The purpose of this study was to examine the prevalence of disordered eating (DE), menstrual dysfunction (MD), and low bone mineral density (BMD) among US collegiate athletes (n = 112) representing 7 different sports (diving, swimming, x-country, track, tennis, field hockey, and softball) and determine differences in prevalence existed between athletes participating in lean-build (LB) and non-lean build (NLB) sports. DE and MD were assessed by a health, weight, dieting, and menstrual history questionnaire. Spinal BMD was determined via dual energy x-ray absorptiometry. Twenty-eight athletes met the criteria for DE, twenty-nine for MD, and two athletes had low BMDs (using a Z score below −2.0). Ten athletes met the criteria for two disorders (one with disordered eating and low BMD and nine with disordered eating and menstrual dysfunction), while only one athlete met the criteria for all three disorders. Using a Z score below −1.0, two additional athletes met the criteria for all three disorders and three more athletes met the criteria for a combination of two disorders. With the exception of MD, which was significantly more prevalent among LB vs. NLB sports (P = 0.053), there were no differences between the groups in the prevalence of individual disorders or combinations of disorders. These data indicate that the combined prevalence of DE, MD, and low BMD among collegiate athletes is small; however, a significant number suffer from individual disorders of the Triad.
Katherine A. Beals and Amanda K. Hill
Han C.G. Kemper
This paper reviews the growth and development of skeletal mass in youth and the effects of physical activity upon the bone mass in young people. The different methods to measure the bone mass are described such as anthropometrics, radiographics, dual energy X-ray absorptiometry, quantitative computed tomography, and ultrasound. Two different mechanisms are important for the formation and plasticity of bone: a central hormonal mechanism (with estrogen production) and a local mechanism (based on mechanical forces of gravity and muscle contractions). This local mechanism is closely connected to physical activity patterns and therefore discussed in more detail. Thereafter the natural course of the development of the bone mass during youth is described, taking into account the pubertal stages of boys and girls and also the age at which the maximal bone mass (peak bone mineral density) will be reached. The last part is devoted to the effects of physical activity on bone mass based on results of randomized controlled trials. Although the number of experimental studies are scarce, significant effects of weight bearing activity and high impact strength training programs are shown on the side specific bone mineral density in both boys and girls.
Alex S. Ribeiro, Brad J. Schoenfeld, Danilo R.P. Silva, Fábio L.C. Pina, Débora A. Guariglia, Marcelo Porto, Nailza Maestá, Roberto C. Burini and Edilson S. Cyrino
The purpose of this study was to compare different split resistance training routines on body composition and muscular strength in elite bodybuilders. Ten male bodybuilders (26.7 ± 2.7 years, 85.3 ± 10.4 kg) were randomly assigned into one of two resistance training groups: 4 and 6 times per week (G4× and G6×, respectively), in which the individuals trained for 4 weeks, 4 sets for each exercise performing 6–12 repetitions maximum (RM) in a pyramid fashion. Body composition was assessed by dual energy X-ray absorptiometry, muscle strength was evaluated by 1RM bench-press testing. The food intake was planned by nutritionists and offered individually throughout the duration of the experiment. Significant increases (p < .05) in fat-free mass (G4× = +4.2%, G6× = +3.5%) and muscular strength (G4× = +8.4%, G6× = +11.4%) with no group by time interaction were observed. We conclude that 4 and 6 weekly sessions frequencies of resistance training promote similar increases in fat-free mass and muscular strength in elite bodybuilders.
Kate Lambourne, Richard Washburn, Jaehoon Lee, Jessica L. Betts, David Thomas, Bryan Smith, Cheryl Gibson, Debra Kay Sullivan and Joseph Donnelly
Fluid milk consumed in conjunction with resistance training (RT) provides additional protein and calcium, which may enhance the effect of RT on body composition. However, the literature on this topic is inconsistent with limited data in adolescents. Therefore, we examined the effects of a supervised RT program (6 mo, 3 d/wk, 7 exercises, 40–85% 1-repetition maximum) with daily milk supplementation (24 oz/day, one 16-oz dose immediately post-RT) on weight, fat mass (FM), and fat-free mass (FFM) assessed via dual-energy X-ray absorptiometry (baseline, 3 mo, 6 mo) in a sample of middle-school students who were randomly assigned to 1 of 3 supplement groups: milk, isocaloric carbohydrate (100% fruit juice), or water (control). Thirty-nine boys and 69 girls (mean age = 13.6 yr, mean BMI percentile = 85th) completed the study: milk n = 36, juice n = 34, water n = 38. The results showed no significant differences between groups for change in body weight (milk = 3.4 ± 3.7 kg, juice = 4.2 ± 3.1 kg, water = 2.3 ± 2.9 kg), FM (milk = 1.1 ± 2.8 kg, juice = 1.6 ± 2.5 kg, water = 0.4 ± 3.6 kg), or FFM (milk = 2.2 ± 1.9 kg, juice = 2.7 ± 1.9 kg, water = 1.7 ± 2.9 kg) over 6 mo. FFM accounted for a high proportion of the increased weight (milk = 62%, juice = 64%, water = 74%). These results from a sample of predominantly overweight adolescents do not support the hypothesis that RT with milk supplementation enhances changes in body composition compared with RT alone.
Claudia Ridel Juzwiak, Olga Maria Silverio Amancio, Maria Sylvia Souza Vitalle, Vera Lúcia Szejnfeld and Marcelo Medeiros Pinheiro
In this prospective, cross-sectional study male adolescent tennis players (44) and nonathletic controls (32) were evaluated to determine the effects of physical activity, dietary nutrient intakes, sexual maturation, and body composition on bone-mineral density (BMD). Dietary nutrient intakes and physical activity expenditure were estimated by 4-d diaries. Total body composition, bone-mineral content (BMC), and BMD (L1–L4, femur, and nondominant forearm) were assessed by dual-energy X-ray absorptiometry. Tennis players had significantly greater lean body mass (mean [SEM] 50.6 [1.6] kg vs. 45.1 [1.7] kg, p = .022), trochanter BMD (1.0 [0.02] g/cm2 vs. 0.9 [0.03] g/cm2, p = .032), and dominant forearm BMC (173.7 [7.4] g vs. 146.5 [9.3] g) but lower BMD in the nondominant forearm (0.7 [0.02] g/cm2 vs. 0.8 [0.03] g/cm2, p = .028). Daily average calcium intake was below the recommendation in both groups. No correlation was found between BMD and calcium intake and exercise. Lean body mass was the best predictor of BMD and BMC for both tennis players and controls (R 2 = .825, .628, and .693 for L1–L4, total femur, and nondominant forearm, respectively). Based on these results the authors conclude that lean body mass is the best predictor of BMD and BMC for both tennis players and others. Tennis exerts a site-specific effect, and training should focus on ways minimize this effect. Although calcium intake showed no effect on BMD, nutrition education for young athletes should focus on promoting a balanced diet, providing energy and nutrients in adequate amounts.
Deborah Fearnley, Louise Sutton, John O’Hara, Amy Brightmore, Roderick King and Carlton Cooke
The Vendée Globe is a solo round-the-world sailing race without stopovers or assistance, a physically demanding challenge for which appropriate nutrition should maintain energy balance and ensure optimum performance. This is an account of prerace nutritional preparation with a professional and experienced female racer and assessment of daily nutritional intake (NI) during the race using a multimethod approach. A daily energy intake (EI) of 15.1 MJ/day was recommended for the race and negotiated down by the racer to 12.7 MJ/day, with carbohydrate and fluid intake goals of 480 g/day and 3,020 ml/day, respectively. Throughout the 99-day voyage, daily NI was recorded using electronic food diaries and inventories piloted during training races. NI was assessed and a postrace interview and questionnaire were used to evaluate the intervention. Fat mass (FM) and fat-free mass (FFM) were assessed pre- (37 days) and postrace (11 days) using dual-energy X-ray absorptiometry, and body mass was measured before the racer stepped on the yacht and immediately postrace. Mean EI was 9.2 MJ/day (2.4–14.3 MJ/day), representing a negative energy balance of 3.5 MJ/day under the negotiated EI goal, evidenced by a 7.9-kg loss of body mass (FM –7.5 kg, FFM –0.4 kg) during the voyage, with consequent underconsumption of carbohydrate by ~130 g/day. According to the postrace yacht food inventory, self-reported EI was underreported by 7%. This intervention demonstrates the practicality of the NI approach and assessment, but the racer’s nutrition strategy can be further improved to facilitate meeting more optimal NI goals for performance and health. It also shows that evaluation of NI is possible in this environment over prolonged periods, which can provide important information for optimizing nutritional strategies for ocean racing.
Lenka Humenikova Shriver, Nancy Mulhollen Betts and Mark Edward Payton
Many wrestlers engage in chronic dieting and rapid “weight cutting” throughout the year to compete in a category below their natural weight. Such weightmanagement practices have a negative influence on their health and nutritional status, so the National Wrestling Coaches Association implemented a new weight-management program for high school wrestlers in 2006.
The purpose of this study was to determine whether seasonal changes in weight, body fat, and eating attitudes occur among high school wrestlers after the implementation of the new weight-management rule.
Fifteen high school wrestlers participated in the study. Their weight, body composition, and eating attitudes were measured preseason, in-season, and off-season. Body fat was assessed using dual-energy X-ray absorptiometry. Attitudes toward dieting, food, and body weight were assessed using the Eating Attitude Test (EAT).
No significant changes in body fat were detected from preseason to off-season. Weight increased from preseason to in-season (p < .05) and off-season (p < .05). Although the EAT score did not change significantly from preseason to offseason, 60% reported “thinking about burning up calories when exercising” during preseason, and only 40% felt that way during the season (p < .05) and 47% during off-season (p < .05).
The wrestlers experienced a significant weight gain from preseason to off-season with no significant changes in body fat. Their eating attitudes did not change significantly from preseason to off-season in this study, but further research using a large sample of high school wrestlers is warranted to confirm these findings.
Robyn S. Mehlenbeck, Kenneth D. Ward, Robert C. Klesges and Christopher M. Vukadinovich
Calcium intake in adolescent and young adult female athletes often is inadequate to optimize peak bone mass, an important determinant of osteoporosis risk. The purpose of this study was to determine if calcium supplementation in eumenorrheic female collegiate athletes increases intake to recommended levels and promotes increases in bone mineral density (BMD). Forty-eight eumenorrheic female athletes from several college teams (15 soccer, 7 crosscountry, 8 indoor track, and 18 basketball) were randomized at the beginning of a competitive season to receive either an oral calcium supplement (1000 mg calcium citrate/400 I.U. Vitamin D) or placebo daily throughout the training season (16 weeks). Self-reported daily pill intake was obtained every 2 weeks to assess adherence. Calcium intake was evaluated using the Rapid Assessment Method, and total body and leg BMD was measured at pre-, mid-, and postseason using dual energy x-ray absorptiometry (DEXA; Hologic QDR-2000). Pre-season calcium intake was lower than national recommendations for this age group (12), averaging 842 mg/d (SD = 719) and was lower in the placebo group compared to the supplemented group (649 ± 268 vs. 1071 ± 986 mg/d, respectively; p = .064). Adherence to supplementation was good, averaging 70% across the training season. Supplementation boosted total calcium intake to a mean of 1397 ± 411 mg/d, which is consistent with recommended levels for this group (37). Supplementation did not influence BMD change during this 16-week intervention. Across teams, a small increase of 0.8% was observed in leg BMD. Change in total body BMD was modified by team, with a significant increase of 1.5% observed in basketball players. These results indicate that providing calcium supplements of 1000 mg/d is adequate to boost total intake to recommended levels during athletic training. Longer intervention trials are required to determine whether calcium supplementation has a positive effect on BMD.
Laurel Wentz, Pei-Yang Liu, Jasminka Z. Ilich and Emily M. Haymes
To compare female runners with and without a history of stress fractures to determine possible predictors of such fractures.
27 female runners (age 18–40 yr) who had had at least 1 stress fracture were matched to a control sample of 32 female runners without a history of stress fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (iDXA). Subjects answered questionnaires on stress-fracture history, training, menstrual status, and diet.
No significant differences were found in menstrual characteristics, diet and dairy intake, or bone measurements. Weekly servings of milk during middle school significantly predicted BMD at the femur (p = .010), femoral neck (p = .002), Ward’s triangle (p = .014), and femoral shaft (p = .005). Number of menstrual cycles in the previous year predicted femoral-neck BMD (p = .004). Caffeine intake was negatively associated with BMD of the femur (p = .010), femoral neck (p = .003), trochanter (p = .038), and femoral shaft (p = .035). Weekly hours of training were negatively associated with total-body BMD (p = .021), total-body bone mineral content (p = .028), and lumbar-spine BMD (p = .011). Predictors for stress fractures included the number of years running, predominantly running on hard ground, irregular menstrual history, low total-body BMD, and low current dietary calcium intake when controlling for body-mass index (Nagelkerke R 2 = .364).
Servings of milk during middle-school years were positively correlated with hip BMD, although current calcium intake, low BMD, irregular menstrual history, hard training surface, and long history of training duration were the most important predictors of stress fractures.
Nuno M. Pimenta, Helena Santa-Clara, Xavier Melo, Helena Cortez-Pinto, José Silva-Nunes and Luís B. Sardinha
Central accumulation and distribution of body fat (BF) is an important cardiometabolic risk factor. Waist-to-hip ratio (WHR), commonly elevated in nonalcoholic fatty liver disease (NAFLD) patients, has been endorsed as a risk related marker of central BF content and distribution, but no standardized waist circumference measurement protocol (WCmp) has been proposed. We aimed to investigate whether using different WCmp affects the strength of association between WHR and BF content and distribution in NAFLD patients. BF was assessed with dual energy X-ray absorptiometry (DXA) in 28 NAFLD patients (19 males, 51 ± 13 years, and 9 females, 47 ± 13 years). Waist circumference (WC) was measured using four different WCmp (WC1: minimal waist; WC2: iliac crest; WC3: mid-distance between iliac crest and lowest rib; WC4: at the umbilicus) and WHR was calculated accordingly (WHR1, WHR2, WHR3 and WHR4, respectively). High WHR was found in up to 84.6% of subjects, depending on the WHR considered. With the exception of WHR1, all WHR correlated well with abdominal BF (r = .47 for WHR1; r = .59 for WHR2 and WHR3; r = .58 for WHR4) and BF distribution (r = .45 for WHR1; r = .56 for WHR2 and WHR3; r = .51 for WHR4), controlling for age, sex and body mass index (BMI). WHR2 and WHR3 diagnosed exactly the same prevalence of high WHR (76.9%). The present study confirms the strong relation between WHR and central BF, regardless of WCmp used, in NAFLD patients. WHR2 and WHR3 seemed preferable for use in clinical practice, interchangeably, for the diagnosis of high WHR in NAFLD patients.