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Dietary restraint and bone health in adolescent runners
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Dietary restraint may be the disordered eating behavior most associated with adverse bone health in adolescent girl runners, according to findings from a recent study.
Researchers from San Diego State University and Rocky Mountain University of Health Professions in Provo, Utah, assessed disordered eating attitudes and behaviors in 93 competitive cross-country girl runners. The girls were aged 13 to 18 years.
Participants completed the Eating Disorder Examination Questionnaire, which included subscales for weight, shape concern, eating concern and dietary restraint. Menstrual history was determined using a questionnaire derived from medical history.
Runners with elevated dietary restraint had a higher incidence of low BMD compared with runners with elevated weight and shape concern (P<.001). After adjustment for possible confounding variables, lumbar spine BMD, bone mineral content and BMD z score values were lowest in runners with elevated restraint, according to the researchers. Total body BMD and total body BMD z scores were lower in runners with elevated restraint (P<.05). – by Christen Haigh
Am J Clin Nutr. 2008;87:36-43.
This study is of interest because the participants were younger than the college-age population usually studied, and results are generally consistent with expectations. Nevertheless, for greater insight into the place of disordered eating in the female athlete triad, readers should refer to the revised 2007 position stand of the American College of Sports Medicine. The Eating Disorder Examination Questionnaire used in this study does not detect some cases of disordered eating that were included in the special definition of that term in the original 1997 ACSM position stand, specifically, cases of inadvertent failure to balance energy expenditures with adequate energy intake. Such inadvertent failure is common in endurance runners due to the suppression of appetite by prolonged exercise, which was found by Stubbs RJ, Hughes DA, Johnstone AM, et al (Am J Physiol Regulatory Integrative Comp Physiol. 2004;286:350-358). Moreover, menstrual history questionnaires like the one used in this study do not detect subclinical menstrual disorders such as anovulation and luteal phase deficiency. In future studies of the female athlete triad, questionnaires should be replaced by quantitative estimates of energy intake and expenditure and biochemical assays of metabolic and ovarian function.
– Anne B. Loucks, PhD
Professor, Department of Biological Sciences, Ohio University