Investigation of the Female Athlete Triad in Japanese Elite Wheelchair Basketball Players

Abstract

Background and objectives: Para-sports have become increasingly competitive, necessitating greater physical activity; secondary disorder prevention is therefore crucial. Among secondary disorders, the female athlete triad (FAT) is defined as low energy availability (EA), menstrual dysfunction, and low bone mineral density (BMD); although studied in able-bodied athletes, reports on female para-athletes are scarce. We retrospectively investigated the FAT in wheelchair basketball players in the Japanese national team. Materials and Methods: Thirteen female wheelchair basketball players (mean age: 28.9 ± 8.1 years) were enrolled. The medical history (underlying diseases, gynecological disorders, and stress fractures), athletic and sport-specific parameters (wheelchair basketball classification, and wheelchair usage conditions), hematological status (hemoglobin, iron, estradiol, progesterone, total P1NP, and TRACP-5b levels), nutritional status (total energy, protein, calcium, and iron intake), body composition (BMD and lean body mass (LBM)), and EA were assessed. Results: Two (15.4%) had pertinent gynecological histories and six (46.2%) had menstrual cycle disorders. Three (23.1%) experienced excessive menstrual flow and nine (69.2%) had menstrual pain. No stress fractures were reported. All laboratory data were within normal limits. Total energy and iron intakes based on age-specific requirements were 99.8% and 59.8%, respectively. Iron and hemoglobin levels correlated with menstrual flow (ρ = −0.63, p = 0.019 and ρ = −0.56, p = 0.046, respectively). The mean total BMD was 109.2%, and the mean EA (41.4 kcal/kg LBM) was lower than recommended levels. The leg BMD in spinal disorders was significantly lower than that in skeletal disorders (p = 0.003). The arm LBM was higher (150.6%) than that of age-matched controls. Conclusion: Among female wheelchair basketball players with FAT, the total BMD was comparable to that of age-matched controls; however, leg BMD in spinal disorders was significantly lower than that in skeletal disorders. Players with heavy menstrual flow had lower hemoglobin and iron levels. Further research is needed on the FAT to optimize health and sports performance among para-athletes.

Practical Application and Methodological Considerations on the Basics of Sports Nutrition in Basketball: A Comprehensive Systematic Review of Observational and Interventional Studies

“…As many as 24% of studies did not use valid methods for the identification of the condition (e.g., subjects were not instructed about keeping food diaries or diet recalling, and dietary evaluation was performed based on solely single-day recall) [15,16,19,21,31,32], and in the next 12% of studies the descriptions of methods for diet evaluation were 'unclear' (e.g., lack of clear description of study participants' familiarization with diet evaluation methodology) [30,34,39]. Studies that used food frequency questionnaires (FFQ) for diet evaluation [18,33] utilised validated tools. In one of the included studies, there was a great risk for lack of a standard way for measuring diet across all participants [31], due to a lack of any instructions given to the participants.…”

“…Still, one study (4%) was evaluated negatively [32] due to nearly 10% of participants who did not complete the dietary recall correctly (and taking into account the baseline compliance rate, which was 71%), and 12% of studies were evaluated as 'unclear' [27,37,39]. As many as 16% of studies (four studies) were rated 'yes' for all the questions [17,33,35,38]. These studies can be evaluated as having 'low' RoB.…”

“…Twenty-five of the studies assessed the energy and macronutrient intake of various samples of BP. The following methods were utilised for dietary intake evaluation: 3-[15,20-22,24,27,29,37,38], 4- [26], 5- [30,31], or 7-day [34,35] food diaries (FD); 24 h [16,19,77], 3 × 24 h [23,25], or 7 × 24 h [17] dietary recall (DR); FFQ [18,28,33], or 4-day recording via mobile app [39]. One study utilised a doubly labeled water method for the evaluation of energy expenditure [36].…”

“…The intake of FAT ranged from 58.5 [21] to 185.3 g FAT •day −1 [32] (from ~1.7 [29] to 2.1 g FAT •kg BM −1 •day −1 [32]) in males and from 63 [29] to 113 g FAT •day −1 [39] (from ~0.9 [29] to 1.5 g FAT •kg BM −1 •day −1 [39]) in females. Seven studies (28%) investigated energy and nutritional value of habitual diet in paraathlete BP [17,19,20,22,33,37,38], of which six studies focused on wheelchair BP [19,20,22,33,37,38] and one on deaf BP [17]. Among female wheelchair BP, EI ranged from ~1635 [33,38] to 2867.8 kcal•day −1 [19] (from 26.8 [38] to ~50.0 kcal•kg BM −1 •day −1 [19]), while in male adult wheelchair BP it was comparable across studied groups [20,22,37,38], being ~2400-2500 kcal•day −1 [from 32.4 [37] to 34.8 kcal•kg BM −1 •day −1 [20]].…”

Edukasi Tentang Pentingnya Gizi Olahraga Pada Atlet Basket Kursi Roda

“…Akan tetapi, hasil studi lain juga menemukan bahwa didapatkan atlet kursi roda pada wanita mengomsumsi asupan gizi di bawah kebutuhan gizinya (Egger & Flueck, 2020). Atlet kursi roda wanita pada timnas di Jepang menemukan bahwa atlet basket kursi roda berisiko memiliki kepadatan tulang yang rendah, kadar hemoglobin dan zat besi yang lebih rendah (Shimizu, Mutsuzaki, Tachibana, Hotta, & Wadano, 2020). Persepsi tentang zat gizi pada atlet dengan keterbatasan ini masih kurang sehingga perlu pendempingan khusus oleh ahli gizi (Deguchi et al, 2021).…”