Fueling the Female Athlete: Auditing Her Representation in Studies of Acute Carbohydrate Intake for Exercise

Kuikman, Megan A.; Smith, Ella S.; McKay, Alannah K A; Ackerman, Kathryn E.; Harris, Rachel; Elliott‐Sale, Kirsty J.; Stellingwerff, Trent; Burke, Louise M.

doi:10.1249/mss.0000000000003056

Cited by 16 publications

(15 citation statements)

References 51 publications

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“…Accordingly, log-transformation of these three variables occurred before analysis. Fixed effects for MC function (athleteNC or athleteHC) and cycle phase (1,2,4) were included, with a random effect of subject ID. Statistical significance of fixed effects occurred using type II Wald tests with Kenward–Roger degrees of freedom, with post hoc analysis performed using Tukey adjustments.…”

Section: Methodsmentioning

confidence: 99%

“…Female athletes are underrepresented in sport and exercise science (SES) research, with audits reporting not only the relative lack of research examining highly trained female athletes, but issues of quality [e.g., inadequate description of the training status/caliber of participants, poor standardization and characterization of menstrual-cycle (MC) function and phase] (1–3). A call to action for better research involving female athletes as participants inspired our research groups to collaborate on a project: Female Athlete Research Camp (FARC).…”

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confidence: 99%

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Female Athlete Research Camp: A Unique Model for Conducting Research in High-Performance Female Athletes

MCKAY,

MINAHAN,

HARRIS

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose To describe the implementation of a novel research protocol for conducting research with highly-trained female athletes, including characterising menstrual cycle (MC) function, hormonal profiles and symptoms of the participating athletes. Methods Twenty-four Australian First Nation female Rugby League athletes completed this study, which involved 11 weeks of cycle tracking, followed by attendance at a 5-week training camp. Throughout the study, athletes completed a daily survey, reporting their MC function and any associated symptoms. During the training camp, athletes reported to the laboratory on three occasions and provided a venous blood sample, which was analysed for reproductive hormones. For naturally cycling athletes (athleteNC, n = 11), this included Phase 1, 2 and 4 of the menstrual cycle, whereas athletes using hormonal contraception (athleteHC; n = 13) were tested at three equally spaced time points in which consistent exogenous hormone provision occurred. Results In the athleteNC cohort, just one athlete reached criteria for classification as eumenorrheic, with five athletes showing evidence of MC dysfunction. The prevalence of symptoms on any given day was similar between athleteNC (33.7%) and athleteHC (22.9%; p = 0.376), however more symptoms were reported in athleteNC, suggesting that they were more likely to report multiple symptoms. Regardless of MC function, there was a significant, positive association between bleeding and symptoms (p < 0.001), where athletes were more likely to report one or more symptoms on bleeding (50.1%) compared to non-bleeding days (22.0%). Conclusions We describe an innovative strategy to investigate the effect of MC function and MC phase in a high-performance sport environment, including approaches to address the challenges of undertaking research with female athletes with MC variability and those using exogenous hormonal therapies.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Female Athlete Research Camp: A Unique Model for Conducting Research in High-Performance Female Athletes

MCKAY,

MINAHAN,

HARRIS

et al. 2023

Medicine &Amp; Science in Sports &Amp; Exercise

Self Cite

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“…However, it may be necessary to account for sex-based differences in determining CHO intake guidelines based on sex and sport type. In a 2022 publication, researchers conducted an audit of 937 research studies evaluating acute CHO intake recommendations to assess if there was evidence to support the use of these strategies among female athletes [4]. Only 11% (n = 197 of 937 studies) of the participants in these studies were women, and of these studies, only 31% utilized sufficient methodologies to define menstrual status [4].…”

Section: Introductionmentioning

confidence: 99%

“…In a 2022 publication, researchers conducted an audit of 937 research studies evaluating acute CHO intake recommendations to assess if there was evidence to support the use of these strategies among female athletes [4]. Only 11% (n = 197 of 937 studies) of the participants in these studies were women, and of these studies, only 31% utilized sufficient methodologies to define menstrual status [4]. The persisting nutritional recommendations for female athletes emphasize the primary goal of obtaining sufficient energy availability (EA) and hydration.…”

Section: Introductionmentioning

confidence: 99%

Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review

Lodge,

Ward-Ritacco,

Melanson

2023

Nutrients

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The purpose of this narrative review is to identify health and performance consequences associated with LCA in female endurance athletes. The intake of carbohydrates (CHO) before, during, and after exercise has been demonstrated to support sport performance, especially endurance activities which rely extensively on CHO as a fuel source. However, low energy availability (LEA) and low carbohydrate availability (LCA) are common in female athletes. LEA occurs when energy intake is insufficient compared to exercise energy expenditure, and LEA-related conditions (e.g., Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S)) are associated with a myriad of health and performance consequences. The RED-S model highlights 10 health consequences and 10 performance consequences related to LEA. The independent effect of LCA on health and performance has been under-researched, despite current CHO intake being commonly insufficient in athletes. It is proposed that LCA may not only contribute to LEA but also have independent health and performance consequences in athletes. Furthermore, this review highlights current recommendations for CHO intake, as well as recent data on LCA prevalence and menstrual cycle considerations. A literature review was conducted on PubMed, Science Direct, and ResearchGate using relevant search terms (i.e., “low carbohydrate/energy availability”, “female distance runners”). Twenty-one articles were identified and twelve met the inclusion criteria. The total number of articles included in this review is 12, with 7 studies illustrating that LCA was associated with direct negative health and/or performance implications for endurance-based athletes. Several studies included assessed male athletes only, and no studies included a female-only study design. Overall, the cumulative data show that female athletes remain underrepresented in sports science research and that current CHO intake recommendations and strategies may fail to consider female-specific adaptations and hormone responses, such as monthly fluctuations in estrogen and progesterone throughout the menstrual cycle. Current CHO guidelines for female athletes and exercising women need to be audited and explored further in the literature to support female athlete health and performance.

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“…We recently conducted an audit of the literature from which guidelines for acute strategies to manipulate CHO availability around a single session of exercise have been derived (Kuikman et al, 2022). Therein we showed both a dearth of female participants and poor attention to hormonal characterization and standardization in the studies that included females.…”

mentioning

confidence: 99%

Female Athlete Representation and Dietary Control Methods Among Studies Assessing Chronic Carbohydrate Approaches to Support Training

Kuikman

McKay

Smith

et al. 2023

International Journal of Sport Nutrition and Exercise Metabolism

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The aim of this audit was to assess the representation of female athletes, dietary control methods, and gold standard female methodology that underpins the current guidelines for chronic carbohydrate (CHO) intake strategies for athlete daily training diets. Using a standardized audit, 281 studies were identified that examined high versus moderate CHO, periodized CHO availability, and/or low CHO, high fat diets. There were 3,735 total participants across these studies with only ∼16% of participants being women. Few studies utilized a design that specifically considered females, with only 16 studies (∼6%) including a female-only cohort and six studies (∼2%) with a sex-based comparison in their statistical procedure, in comparison to the 217 studies (∼77%) including a male-only cohort. Most studies (∼72%) did not provide sufficient information to define the menstrual status of participants, and of the 18 studies that did, optimal methodology for control of ovarian hormones was only noted in one study. While ∼40% of male-only studies provided all food and beverages to participants, only ∼20% of studies with a female-specific design used this approach for dietary control. Most studies did not implement strategies to ensure compliance to dietary interventions and/or control energy intake during dietary interventions. The literature that has contributed to the current guidelines for daily CHO intake is lacking in research that is specific to, or adequately addresses, the female athlete. Redressing this imbalance is of high priority to ensure that the female athlete receives evidence-based recommendations that consider her specific needs.

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Fueling the Female Athlete: Auditing Her Representation in Studies of Acute Carbohydrate Intake for Exercise

Cited by 16 publications

References 51 publications

Female Athlete Research Camp: A Unique Model for Conducting Research in High-Performance Female Athletes

Female Athlete Research Camp: A Unique Model for Conducting Research in High-Performance Female Athletes

Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review

Female Athlete Representation and Dietary Control Methods Among Studies Assessing Chronic Carbohydrate Approaches to Support Training

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