Disordered Eating, Development of Menstrual Irregularity, and Reduced Bone Mass Change After a 3-Year Follow-Up In Female Adolescent Endurance Runners

in International Journal of Sport Nutrition and Exercise Metabolism
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  • 1 California State University Long Beach
  • | 2 University of California Davis
  • | 3 San Diego State University
  • | 4 University of California San Diego
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This prospective study evaluated the 3-year change in menstrual function and bone mass among 40 female adolescent endurance runners (age 15.9 ± 1.0 years) according to baseline disordered eating status. Three years after initial data collection, runners underwent follow-up measures including the Eating Disorder Examination Questionnaire and a survey evaluating menstrual function, running training, injury history, and prior sports participation. Dual-energy X-ray absorptiometry was used to measure bone mineral density and body composition. Runners with a weight concern, shape concern, or global score ≥4.0 or reporting >1 pathologic behavior in the past 28 days were classified with disordered eating. Compared with runners with normal Eating Disorder Examination Questionnaire scores at baseline, runners with disordered eating at baseline reported fewer menstrual cycles/year (6.4 ± 4.5 vs. 10.5 ± 2.8, p = .005), more years of amenorrhea (1.6 ± 1.4 vs. 0.3 ± 0.5, p = .03), and a higher proportion of menstrual irregularity (75.0% vs. 31.3%, p = .02) and failed to increase lumbar spine or total hip bone mineral density at the 3-year follow-up. In a multivariate model including body mass index and menstrual cycles in the past year at baseline, baseline shape concern score (B = −0.57, p value = .001) was inversely related to the annual number of menstrual cycles between assessments. Weight concern score (B = −0.40, p value = .005) was inversely associated with lumbar spine bone mineral density Z-score change between assessments according to a multivariate model adjusting for age and body mass index. These finding support associations between disordered eating at baseline and future menstrual irregularities or reduced accrual of lumbar spine bone mass in female adolescent endurance runners.

Barrack is with the Department of Family and Consumer Sciences, California State University, Long Beach, California, USA. Van Loan is with the Western Human Nutrition Research Center, University of California, Davis, Davis, CA, USA. Rauh is with the Doctor of Physical Therapy Program, San Diego State University, San Diego, CA, USA. Nichols is with the School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA; and Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, CA, USA.

Barrack (michelle.barrack@csulb.edu) is corresponding author.
  • Barrack, M.T., Gibbs, J.C., De Souza, M.J., Williams, N.I., Nichols, J.F., Rauh, M.J., & Nattiv, A. (2014). Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: A prospective multisite study of exercising girls and women. American Journal of Sports Medicine, 42(4), 949958. PubMed ID: 24567250 doi:10.1177/0363546513520295

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barrack, M.T., Rauh, M.J., Barkai, H.S., & Nichols, J.F. (2008a). Dietary restraint and low bone mass in female adolescent endurance runners. The American Journal of Clinical Nutrition, 87(1), 3643. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18175735

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barrack, M.T., Rauh, M.J., & Nichols, J.F. (2008b). Prevalence of and traits associated with low BMD among female adolescent runners. Medicine & Science in Sports & Exercise, 40(12), 20152021. PubMed ID: 18981950 doi:10.1249/MSS.0b013e3181822ea0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barrack, M.T., Rauh, M.J., & Nichols, J.F. (2010a). Cross-sectional evidence of suppressed bone mineral accrual among female adolescent runners. Journal of Bone and Mineral Research, 25(8), 18501857. doi:10.1002/jbmr.63

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barrack, M.T., Van Loan, M.D., Rauh, M.J., & Nichols, J.F. (2010b). Physiologic and behavioral indicators of energy deficiency in female adolescent runners with elevated bone turnover. The American Journal of Clinical Nutrition, 92(3), 652659. doi:10.3945/ajcn.2009.28926

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barrack, M.T., Van Loan, M.D., Rauh, M.J., & Nichols, J.F. (2011). Body mass, training, menses, and bone in adolescent runners: A 3-yr follow-up. Medicine & Science in Sports & Exercise, 43(6), 959966. PubMed ID: 20980925 doi:10.1249/MSS.0b013e318201d7bb

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Burke, L.M., Lundy, B., Fahrenholtz, I.L., & Melin, A.K. (2018). Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes. The International Journal of Sport Nutrition and Exercise Metabolism, 28(4), 350363. PubMed ID: 30029584 doi:10.1123/ijsnem.2018-0142

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cano Sokoloff, N., Eguiguren, M.L., Wargo, K., Ackerman, K.E., Baskaran, C., Singhal, V., . . . Misra, M. (2015). Bone parameters in relation to attitudes and feelings associated with disordered eating in oligo-amenorrheic athletes, eumenorrheic athletes, and nonathletes. The International Journal of Eating Disorders, 48(5), 522526. PubMed ID: 25823597 doi:10.1002/eat.22405

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carter, J.C., Stewart, D.A., & Fairburn, C.G. (2001). Eating disorder examination questionnaire: Norms for young adolescent girls. Behaviour Research and Therapy, 39(5), 625632. PubMed ID: 11341255 doi:10.1016/s0005-7967(00)00033-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chan, J.L., & Mantzoros, C.S. (2005). Role of leptin in energy-deprivation states: Normal human physiology and clinical implications for hypothalamic amenorrhoea and anorexia nervosa. The Lancet, 366(9479), 7485. PubMed ID: 15993236 doi:10.1016/S0140-6736(05)66830-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Day, J., Wengreen, H., Heath, E., Brown, K. (2015). Prevalence of low energy availability in collegiate female runners and implementation of nutrition education intervention. Sports and Nutrition Therapy, 1(1), 17.

    • Search Google Scholar
    • Export Citation
  • De Souza, M.J., Nattiv, A., Joy, E., Misra, M., Williams, N. I., Mallinson, R. J., . . . Expert, P. (2014). 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad: 1st international conference held in San Francisco, California, May 2012 and 2nd international conference held in Indianapolis, Indiana, May 2013. The British Journal of Sports Medicine, 48(4), 289. doi:10.1136/bjsports-2013-093218

    • Search Google Scholar
    • Export Citation
  • De Souza, M.J., & Williams, N.I. (2005). Beyond hypoestrogenism in amenorrheic athletes: Energy deficiency as a contributing factor for bone loss. Current Sports Medicine Reports, 4(1), 3844. PubMed ID: 15659278. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15659278

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gibbs, J.C., Nattiv, A., Barrack, M.T., Williams, N.I., Rauh, M.J., Nichols, J.F., & De Souza, M.J. (2014). Low bone density risk is higher in exercising women with multiple triad risk factors. Medicine & Science in Sports & Exercise, 46(1), 167176. PubMed ID: 23783260 doi:10.1249/MSS.0b013e3182a03b8b

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gibbs, J.C., Williams, N.I., Mallinson, R.J., Reed, J.L., Rickard, A.D., & De Souza, M.J. (2013). Effect of high dietary restraint on energy availability and menstrual status. Medicine & Science in Sports & Exercise, 45(9), 17901797. PubMed ID: 23954993 doi:10.1249/MSS.0b013e3182910e11

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gibbs, J.C., Williams, N.I., Scheid, J.L., Toombs, R.J., & De Souza, M.J. (2011). The association of a high drive for thinness with energy deficiency and severe menstrual disturbances: Confirmation in a large population of exercising women. The International Journal of Sport Nutrition and Exercise Metabolism, 21(4), 280290. PubMed ID: 21813911 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21813911

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hayes, J.F., Fitzsimmons-Craft, E.E., Karam, A.M., Jakubiak, J., Brown, M.L., & Wilfley, D. E. (2018). Disordered eating attitudes and behaviors in youth with overweight and obesity: Implications for treatment. Current Obesity Reports, 7(3), 235246. PubMed ID: 30069717 doi:10.1007/s13679-018-0316-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Heikura, I.A., Uusitalo, A.L.T., Stellingwerff, T., Bergland, D., Mero, A.A., & Burke, L. M. (2018). Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes. The International Journal of Sport Nutrition and Exercise Metabolism, 28(4), 403411. PubMed ID: 29252050 doi:10.1123/ijsnem.2017-0313

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Logue, D., Madigan, S.M., Delahunt, E., Heinen, M., Mc Donnell, S.J., & Corish, C.A. (2018). Low energy availability in athletes: A review of prevalence, dietary patterns, physiological health, and sports performance. Sports Medicine, 48(1), 7396. PubMed ID: 28983802 doi:10.1007/s40279-017-0790-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Luce, K.H., & Crowther, J.H. (1999). The reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q). The International Journal of Eating Disorders, 25(3), 349351. PubMed ID: 10192002 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10192002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Luce, K.H., Crowther, J.H., & Pole, M. (2008). Eating Disorder Examination Questionnaire (EDE-Q): Norms for undergraduate women. The International Journal of Eating Disorders, 41(3), 273276. PubMed ID: 18213686 doi:10.1002/eat.20504

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McLean, J.A., & Barr, S.I. (2003). Cognitive dietary restraint is associated with eating behaviors, lifestyle practices, personality characteristics and menstrual irregularity in college women. Appetite, 40(2), 185192. PubMed ID: 12781168 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12781168

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Melin, A., Tornberg, A.B., Skouby, S., Moller, S.S., Sundgot-Borgen, J., Faber, J., . . . Sjodin, A. (2015). Energy availability and the female athlete triad in elite endurance athletes. Scandinavian Journal of Medicine & Science in Sports, 25(5), 610622. doi:10.1111/sms.12261

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mond, J.M., Hay, P.J., Rodgers, B., Owen, C., & Beumont, P.J. (2004). Validity of the Eating Disorder Examination Questionnaire (EDE-Q) in screening for eating disorders in community samples. Behaviour Research and Therapy, 42(5), 551567. PubMed ID: 15033501 doi:10.1016/S0005-7967(03)00161-X

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Moreira, P., de Almeida, M.D., & Sampaio, D. (2005). Cognitive restraint is associated with higher intake of vegetables in a sample of university students. Eating Behaviors, 6(3), 229237. PubMed ID: 15854869 doi:10.1016/j.eatbeh.2005.01.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., . . . Ackerman, K. (2015). The IOC relative energy deficiency in sport clinical assessment tool (RED-S CAT). British Journal of Sports Medicine, 49(21), 1354. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26764434

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mountjoy, M., Sundgot-Borgen, J.K., Burke, L.M., Ackerman, K.E., Blauwet, C., Constantini, N., . . . Budgett, R. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11), 687697. doi:10.1136/bjsports-2018-099193

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nattiv, A., Loucks, A.B., Manore, M.M., Sanborn, C.F., Sundgot-Borgen, J., Warren, M.P., & American College of Sports Medicine. (2007). American College of Sports Medicine position stand. The female athlete triad. Medicine & Science in Sports & Exercise, 39(10), 18671882. PubMed ID: 17909417 doi:10.1249/mss.0b013e318149f111

    • Search Google Scholar
    • Export Citation
  • Nichols, J.F., Rauh, M.J., Lawson, M.J., Ji, M., & Barkai, H.S. (2006). Prevalence of the female athlete triad syndrome among high school athletes. The Archives of Pediatrics & Adolescent Medicine, 160(2), 137142. PubMed ID: 16461868 doi:10.1001/archpedi.160.2.137

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Qato, D.M., Alexander, G.C., Guadamuz, J.S., & Lindau, S.T. (2018). Prevalence of dietary supplement use in US children and adolescents, 2003-2014. JAMA Pediatrics, 172(8), 780782. PubMed ID: 29913013 doi:10.1001/jamapediatrics.2018.1008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reed, J.L., De Souza, M.J., & Williams, N.I. (2013). Changes in energy availability across the season in Division I female soccer players. Journal of Sports Sciences, 31(3), 314324. PubMed ID: 23075047 doi:10.1080/02640414.2012.733019

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rideout, C.A., McLean, J.A., & Barr, S.I. (2004). Women with high scores for cognitive dietary restraint choose foods lower in fat and energy. J Am Diet Assoc, 104(7), 11541157. PubMed ID: 15215776 doi:10.1016/j.jada.2004.04.024

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tenforde, A. S., Fredericson, M., Sayres, L. C., Cutti, P., & Sainani, K. L. (2015). Identifying sex-specific risk factors for low bone mineral density in adolescent runners. American Journal of Sports Medicine, 43(6), 14941504. PubMed ID: 25748470 doi:10.1177/0363546515572142

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vescovi, J.D., Scheid, J.L., Hontscharuk, R., & De Souza, M.J. (2008). Cognitive dietary restraint: Impact on bone, menstrual and metabolic status in young women. Physiology & Behavior, 95(1–2), 4855. PubMed ID: 18508099 doi:10.1016/j.physbeh.2008.04.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Viner, R.T., Harris, M., Berning, J.R., & Meyer, N.L. (2015). Energy availability and dietary patterns of adult male and female competitive cyclists with lower than expected bone mineral density. The International Journal of Sport Nutrition and Exercise Metabolism, 25(6), 594602. PubMed ID: 26131616 doi:10.1123/ijsnem.2015-0073

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wiita, B.G., & Stombaugh, I.A. (1996). Nutrition knowledge, eating practices, and health of adolescent female runners: A 3-year longitudinal study. International Journal of Sport Nutrition, 6(4), 414425. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8953343

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Woodruff, S.J., & Meloche, R.D. (2013). Energy availability of female varsity volleyball players. The International Journal of Sport Nutrition and Exercise Metabolism, 23(1), 2430. PubMed ID: 22899818 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22899818

    • Crossref
    • Search Google Scholar
    • Export Citation
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