ECSS Paris 2023: OP-PN13
INTRODUCTION: CrossFit® (CF) is characterized as a constantly varied, high-intensity, functional movement training program, performed with little or no rest between bouts, combining strength and endurance exercises. Due to CF characteristics, female CF practitioners may be at risk to experience low energy availability (LEA), which is the etiological process underpinning several disturbances such as hormone imbalance and consequent Relative Energy Deficiency in Sports (RED-S). The aim of this study is to verify possible LEA and leptin levels of recreational and elite female CF athletes. METHODS: This is a cross-sectional study with nonprobability sampling. Inclusion criteria: healthy female CF practitioners aged 18-39 years, CF training experience ≥1 year; 5-7 training sessions (5-7 hours) per week for ≥6 months for the recreational practitioners group (RG); ≥12 hours of CF practice per week for ≥6 months for the elite group (EG). Subjects visited the laboratory once. They answered a health and sociodemographic questionnaire plus the Low Energy Availability in Females Questionnaire (LEAF-Q). Resting energy expenditure (REE) via indirect calorimetry and body composition (bioelectrical impedance analysis) were assessed in a fasting state, followed by blood test (levels of leptin). Data were analyzed using Jamovi® 2.3.21 version. RESULTS: Data of a preliminary sample of 12 subjects are presented as mean (SD). Students t-test showed no differences regarding age (31.7 (5.6) and 30.2 (7.2) years), body mass index (23.9 (2.1) and 25.6 (1.8) kg/m2), REE (1645.7 (184.6) and 1595.8 (147.4) kcal/day), and daily energy intake (EI: 1569.7(774.2) and 1847.2(422.1) kcal/day) between RG (n = 6) and EG (n = 6), respectively. Body fat percentage (BF%: 23.6(3.8) and 18.5(3.0); p = 0.028), fat free mass (FFM: 45.1(4.0) and 55.4(4.1) kg; p = 0.001), and leptin levels (7.1(2.0) and 0.8(0.1) ng/mL; p < 0.001) were significantly lower in the EG (bellow reference range). About 90% of leptin levels variability is explained by the multiple regression model (R2: 0.895; p < 0.001). After controlling for group, EI, and BF %, the linear regression model showed that group (EG) was negatively associated with the levels of leptin, independently of EI and BF % (B = -5.820; 95% IC: -7.43 to -4.22; p < 0.001). EA calculation resulted in 26.29 and 20.37 kcal/kg FFM/day for RG and EG, respectively. LEAF-Q scores were 4.7 (RG) and 7.0 (EG). CONCLUSION: We found probable LEA in female CF practitioners, especially in the EG. An EA of < 30 kcal/kg FFM/day is typically defined as clinically LEA, which in mid- and long-term results in health implications with impairment of many body systems. It has been shown that LEA suppressed the 24-h mean and amplitude of the diurnal rhythm of leptin in other female athletes, but this is the first study to show it in CF elite female athletes. It might precede other perceived disturbances associated with RED-S in this population. Our results are preliminary and further investigation is necessary.
Read CV FERNANDA PATTI NAKAMOTOECSS Paris 2023: OP-PN13
INTRODUCTION: Athletes who fail to consume sufficient energy are at risk of serious consequences to reproductive and skeletal health. Estimating energy availability has clear limitations for real-life assessments. Metabolic hormones and resting metabolic rate tests are precise measurements, but may not be feasible in clinical practice. Questionnaires may be valuable to estimate the risk of energy deficiency. We aimed to develop and validate a risk-assessment tool for energy deficiency in young exercising women using disordered eating subscales and self-reported health-related information. METHODS: This study is a retrospective analysis of seven studies in competitive female athletes and recreationally active women [n=202, age 21.7±0.3 years, body mass index (BMI) 21.21±0.14 kg/m2, presented as mean±S.E.M.]. Participants completed the Women’s Health and Exercise Laboratory’s Health, Exercise and Nutrition Survey (HENS), the Three-Factor Eating Questionnaire (TFEQ), and the Eating Disorder Inventory – 3 (EDI-3). Fasting serum total triiodothyronine (T3) was assessed with chemiluminescence. Participants were categorized as energy deficient if they had T3 <73.2 ng/dL, and as energy replete otherwise. The following variables were tested as potential predictors of low T3: age of menarche and gynecological age; HENS items related to disordered eating, menstrual status, and bone health; cognitive restraint (CR) from TFEQ; and Perfectionism, Body Dissatisfaction (BD), and Drive for Thinness from EDI-3. The dataset was divided into a model set (n=152; 21.8±0.3 years, 21.23±0.16 kg/m2) and a validation set (n=50; 21.6±0.4 years, 21.15±0.3 kg/m2). The model set was used to fit stepwise logistic regressions on 500 random iterations using Akaike information criterion. Predictors included in at least 400 models were used in a final logistic regression model, which was tested on the validation set to determine sensitivity and specificity. RESULTS: The predictors included in the final logistic regression model were: BMI; number of menstrual cycles experienced in the last 6 months (from HENS), a binary predictor to control for oral contraceptive use, CR from TFEQ, and BD from EDI-3. When tested on the validation set, the model yielded a 73.7% sensitivity and a 93.5% specificity to detect T3 <73.2 ng/dL, therefore yielding an 86% accuracy. Using the clinically used T3 cut-off of 80 ng/dL, the model yielded 75% sensitivity, 96.7% specificity, and 88% accuracy. CONCLUSION: The model has yielded high accuracy to predict the probability of having energy deficiency and was validated against a reliable physiological marker, serum T3 concentrations. The Female Energy Deficiency Questionnaire was developed from a large dataset of exercising women from various competitive and recreational sports; therefore, it is applicable to a wide population. At present, this is the only questionnaire that has been validated to be used as an indicator of energy deficiency in exercising women beyond endurance athletes and dancers.
Read CV Ana Carla SalamunesECSS Paris 2023: OP-PN13
INTRODUCTION: Symptoms of eating disorders (EDs) have been reported to be more frequent within the elite sport environment compared to the general population. In this study we aimed to investigate symptoms of EDs among female elite athletes and recreational active women, and the associations to exercise behaviour and perceiving well-being. METHODS: Swedish national team athletes [Tier 4 (n=172), 24.8 ± 6.1 years of age] from 24 sport disciplines, and aged matched recreational active women [Tier 1-2 (n=100), 25.8 ± 6.7 years of age] were recruited via sport organisations and social media. The protocol of this two-step study included an anonymous on-line survey comprising of the Eating Disorder Examination Questionnaire [(EDE-Q); a Global score >2.30 categorised participants as having symptoms of EDs], the Major Depression Inventory [(MDI) a total score >25 categorised participants as having moderate/severe depression], the Exercise Addiction Inventory [(EAI) a total score >24 categorised participants as having exercise addiction], and the Low Energy Availability in Females Questionnaire to assess menstrual cycle disturbances (MCD) and gastrointestinal (GI) problems [a GI-score >3]. Participants with symptoms of EDs who providing their contact information were invited to a clinical EDE interview for differential diagnosis (DSM-5). RESULTS: Among all subjects (25.2 ± 6.3 years, training 13.3 ± 6.6 h/week), 27% had symptoms of EDs, of which 40% participated in the clinical EDE interview confirming an ED diagnosis in all but one participant. More of the participating recreational active women had symptoms of EDs compared to the elite athletes (36% vs. 21%, p=0.010). There were no differences in training load (14.3 ± 7.1 vs. 13.0 ± 6.2 h/week, p=0.167), BMI (22.7 ± 2.8 vs. 22.7 ± 2.9, p=0.840) or the frequency of MCD (34% vs. 29%, p=0.567) between participants with and without symptoms of EDs. Participants with symptoms of EDs had a greater weight fluctuation (11.8 ± 8.5 vs. 9.6 ± 6.2, p=0.019), a higher GI-score (3.4 ± 2.3 vs. 2.5 ± 1.8, p=0.004), and more reported having moderate to severe depression (49% vs. 14%, p<0.001), exercise addiction (42% vs. 20%, p=0.001) as well as perceived poorer general health (p<0.001), worse life-situation (p<0.001), and lower self-esteem (p<0.001), compared to those without ED symptoms. CONCLUSION: In contrary to earlier reports, we found that symptoms of EDs confirmed by diagnostic interviews were more common in this group of Swedish recreational active women than the included national team athletes. The surprisingly high prevalence of symptoms of EDs in the present study could be due to respons bias (e.g., people with EDs are more prone to participate). However, the overwhelming association between ED symptoms and poor well-being emphasise the need for implementing prevention strategies in both the general population and within Swedish elite sport. Future intervention studies focusing on primary, secondary and tertiary prevention initiatives are warranted.
Read CV Anna MelinECSS Paris 2023: OP-PN13