Triad Components Found in Female High School Athletes


A significant proportion of female high school athletes meet the criteria for one of three health disorders that comprise the female athlete triad syndrome, according to a cross-sectional study.

Jeanne F. Nichols, Ph.D., of San Diego State University, and her colleagues reported that of 170 female athletes aged 13–18 years, 18% demonstrated disordered eating, 24% menstrual irregularity, and 22% low bone mass. Although only 10 girls (6%) qualified as having two triad components and 2 (1%) had the full triad, the investigators stated that “a substantial number of these young athletes may be at increased risk for developing the full triad over time” (Arch. Pediatr. Adolesc. Med. 2006;160:137–42).

The researchers also identified several interrelationships among the triad components.

Girls whose menstrual cycles occurred at intervals longer than 35 days or who missed their period for more than 3 months within the previous year reported significantly more dietary restraint, scored significantly higher on an eating disorder questionnaire, and experienced menarche more than 6 months later than girls with normal menstrual cycles.

Similarly, girls with low and very low bone mineral density scores experienced menarche more than 7 and 12 months later, respectively, than girls with normal bone density. These findings were observed despite similar values for chronological age, body weight, and the percentage of body fat between the groups being compared.

Few studies to date have concurrently assessed the prevalence of all three triad components in female athletes, and no studies have tested for the triad among high school athletes. Most reports on triad components focus on collegiate or elite athletes.

“We believe that screening for disordered eating and menstrual irregularity is potentially more important for high school than for college athletes as a first step in preventing comorbidities associated with the triad, particularly because adolescence is a critical period for optimizing bone mineral accrual,” noted the investigators.

Adolescents with pathogenic eating patterns may be at risk for serious health problems in the short and long term, such as nutrient deficiencies, cardiac disturbances, and osteoporosis, Dr. Nichols and her associates said. Also, teens with persistent menstrual dysfunction are at risk of premature osteoporosis.

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