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Energy deficiency in young athletes – prevalence, consequences and screening
Anna MELIN
Friday, Sept. 22, 2017 · 11:39 a.m. · 23m 55s
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00:00:02
yeah
00:00:05
oh thank you very much if it's a great place or to be in this
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beautiful spot and um i would like to thank the organised in committee
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for this opportunity to talk about any deficiency in young halfway
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and for the next twenty minutes i will present some
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of the results concerning prevalence in this population
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and talk about some of the most severe consequences
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and was to uh talk about any
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identification on non halfway it's activates
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in two thousand and fourteen the international olympic committee
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a percent of the new consensus statement replacing their one
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concerning the female laughing tried from two thousand and five
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and this position statement introduces a new concept
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they call it the relatively new deficiencies boards or write us and
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i it's you know what it should point out the complexity involved
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in days that it's not just a question about menstrual dysfunction
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and impaired ben elton female athletes but
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many more a physiological aspects are involved in normal so that it
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it's not just a question for females but also for males
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i'm not just a question for half days but
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also for recreational active people and finally that
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different aspect of performance art compromise that's well
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but independently if we talk about the female athlete fired more
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right the central aspect is low energy availability
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and then it's availability is the amount of energy left over at
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for basic physiological functions when we have a
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movie and you'd use doing exercise
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uh energy availability i there are due to increase excise
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energy expenditure or by reduced energy into eight
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we'll in actually lead to negative energy bouncing weight loss
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but gradually after a few days or weeks low energy
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availability cool was just ending korean and metabolic alterations
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creating energy balance at a new low level and this is very
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important to understand because athletes that we work with it
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can be in energy bowels and have a normal state d.
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body weight but at the same time have insufficient levels of energy
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available to support all basically to logical functions so it's not a question about why it
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there are of course several potential closest for any deficiency enough it's
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we know from studies the time since it's designs uh
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suppresses acutely appetite route doesn't the compare us and therefore
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it is nutritional chow and for many after it
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that there isn't a strong drive automatically e. to matt so
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high amount for any g. during periods with heavy training
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also for nutrition norwich especially upon the adolescent tough eight
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low meal frequency with that sufficiently any d. n. eugene dennis
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snaps between males increases the risk free needed efficiency
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and we narrate from studies that we have performed in our lab that it all
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female elites have weighed following the general
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guidelines concerning healthy diet with high
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dietary fibre intake in low sugar haven't increased risk
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for both menstrual dysfunction and a range availability
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any g. differences it can also emerged with the intention to loose weight in of course
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uh it should be reduced to body ideals this is one
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of the walls best swim it's sort of cross them
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uh and she just recently did this uh in a low
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in a swedish a national paper which says well many
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athletes that i know i focus on the wraps i trained twenty five hours a week you know have one
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so it's again about what work what is the importance here it is performance
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from a respected by body ideas of course affects athletes as well
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it could also of course we do to sports specific to mounds and
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unfortunately studies have reported weights manipulation athletes as young as twelve years
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so dieting is some force and it was so in issue
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among our young athletes especially in the nest amounting schools
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and also other studies report that most athletes we do manipulate that body weight or
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body composition most often not guided by their coach and not by professionals
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but is manipulating body weight for young athletes a problem
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well according to the international olympic consensus statement concerning
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save which regulation from two thousand and fourteen
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young i things under the age of eighteen should not manipulative body weight in the course is of
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course because it is an increase whisper standard grief
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impair development but especially for premature osteoporosis
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and we also know that died seen in in the early eighties
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increases the risk of developing severe clinical coverage eating disorders
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and eating disorders uh i would say this would
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even continue ranges from normal healthy eating
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and a healthy body image to do a dieting
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and restricted eating behaviour disordered eating behaviour
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wait a restricted eating and or excessive training to control way
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or if it's a clinical avert a eating disorders and many
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encourage individuals move within the spectrum and some experience
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diagnostic cross overs and most commonly used for men rex university billion universal across
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this is a huge problem because the athletes go from being severely underweight
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where everybody to see that there is a problem to begin end of
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those uh with no what the house an increase in body weight
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um and also of course having an eating disorder or
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even disordered eating behaviour courses serious medical problems
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because if besides the obvious psychological ones and they can even be it so
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the mentality of wait for an extended those occasions it's it's
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six percent and subliminal very say to that too
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uh the prevalence of eating disorder is highest among female
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adult elephant especially those from venus demanding spell words
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such as aesthetics balls and us both some weight categories balls and we have
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you know in static sports the prevalence is is up
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to forty five percent sounds really really high
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uh and as i said it's more prevalent among female athletes then mail
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out it may last it's in general says but eighty percent which
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it's a huge problem as compared to the normal population where
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we have a prevalence posted opened wine dissenting males
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and also that female adult athletes uh it's more prevalent than in
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young female athlete and also compared to seventy we controls
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the reported prevalence in john athletes is inconsistent
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there's one study from below three point fifty to
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send wait consensus among female volleyball players
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and several studies reports similar and or even a logo
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deleting behaviour among athletes this is set into a it's mass control
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and therefore it doesn't seem like adolescent i think seven increase risk
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pathogenic weight control behave as compared to seven to controls
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however and we do have our concerns because there is an increased
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risk for all the athletes in the midst of owning sports
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and also for athletes and when the transition hops for moving away from her
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two sports a college or something or when they move up to hire with it to make a hat
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affected level that is a period where it is an
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increased risk for developing these kinds of problems
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and that is that fact is that mary studies that is
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investigate disordered eating behaviour by using self reported question as
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and when there there's i i asked it's on the report
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what concerns and usage of pathological weight control methods
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uh and the few studies that have choose gold standard methods like
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clinical interviews they would put a higher prevalence of eating disorders
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in half its compared to a a sedentary controls
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looking at the prevalence of low energy availability there are very few studies performed young athletes
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how we put to the same high prevalence run forty percent
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in female affix compared to to a sedentary controls
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and curl are reported the same high prevalence of a fifty
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per cent in both male and female young athletes
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and how yeah it investigated the prevalence in
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the most soccer players and reported various difference in the prevalence
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depending on when uh this was assessed during the season
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okay this is back to prevent this uh important thing here
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is that it doesn't matter what because it's it's
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the eating disorder or if it's just lack of appetite
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if it's you logical consequences are the same
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uh we know that assisted limited availability a metabolic fuels
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if the primary cause of the developmental functional hyper syllabic i'm in a year
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and the payment and clinical studies that have been
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profound by professor highlights from high university
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assuring that only five days with and you tell ability
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very very few cows regular factory moscow die
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distracts the paucity let's see a blue to nice improvement and
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reduces both tested in input just throwing in healthy women
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and i think one of the most important findings in this fashion done by
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professor and outs is that it seems like a
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the looks nice in one pile fertility ease move since it's a in when the young women
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young women with a kind ecological age below forty years of age compared to women with a more mature or
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i'm into green system and of course this is one of the reason why it's so important to emphasise
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but we prevent dieting and any deficiency in young athletes
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uh i think estimated prevalence a menstrual dysfunction in
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young athletes is up to sixty percent
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and it depends of course on on which are things we are investigating
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and the methods that we use in was to push it
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the um definitions that we use and one a steady just
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recently presented by seven five uh reported it to
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the province of one hundred percent in competitive with me
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gymnast with the mean age of eighteen point seven
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but when i was a consent why is it so important that
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big bills get their periods by the age of fifteen
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and does it matter if the puberty development exhibit lighting boys and girls
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well the major concern that we have a one of them is of course bone health
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for us to have a good kick butt in mass asset doll uh it's flight
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so that people information exceed spend with socks it especially doing adolescent yes
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and of course are buying health reflects a lifelong history of any t. availability reproductive
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function one of function and of course was so mechanical load from physical activity
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and our fleets on normally in a in to have about ten to fifteen percent higher but
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minute density than sedentary people due to the positive effect of mechanical loading from physical activity
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this study performed by ms so direct and her colleagues from u. c. l. a. e. investigated um
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yeah but i mean the density in insurance well running midland long
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distance running bells and a place from non lehman's schools
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and they would put them in a density in the whole body and number spine
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and you can see that there is no difference between the groups at the age of thirteen fourteen
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but only because from now on the invisible woods improve
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their bone mineral density at the age of eighteen
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as the as they say last week prevent it will be wanting to do
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while the girls from the middle long distance runners they actually have reduced than
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the density in the longest time uh at the age of eighteen
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and they concluded that long term participation in an insurance
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board doing of lessons may be associated with
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inadequate energy in tight or men's we you regularities that
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negatively and uses what effects in minute density
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and yeah it this was concerned enough to study from the same group investigating been healthy net
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lesson cross country wonders what they show that one is haven't elevated bear in chattanooga
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and they had a higher prevalence of berries in is deficiency on the
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weight and i mean real than than a density vitamin d. deficiency
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and not and the goals are at first for for ben health
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will say the young men opal use this study by
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all mathias investigated been helping young male roadside it's raining ten
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hours a week compared into h. mass recreational active control
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and they found that the adolescence i it's a lower bone mineral density compared with
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the controls in regionals of clinical interest such as hip and pulled isn't remote neck
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and the differences between disciples and controls were higher in the voice within h. of is seventy
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okay sorry now in areas that there are some
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quite save your clinical consequence it's um
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but in my experience i have lisa not that and send about their health they
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are concerned about performance and to compete so what is the impact on performance
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well one aspect is concerned it's in training because it's crucial
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uh in order to progress in performance and this is a study it done by
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me too he's call it's a it's a prospective study with train is
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subsequent to reap who did the number type and you ratio of injuries
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in over one hundred and sixty young female athletes doing a year
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and as you can see the molasses we disordered eating behaviour or even respected eating
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and those with low but minute density had significantly more severe injuries during the year
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uh compared to those would not with an intensity in normal eating behaviour
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as of your injury was uh that they were not able to
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train for at least twenty two days in where um
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and it will say they will say reported that you notice that the that meant to write to reality was
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more common in i'm sorry mostly mostly to injuries to
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the so we had severe ones were more
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a common in there is with menstrual dysfunction days we human we uh
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so if we look at the this was injuries but we look at the full men's
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the potential impact on the solution behaviour is of course that
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many asked me to have the develop eating disorders
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wow so change their exercise behaviour they develop excessive income piles of exercise
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and this of course increases the risk for retraining designs that it will say is
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very superior when it comes to eating is good because it it is
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one of the most of your the uh it types of
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eating disorders with the highest prevalence of for instance um
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uh you're deaf uh was so long term died to restriction
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of course leads to lower glycogen stores and loss of fat free mouse
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and yes lazy used her to nasa weight control behaviour course besides the ones i
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just mentioned also increase was with the hydration and have a claim yeah
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uh i'll taking into account the reporters high prevalence a
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men's to dysfunction among people laughing fair are
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surprisingly few studies that have looked into effect on performance
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and during my career minutes coaches at it and they have told me that but use the fact
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that the women are not having demonstration at the sign that they are training hard enough
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um one of the few studies it's done by fun he's to fatten that
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young elites women is had it with ovarian
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suppression headed tend to send to climb
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in its when velocity during the twelve week competitive cease in
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compared to eight percent improvement in the human really group
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and just recently we you presented this but this is done in adult female elite endurance athletes
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but that is as i said one of the few studies that have been caught fish
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and we found that there is where i am in a really a
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secondary i'm in every uh had significantly reduce no muscular strength
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no one and no monthly performance compared to human week i have it
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and to be fair and to improve its size capacity despite
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the lower body weight can be some week off late
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and that they never know musky performance whistling to both lower fear factor mouse
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your fasting glucose test it into three and elevated cody so levels
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so in order for us to ensure a long and
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prosper scroll really are for our young talented ah
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we need to ensure that the team supporting our
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young athletes are well educated in this area
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and that would work both with primary and secondary prevention
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as well as evidence based treatment and
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individual say pretend to clay fans
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yeah the identification of athletes at face is crucial and
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when we talk about your daughter after if there are several validate the screening tools when it come to
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the disordered eating behaviour this is one of the few
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that has invalidated inclined both male and female uh
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i face could be the cute and it's promising but this is very brief an easy to use
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but due to the fact that so for cool to disordered eating behaviour is on the report it
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and that included efficiency it's it's without disabilities and behaviour
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we also need to screen for physiological consequences and sometimes
00:20:53
and are we screwed up we develop delete key uh back together with the
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disordered eating screening tool is useful for identifying beam enough faith that waste
00:21:05
but this is not validated in john freeman after it so that needs to be done
00:21:10
and we also working with a a limit you in order to identify male
00:21:14
athletes that with a story and we do that together with the
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uh it's it's as a professor monica tossed the phone either university and respected yeah yeah yes
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another important question is when to scream well it could be
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during the prepaid spacing psalm or as an annual checkup
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well actually any time that you find in athletes that needs to be evaluated for one
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of these related conditions that could be if they have a current injuries or illnesses
00:21:47
if they have one or several it's especially if they have
00:21:51
several stress fractures idols of performance with this function
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uh oh and there is that you do identify to be at risk you really
00:22:01
do to correct for uh and also to have in depth personal interviews
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um and you also need to do clinical investigations in order to identify
00:22:14
both the courses and also of course the severity of the physical
00:22:18
uh impairment peripherally by a multi disciplinary team
00:22:24
and you do not need to write event it yourself you can
00:22:29
pick these things ah i see have published great uh
00:22:32
tools usable search for return say pretend to play
00:22:36
to use them so they take a message here is that any deficiency
00:22:41
with the with that disability in behaviour eating disorders it ceased in
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both male and female athletes as well assume recreational active people
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and there is an increased risk repair if you miss injuries
00:22:54
and you had performance despite and normal body weight
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and we will do need to work with implementation of
00:23:04
primary prevention and and in short early detection
00:23:08
and treatment strategies and we need to focus on male athletes as well
00:23:14
um and i this is one of the way we work unit when this would usually
00:23:19
be committee where we have the young athletes that usually becomes several times a year
00:23:24
and they're of course besides the lectures on on you know as recovery behaviour
00:23:30
we'll say do practical like some practical the things with them by
00:23:35
uh going through where the individual we do from the
00:23:39
sport their weights and their goal with their training
Conference Program
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Resistance training during long-term athlete development
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The development of aerobic power in young athletes
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Training young athletes: challenges and opportunities
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Combine sport and studies, are the schools doing enough ?
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COACHING, PARENTING AND DEVELOPMENT - Q&A
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Back pain in young athletes
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Injuries and illnesses amongst young elite athletes – so healthy it hurts?
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Sept. 22, 2017 · 9:57 a.m.
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Long term sequelae of youth overuse injuries
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OVERUSE INJURIES - Q&A
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Concussions in young athletes : myths and reality
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Sept. 22, 2017 · 10:52 a.m.
Screening for heart disease in sports – nonsense or necessary?
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Sept. 22, 2017 · 11:16 a.m.
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Energy deficiency in young athletes – prevalence, consequences and screening
Anna MELIN
Sept. 22, 2017 · 11:39 a.m.
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Competitive Sport & Health: hidden issues
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Sept. 22, 2017 · 12:04 p.m.
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THE COMPLEX MEDICAL PROBLEMS - Q&A
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Sept. 22, 2017 · 3:47 p.m.
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Closing Address
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