Markers of Low Iron Status Are Associated with Female Athlete Triad Risk Factors. Medicine and science in sports and exercise Finn, E. E., Tenforde, A. S., Fredericson, M., Golden, N. H., Carson, T. L., Karvonen-Gutierrez, C. A., Carlson, J. L. 2021


PURPOSE: The Female Athlete Triad (Triad) is common in female athletes. The Triad is caused by low energy availability (EA), which is often difficult to measure and has been postulated to be associated with low iron status. Here, we explore whether markers of low iron status may be associated with indicators of low EA including Triad risk factors.METHODS: 239 female NCAA Division I athletes completed pre-participation examinations that included Triad risk factors, medication/supplement use, diagnosis of anemia, and elected to complete dual-energy x-ray absorptiometry scan to measure bone mineral density (BMD). Association of markers of low iron (defined as self-report of iron supplementation and/or history of anemia) with each component of the Triad risk assessment score were assessed by stratifying low iron status across different levels of Triad risk category. Differences across iron status groups were assessed using Fisher exact testing.RESULTS: Every component of the Triad risk assessment score excluding delayed menarche was associated with low iron status. 11.5% of women reported low iron in the low-risk EA group, compared to 50% in the moderate-risk and 66.7% in the high-risk EA groups (P=0.02); respectively, these numbers were 11.6%, 25.0%, and 66.7% (P=0.02) for body mass index, 9.7%, 16.7%, and 25.0% (P<0.05) for oligomenorrhea, 10.3%, 45.5%, and 50.0% (P<0.01) for BMD, and 10.4%, 20.8%, and 30.8% (P=0.03) for history of stress reaction or fracture. Lean/endurance athletes were more likely to have low iron status than other athletes (15.5% vs. 3.4%, P=0.02).CONCLUSION: Markers for low iron status were associated with Triad risk factors. Our study suggests that female athletes with history of anemia or iron supplementation may require further screening for low EA.

View details for DOI 10.1249/MSS.0000000000002660

View details for PubMedID 33731653