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Nutrients 2014, 6(8), 3018-3039; doi:10.3390/nu6083018

Dietary Intervention Restored Menses in Female Athletes with Exercise-Associated Menstrual Dysfunction with Limited Impact on Bone and Muscle Health

1
School of Medicine, Department of Nutrition, Case Western Reserve University, WG 48, 2109 Aldebert Rd., Cleveland, OH 44106-4954, USA
2
Tahoe Forest Hospital, 10121 Pine Ave, Truckee, CA 96161, USA
3
School of Biological and Population Sciences, Nutrition and Exercise Science, Oregon State University, 103 Milam Hall, Corvallis, OR 97331, USA
*
Author to whom correspondence should be addressed.
Received: 31 March 2014 / Revised: 11 July 2014 / Accepted: 22 July 2014 / Published: 31 July 2014
(This article belongs to the Special Issue Sport and Performance Nutrition)
View Full-Text   |   Download PDF [365 KB, uploaded 31 July 2014]   |  

Abstract

Exercise-related menstrual dysfunction (ExMD) is associated with low energy availability (EA), decreased bone mineral density (BMD), and increased risk of musculoskeletal injury. We investigated whether a 6-month carbohydrate-protein (CHO-PRO) supplement (360 kcal/day, 54 g CHO/day, 20 g PRO/day) intervention would improve energy status and musculoskeletal health and restore menses in female athletes (n = 8) with ExMD. At pre/post-intervention, reproductive and thyroid hormones, bone health (BMD, bone mineral content, bone markers), muscle strength/power and protein metabolism markers, profile of mood state (POMS), and energy intake (EI)/energy expenditure (7 day food/activity records) were measured. Eumenorrheic athlete controls with normal menses (Eumen); n = 10) were measured at baseline. Multiple linear regressions were used to evaluate differences between groups and pre/post-intervention blocking on participants. Improvements in EI (+382 kcal/day; p = 0.12), EA (+417 kcal/day; p = 0.17) and energy balance (EB; +466 kcal/day; p = 0.14) were observed with the intervention but were not statistically significant. ExMD resumed menses (2.6 ± 2.2-months to first menses; 3.5 ± 1.9 cycles); one remaining anovulatory with menses. Female athletes with ExMD for >8 months took longer to resume menses/ovulation and had lower BMD (low spine (ExMD = 3; Eumen = 1); low hip (ExMD = 2)) than those with ExMD for <8 months; for 2 ExMD the intervention improved spinal BMD. POMS fatigue scores were 15% lower in ExMD vs. Eumen (p = 0.17); POMS depression scores improved by 8% in ExMD (p = 0.12). EI, EA, and EB were similar between groups, but the intervention (+360 kcal/day) improved energy status enough to reverse ExMD despite no statistically significant changes in EI. Similar baseline EA and EB between groups suggests that some ExMD athletes are more sensitive to EA and EB fluctuations. View Full-Text
Keywords: amenorrhea; oligomenorrhea; energy intake; energy expenditure; exercise performance; bone health; protein synthesis; protein degradation; muscle strength amenorrhea; oligomenorrhea; energy intake; energy expenditure; exercise performance; bone health; protein synthesis; protein degradation; muscle strength
This is an open access article distributed under the Creative Commons Attribution License (CC BY 3.0).

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MDPI and ACS Style

Cialdella-Kam, L.; Guebels, C.P.; Maddalozzo, G.F.; Manore, M.M. Dietary Intervention Restored Menses in Female Athletes with Exercise-Associated Menstrual Dysfunction with Limited Impact on Bone and Muscle Health. Nutrients 2014, 6, 3018-3039.

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