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. 2009 Sep;19(5):421-8.
doi: 10.1097/JSM.0b013e3181b8c136.

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

Anne Z Hoch  1 , Nicholas M Pajewski, Luann Moraski, Guillermo F Carrera, Charles R Wilson, Raymond G Hoffmann, Jane E Schimke, David D Gutterman
Affiliations

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

Anne Z Hoch et al. Clin J Sport Med. 2009 Sep.

Abstract

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.

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Conflict of interest statement

Conflict of Interest: There are no conflicts of interest.

Figures

Figure 1
Figure 1
Prevalence of Female Athlete Triad Components in Athletes N=14 (18%) – number of subjects with Low Energy Availability and Menstrual Dysfunction N=3 (4%) – number of subjects with Low Energy Availability and Low BMD N=6 (8%) – number of subjects with Menstrual Dysfunction and Low BMD N=1 (1%) – number of subjects with Low Energy Availability, Menstrual Dysfunction and Low BMD
Figure 2
Figure 2
Prevalence of Female Athlete Triad Components in Sedentary Students/Controls N=8 (10%) – number of subjects with Low Energy Availability and Menstrual Dysfunction N=4 (5%) – number of subjects with Low Energy Availability and Low BMD N=8 (10%) – number of subjects with Menstrual Dysfunction and Low BMD N=1 (1%) – number of subjects with Low Energy Availability, Menstrual Dysfunction and Low BMD
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References

    1. Nattiv A, Loucks AB, Manore MM, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39:1867–1882. - PubMed
    1. American Academic of Pediatrics. Committee on Adolescence. Identifying and treating eating disorders. Pediatrics. 2003;111:204–211. - PubMed
    1. Beals KA, Hill AK. The prevalence of disordered eating, menstrual dysfunction, and low bone mineral density among US collegiate athletes. Int J Sport Nutr Exerc Metab. 2006;16:1–23. - PubMed
    1. Nichols JF, Rauh MJ, Lawson MJ, et al. Prevalence of the female athlete triad syndrome among high school athletes. Arch Pediatr Adolesc Med. 2006;160:137–142. - PubMed
    1. Torstveit MK, Sundgot-Borgen J. The female athlete triad exists in both elite athletes and controls. Med Sci Sports Exerc. 2005;37:1449–1459. - PubMed

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