Child and Adolescent Athletes
Pubertal growth is a critical component of the growth process; the increase in oestrogen is related to clinically important increases in bone length and bone mineral content, and fusion of the epiphysis. Participation in regular exercise is important to optimise physical and psychological development. However inadequate nutrition (particularly low energy intake) creates a scenario where athletes may be at increased risk of reduced growth, delayed maturation and primary amenorrhea, as well as impaired performance. This may expose these athletes to increased risk of future short stature, low bone mineral density and secondary amenorrhea. Catch-up growth of bone length and mass, and pubertal progression have been reported with dietary intervention and/or reduced training schedules, and may reduce deficits in skeletal growth; however, final stature may be compromised when maturation is severely delayed or when the epiphysis is nearing fusion. It is recommended that the nutrition and growth and development of all young athletes are monitored, particularly in sports where body image or leanness is a performance advantage.
Treating the Female Athlete Triad
Effective treatment of the Female Athlete Triad athlete involves a multidisciplinary team including a nutritionist, psychologist, and/or psychiatrist, headed by a physician experienced in sports medicine. The goal of treatment is to restore energy balance, healthy eating habits, mental health and normal menstrual cycles, and to improve bone health. Nutritional counselling is an essential component of the treatment plan. If the athlete is unable to respond to the recommendations of the physician and nutritionist, then a referral to a psychologist or psychiatrist specialised in eating disorders is necessary. Increased nutritional intake with a subsequent weight gain will result in the resumption of menses and an increase in bone mineral density. A decrease in training may be necessary. Hormone therapy is often prescribed for amenorrheic athletes, however scientific evidence supporting its use is inconclusive. Education of the athlete, coach and the athlete’s entourage is an important component of the treatment plan. Athletes with anorexia nervosa or bulimia nervosa should be excluded from competition. It is important that coaches emphasise that good health rather than weight ensures optimal performance. The coaches’ support of treatment will encourage an athlete’s compliance with the treatment plan.
Preventing disordered eating is the key to Female Athlete Triad prevention. It is essential for coaches to increase awareness of the Female Athlete Triad and increase understanding of nutritional principles and how they impact health and performance. Athletes, health care professionals and their entourage should have the opportunity to undertake educational programmes to support the female athlete. Annual pre-participation screening should include questionnaires and physical examinations to identify early signs of the Female Athlete Triad. Other medical encounters can also be used for this purpose. International and National Federations and National Olympic Committees are encouraged to develop coach and team physician Female Athlete Triad education programmes, and where possible modify rules to reduce the incidence of the drive for thinness and subsequent unhealthy eating behaviours.