Kelci McHugh The Female Athlete Triad

Abstract:

The Female Athlete Triad was first noted as an epidemic in the 90s. Since symptoms had clearly been defined,
the occurrence in female athletes has only became stronger and created a larger concern for young, developing
women. The Female Athlete Triad components are menstrual function, bone mineral density, and energy
availability. It has been found that energy availability, or eating disorders, is where the issue starts. From then
menstrual function and bone mineral density are compromised. According to one study by Weiss Kelly et al.,
only 0-16% of the female athlete population show symptoms of all three at a given time.

Melin et al. conducted a study that researched endurance athletes. This included running, biking and
swimming. It took place outside of the United States among Danish and Swedish athletes and only had 40
participants. There was a two day initial examination of eating habits, training records, and overall health of
the athlete followed up by seven days of observing the athletes behaviors in their normal everyday habits.
There were three categorized groups for energy availability; lower, reduced and optimal. The lower group was
statistically significant in the sense that they consumed less calories, they had higher training hours and they
had an 80% higher exercise energy expenditure. The lower group was also found to have decreased resting
metabolic rate. 10 subjects out of the total 40 were found to have an eating disorder and 1 subject with
disordered eating. 35% of subjects had one symptom of the Triad, 33% had two symptoms and 8% had only
one symptom present. None of the results related the prevalence of eating disorders to the likeness of
developing other symptoms.

Reed et al. examine macronutrient intake, energy density and energy intake distribution associated with low
energy availability in Division I female soccer players. This study did take place in the U.S. but only looked at
one collegiate team with 19 participants. Reed et al. defined energy availability as calculating the difference
between energy intake and exercise energy expenditure. The athletes underwent a three day assessment
preseason, three day assessment midseason and a three day assessment post season. The assessment including
anthropometric data, fitness level, three day diet log for food intake and body composition found through a
DXA body scan. The standards for proper nutrition intake were set forth by The American College of Sports
Medicine. Statistical significance was found that the low energy available athletes did not meet these standards
and that they consumed lower energy density meals after games during mid season only. The final results
showed that the low energy available athletes made conscious decisions to eat lower energy dense foods post
game meal to maintain a low body weight and tend to have poor eating attitudes.

The Female Athlete Triad has been found to have serious health impacts in the long run that can damage an
athletes future well being. Both studies reviewed looked at either the prevalence of the Triad or tried to get a
bigger picture on how to prevent the Triad in young athletes. The ultimate take home message is that nutrition
education by trained professionals, like dietitians, is necessary. Finally, all members of the interdisciplinary
team need to be included. This issue involves not only athletes but coaches, trainers, dietitians and physicians
to properly monitor the health and well being of young female athletes.

References:

Melin A et al. Energy availability and the female athlete triad in elite endurance athletes. Scandinavian Journal
of Medicine and Science in Sports. 2014;25(5):610-22.

Reed JL et al. Nutritional practices associated with low energy availability in Division I female soccer players.
Journal of Sports Sciences. 2014;32(16):1499-509.
Kelci McHugh The Female Athlete Triad

Weiss Kelly AK et al. The Female Athlete Triad. American Academy of Pediatrics. 2016;138(2):2015-3983.