title: Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study. The female athlete triad exists in both elite athletes and controls. Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in adolescent females with anorexia nervosa: a double-blind, placebo-controlled study. Sexual harassment and eating disorders in female elite athletes - a controlled study. Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women. Bone mineral density in adolescent female athletes: relationship to exercise type and muscle strength. Assessment of eating disorders: comparison of interview and questionnaire data from a long-term follow-up study of bulimia nervosa. Dose-response relationships between energy availability and bone turnover in young exercising women. Prevalence of the Female Athlete Triad in High School Athletes and Sedentary Students The influence of puberty onset, body mass index, and pressure to be thin on disordered eating behaviors in children and adolescents.
abstract: The purpose s of this study were to examine the percentage of female elite athletes and controls with disordered eating ( DE ) behavior and clinical eating disorders ( EDs )  , to investigate what characterize the athletes with EDs , and to evaluate whether a proposed method of screening for EDs in elite athletes does not falsely classify sport-specific behaviors as indicators of EDs . All athletes representing the national teams at the junior or senior level , aged 13 - 39 years ( n=938 ) , and age-group matched , r and omly selected population -based controls ( n=900 ) were invited to participate . From the screening data , a r and om sample of athletes ( n=186 ) and controls ( n=145 ) were subjects for a clinical interview . More athletes in leanness sports ( 46.7 % ) had clinical EDs than athletes in non-leanness sports ( 19.8 % ) and controls ( 21.4 % ) ( P<0.001 ) . Variables predicting clinical EDs , and thus c and i date s for valid screening procedures , were menstrual dysfunction in leanness athletes , self-reported EDs in non-leanness athletes , and self-reported use of pathogenic weight control methods in controls . Hence , statistically based risk factors are not universally valid , but specifically related to athletes and non-athletes , respectively PURPOSE To examine the prevalence of the female athlete triad ( the Triad ) in Norwegian elite athletes and controls . METHODS This study was conducted in three phases : ( part I ) screening by means of a detailed question naire , ( part II ) measurement of bone mineral density ( BMD )  , and ( part III ) clinical interview . In part I , all female elite athletes representing the national teams at junior or senior level , aged 13 - 39 yr ( N = 938 ) and an age group-matched r and omly selected population -based control group ( N = 900 ) were invited to participate . The question naire was completed by 88 % of the athletes and 70 % of the controls . Based on data from part I , a stratified r and om sample of athletes ( N = 300 ) and controls ( N = 300 ) was selected and invited to participate in parts II and III of the study . 186 athletes ( 62 % ) and 145 controls ( 48 % ) participated in all parts of the study . RESULTS Eight athletes ( 4.3 % ) and five controls ( 3.4 % ) met all the criteria for the Triad ( disordered eating/eating disorder , menstrual dysfunction , and low BMD ) . Six of the athletes who met all the Triad criteria competed in leanness sports , and two in nonleanness sports . When evaluating the presence of two of the components of the Triad , prevalence ranged from 5.4 to 26.9 % in the athletes and from 12.4 to 15.2 % in the controls . CONCLUSION Our results support the assumption that a significant proportion of female athletes suffer from the components of the Triad . In addition , we found that the Triad is also present in normal active females . Therefore , prevention of one or more of the Triad components should be geared towards all physically active girls and young women PURPOSE To evaluate the effect of an oral contraceptive ( OC ) on bone mineral density ( BMD ) in adolescent females with anorexia nervosa ( AN ) or eating disorder not otherwise specified ( EDNOS ) . METHODS Females 11 - 17 years of age with AN or EDNOS entered the study . Subjects were r and omized equally to treatment with a triphasic OC containing norgestimate ( NGM ) 180 - 250 microg and ethinyl estradiol ( EE ) 35 microg or placebo for 13 28-day cycles . Dual energy x-ray absorptiometry scans  ( DXA ) of the lumbosacral spine ( LS ) and hip were obtained at baseline and after 6 and 13 cycles . RESULTS Demographic characteristics of the 112 subjects ( NGM/EE 53 ; Placebo 59 ) who received study drug and had at least one on-treatment DXA were similar between groups for age ( mean : 15 years in each group ) and body mass index ( mean : NGM/EE 17.9 kg/m2 ; Placebo 17.6 kg/m2 ) . At the end of Cycle 6 , there was a significant increase in the mean LS BMD in the NGM/EE group compared with placebo ( .020 g/cm2 vs. .008 g/cm2 ; p = .021 ) ; however , at the end of Cycle 13 the mean increase in LS BMD in the NGM/EE group compared with placebo was no longer significant ( .026 g/cm2 vs. .019 g/cm2 , p = .244 ) . There was no significant difference in change in hip BMD between groups . The incidence of adverse events was similar between groups . CONCLUSIONS In a group of adolescent females with AN or EDNOS , treatment with a triphasic OC for 13 cycles did not have a statistically significant effect on LS or hip BMD The aims were to examine the percentage of female elite athletes and controls reporting sexual harassment and abuse ( SHAB )  , and whether a higher percentage of female athletes with eating disorders ( ED ) had experienced SHAB . A question naire was administered to the total population of female elite athletes ( n = 660 ) and controls ( n = 780 ) aged 15 - 39 years .  Sexual harassment and abuse were measured through 11 questions , ranging from light to severe SHAB . In addition , questions about  dietary- , menstrual- and training-history and the Eating Disorder Inventory  were included . The response rate was 88 % for athletes and 71 % for controls . Athletes ( n = 121 ) and controls ( n = 81 ) classified as " at risk " for ED and non-ED controls participated in a clinical interview . A higher percentage of controls compared with athletes reported experiences of SHAB in general ( 59 % vs. 51 % , P < 0.001 ) . A lower percentage of athletes had experienced SHAB inside sports than outside sport ( 28 % vs. 39 % , P < 0.001 ) . A higher percentage of ED athletes than non-ED athletes had experienced SHAB ( 66 % vs. 48 % , P < 0.01 ) , both inside sport and outside sport . In spite of the fact that a higher percentage of controls compared with athletes had experienced SHAB , it is necessary to formulate clear guidelines , set up educational workshops and implement intervention programs for both ED and SHAB in sport To investigate the dependence of LH pulsatility on energy availability ( dietary energy intake minus exercise energy expenditure ) , we measured LH pulsatility after manipulating the energy availability of 29 regularly menstruating , habitually sedentary , young women of normal body composition for 5 d in the early follicular phase . Subjects expended 15 kcal/kg of lean body mass ( LBM ) per day in supervised exercise at 70 % of aerobic capacity while consuming a clinical dietary product to set energy availability at 45 and either 10 , 20 , or 30 kcal/kg LBM.d in two r and omized trials separated by at least 2 months . Blood was sample d daily during treatments and at 10-min intervals for the next 24 h. Sample s were assayed for LH , FSH , estradiol ( E2 ) , glucose , beta-hydroxybutyrate , insulin , cortisol , GH , IGF-I , IGF-I binding protein (IGFBP)-1 , IGFBP-3 , leptin , and T3 . LH pulsatility was unaffected by an energy availability of 30 kcal/kg LBM.d ( P > 0.3 ) , but below this threshold LH pulse frequency decreased , whereas LH pulse amplitude increased ( all P < 0.04 ) . This disruption was more extreme in women with short luteal phases ( P < 0.01 ) . These incremental effects most closely resembled the effects of energy availability on plasma glucose , beta-hydroxybutyrate , GH , and cortisol and contrasted with the dependencies displayed by the other metabolic hormones ( simultaneously P < 0.05 ) . These results demonstrate that LH pulsatility is disrupted only below a threshold of energy availability deep into negative energy balance and suggest priorities for future investigations into the mechanism that mediates the nonlinear dependence of LH pulsatility on energy availability PURPOSE This study investigated the influence of different exercise types and differences in anatomical distribution of mechanical loading patterns on bone mineral density ( BMD ) in elite female cyclists , runners , swimmers , triathletes , and controls ( N = 15 per group ) . Associations between leg strength and BMD were also examined . METHODS Areal BMD ( g x cm(-2 ) ) was assessed by duel-energy x-ray absorptiometry ( DXA ) ( total body ( TB ) , lumbar spine ( LS ) , femoral neck ( FN ) , legs , and arms ) . Right knee flexion and extension strength was measured using a Cybex Norm isokinetic dynamometer at 60 degrees x s(-1 ) . RESULTS Runners had significantly higher unadjusted TB , LS , FN , and leg BMD than controls ( P < 0.05 ) ; higher TB , FN , and leg BMD than swimmers ( P < 0.05 ) ; and greater leg BMD than cyclists ( P < 0.05 ) . Absolute knee extension strength was significantly ( P < 0.01 ) correlated ( 0.33 < or = r < or = 0.44 ) with TB , FN , LS , and leg BMD for all groups combined . Weaker but still significant correlations ( 0.28 < or = r < or = 0.33 ) existed for normalized ( per leg lean tissue mass ) knee extension strength and all BMD sites , except FN BMD . There were no significant correlations between absolute or normalized knee flexion strength and any of the BMD variables . Absolute knee extension strength was entered as the second independent predictor for LS and leg BMD in stepwise multiple linear regression analysis ( MLRA ) , accounting for increments of 4 % and 12 % , respectively , in total explained variation . CONCLUSION We conclude that running , a weight bearing exercise , is associated with larger site-specific BMD than swimming or cycling , that the generalized anatomical distribution of loads in triathlon appears not to significantly enhance total body BMD status , and that knee extension strength is only a weak correlate and independent predictor of BMD in adolescent females OBJECTIVE This paper examines diagnostic agreement between interview and question naire assessment s of women participating in a long-term follow-up study of bulimia nervosa . METHODS Women ( N = 162 ) completed follow-up evaluations  comprising question naires and either face-to-face or telephone interviews . RESULTS Consistent with previous research , rates of eating disorders were higher when assessed by question naire than when assessed by interview ; however , rates of full bulimia nervosa were similar . Overall diagnostic agreement was adequate for eating disorders ( kappa=.64 ) but poor for bulimia nervosa ( kappa=.49 ) , with greater agreement between question naires and telephone interviews ( kappa 's range : .67-.71 ) than between question naires and face-to-face interviews ( kappa 's range : .35-.58 ) . CONCLUSION Findings support the possibility that increased rates of eating pathology on question naire assessment s may be due , in part , to increased c and or when participants feel more anonymous . Question naire assessment s may not be inferior to interview assessment s ; they may reveal different aspects of disordered eating UNLABELLED To help refine nutritional guidelines for military servicewomen , we assessed bone turnover after manipulating the energy availability of 29 young women . Bone formation was impaired by less severe restrictions than that which increased bone resorption . Military servicewomen and others may need to improve their nutrition to avoid these effects . INTRODUCTION We determined the dose-response relationship between energy availability ( defined as dietary energy intake minus exercise energy expenditure ) and selected markers of bone turnover in 29 regularly menstruating , habitually sedentary , young women of normal body composition . MATERIAL S AND METHODS For 5 days in the early follicular phase of two menstrual cycles separated by at least 2 months , subjects expended 15 kcal/kgLBM/day in supervised exercise at 70 % of aerobic capacity and consumed controlled amounts of a clinical dietary product in balanced ( 45 kcal/kgLBM/day ) and one of three restricted ( either 10 , 20 , or 30 kcal/kgLBM/day ) energy availability treatments in r and om order . Blood was sample d at 10-minute intervals , and urine was collected for 24 h. Sample s were assayed for plasma osteocalcin ( OC ) , serum type I procollagen carboxy-terminal propeptide ( PICP ) , and urinary N-telopeptide ( NTX ) . RESULTS NTX concentrations ( p < 0.01 ) and indices of bone resorption/formation uncoupling ( Z(NTX-OC ) and Z(NTX-PICP ) ; both p < 10(-4 ) ) were increased by the 10 kcal/kgLBM/day treatment . OC and PICP concentrations were suppressed by all restricted energy availability treatments ( all p < 0.05 ) . PICP declined linearly ( p < 10(-6 ) ) with energy availability , whereas most of the suppression of OC occurred abruptly between 20 and 30 kcal/kgLBM/day ( p < 0.05 ) . CONCLUSIONS These dose-response relationships closely resembled those of particular reproductive and metabolic hormones found in the same experiment and reported previously : similar relationships were observed for NTX and estradiol ; for PICP and insulin ; and for OC , triiodothyronine ( T3 ) , and insulin-like growth factor (IGF)-I. The uncoupling of bone resorption and formation by severely restricted energy availability , if left to continue , may lead to irreversible reductions in BMD , and the suppression of bone formation by less severe restrictions may prevent young women from achieving their genetic potential for peak bone mass . More prolonged experiments are needed to determine the dose-response relationships between chronic restrictions of energy availability and bone turnover 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 : Prospect i ve 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 question naires , had their blood drawn , and underwent bone mineral density testing . Main Outcome Measures : Each participant completed screening question naires 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 The main objective of this study is to verify the hypothesis that pubertal development , obesity , body satisfaction , as well as family and peer influences predict unhealthy eating habits in children and adolescents . A r and omized stratified sample of young Quebecers aged 9 , 13 , and 16 years on March 31 , 1999 [ 608 children aged of 9 years ( 325 girls and 283 boys ) and 662 adolescents aged of 13 and 16 years ( 349 girls and 313 boys ) ] were used . Children 's weight , height , and Body Mass Index ( BMI ) were recorded . Question naires were administered to children and a parent ( usually the mother ) . Among 9-year-old children , this study found that weight loss or weight control behaviors were predicted mainly by the onset of puberty , lower maternal abusive control , and the level of peer pressure . Among adolescents , mother 's BMI , income , peer pressure , and negative comments about the child 's weight most strongly predicted behaviors to control weight , strategies to lose weight and the frequency of such behaviors . The findings suggest that both parents and children need to underst and the impact of comments on a child 's behavior
target: Not all the studies that investigated all the conditions in the triad , but the authors concluded that it seemed that athletes were in more severe stage of this disorder .
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