The Female Athlete Triad

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Bulimia Nervosa: Purging type

regularly engages in self inducing vomiting

Risk Factors

Athletes at risk for low energy availability: restrict dietary intake, exercise for prolonged periods, limit the types of food they eat

Risk Factors Specific to Sports for Developing Eating disorders

Characteristics of sport, emphasis on leanness or individual competition Sudden increase of training volume Injury or illness results in fear or weight gain

Anorexia Nervosa

Characterized by restrictive eating Refusal to maintian body weight at or above a minimally normal weirght for age and heigh

Outflow Tract Abnormalities

Consider when primary amenorrhoea and normal sexual development Endometrial lining Obstructed outflow tract

Amenorrhea

Continually to be the problem that first brings a female athlete to medical attention 2-5% in general female population 8.5% in unselected adolescent population 19% in Olympic marathon athletes 3.4-66^ of certain groups of athletes

Weight Loss Performance

Could reducing body fat improve sports performance? No evidence will enhance in already lean athletes Further loss of lean mass- adverse effects

Body Composition and Amenorrhoea

Critical fat content for normal menstrual function? Possible, but vary widely among individuals Regional adiposity? Fat threshold in femoral region?

Menstrual Disorders

Delayed menarche- onset of menses after age of 15 years, retrospective definition Review- establishment of ovarian cycle

Disordered Eating

Eating disordesr: anorexia nervoa, bulimia nervosa Binge eating Other disordered eating behaviors

Pituitary Reason

Energy availability: LH pulsatility is disrupted within 5 days when energy availability is reduced by >33% High prolactic levels (secreted by pituitary gland)- suppressed GnRH secretion

Prevalence

High in female athletes than the general female population Higher in aesthetic, weight dependent sports, and leanness sports

Health consequences of Amenorrhea: Hypoestrogenism

Impaired endothlium dependent arterial vasodilation reduces perfusion of working muscle, impaired skeletal muscle oxidative metabolism Unfavorable lipid profile

Low Energy Availability

Inadequate energy intake compared to energy expenditure Insufficient stored energy to maintain physiological processes

Low Energy Availability Energy Balance

Increase energy expenditure, sports participation

Health Consequences of Amenorrhea

Infertility While recover, may ovulate before menses are restored, unexpected pregnany Musculoskeletal injuries higher

Anorexia Nervosa

Intense fear of gianing weight or becoming fat, enough though underweight Rapid weight loss

Other symptoms

Irregular periods Chronic sore throat Worn tooth enamel Swollen salivary glands Heartburn Constipation Dehydration Electrolyte imbalance

Lowe Energy Availability

Is source of the other two components (amenorrhea and osteoporosis) Physiological adaptations, energy conservation- menstrual cycle disturbances and affected bone metabolism

Eating Disorders on Sports Performance

Loss of endurance due to dehydration: reduced plasma volume, impaired thermoregulation and nutrient exchange, decreased glycogen availability

Other symptoms

Loss of menstrual periods Brittle hair and nails Yellowing skin Cold sensitivity Slow reaction or lethargy Depression Long term- anemia, thinning bones, damage to heart, organ failure, and death

Body Composition and Osteoporosis

Low body weight is a risk factor for osteoporosis In general, large muscle mass also large bone mass; muscle strength is a determinant of bone muscle density in the skeletal regions on which the muscles act

Mechanism for Menstrual Disorders in the Triad

Low energy availability alters levels of metabolic hormones and substrates: insulin, cortisol, growth hormone, glucose, fatty acids Metabolic signals to GnRH secreting neurons

Menstrual Disorders

Luteal phase deficiency- a lag of more than 2 days in histological development of endometrium Endometrium biopsies, progesterone measurements

Menstrual Disorders: Oligomenorrhea

Menstrual cycles occur at intervals longer than 35 days, with only 4-9 periods a year Usually associated with anovulation

Bulimia Nervosa: Non purging type

Other inappropriate compensatory behaviors, such as self induced vomiting, misuse of laxatives, diuretics, fasting or excessive exercise

Ovarian Reason

Ovarian failure- few or no functional oocytes remaining When estrogen is present but not progesterone, the endometrium develops but bleed erratically and infrequent

Ovarian Reason

Polycysitc ovarian disease- chronic anovulation with excessive androgen Administration of androgens

Triad

Potentially irreversible health consequences Tend to occur in female athletes participating in sports where successful performance is dependent on, physiologically and/or aesthetically, a low body fat content

Cause of Amenorrhea and Menstrual Dysfunctions

Pregnancy

Body Composition and Sports Performance

Principle driving force behind the development of female athlete triad Body fat tend to be lower: sports that require moving/lifting the body mass Elite sports women < non elite < non athletes

Health Consequences of Disordered Eating

Psychological problems: low self esteem, depression, anxiety disorders Medical complications involve many systems Mortality rates higher: fluid and electrolyte abnormalities, suicide

Bulimia Nervosa

Recurrent episodes of binge eating and then purging or other compensatory behaviors in order to prevent weight gain Eating an amount of food larger than most people would eat A sense of lack of control over eating during the episode

Low Energy availability Energy Balance

Reduce energy intake: disordered eating behaviors - fasting, binge eating and purging, use diet pills, laxatives Eating disorders

Treatment Considerations

Reduce exercise volume, intensity? Estrogen or progesterone treatment Assessment of eating disorders GnRH, LH, FSH treatment

Low Energy Availability

Reproductive dysfunction - low estrogen concentrations - impairs bone health Low energy availability also causes endocrine changes- further impairs

Risk Factors Specific to Sports for Developing Eating Disorders

Sport attracts individuals who are anorectic Pressure to reduce weight, and rapid periods of restrictive dieting or weight cycling Characteristics of sport, emphasis on leanness or individual competition

Hypothalamic Reason

Stressful life events: physical and emotional stress GnRH producing cells in hypothalamus

Triad

The three interrelated spectrum: low energy availability (with or without eating disorders), amenorrhea, and osteoporosis

Hypothalamic Reason

When the GnRH pulses that reach the pituitary gland decrease below a critical frequency or concentration, or are disorders Low energy availability alters metabolic hormone levels and substrates - metabolic signal to GnRH secreting neurons to disrupt GnRH pulsatility

Eating disorder not otherwise specific

Who do not meet all criteria for anorexia nervosa or bulimia nervos. Ex an individual who: Meet all anorexia nervosa criteria but has regular menses Meet all bulimia nervosa criteria but binges and purges less than twice per week

Menstrual Disorders: Amenorrhea

Absence of menstrual bleeding for 3 months Primary amenorrhoea- have not had menstrual bleeding by 15 years. A daly in age of menarche Secondary amenorrhoea

Bulimia Nervosa

Affected individuals usually in normal weight range or just slightly overweight Deep fear or gaiing weight

Treatment

Aim-increase energy availability Trusting relationship between the athlete and care providers Training and competition during treatment Type of treatment: individual, group, family / inpatient vs out patient / nutrition counseling/ medication for mood problems

Menstrual Cycle and Bone

Amenorrheic atheletes have lower lumbar spine bone mineral density than eumenorrheic matched for body composition Hormonal status: estrogen

Eating Disorders on Sports Performance

Anaerobic performance and muscle strength typically decrease after rapid weight reduction, resumed after rehydration Possible mood alterations

Mechanism for Menstrual Disorders in the Triad

Animal studies- reducing dietary intake by >30% causes infertility Human - LH pulsatility is disrupted within 5 days when energy avaialbility reduced by 33% to <30 kcal/kg/FFM/day Menses can restore when energy availability increases


Conjuntos de estudio relacionados

Assignment 8 - Optimizing Risk for Strategic Advantage

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