Energy availability discriminates clinical menstrual status in exercising women

Jennifer L Reed; Mary Jane De Souza; Rebecca J Mallinson; Jennifer L Scheid; Nancy I Williams

doi:10.1186/s12970-015-0072-0

Energy availability discriminates clinical menstrual status in exercising women

J Int Soc Sports Nutr. 2015 Feb 19:12:11. doi: 10.1186/s12970-015-0072-0. eCollection 2015.

Authors

Jennifer L Reed¹, Mary Jane De Souza², Rebecca J Mallinson², Jennifer L Scheid³, Nancy I Williams²

Affiliations

¹ Department of Kinesiology, Women's Health and Exercise Laboratory, 108 Noll Laboratory, The Pennsylvania State University, University Park, PA 16802 USA ; Current address: Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON K1Y 4W7 Canada.
² Department of Kinesiology, Women's Health and Exercise Laboratory, 108 Noll Laboratory, The Pennsylvania State University, University Park, PA 16802 USA.
³ Department of Kinesiology, Women's Health and Exercise Laboratory, 108 Noll Laboratory, The Pennsylvania State University, University Park, PA 16802 USA ; Current address: Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY USA.

Abstract

Background: Conditions of low energy availability (EA) (<30 kcal/kgLBM) have been associated with suppressed metabolic hormones and reductions in LH pulsatility in previously sedentary women during short-term manipulations of energy intake (EI) and exercise energy expenditure (EEE) in a controlled laboratory setting. The purpose of this study was to examine if EA, defined as EA = (EI-EEE)/kgLBM, is associated with disruptions in ovarian function in exercising women.

Methods: Menstrual status was confirmed with daily measures of urinary reproductive metabolites across 1-3 menstrual cycles or 28-day monitoring periods. EA was calculated for exercise days using EI from 3-day diet logs, EEE from heart-rate monitors and/or exercise logs for a 7-day period, and body composition from DXA. Resting energy expenditure (REE) was measured by indirect calorimetry. Total triiodothyronine (TT3) was measured from a fasting blood sample.

Results: 91 exercising women (23.1 ± 0.5 years) were categorized clinically as either exercising amenorrheic (ExAmen, n = 30), exercising oligomenorrheic (ExOligo, n = 20) or exercising eumenorrheic (ExEumen, n = 41). The eumenorrheic group was further divided into more specific subclinical groups as either exercising ovulatory (ExOv, n = 20), exercising inconsistent (ExIncon, n = 13), or exercising anovulatory (ExAnov, n = 8). An EA threshold of 30 kcal/kgLBM did not distinguish subclinical menstrual status (χ (2) = 0.557, p = 0.46) nor did EA differ across subclinical disturbance groups (p > 0.05). EA was lower in the ExAmen vs. ExEumen (30.9 ± 2.4 vs. 36.9 ± 1.7 kcal/kgLBM, p = 0.04). The ratio of REE/predicted REE was lower in the ExAmen vs. ExEumen (0.85 ± 0.02 vs. 0.92 ± 0.01, p = 0.001) as was TT3 (79.6 ± 4.1 vs. 95.3 ± 2.9 ng/mL, p = 0.002).

Conclusions: EA did not differ among subclinical forms of menstrual disturbances in a large sample of exercising women, but EA did discriminate clinical menstrual status, i.e., amenorrhea from eumenorrhea.

Keywords: Dietary energy intake; Energy balance; Exercise training; Females; Resting metabolic rate; Total triiodothyronine.

Grants and funding

UL1 TR000077/TR/NCATS NIH HHS/United States