Active women with and without menstrual disorders : comparison of resting metabolic rate and energy availability Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/9306t249b

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  • The prevalence of exercise-induced menstrual dysfunction (ExMD) ranges between 6-79% in endurance-trained women and may result from a low energy availability (EA; kcal/kgFFM/d). EA is the energy remaining after planned exercise, which is available for basic physiological processes and daily living activities. One mechanism for energy conservation may be a reduced resting metabolic rate (RMR). PURPOSE: To determine if the restoration of menses in endurance-trained women with ExMD, using a daily carbohydrate-protein (CHO-PRO) supplement, is associated with improvements in EA and RMR. Eumenorrheic (Eumen) active controls were also compared to ExMD before and after the 6-mo diet intervention. METHODS: Active women with ExMD (n=8; 7 amenorrheic, 1 oligomenorrheic, age=23±3y, VO₂max=49±6 mL/kg/min, body fat=22±5%) participated in a 6-mo intervention and consumed 325 mL/d of CHO-PRO supplement (360 kcal/d). Menstrual status was confirmed by measuring reproductive hormones. At baseline (0-mo) and 6-mo, two RMR measurements were made using indirect calorimetry. Energy intake (EI) and expenditure were assessed using 7-d diet and activity records, respectively. All ExMD participants wore an accelerometer for 7-d. Exercise energy expenditure (EEE) was defined using 4 methods. ExMD participants completed all measurements at 0-mo and 6-mo; Eumen controls (n=9, age 25±5y, VO₂max=50±5 mL/kg/min, body fat=23±5%) were measured at 0-mo only. Pre- to post-intervention comparisons (ExMD only) of EI, EA, EB, and RMR were made using one-sided paired t-tests; two-sided paired t-tests were used for all remaining comparisons. Between-group comparisons (ExMD vs. Eumen) were made using one-sided unpaired t-tests for the previously listed variables and two-sided unpaired t-tests for the remaining variables. RESULTS: All ExMD participants resumed menses (2.6±2.2 mo to 1st menses, 3.5±1.9 cycles) during the 6-mo intervention; mean weight gain was 1.6±2.0 kg (p=0.029). No significant changes in EA (0-mo=36.7; 6-mo=45.4 kcal/kgFFM/d) or RMR (0-mo=1515±142; 6-mo=1522±134 kcal/d) occurred due to the intervention; however, mean EA improved 24-39% over the intervention. When comparing ExMD to Eumen, there were no significant differences in EI and EA (Eumen=38.3 kcal/kgFFM/d); however, EA for ExMD was 18.5% higher at 6-mo compared to Eumen. Mean EI for ExMD was 2312 kcal/d and 2694 kcal/d at 0-mo and 6-mo, respectively, while mean EI for Eumen was 2430 kcal/d. Training volume (min/wk) for ExMD was higher than Eumen controls (p<0.04) when exercise was defined as all planned exercise (Method 1) (ExMD=736±199; Eumen=473±168 min/wk) and all planned exercise+ bike commute+all walking (Method 2) (ExMD=1215±305; Eumen=934±183 min/wk). At 0-mo, mean total energy expenditure (TEE) was not different between groups (ExMD=2822±264 kcal/d; Eumen=2601±273 kcal/d (p=0.122), yet EB was different (p=0.049) (ExMD=-10.3±6.9; Eumen=-3.0±9.7 kcal/kgFFM/d). RMR was significantly lower in Eumen (29.1±1.9 kcal/kg FFM/d) vs. ExMD (0-mo=31.3±1.8; 6-mo=31.5±2.7 kcal/kg FFM/d) (p<0.02). CONCLUSION: The addition of 360 kcal/d to improve EA was effective in resuming menses in active women with ExMD, but did not alter RMR. EA was similar between ExMD and Eumen at baseline. Conversely, when menses resumed at post-intervention, the EA of ExMD was 18% higher than Eumen, suggesting varying susceptibility to low EA. Differences in menstrual status may be more closely linked to higher TEE in those with ExMD, rather than an absolute EA value.
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