RESUMEN
Functional hypothalamic amenorrhoea (FHA) can occur due to the independent or combined effects of psychogenic and energetic stressors. In exercising women, research has primarily focused on energy deficiency as the cause of FHA while psychological stressors have been ignored. To assess both psychological and metabolic factors associated with FHA in exercising women, we performed across-sectional comparison of 61 exercising women (≥2 hours/week, age 18-35 years, BMI 16-25kg/m2), who were eumenorrheic or amenorrhoeic confirmed by daily urine samples assayed for reproductive hormone metabolites. Psychological factors and eating behaviours were assessed by self-report questionnaires. Exercising women with FHA had lower resting metabolic rate (p=0.023), T3 (p<0.001), T4 (p=0.013), leptin (p=0.002), higher peptide YY (p<0.001), greater drive for thinness (p=0.017), greater dietary cognitive restraint (p<0.001), and displayed dysfunctional attitudes, i.e., need for social approval (p=0.047) compared to eumenorrheic women. Amenorrhoeic women displayed asignificant positive correlation between the need for social approval and drive for thinness with indicators of stress, depression, and mood, which was not apparent in eumenorrheic women. In exercising women with FHA, eating behaviours are positively related to indicators of psychological stress and depression.
Asunto(s)
Amenorrea/metabolismo , Amenorrea/psicología , Ejercicio Físico/psicología , Conducta Alimentaria/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/metabolismo , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Estrés Psicológico , Adolescente , Adulto , Amenorrea/fisiopatología , Metabolismo Basal , Índice de Masa Corporal , Estudios Transversales , Depresión/psicología , Dieta , Ejercicio Físico/fisiología , Trastornos de Alimentación y de la Ingestión de Alimentos/fisiopatología , Femenino , Humanos , Hipotálamo/fisiología , Ciclo Menstrual , Delgadez/psicología , Adulto JovenRESUMEN
We examine the scientific evidence supporting The Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S) syndromes. More research is necessary to advance the understanding of both syndromes; however, it is premature to consider RED-S as an evidence-based syndrome. Future research should specifically define RED-S components, determine its clinical relevance, and establish the causality of relative energy deficiency on RED-S outcomes.
Asunto(s)
Investigación Biomédica , Medicina Basada en la Evidencia , Síndrome de la Tríada de la Atleta Femenina , Deficiencia Relativa de Energía en el Deporte , Femenino , Síndrome de la Tríada de la Atleta Femenina/diagnóstico , Síndrome de la Tríada de la Atleta Femenina/etiología , Humanos , Deficiencia Relativa de Energía en el Deporte/diagnóstico , Deficiencia Relativa de Energía en el Deporte/etiologíaRESUMEN
INTRODUCTION: Chronic reductions in energy availability (EA) suppress reproductive function. A particular calculation of EA quantifies the dietary energy remaining after exercise for all physiological functions. Reductions in luteinizing hormone pulse frequency have been demonstrated when EA using this calculation is <30 kcal·kg·fat-free mass (ffm)·d. PURPOSE: We determined whether menstrual disturbances (MD) are induced when EA is <30 kcal·kg ffm·d. METHODS: Thirty-five sedentary, ovulatory women age 18 to 24 yr (weight, 59.0 ± 0.8 kg; body mass index, 21.8 ± 0.4 kg·m) completed a diet and exercise intervention over three menstrual cycles. Participants were randomized to groups that varied in the magnitude of negative energy balance created by the combination of exercise and energy restriction. Menstrual disturbances were determined using daily urinary estrone-1-glucuronide and pregnanediol glucuronide, midcycle luteinizing hormone, and menstrual calendars. In a secondary analysis, we calculated EA from energy balance data and tested the association of EA with MD. RESULTS: A generalized linear mixed-effects model showed that the likelihood of a MD decreased by 9% for each unit increase in EA (odds ratio, 0.91; 95% confidence interval, 0.84-0.98; P = 0.010). No specific value of EA emerged as a threshold below which MD were induced. When participants were partitioned into EA tertile groups (low EA, 23.4-34.1; n = 11; moderate EA, 34.9-40.7; n = 12, and high EA, 41.2-50.1; n = 12 [kcal·kg ffm·d]), estrone-1-glucuronide (P < 0.001), pregnanediol glucuronide (P < 0.001), and luteal phase length (P = 0.031) decreased significantly, independent of tertile. CONCLUSIONS: These findings do not support that a threshold of EA exists below which MD are induced but do suggest that MD increase linearly as EA decreases. Menstrual disturbances can likely be prevented by monitoring EA using a simplified assessment of metabolic status.