Bone disease in female athletes

Regular exercise and physical activity have many health benefits for both females and males. In particular, weight-bearing exercise has a protective effect on the skeleton, and can even be osteogenic (stimulating to bone formation). However, achievement of optimal bone mineral density and regulation of bone maintenance depend upon a combination of mechanical, hormonal and dietary factors. Adequate hormonal status (oestrogen and progesterone), and sufficient nutrition (calcium, protein, and other bone-building materials) are essential. For young women with components of the Female Athlete Triad (such as disordered eating, amenorrhea and other forms of menstrual dysfunction), one or more of these may be lacking, and decreased bone density can result. With an effort to maximize peak bone mineral density in the young athlete and to preserve or restore gonadal function during the reproductive years, the complications of altered bone mineral density and frank osteoporosis can be avoided.     

Assessment of nutritional knowledge in female athletes susceptible to the Female Athlete Triad syndrome

Background  

The study aimed to i) assess nutritional knowledge in female athletes susceptible to the Female Athlete Triad (FAT) syndrome and to compare with controls; and ii) to compare nutritional knowledge of those who were classified as being 'at risk' for developing FAT syndrome and those who are 'not at risk'.     

Iron status in female endurance athletes and in non-athletes

Iron status was studied in 126 female endurance athletes and 52 control subjects, all aged 16-20 years. The study aimed at identifying factors responsible for iron deficiency. Twenty-six percent of athletes and 50% of controls had latent iron-deficiency without anemia symptoms. A too low intake of iron (especially heme iron: 0.3 mg daily), and of nutrients influencing iron metabolism, were identified as main causes of iron deficiency in control subjects. In athletes, whose iron intake was sufficient (14.6 mg), the principal cause of iron deficiency were blood losses due to menstruation. High level of physical activity, expressed as training volume and experience, did not adversely affect iron stores, as these were higher than in control subjects and the incidence of iron deficiency was much lower than in the control group. It was concluded that an increased intake of iron and of dietary factors involved in iron metabolism prevented possible exercise-induced losses of iron in young athletes.     

Nutrition education intervention for college female athletes

OBJECTIVE: To evaluate the efficacy of a nutrition education intervention for college female athletes to improve nutrition knowledge, build self-efficacy with respect to making healthful dietary choices, and improve dietary intake. DESIGN: A pretest-posttest control group design was implemented. PARTICIPANTS: A women's soccer team (n =15) and a women's swim team (n = 15) were randomly assigned to experimental and control groups, respectively. INTERVENTION: The intervention focused on nutrition knowledge, self-efficacy in making healthful dietary choices, and dietary practices to demonstrate treatment effect. MAIN OUTCOME MEASURES: Dependent variables were nutrition knowledge, self-efficacy, and dietary practices. Independent variables were group assignment. ANALYSES: The Mann-Whitney U test was used to analyze the results between groups, and the Fisher exact probability test was used to detect differences between groups in the number of positive dietary changes. RESULTS: Treatment participants significantly improved nutrition knowledge, self-efficacy (P <.05), and the overall number of positive dietary changes (P <.03). CONCLUSIONS: This study reduces the paucity of nutrition education intervention research among athletes and demonstrates the ability to increase not only nutrition knowledge, which is typically reported, but also self-efficacy and improvement in overall positive dietary changes during an 8-week intervention.     

Low back pain among Iranian industrial workers

BACKGROUND: Most epidemiological data concerning low back pain (LBP) are from high-income countries and there is very little information about LBP in the working population in developing countries. OBJECTIVES: To determine the prevalence of LBP in Iranian industrial workers. To explore associations between LBP and physical and psychosocial factors at work, as well as lifestyle factors. METHODS: Cross-sectional study of the largest car-manufacturing group in Iran. The prevalence of LBP, work exposures and lifestyle factors were recorded using the standardized Nordic questionnaire for analysis of musculoskeletal symptoms. Demographic data and lifestyle factors (age, sex, education, weight, work experience, smoking and fitness training) were also collected. RESULTS: Of the 18,031 employees, 78% participated. The majority of subjects in this study population were young males (<30 years) and a small proportion was female (4%). The 1-year prevalence of self-reported LBP in this Iranian industrial population was 21% (20% males and 27% females). The prevalence rate of absence due to LBP was 5% per annum. The multiple logistic regression models indicated that the following remained risk indicators for LBP in the previous 12 months: increasing age, no regular exercise, heavy lifting, repetitive work and monotonous work. CONCLUSION: LPB is a common problem in the working population even in a developing country. Age and gender as well as certain work-related physical and psychosocial factors influenced the prevalence of LBP but the differences between different categories of workers were small.     

Neuromuscular differences between male and female athletes

Female athletes who participate in jumping and cutting-type sports have a four- to six-fold higher incidence of serious knee injuries compared with male athletes in the same sports. Many of these injuries involve the anterior cruciate ligament, and occur by non-contact mechanisms. The susceptibility of the female athlete's knee to injury is likely multifactorial, although neuromuscular factors seem to have an important role. Recent studies have identified neuromuscular differences between male and female athletes. Specifically, female athletes have decreased stiffness and decreased potential for dynamic stabilization of the knee joint. Proprioception deficits involving the knee and side-to-side strength and coordination imbalances are more frequent in female athletes. Also, female athletes more commonly demonstrate imbalances in strength, timing of activation, and recruitment patterns of the lower extremity muscles. Based on these findings, neuromuscular training programs have been studied in an effort to correct lower extremity neuromuscular imbalances. Preliminary results from these programs have been encouraging in reducing peak landing imact forces in the knee, correcting strength and proprioception deficits, and ultimately in decreasing the incidence of serious knee injuries in female athletes.     

Copper status of collegiate female athletes involved in different sports

Copper status was assessed in 70 female collegiate athletes aged 18 to 25 years participating in cross country track, tennis, softball, swimming, soccer, basketball, and gymnastics during the 2000-2001 season. A group of 8 college-aged females, 20 to 23 years of age, who were not collegiate athletes, served as controls. Mean copper intakes including supplements did not differ significantly among the controls and athletic teams. Mean copper intakes including supplements as micrograms/day and percent recommended dietary allowance (RDA) were as follows: controls 1071 +/- 772 microg (119 +/- 86%), cross country track 1468 +/- 851 microg (163 +/- 95%), tennis 1099 +/- 856 microg (122 +/- 95%), softball 654 +/- 420 microg (73 +/- 47%), swimming 1351 +/- 1060 g (150 +/- 118%), soccer 695 +/- 368 microg (77 +/- 41%), and gymnastics 940 +/- 863 microg (104 +/- 96%). Forty-one percent of athletes and 29% of controls failed to consume two thirds of the RDA for copper. Mean serum copper and ceruloplasmin concentrations were within the normal range and did not differ significantly among the controls (117 +/- 22 microg/dl, 445 +/- 122 mg/L) and cross country track (98 +/- 17 microg/dl, 312 +/- 59 mg/L), tennis (140 +/- 84 microg/dl, 424 +/- 244 mg/L), softball (95 +/- 30 microg/dl, 310 +/- 77 mg/L), swimming (98 +/- 25 microg/dl, 312 +/- 40 mg/L), soccer (93 +/- 15 microg/dl, 324 +/- 54 mg/ L), basketball (85 +/- 10 microg/dl, 280 +/- 62 mg/L), and gymnastics (96 +/- 21 microg/dl, 315 +/- 68 mg/L) teams. Copper status of female collegiate athletes appears to be adequate in this cross-sectional assessment.     

A pilot intervention to increase calcium intake in female collegiate athletes

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 cross-country, 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.     

Disorders of the female athlete triad among collegiate athletes

This study examined the prevalence of and relationship between the disorders of the female athlete triad in collegiate athletes participating in aesthetic, endurance, or team/anaerobic sports. Participants were 425 female collegiate athletes from 7 universities across the United States. Disordered eating, menstrual dysfunction, and musculoskeletal injuries were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), and the Eating Disorder Inventory Body Dissatisfaction Subscale (EDI-BD). The percentage of athletes reporting a clinical diagnosis of anorexia and bulimia nervosa was 3.3% and 2.3%, respectively; mean ( SD) EAT and EDI-BD scores were 10.6 9.6 and 9.8 7.6, respectively. The percentage of athletes with scores indicating "at-risk" behavior for an eating disorder were 15.2% using the EAT-26 and 32.4% using the EDI-BD. A similar percentage of athletes in aesthetic, endurance, and team/anaerobic sports reported a clinical diagnosis of anorexia or bulimia. However, athletes in aesthetic sports scored higher on the EAT-26 (13.5 10.9) than athletes in endurance (10.0 9.3) or team/anaerobic sports (9.9 9.0, p <.02); and more athletes in aesthetic versus endurance or team/anaerobic sports scored above the EAT-26 cut-off score of 20 (p <.01). Menstrual irregularity was reported by 31% of the athletes not using oral contraceptives, and there were no group differences in the prevalence of self-reported menstrual irregularity. Muscle and bone injuries sustained during the collegiate career were reported by 65.9% and 34.3% of athletes, respectively, and more athletes in aesthetic versus endurance and team/anaerobic sports reported muscle (p =.005) and/or bone injuries (p <.001). Athletes "at risk" for eating disorders more frequently reported menstrual irregularity (p =.004) and sustained more bone injuries (p =.003) during their collegiate career. These data indicate that while the prevalence of clinical eating disorders is low in female collegiate athletes, many are "at risk" for an eating disorder, which places them at increased risk for menstrual irregularity and bone injuries.     

Nutrition knowledge of female varsity athletes and university students

The objectives of this study were to compare the nutrition knowledge, including knowledge about nutrition in relation to physical activity, of female university students and members of varsity athletic teams and to document selected nutrition practices of those groups. Instruments developed for the study were completed by varsity athletes (no. = 70) and students not on teams (no. = 129). The two groups were similar in education, but the athletes were younger, taller, and heavier than the students and were considerably more active. The athletes used more nutritional supplements (especially iron) and were less likely to exclude red meat from their diet than were students. Scores on the knowledge test (which had a possible range of - 100% to 100%) averaged 34% for both team members and students. Both groups scored higher on general nutrition questions than on questions about nutrition in relation to activity. Among students, age, education, dietary pattern, total number of nutrition information sources, and length of time an activity program had been maintained were positively associated with nutrition knowledge. Those relationships were not detected among varsity athletes. It was concluded that female varsity athletes had levels of both general and sports-related nutrition knowledge that were similar to those of female students not participating on varsity teams.     

Anxiety of young female athletes with disordered eating behaviors

The aim of this study was to investigate the prevalence rate of disordered eating behaviors in young female athletes and to compare the anxiety levels of the athletes with or without disordered eating behaviors. Female athletes (n=243) of 15 to 25 years old from the city, Edirne, in Turkey participated our study. Disordered eating behaviors and anxiety levels of participants were evaluated by the Eating Attitudes Test (EAT-40) and State-Trait Anxiety Inventory. Disordered eating behaviors was reported as 40 (16.7%) among all athletes. Both state and trait anxiety scores were higher in athletes with disordered eating behaviors than the athletes without disordered eating behaviors (p=0.01). The athletes who engage in leanness and non leanness sports were reported as having similar EAT-40 scores and anxiety scores. In conclusion, athletes with disordered eating behaviors have higher state and trait anxiety scores.     

Cardiac troponin T in female athletes during a two-day mountain marathon

BACKGROUND: Equivocal studies exist on the potential of cardiac damage following prolonged endurance exercise. AIMS: The aim of the study was to examine humoral markers of cardiac damage in female athletes during a 2-day mountain endurance race. METHODS: Venous blood samples were drawn from seven female competitors prior to, and immediately following day-1 and day-2 of the event. The serum was analysed for total creatine kinase (CK), creatine kinase isoenzyme MB (CKMB), and cardiac troponin T (cTnT). RESULTS: Elevations in CK and CKMB were apparent following day-1 of the event (mean +/- SD; CK 84.1 +/- 54.6 mg/L vs. 387 +/- 276.7 mg/L, CKMB 2 +/- 1.7 mg/L vs. 5.9 +/- 1.7 mg/L) and subsequently rose further following race completion (CK 743 +/- 500 mg/L, CKMB 11.9 +/- 4.9 mg/L). Elevations in cTnT were noted in three competitors following day-1 cTNT (range 0.013-0.044 mg/L) and remained elevated in two competitors following day-2 (range 0.014-0.017 mg/L). CONCLUSIONS: The elevations in cTnT likely represent release from the cytosolic fraction. The mechanism responsible for such release is yet to be elucidated.