The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review
Abstract
Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the 'female athlete triad.' This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.
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Iron deficiency is a common concern in athletes with LEA and LCA.
“Iron deficiency is a common concern in athletes with LEA and LCA [55,56].”
From Considerations of Low Carbohydrate Availability (LCA) to Relative Energy Deficiency in Sport (RED-S) in Female Endurance Athletes: A Narrative Review (2023) · cites this paper as [56]
Cites
(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318149f111 · Cited by 1,554 · see citing works
Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation
Ganz, T. (2003) · Blood · doi:10.1182/blood-2003-03-0672 · Cited by 1,544 · see citing works
RIZZA, R. A., MANDARINO, L. J., & GERICH, J. E. (1982) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-54-1-131 · Cited by 696 · see citing works
Low energy availability, not stress of exercise, alters LH pulsatility in exercising women
Loucks, A. B., Verdun, M., Heath, E. M., & (With the Technical Assistance of T. Law, S. A. J. R. T. (1998) · Journal of Applied Physiology · doi:10.1152/jappl.1998.84.1.37 · Cited by 539 · see citing works
Swinbourne, J., Hunt, C., Abbott, M., Russell, J., St Clare, T., & Touyz, S. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867411432071 · Cited by 316 · see citing works
De Souza, M. J., Miller, B. E., Loucks, A. B., Luciano, A. A., Pescatello, L. S., Campbell, C. G., & Lasley, B. L. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.83.12.5334 · Cited by 315 · see citing works
Acute exercise and subsequent energy intake. A meta-analysis
Schubert, M. M., Desbrow, B., Sabapathy, S., & Leveritt, M. (2013) · Appetite · doi:10.1016/j.appet.2012.12.010 · Cited by 240 · see citing works
Hou, Y., Zhang, S., Wang, L., Li, J., Qu, G., He, J., Rong, H., Ji, H., & Liu, S. (2012) · Gene · doi:10.1016/j.gene.2012.09.060 · Cited by 210 · see citing works
Loss of Skeletal Muscle HIF-1α Results in Altered Exercise Endurance
Mason, S. D., Howlett, R. A., Kim, M. J., Olfert, I. M., Hogan, M. C., McNulty, W., Hickey, R. P., Wagner, P. D., Kahn, C. R., Giordano, F. J., et al. (2004) · PLoS Biology · doi:10.1371/journal.pbio.0020288 · Cited by 210 · see citing works
17β-Estradiol Inhibits Iron Hormone Hepcidin Through an Estrogen Responsive Element Half-Site
Yang, Q., Jian, J., Katz, S., Abramson, S. B., & Huang, X. (2012) · Endocrinology · doi:10.1210/en.2011-2045 · Cited by 208 · see citing works
The effect of graded levels of exercise on energy intake and balance in free-living women
Stubbs, R., Sepp, A., Hughes, D., Johnstone, A., King, N., Horgan, G., & Blundell, J. (2002) · International Journal of Obesity · doi:10.1038/sj.ijo.0801874 · Cited by 180 · see citing works
Metabolic effects of the nocturnal rise in cortisol on carbohydrate metabolism in normal humans.
Dinneen, S., Alzaid, A., Miles, J., & Rizza, R. (1993) · Journal of Clinical Investigation · doi:10.1172/jci116832 · Cited by 175 · see citing works
Exercise, Appetite and Appetite-Regulating Hormones: Implications for Food Intake and Weight Control
Stensel, D. (2010) · Annals of Nutrition and Metabolism · doi:10.1159/000322702 · Cited by 171 · see citing works
Whybrow, S., Hughes, D. A., Ritz, P., Johnstone, A. M., Horgan, G. W., King, N., Blundell, J. E., & Stubbs, R. J. (2008) · British Journal of Nutrition · doi:10.1017/s0007114508968240 · Cited by 164 · see citing works
Pasricha, S.-R., Low, M., Thompson, J., Farrell, A., & De-Regil, L.-M. (2014) · The Journal of Nutrition · doi:10.3945/jn.113.189589 · Cited by 158 · see citing works
Kwik-Uribe, C. L., Gietzen, D., German, J. B., Golub, M. S., & Keen, C. L. (2000) · The Journal of Nutrition · doi:10.1093/jn/130.11.2821 · Cited by 156 · see citing works
The anabolic effects of GH/IGF system on bone
Kasukawa, Y., Miyakoshi, N., & Mohan, S. (2004) · Current Pharmaceutical Design · doi:10.2174/1381612043383764 · Cited by 65 · see citing works
Rocha, J., Paxman, J., Dalton, C., Winter, E., & Broom, D. (2013) · Appetite · doi:10.1016/j.appet.2013.09.009 · Cited by 26 · see citing works
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Mountjoy, M., Ackerman, K. E., Bailey, D. M., Burke, L. M., Constantini, N., Hackney, A. C., Heikura, I. A., Melin, A., Pensgaard, A. M., Stellingwerff, T., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-106994 · Cited by 724 · see citing works
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A., Meyer, N., et al. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0136 · Cited by 447 · see citing works
Iron considerations for the athlete: a narrative review
Sim, M., Garvican-Lewis, L. A., Cox, G. R., Govus, A., McKay, A. K. A., Stellingwerff, T., & Peeling, P. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04157-y · Cited by 274 · see citing works
Recommendations and Nutritional Considerations for Female Athletes: Health and Performance
Holtzman, B., & Ackerman, K. E. (2021) · Sports Medicine · doi:10.1007/s40279-021-01508-8 · Cited by 111 · see citing works
Stellingwerff, T. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2017-0312 · Cited by 72 · see citing works
Iron Metabolism: Interactions with Energy and Carbohydrate Availability
McKay, A. K. A., Pyne, D. B., Burke, L. M., & Peeling, P. (2020) · Nutrients · doi:10.3390/nu12123692 · Cited by 51 · see citing works
Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know
Charlton, B. T., Forsyth, S., & Clarke, D. C. (2022) · International Journal of Sports Science & Coaching · doi:10.1177/17479541211054458 · Cited by 36 · see citing works
Lodge, M. T., Ward-Ritacco, C. L., & Melanson, K. J. (2023) · Nutrients · doi:10.3390/nu15204457 · Cited by 33 · see citing works
Þegar orkuna skortir–áhrif hlutfallslegs orkuskorts í íþróttum (RED-s) á heilsu og árangur
Faculty of Health promotion, S. A. L. S., Varðardóttir, B., Guðmundsdóttir, S. L., Faculty of Health promotion, S. A. L. S., Ólafsdóttir, A. S., & Faculty of Health promotion, S. A. L. S. (2020) · Læknablaðið · doi:10.17992/lbl.2020.09.596 · Cited by 10 · see citing works
- Authors
- Petkus, D. L., Murray-Kolb, L. E., & De Souza, M. J.
- Affiliations
- Pennsylvania State University (US)
- Venue
- Sports Medicine
- Published
- 2017-03-13
- Volume
- 47
- Issue
- 9
- Pages
- 1721-1737
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- OpenAlex
- W2595080991
- Cited by
- 92
- References
- 18
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 12 · 2023: 12 · 2022: 11 · 2021: 10 · 2020: 12 · 2019: 9 · 2018: 10 · 2017: 2
- FWCI
- 1.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense (PR054531)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- female athlete triad, iron deficiency, female athletes, energy status, reproductive function, bone health, thyroid function, hyperprolactinemia, menstrual blood loss, estrogen, iron metabolism, growth hormone/insulin-like growth factor-1 axis, hypoxia, hypothyroidism, dietary habits, energy expenditure
- MeSH terms
- Bone and Bones, Energy Metabolism, Female, Fertility, Humans, Hyperprolactinemia, Exercise, Bone Density, Fractures, Stress, Anemia, Iron-Deficiency, Female Athlete Triad Syndrome
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