Interrelationships of diet, athletic activity, menstrual status, and bone density in collegiate women

Lloyd, Tom; Buchanan, J.R.; Bitzer, Sally; Waldman, Chen; Myers, Cathleen; Ford, B.

doi:10.1093/ajcn/46.4.681

Cited by 74 publications

(29 citation statements)

References 31 publications

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“…Numerous studies have shown a correlation between menstrual irregularities and incidence of scoliosis and stress fractures among athletes (Cann et al 1984, Drinkwater et al 1984, Lindberg et al 1984, Marcus et al 1985, Warren et al 1986, Lloyd et al 1987, Barrow & Saha 1988. In one study, scoliosis was reported in 24% of ballet dancers, much higher than that in the general population; 83% of dancers with scoliosis had delayed menarche, whereas only 54% of dancers without scoliosis reported delayed menarche (Warren et al 1986).…”

Section: Skeletal Problemsmentioning

confidence: 99%

The effects of intense exercise on the female reproductive system

Warren¹,

Perlroth²

2001

Journal of Endocrinology

375

198

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Women have become increasingly physically active in recent decades. While exercise provides substantial health benefits, intensive exercise is also associated with a unique set of risks for the female athlete. Hypothalamic dysfunction associated with strenuous exercise, and the resulting disturbance of GnRH pulsatility, can result in delayed menarche and disruption of menstrual cyclicity.Specific mechanisms triggering reproductive dysfunction may vary across athletic disciplines. An energy drain incurred by women whose energy expenditure exceeds dietary energy intake appears to be the primary factor effecting GnRH suppression in athletes engaged in sports emphasizing leanness; nutritional restriction may be an important causal factor in the hypoestrogenism observed in these athletes. A distinct hormonal profile characterized by hyperandrogenism rather than hypoestrogenism is associated with athletes engaged in sports emphasizing strength over leanness. Complications associated with suppression of GnRH include infertility and compromised bone density. Failure to attain peak bone mass and bone loss predispose hypoestrogenic athletes to osteopenia and osteoporosis.Metabolic aberrations associated with nutritional insult may be the primary factors effecting low bone density in hypoestrogenic athletes, thus diagnosis should include careful screening for abnormal eating behavior. Increasing caloric intake to offset high energy demand may be sufficient to reverse menstrual dysfunction and stimulate bone accretion. Treatment with exogenous estrogen may help to curb further bone loss in the hypoestrogenic amenorrheic athlete, but may not be sufficient to stimulate bone growth. Treatment aimed at correcting metabolic abnormalities may in fact prove more effective than that aimed at correcting estrogen deficiencies.

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Section: Skeletal Problemsmentioning

confidence: 99%

The effects of intense exercise on the female reproductive system

Warren¹,

Perlroth²

2001

Journal of Endocrinology

375

198

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“…Lloyd et al (1987) encontraram uma relação positiva entre o consumo de fibras e as irregularidades menstruais. O aumento deste consumo também está relacionado com alterações no metabolismo do estrógeno.…”

Section: Inadequação Nutricionalunclassified

“…No entanto, atletas com baixo consumo de energia têm ingestão protéica inferior à daquelas com consumo energético normal. Assim, estudos mostraram que a ingestão protéica em si não possui relação com as irregularidades menstruais (Hale, 1984;Lloyd et al, 1987;Fruth & Worrell, 1995).…”

Section: Inadequação Nutricionalunclassified

Amenorréia e osteoporose em adolescentes atletas

2002

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A participação feminina no esporte foi crescendo ao longo dos anos. Trabalhos científicos têm mostrado os benefícios trazidos por esta prática para a saúde da mulher, mas quando se trata de esporte competitivo podem surgir problemas. A complicação mais comum descrita pela literatura é a "tríade da atleta", a qual envolve três processos: o distúrbio alimentar, a amenorréia e a osteoporose. A amenorréia atinge, nos Estados Unidos, até 66% das atletas de competição, e algumas de suas possíveis causas são: perda de peso, excesso de treino, quantidade insuficiente de gordura corporal, perda de estoques específicos de gordura corporal e dieta inadequada. Como conseqüência da amenorréia, a esportista pode desenvolver osteoporose precoce.Não se sabe ao certo a porcentagem de atletas com osteopenia, mas há indícios de que a falta de estrógeno, a dieta inadequada e o consumo insuficiente de cálcio serem fatores que as predispõem a desenvolver a doença.Termos de indexação: puberdade, amenorréia, osteoporose, exercício, atletas, adolescente, dieta. A B S T R A C T

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“…Marcus et al (33) More specifically, Lloyd et al (29) suggested that a high fiber intake could be considered a cause of menstrual irregularity. In contrast, Nelson et a1 (37) found no difference in fiber consumption between their amenorrheic and eumenorrheic subjects.…”

Section: Training Parametersmentioning

confidence: 99%

“…Criteria for amenorrhea have ranged from 3 to 12 months without menstruation (12,32,34). Oligomenorrhea has been used as a somewhat arbitrary term, denoting irregular cycles occurring from 33-to 90-day intervals (10,29,48,49). Eumenorrhea describes a normal menstrual pattern of 10-13 menses per year (12,32,40).…”

mentioning

confidence: 99%

Factors Associated With Menstrual Irregularities and Decreased Bone Mineral Density in Female Athletes

Fruth¹,

Worrell²

1995

J Orthop Sports Phys Ther

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n intense preoccupation with leanness and low body weight exists in the athletic population. This is especially apparent in young female athletes. M'ith strong intrinsic and extrinsic pressure to perform and the need to appear lean and fit, training is often taken to extremes. Whether the athlete's goal is to improve performance, become "ultra fit," o r lose weight, the results are often similar in the female population: menstrual irregularity, namely amenorrhea. While the absence of menses may be a pleasant convenience for the female athlete, she may be completely unaware that her skeleton could suffer irreversible consequences, such as decreased peak bone mass and eventual osteoporosis (7,38). Athletic amenorrhea, also termed hypothalamic hypogonadism (23), has been shown to cause substantial decreases in bone mineral density (BMD) at various sites in the body, especially in areas of high trabecular content (10,13,14, 29,32,38,44). Unfortunately, the loss of BMD is a silent process, and the athlete is usually unaware that a problem exists until a related injury, such as a stress fracture, occurs.Numerous variables are thought to be associated with athletic amenorrhea: training intensity, hours spent training, diet, body weight, body composition, age of menarche, type of sport, and psychological stress (8, l2,29). While many authors have sought to determine the specific cause of menstrual irregularities in female athletes, n o evidence exists demonstrating that a single risk factor is responsible (32). Therefore, it is likely that all (or at least several) of these factors are working in concert and contribute to menstrual disturbance (7,12,32,40).Regardless of the cause, menstrual irregularities are common among female athletes ( 1 2-15,23). As many as 51 % of endurance runners (1 1 ), 44% of ballet dancers (5), and 12% of swimmers and cyclist3 (45) have reported menstrual disturbances during periods of training. Rutherford (44), who studied female triathletes, found that 50% of the subjects experienced menstrual disturbances. Furthermore, these women reported that "[menstrual irregularities] were representative of the general incidence among good triathletes." Although resumption of menses usually occurs following a reduction o r cessation of training (13,15,41), it is not known if the decrease in BMD is permanent and will predispose the women to stress fractures or osteope rosis (1 3,15,32,4O).In addition to the large number of variables involved in these studies, interpretation of the results is made difficult by the lack of standard definitions of menstrual categories. Criteria for amenorrhea have ranged from

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Interrelationships of diet, athletic activity, menstrual status, and bone density in collegiate women

Cited by 74 publications

References 31 publications

The effects of intense exercise on the female reproductive system

The effects of intense exercise on the female reproductive system

Amenorréia e osteoporose em adolescentes atletas

Factors Associated With Menstrual Irregularities and Decreased Bone Mineral Density in Female Athletes

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