The Female Athlete Triad – IAAF Nutrition for Athletics

This summary is from the IAAF 2nd International Consensus Conference on “Nutrition for Athletics“ held in Monaco from April 18-20, 2007. Copies of the CD and booklet are available from the IAAF website www.iaaf.org.

The Female Athlete Triad
Presenter: Melinda Manore (USA)

The female athlete triad consists of three interrelated health problems: amenorrhea, eating disorders and osteoporosis. New research shows that each component can occur on a continuum. In addition to the primary issues, these three can lead to other health problems: growth might be impaired (but catch-up growth has been shown in elite gymnasts), delayed menarche has been shown in lean dancers, low fuel availability suppresses reproductive function and stress fractures occur more often in amenorrheic athletes.

Screening for disorders of the triad should include a menstrual history, physical activity history and current activity level, diet history and current dietary behaviour in relationship to weight and sport expectations, and family history, especially mother’s age of menarche. Treatment should consist of improving the energy balance. This can be done by increasing energy intake or reducing energy expenditure.

In healthy young adults, energy balance is met at an energy availability of about 45kcal(188 kJ)/kg Fat Free Mass/day. For most athletes, energy availability should be in the range of 30-45kcal/kgFFM/day for weight loss and around 45kcal/kgFFM/day for weight maintenance and above this amount for growth and glycogen loading. Commercial products for estimating energy intake, energy expenditure, and fat free mass can be used for calculating energy availability.

When energy availability drops below 30kcal(125 kJ)/kgFFM/day, the body suppresses reproductive function, bone turnover and other physiological processes. Energy availability of amenorrheic athletes has been shown consistently under 30kcal/kgFFM/day. Low energy availability can be caused by eating disorders. Eating disorders are life-threatening, clinical mental illnesses that require medical and psychiatric treatment.

Clinical menstrual disorders are easy to detect. Sub-clinical disorders are not that obvious and the underlying etiology is often uncertain. Medical tests are required for proper diagnosis and adequate treatment.

Low gynecological age (years since menarche) is associated with occurrence of amenorrhea in athletes: it was found in 9% of marathon runners with gynecological age of 15 years or more and 67% among those who were younger.

Bone strength and the risk of fracture depend not only on bone minerals but also on bone protein. Nevertheless, osteoporosis is diagnosed on the basis of bone mineral density (BMD) alone. Estimating bone fracture risk in pre-menopausal women is hard because of many confounding factors.

Amenorrheic athletes report low intake of total energy, protein and fat and higher intake of fibre. Micronutrient deficiency occurs more often in amenorrheic athletes than in eumenorrheic athletes. Deficiencies in calcium and iron are most common. Use of a broad spectrum low dose multi-vitamin/mineral supplement might be warranted.

The above summary was written by Peter Res

If you wish to download this handy Grams and Calorie Calculator for Carbohydrate, Protein, and Fat, click here for the Excel spreadsheet.

This is part 7 of 14 in a series from the 2007 2nd IAAF International Consensus Conference “Nutrition for Athletics”