Am J Clin Nutr. 2022 Feb 16:nqac044. doi: 10.1093/ajcn/nqac044. Online ahead of print.
ABSTRACT
BACKGROUND: Energy deficiency can result in menstrual disturbances and compromised bone health in women, a condition known as the Female Athlete Triad.
OBJECTIVE: The REFUEL randomized controlled trial assessed the impact of increased energy intake on bone health and menstrual function in exercising women with menstrual disturbances.
METHODS: Exercising women with oligo/amenorrhea were randomized to an intervention group (Oligo/Amen+Cal, n=40, 21.3±0.5 yrs, 55.0±1.0kg, 20.4±0.3 kg/m2) who increased energy intake 20-40% above baseline energy needs for 12 months or a control group (Oligo/Amen Control, n=36, 20.7±0.5 yrs, 59.1±1.3kg, 21.3±0.4 kg/m2). Energy intake and expenditure, metabolic and reproductive hormones, body composition, and areal bone mineral density (aBMD) were assessed.
RESULTS: The Oligo/Amen+Cal group improved energy status (increased body mass (2.6±0.4 kg), body mass index (0.9±0.2 kg/m2), fat mass (2.0±0.3 kg), body fat percentage (2.7±0.4%), and insulin-like growth factor 1 (37.4±14.6 ng/ml)) compared to the control group and experienced a greater likelihood of menses (p<0.05). Total body and spine aBMD remained unchanged (p>0.05). Both groups demonstrated decreased femoral neck aBMD at month 6 (-0.006 g/cm2, 95%CI: -0.011, -0.0002 time main effect p=0.043) and month 12 (-0.011 g/cm2, 95%CI: -0.021, -0.001, time main effect p=0.023). Both groups demonstrated a decrease in total hip aBMD at month 6 (-0.006 g/cm2, 95%CI: -0.011, -0.002, time main effect p=0.004).
CONCLUSIONS: Although higher dietary energy intake increased weight, body fat and menstrual frequency, bone mineral density was not improved, compared to the control group. The 12-month intervention may have been too short and the increase in energy intake (∼352 kcal/day), while sufficient to increase menstrual frequency, was insufficient to increase estrogen or improve aBMD. Future research should refine the optimal nutritional and/or pharmacological intervention(s) for the recovery of bone health in athletes and exercising women with oligo/amenorrhea. Clinical Trial Registry Number: NCT00392873 https://www.clinicaltrials.gov/ct2/show/NCT00392873.
PMID:35170727 | DOI:10.1093/ajcn/nqac044
