Association between the female athlete triad and endothelial dysfunction in dancers.

OBJECTIVE: To determine the prevalence of the 3 components of the female athlete triad [disordered eating, menstrual dysfunction, low bone mineral density (BMD)] and their relationships with brachial artery flow-mediated dilation in professional dancers. DESIGN: Prospective study. SETTING: Academic institution in the Midwest. PARTICIPANTS: Twenty-two professional ballet dancers volunteered for this study. INTERVENTIONS: The prevalence of the female athlete triad and its relationship to endothelial dysfunction. MAIN OUTCOME MEASURES: Subjects completed questionnaires to assess disordered eating and menstrual status/history. They also completed a 3-day food record and wore an accelerometer for 3 days to determine energy availability. Serum baseline thyrotropin, prolactin, and hormonal concentrations were obtained. Bone mineral density and body composition were measured with a GE Lunar Prodigy dual-energy X-ray absorptiometry. Endothelial function was determined as flow-mediated vasodilation measured by high-frequency ultrasound in the brachial artery. An increase in brachial diameter <5% to hyperemic flow stimulus was defined a priori as endothelial dysfunction. RESULTS: Seventeen dancers (77%) had evidence of low/negative energy availability. Thirty-two percent had disordered eating (EDE-Q score). Thirty-six percent had menstrual dysfunction and 14% were currently using hormone contraception. Twenty-three percent had evidence of low bone density (Z-score < -1.0). Sixty-four percent had abnormal brachial artery flow-mediated dilation (<5%). Flow-mediated dilation values were significantly correlated with serum estrogen and whole-body and lumbar BMD. All the 3 components of the triad plus endothelial dysfunction were present in 14% of the subjects. CONCLUSIONS: Endothelial dysfunction was correlated with reduced BMD, menstrual dysfunction, and low serum estrogen. These findings may have profound implications for cardiovascular and bone health in professional women dancers.

Folic acid supplementation improves vascular function in amenorrheic runners.

OBJECTIVE: The purpose of this study was to determine if folic acid supplementation improves endothelial vascular function (brachial artery flow-mediated dilation; FMD) in amenorrheic runners. DESIGN: Prospective cross-sectional study. SETTING: Academic medical center in the Midwest. PARTICIPANTS: Ten amenorrheic and 10 eumenorrheic women runners from the community volunteered for this study. INTERVENTIONS: Each participant was treated with folic acid (10 mg/d) for 4 weeks. MAIN OUTCOME MEASURES: Brachial artery FMD was measured before and after folic acid supplementation with standard techniques. RESULTS: The brachial artery FMD response to reactive hyperemia improved after folic acid supplementation in amenorrheic women (3.0% +/- 2.3% vs. 7.7% +/- 4.5%; P = 0.02). In the eumenorrheic control group, there was no change in brachial artery FMD (6.7% +/- 2.0% vs. 5.9% +/- 2.6%; P = 0.52). CONCLUSIONS: This study demonstrates that brachial artery FMD, an indicator of vascular endothelial function, improves in amenorrheic female runners after short-term supplementation with folic acid.

Prevalence of the female athlete triad in high school athletes and sedentary students.

OBJECTIVE: To determine the prevalence of the female athlete triad (low energy availability, menstrual dysfunction, and low bone mineral density) in high school varsity athletes in a variety of sports compared with sedentary students/control subjects. DESIGN: Prospective study. SETTING: Academic medical center in the Midwest. PARTICIPANTS: Eighty varsity athletes and 80 sedentary students/control subjects volunteered for this study. INTERVENTION: Subjects completed questionnaires, had their blood drawn, and underwent bone mineral density testing. MAIN OUTCOME MEASURES: Each participant completed screening questionnaires assessing eating behavior, menstrual status, and physical activity. Each subject completed a 3-day food diary. Serum hormonal, thyroid-stimulating hormone, and prolactin levels were determined. Bone mineral density and body composition were measured by dual-energy x-ray absorptiometry. RESULTS: Low energy availability was present in similar numbers of athletes (36%) and sedentary/control subjects (39%; P = 0.74). Athletes had more menstrual abnormalities (54%) compared with sedentary students/control subjects (21%) (P < 0.001). Dual-energy x-ray absorptiometry revealed that 16% of the athletes and 30% of the sedentary/control subjects had low bone mineral density (P = 0.03). Risk factors for reduced bone mineral density include sedentary control student, low body mass index, and increased caffeine consumption. CONCLUSIONS: A substantial number of high school athletes (78%) and a surprising number of sedentary students (65%) have 1 or more components of the triad. Given the high prevalence of triad characteristics in both groups, education in the formative elementary school years has the potential to prevent several of the components in both groups, therefore improving health and averting long-term complications.

Possible relationship of folic Acid supplementation and improved flow-mediated dilation in premenopausal, eumenorrheic athletic women.

The purpose of this study was to determine if six weeks of folic acid supplementation would improve brachial artery endothelial-dependent flow-mediated dilation in eumenorrheic female runners with previously normal serum folate levels. This was a prospective, double-blinded, randomized pilot study with convenience sampling. Sixteen eumenorrheic subjects who were not taking birth control pills and who ran at least 20 miles/week were randomly assigned to 10 mg/day of folic acid supplementation or placebo for at least 6 weeks. Serum folate levels and brachial artery measurements were made during the early follicular phase of the menstrual cycle, in a sedentary state, following an 8 hour fast; a standard ultrasound technique was used. The brachial artery vasodilator response to reactive hyperemia was similar between the folic acid (6.6% ± 0.8%, mean ± SE) and placebo groups (6.5% ± 0.7%) at baseline. After six weeks, there was a significantly higher change in flow-mediated dilation for the folic acid group (3.5% ± 0.6%) compared to the placebo group (0.1% ± 0.2%) (p = 0.01). Serum folate levels also increased significantly in the folic acid group following six weeks of folic acid supplementation. This study demonstrates that brachial artery flow-mediated dilation improves significantly in eumenorrheic female runners with previously normal serum folate levels after 6 weeks of supplementation with folic acid. Key pointsFolic acid improves FMD in eumenorrheic runners.Folic acid improves FMD in women runners.

Prevalence of female athlete triad characteristics in a club triathlon team.

OBJECTIVE: To determine the prevalence of the female athlete triad in club triathletes. DESIGN: Cross-sectional. SETTING: Academic medical center in the midwestern United States. PARTICIPANTS: Fifteen women (mean age, 35+/-6 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disordered eating and menstrual status were determined by questionnaires. Energy status was determined by a 3-day food record, resting energy expenditure, and exercise energy output. Bone mineral density (BMD) was measured in the total left hip and lumbar spine (L2-4) by dual-energy x-ray absorptiometry. RESULTS: Sixty percent of the triathletes were found to be in calorie deficit, 53% had a carbohydrate deficit, 47% had a fat deficit, 40% had a protein deficit, and 33% had a calcium deficit. Forty percent of triathletes reported a history of amenorrhea. BMD was normal in the lumbar spine (L2-4) (1.3+/-0.1 g/cm(2)) and total left hip (1.1+/-0.1 g/cm(2)). CONCLUSIONS: Triathletes are at risk for components of the female athlete triad. Continued efforts need to be directed at prevention through education of athletes, coaches, parents, and health care professionals.