Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea/amenorrhea: the REFUEL randomized controlled trial
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Background Energy deficiency can result in menstrual disturbances and compromised bone health in women, a condition known as the Female Athlete Triad. Objectives The REFUEL randomized controlled trial assessed the impact of increased energy intake on bone health and menstrual function in exercising women with menstrual disturbances. Methods Exercising women with oligomenorrhea/amenorrhea (Oligo/Amen) were randomly assigned to an intervention group (Oligo/Amen + Cal, n = 40, mean ± SEM age: 21.3 ± 0.5 y; weight: 55.0 ± 1.0 kg; BMI: 20.4 ± 0.3 kg/m2) who increased energy intake 20%-40% above baseline energy needs for 12 mo or a control group (Oligo/Amen Control, n = 36; mean ± SEM age: 20.7 ± 0.5 y; weight: 59.1 ± 1.3 kg; BMI: 21.3 ± 0.4 kg/m2). Energy intake and expenditure, metabolic and reproductive hormones, body composition, and areal bone mineral density (aBMD) were assessed. Results Oligo/Amen + Cal improved energy status [increased body mass (2.6 ± 0.4 kg), BMI (0.9 ± 0.2 kg/m2), fat mass (2.0 ± 0.3 kg), body fat percentage (2.7% ± 0.4%), and insulin-like growth factor 1 (37.4 ± 14.6 ng/mL)] compared with Oligo/Amen Control and experienced a greater likelihood of menses (P 0.05). Both groups demonstrated decreased femoral neck aBMD at month 6 (-0.006 g/cm2; 95% CI: -0.011, -0.0002 g/cm2 ; time main effect P = 0.043) and month 12 (-0.011 g/cm2; 95% CI: -0.021, -0.001 g/cm2; time main effect P = 0.023). Both groups demonstrated a decrease in total hip aBMD at month 6 (-0.…
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In the one intention-to-treat 12-month, randomised controlled clinical trial that implemented dietary changes to increase EI in exercising females with REDs-related biomarkers, there was a high drop-out rate (57%), and improvement in some but not all symptoms.
“Indeed, in the one intention-to-treat 12-month, randomised controlled clinical trial that implemented dietary changes to increase EI in exercising females with REDs-related biomarkers, there was a high drop-out rate (57%), and improvement in some (eg, menstrual function resumption in select participants), 161 but not all symptoms (eg, inability to retard bone loss).162”
From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [162]
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(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e318149f111 · Cited by 1,554 · see citing works
Estrogen deficiency and bone loss: an inflammatory tale
Weitzmann, M. N. (2006) · Journal of Clinical Investigation · doi:10.1172/jci28550 · Cited by 990 · see citing works
Metabolic fuels and reproduction in female mammals
Wade, G. N., & Schneider, J. E. (1992) · Neuroscience & Biobehavioral Reviews · doi:10.1016/s0149-7634(05)80183-6 · Cited by 686 · 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
- Authors
- De Souza, M. J., Ricker, E. A., Mallinson, R. J., Allaway, H. C., Koltun, K. J., Strock, N. C., Gibbs, J. C., Kuruppumullage Don, P., & Williams, N. I.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- Williams, Nancy I
- ORCID
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2022-06
- Volume
- 115
- Issue
- 6
- Pages
- 1457-1472
- ISSN
- 0002-9165 (ISSN-L)
- PMC
- PMC9170471
- OpenAlex
- W4211069294
- Cited by
- 46
- References
- 3
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 9 · 2023: 9 · 2022: 2
- FWCI
- 8.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Defense
- Congressionally Directed Medical Research Programs (PR05431)
- National Center for Advancing Translational Sciences (UL1 TR002014)
- NIH
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- bone mineral density, energy deficiency, oligomenorrhea, amenorrhea, female athlete triad, energy intake, menstrual irregularity, bone health, physical activity, body composition, insulin-like growth factor I, femoral neck, total hip, reproductive hormones, body mass index, female athletes, body fat percentage, fat mass, energy expenditure
- MeSH terms
- Adult, Amenorrhea, Energy Intake, Female, Femur Neck, Humans, Oligomenorrhea, Bone Density, Young Adult
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