabolic and Physiological Effects Of Low Energymentioning

confidence: 99%

Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males

2020

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Energy availability (EA) is defined as the amount of dietary energy available to sustain physiological function after subtracting the energetic cost of exercise. Insufficient EA due to increased exercise, reduced energy intake, or a combination of both, is a potent disruptor of the endocrine milieu. As such, EA is conceived as a key etiological factor underlying a plethora of physiological dysregulations described in the female athlete triad, its male counterpart and the Relative Energy Deficiency in Sport models. Originally developed upon female-specific physiological responses, this concept has recently been extended to males, where experimental evidence is limited. The majority of data for all these models are from cross-sectional or observational studies where hypothesized chronic low energy availability (LEA) is linked to physiological maladaptation. However, the body of evidence determining causal effects of LEA on endocrine, and physiological function through prospective studies manipulating EA is comparatively small, with interventions typically lasting ≤ 5 days. Extending laboratory-based findings to the field requires recognition of the strengths and limitations of current knowledge. To aid this, this review will: (1) provide a brief historical overview of the origin of the concept in mammalian ecology through its evolution of algebraic calculations used in humans today, (2) Outline key differences from the ‘energy balance’ concept, (3) summarise and critically evaluate the effects of LEA on tissues/systems for which we now have evidence, namely: hormonal milieu, reproductive system endocrinology, bone metabolism and skeletal muscle; and finally (4) provide perspectives and suggestions for research upon identified knowledge gaps.

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“…Of the more specific issues for the athlete, undoubtedly the biggest factor is the avoidance of low energy availability, which is essential to avoid negative consequences for bone (Papageorgiou et al, 2018a(Papageorgiou et al, , 2018b). Ihle and Loucks (2004) were among the first to demonstrate this, showing that bone formation was reduced at an energy availability (EA) of 30 kcal•kg LBM −1 •day −1 .…”

Section: Nutrition To Prevent and Treat Bone Injuriesmentioning

confidence: 99%

“…In athletes, this poses the question of whether the effect of low energy availability on bone is a result of dietary restriction or high exercise energy expenditures. Recently, the effects of 3 days low energy availability (at 15 kcal•kg LBM −1 •day −1 ) achieved by diet or exercise on bone turnover markers in active, eumenorrheic women were examined (Papageorgiou et al, 2018b). Low EA achieved through inadequate dietary energy intake resulted in decreased bone formation but no change in bone resorption, whereas low EA achieved through exercise did not significantly influence bone metabolism, highlighting the importance of adequate dietary intakes for the athlete.…”

Section: Nutrition To Prevent and Treat Bone Injuriesmentioning

confidence: 99%

Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes

Sale

Baar³

et al. 2019

International Journal of Sport Nutrition and Exercise Metabolism

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Injuries are an inevitable consequence of athletic performance with most athletes sustaining one or more during their athletic careers. As many as one in 12 athletes incur an injury during international competitions, many of which result in time lost from training and competition. Injuries to skeletal muscle account for over 40% of all injuries, with the lower leg being the predominant site of injury. Other common injuries include fractures, especially stress fractures in athletes with low energy availability, and injuries to tendons and ligaments, especially those involved in high-impact sports, such as jumping. Given the high prevalence of injury, it is not surprising that there has been a great deal of interest in factors that may reduce the risk of injury, or decrease the recovery time if an injury should occur: One of the main variables explored is nutrition. This review investigates the evidence around various nutrition strategies, including macro- and micronutrients, as well as total energy intake, to reduce the risk of injury and improve recovery time, focusing upon injuries to skeletal muscle, bone, tendons, and ligaments.

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Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women

Cited by 43 publications

References 49 publications

Severely restricting energy intake for 24 h does not affect markers of bone metabolism at rest or in response to re-feeding

Severely restricting energy intake for 24 h does not affect markers of bone metabolism at rest or in response to re-feeding

Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males

Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes

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