The female athlete triad in athletes representing leanness and non-leanness sports

Por: Jorunn Sundgot-borgen e Monica Klungland Torstveit.

Athens 2004: Pre-olympic Congress

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A serious syndrome comprising three interrelated components, disordered eating, amenorrhea and osteoporosis, has been termed the female athlete triad (the Triad). It has been stated that athletes representing sports in which leanness and/or a specific weight is considered important are at increased risk for the Triad [1]. However, the prevalence of the Triad is unknown. Therefore, the purpose of this study was to examine the prevalence of the Triad in elite athletes representing leanness sports, non-leanness sports and non athletic controls.


This is a three-phase study including part I: a detailed questionnaire, part II: measurement of bone mineral density with dual-energy X-ray absorptiometry (Prodigy, Lunar) and part III: clinical interview. In part I, the total population of female elite athletes representing the national teams at junior or senior level, aged 13-39 years (n=938) and a same-age random sample control group (n=900) were invited to participate. The questionnaire was completed by 88% of the athletes and 70% of the controls. Based on data from part I, a random sample of athletes (n=300) and controls (n=300) were selected and invited to participate in part II and III of the study. One-hundred-and eighty-six athletes (62%) and 145 controls (48%) participated in both part II and III of the study.


Two athletes representing leanness, one athlete representing non-leanness sports and three non athletes were diagnosed with the "full blown" Triad (present clinical or subclinical eating disorder (ED), menstrual dysfunction (MD) and osteopenia/osteoporosis (OP)). A higher percentage of leanness athletes (16.7%) compared with non-leanness athletes (5.2%) was diagnosed with current ED and MD (p<0.05), and current ED and OP (12.2% versus 1.0%, respectively) (p<0.01). A similar percentage of leanness athletes (3.3%) and non-leanness athletes (2.1%) was diagnosed with current MD and OP.
A high prevalence of athletes was diagnosed with present prevalence of two of the components of the Triad. Therefore it is important to focus on the continuum, and not only on the "end point" of the Triad. These results confirm the need for primary and secondary prevention, especially aimed at athletes representing leanness sports.


[1]. American College of Sports Medicine. (1995).Med. Sci. Sports Exerc. 27: i-vii.
Supported by The Norwegian Olympic Committee and Confederation of Sport, and The Norwegian Foundation for Health and Rehabilitation.







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