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1.
Curr Sports Med Rep ; 20(11): 588-590, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34752432

RESUMO

ABSTRACT: A 16.5-year-old, distance runner, female gender-assigned at birth, who identifies as male, presented with menstrual dysfunction and impaired athletic performance. The cause of the menstrual dysfunction and decreased athletic performance was identified as inadequate energy availability, largely motivated by a desired avoidance of menstruation and further development of secondary sex characteristics. The patient achieved significant weight gain (4.75 kg) in the year after presentation and resumed normal menses. When evaluating and treating transgender athletes for menstrual dysfunction and inadequate energy availability, psychological motivators related to the complex interplay between gender identity, disordered eating, and athletic performance must be addressed.


Assuntos
Desempenho Atlético , Pessoas Transgênero , Adolescente , Atletas , Feminino , Identidade de Gênero , Humanos , Recém-Nascido , Masculino , Menstruação
2.
Sports Med ; 51(Suppl 1): 43-57, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515972

RESUMO

Optimal nutrition is an important aspect of an athlete's preparation to achieve optimal health and performance. While general concepts about micro- and macronutrients and timing of food and fluids are addressed in sports science, rarely are the specific effects of women's physiology on energy and fluid needs highly considered in research or clinical practice. Women differ from men not only in size, but in body composition and hormonal milieu, and also differ from one another. Their monthly hormonal cycles, with fluctuations in estrogen and progesterone, have varying effects on metabolism and fluid retention. Such cycles can change from month to month, can be suppressed with exogenous hormones, and may even be manipulated to capitalize on ideal timing for performance. But before such physiology can be manipulated, its relationship with nutrition and performance must be understood. This review will address general concepts regarding substrate metabolism in women versus men, common menstrual patterns of female athletes, nutrient and hydration needs during different phases of the menstrual cycle, and health and performance issues related to menstrual cycle disruption. We will discuss up-to-date recommendations for fueling female athletes, describe areas that require further exploration, and address methodological considerations to inform future work in this important area.

3.
J Eat Disord ; 9(1): 50, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865448

RESUMO

BACKGROUND: To determine if following specific diets was associated with reporting behaviors that are consistent with disordered eating compared to non-diet-adherent athletes. We hypothesized that athletes adhering to specific diets were more likely to report disordered eating than those not following a diet. METHODS: One thousand female athletes (15-30 years) completed a comprehensive survey about athletic health and wellness. Athletes were asked to specify their diet and completed 3 eating disorder screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of eating disorder or disordered eating. Descriptive statistics were calculated for all study measures and chi-squared tests assessed relationships between athletes' dietary practices and their responses to eating disorder screening tools. Statistical significance was defined as p < 0.05. RESULTS: Two hundred thirty-four of 1000 female athletes reported adherence to specific diets. 69 of the 234 diet-adhering athletes (29.5%) were excluded due to medically-indicated dietary practices or vague dietary descriptions. Of the 165 diet-adherent athletes, 113 (68.5%) screened positively to ≥1 of the 3 eating disorder screening tools. Specifically, athletes practicing a low-carbohydrate diet were more likely to report disordered eating vs. athletes without dietary restrictions (80% vs. 41.8%; p < 0.0001). CONCLUSION: Specific diet adherence in female athletes may be associated with reporting behaviors that are consistent with disordered eating. Health practitioners should consider further questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent eating disorders or disordered eating.

4.
J Pediatr Urol ; 17(3): 290.e1-290.e7, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33622629

RESUMO

INTRODUCTION: Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome that includes the many complex health and performance consequences of low energy availability (EA) in athletes, when there is insufficient caloric intake to meet exercise-related energy expenditure and to support basic physiologic functions. There is a high prevalence of urinary incontinence (UI) in female athletes and it is more common in female athletes than non-athletes. The objective of this study was to determine if low EA is associated with UI in a population of adolescent and young adult female athletes and to evaluate for an association between sport categories and UI. MATERIAL AND METHODS: 1000 nulliparous female patients, ages 15-30 years, presenting to a sports medicine subspecialty clinic, provided informed consent/assent to participate in a cross-sectional study involving a comprehensive survey, anthropomorphic measurements, and medical record review. Low EA was defined as meeting ≥1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), and/or a high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or a high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed using questions adapted from the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), questions regarding timing of UI onset/duration, and a binary question regarding UI during sport activities. A total of 36 sport types were included in the survey and sub-divided into categories. RESULTS AND DISCUSSION: Of the 1000 female athletes surveyed, 165 (16.5%) reported a history of experiencing UI during athletic activities. ICIQ- UI-SF responses indicated that 14% (137/1000) of the cohort experienced slight incontinence, 4% (35/1000) moderate incontinence, and 2 athletes experienced severe incontinence. There was a significant difference between UI categories in age (p = 0.01), low EA (p < 0.001), and sport category (p < 0.001). Females who had low EA had twice the likelihood (OR = 1.97; 95% CI = 1.39 to 2.81; p < 0.001) of UI compared to those with adequate EA, controlling for sports category and menstrual dysfunction. Females who participated in high impact sports were 4.5 times more likely (OR = 4.47; 95% CI = 2.29 to 8.74; p < 0.001) to have had UI compared to females who participated in ball sports, controlling for EA and menstrual dysfunction. CONCLUSIONS: UI during athletic activities is a common problem among nulliparous adolescent and young adult female athletes, occurring in 16.5% of female athletes surveyed. UI was significantly associated with low EA across all sport categories. Sport type was significantly associated with UI, with the highest impact sport group demonstrating a higher prevalence and symptom severity compared to other sport categories.


Assuntos
Esportes , Incontinência Urinária , Adolescente , Adulto , Atletas , Estudos Transversais , Feminino , Humanos , Prevalência , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Adulto Jovem
5.
J Law Med Ethics ; 49(4): 661-665, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35006045

RESUMO

As medical professionals, we outline the science underlying disorders or differences of sexual development (DSD), discuss the nuances of sex and gender and how terminology can differ based on medical vs. non-medical context, briefly review the evidence of the ergogenic effects of hyperandrogenism, and discuss the medical complications with the hormonal contraceptive use currently dictated by World Athletics to allow DSD athletes to compete in the female category.

7.
Int J Sport Nutr Exerc Metab ; 29(6): 569-575, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31034246

RESUMO

This study's objective was to identify differences in risk for low energy availability and athletic clearance level by comparing scores on Female Athlete Triad Cumulative Risk Assessment (Triad CRA) and Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT). A total of 1,000 female athletes aged 15-30 years participating in ≥4 hr of physical activity/week for the previous ≥6 months completed an extensive survey assessing health, athletic history, family disease history, and specific Triad/RED-S risk factors. Retrospective chart review ascertained laboratory and bone mineral density measures. Triad CRA and RED-S CAT were used to assign each athlete's risk level (low, moderate, and high), and case-by-case comparison measured the level of agreement between the tools. We hypothesized that the tools would generally agree on low-risk athletes and that the tools would be less aligned in the specific elevated risk level (moderate or high). Most of the sample was assigned moderate or high risk for Triad CRA and RED-S CAT (Triad: 54.7% moderate and 7.9% high; RED-S: 63.2% moderate and 33.0% high). The tools agreed on risk for 55.5% of athletes. Agreement increased to 64.3% when only athletes with bone mineral density measurements were considered. In conclusion, Triad CRA and RED-S CAT provide consensus on the majority of athletes at elevated (moderate or high) risk for low energy availability, but have less agreement on the specific risk level assigned.


Assuntos
Deficiência Energética Relativa no Esporte/diagnóstico , Medição de Risco/métodos , Inquéritos e Questionários , Adolescente , Adulto , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
8.
Nutrients ; 11(3)2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30893893

RESUMO

Appropriate energy intake is important for the health and performance of athletes. When an athlete's energy intake is not concordant with energy expenditure, short- and long-term performance can be compromised and negative health effects may arise. The energy intake patterns of athletes are subject to numerous effectors, including exercise response, time, and availability of food. To assess different determinants of energy intake in athletes, we reviewed recent literature regarding the response of appetite-regulating hormones to exercise, appetite perceptions following exercise, chronic exercise-induced adaptations regarding appetite, and social factors regarding energy intake. Additionally, we discussed consequences of aberrant energy intake. The purpose of this review is to clarify understanding about energy intake in athletes and provide insights into methods toward maintaining proper energy intake.


Assuntos
Atletas , Ingestão de Energia , Metabolismo Energético , Exercício Físico , Humanos
9.
Br J Sports Med ; 53(10): 628-633, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29860237

RESUMO

Low energy availability (EA) is suspected to be the underlying cause of both the Female Athlete Triad and the more recently defined syndrome, Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee (IOC) defined RED-S as a syndrome of health and performance impairments resulting from an energy deficit. While the importance of adequate EA is generally accepted, few studies have attempted to understand whether low EA is associated with the health and performance consequences posited by the IOC. OBJECTIVE: The purpose of this cross-sectional study was to examine the association of low EA with RED-S health and performance consequences in a large clinical population of female athletes. METHODS: One thousand female athletes (15-30 years) completed an online questionnaire and were classified as having low or adequate EA. The associations between low EA and the health and performance factors listed in the RED-S models were evaluated using chi-squared test and the odds ratios were evaluated using binomial logistic regression (p<0.05). RESULTS: Athletes with low EA were more likely to be classified as having increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA. Performance variables associated with low EA included decreased training response, impaired judgement, decreased coordination, decreased concentration, irritability, depression and decreased endurance performance. CONCLUSION: These findings demonstrate that low EA measured using self-report questionnaires is strongly associated with many health and performance consequences proposed by the RED-S models.


Assuntos
Metabolismo Energético , Síndrome da Tríade da Mulher Atleta/fisiopatologia , Estado Nutricional , Adolescente , Adulto , Atletas , Desempenho Atlético , Densidade Óssea , Estudos Transversais , Ingestão de Energia , Feminino , Humanos , Distúrbios Menstruais , Autorrelato , Fenômenos Fisiológicos da Nutrição Esportiva , Inquéritos e Questionários , Adulto Jovem
10.
Int J Sport Nutr Exerc Metab ; 28(4): 335-349, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30008240

RESUMO

The term Relative Energy Deficiency in Sport was introduced by the International Olympic Committee in 2014. It refers to the potential health and performance consequences of inadequate energy for sport, emphasizing that there are consequences of low energy availability (EA; typically defined as <30 kcal·kg-1 fat-free mass·day-1) beyond the important and well-established female athlete triad, and that low EA affects populations other than women. As the prevalence and consequences of Relative Energy Deficiency in Sport become more apparent, it is important to understand the current knowledge of the hormonal changes that occur with decreased EA. This paper highlights endocrine changes that have been observed in female and male athletes with low EA. Where studies are not available in athletes, results of studies in low EA states, such as anorexia nervosa, are included. Dietary intake/appetite-regulating hormones, insulin and other glucose-regulating hormones, growth hormone and insulin-like growth factor 1, thyroid hormones, cortisol, and gonadal hormones are all discussed. The effects of low EA on body composition, metabolic rate, and bone in female and male athletes are presented, and we identify future directions to address knowledge gaps specific to athletes.


Assuntos
Sistema Endócrino/fisiopatologia , Metabolismo Energético , Desnutrição/fisiopatologia , Necessidades Nutricionais , Fenômenos Fisiológicos da Nutrição Esportiva , Atletas , Composição Corporal , Densidade Óssea , Ingestão de Energia , Feminino , Hormônios/fisiologia , Humanos , Masculino , Menstruação , Esportes
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