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Int J Sports Med 2000; 21(3): 210-215
DOI: 10.1055/s-2000-8875
Nutrition
Georg Thieme Verlag Stuttgart ·New York

Peripubertal Pertubations in Elite Gymnasts Caused by Sport Specific Training Regimes and Inadequate Nutritional Intake

E. Weimann, C. Witzel, S. Schwidergall, H. J. Böhles
  • Medical Center for Child Health, Clinic for Pediatric Endocrinology and Metabolism, Johann Wolfgang Goethe University of Frankfurt/Main, Germany
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Publication History

Publication Date:
31 December 2000 (online)

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Low body fat masses of elite female gymnasts are favoured for the current aesthetic appeal required for complex movements performed by the gymnasts. Optimal nutritional intake relative to physical training regimes is essential for pubertal development. Here we evaluate how high intensity training in combination with nutritional intake affects pubertal development. Twenty-two female (13.6 ± 1.0 years) and 18 male (12.4 ± 1.6 years) elite gymnasts from national cadres were enlisted in this study. Skeletal maturation and hormonal levels of the hypophyseal, gonadal, and adrenal axes were estimated. Prepubertal and pubertal stages were determined, and body composition was measured using two indirect methods. Whereas female gymnasts showed bone retardation (1.7 years), reduced height potential, minimal fat mass (4.3 ±1.3 kg), no significant increase in pubertal oestradiol levels (17.6 ± 4.2 pg/ml vs. 23.9 ± 13.4 pg/ml), and delayed menarche (2.3 years), male gymnasts displayed virtually unaltered pubertal development due to different training regimes. Nutritional intake was insufficient in all gymnasts although to a lesser extent for male gymnasts. Intensive physical training of elite female gymnasts combined with inadequate nutritional intake can alter the normal pattern of pubertal development. In female gymnasts the onset of menarche can be influenced by keeping the amount of fat mass low. There is a peripubertal change favouring fat mass over muscle mass in females while there is a net gain of muscle mass during pubertal development in males.

Key words:

Delayed puberty - gymnastics - nutrition - body composition - menarche

References

  • 1 Barron J L, Noakes T D, Levy W, Smith C, Millar P R. Hypothalamic dysfunction in overtrained athletes.  J Clin Endocrinol Metab. 1985;  60 803-806
    PubMedSearch in Google Scholar
  • 2 Bayley N, Pinneau S. Tables for predicting adult height from skeletal age.  J Pediatr. 1952;  14 432-436
    PubMedSearch in Google Scholar
  • 3 Benson J E, Geiger C J, Eiserman P A, Wardlaw G M. Relationship between nutrient intake, body mass index, menstrual function and ballet injury.  J Am Med Ass. 1989;  1 58-63
    PubMedSearch in Google Scholar
  • 4 Brandt I, Reinken L. Human Growth. A. Comprehensive Treatise. In: Falkner F (ed) Tanner 2nd volume. New York; 1986
    Search in Google Scholar
  • 5 Burr I M, Sizonenko P C, Kaplan S L, Grumbach S L, Grumbach M M. Hormonal changes in puberty. Correlation of serum luteineizing hormone and follicle stimulating hormone with stages of puberty, testicular size, and bone age in normal boys.  Pediatr Res . 1970;  4 25
    PubMedSearch in Google Scholar
  • 6 Constantini N W, Warren M P. Special problems of the female athlete.  Baillière's Clin Rheumatol. 1994;  8 199-219
    PubMedSearch in Google Scholar
  • 7 Cumming D C, Vickovic M M, Wall S R, Fluker M R. Defects in pulsatile LH release in normally menstruating runners.  J Clin Endocrinol Metab. 1985;  60 810-812
    PubMedSearch in Google Scholar
  • 8 Cumming D C, Wheeler G D, MacCall E M. The effects of exercise on reproductive function in men.  Sports Med. 1989;  7 1-17
    PubMedSearch in Google Scholar
  • 9 Dann T C, Roberts D F. Menarcheal age in University of Warwick young women.  J Biosoc Sci. 1993;  25 531-538
    PubMedSearch in Google Scholar
  • 10 Dixon G, Eurman P, Stern B E, Schwartz B, Rebar R W. Hypothalamic function in amenorrheic runners.  Fertility and Sterility. 1984;  42 377-383
    PubMedSearch in Google Scholar
  • 11 Ducharme J R, Forest M G. Normal pubertal development. In: Bertrand J, Rappaport R, Sizonenko PS (eds) Pediatric endocrinology. 2nd edition. Baltimore; Williams and Wilkens 1992: 372-386
    Search in Google Scholar
  • 12 Frisch R E. Fatness and fertility.  Sci Am. 1988;  3 70-77
    PubMedSearch in Google Scholar
  • 13 Frisch R E, Gotz-Welbergen A V, McArthur J W, Albright T, Witschi J, Bullen B, Birnholtz J, Reed R, Hermann H. Delayed menarche and amenorrhea of college athletes in relation to age of onset of training.  J Am Med Ass. 1981;  246 1559-1563
    CrossrefPubMedSearch in Google Scholar
  • 14 Frisch R E, Whyshak G, Vincent L. Delayed menarche and amenorrhea of ballet dancers.  N Engl J Med. 1980;  303 17-19
    PubMedSearch in Google Scholar
  • 15 Frisch R E. The right weight: body fat, menarche and ovulation.  Clin Obstet Gynaecol. 1990;  3 419-439
    PubMedSearch in Google Scholar
  • 16 Frusztajer N T, Dhuper S, Warren M P, Brooks-Gunn F, Fox R P. Nutrition and the incidence of stress fractures in ballet dancers.  Am J Clin Nutr. 1990;  51 779-783
    PubMedSearch in Google Scholar
  • 17 Garrick J G, Requa R K. Epidemiology of women's gymnastics injuries.  Am J Sports Med. 1980;  8 261-264
    PubMedSearch in Google Scholar
  • 18 Greulich W W, Pyle S I. Radiographic Skeletal Development of the Hand and Wrist. Stanford; Stanford University 1959
  • 19 Job J C, Chaussain J C, Garnier P E. The use of luteinizing hormone-releasing hormone in pediatric patients.  Horm Res. 1977;  8 171-187
    PubMedSearch in Google Scholar
  • 20 Johnell O, Gullberg B, Kanis J A . et al . Risk factors for hip fractures in European women: the Medos (Mediterranean osteoporosis) study.  J Bone Mineral Res. 1995;  10 1802-1815
    PubMedSearch in Google Scholar
  • 21 Lindholm C, Hagenfeldt K, Hagmann U. A nutrition study in juvenile elite gymnasts.  Acta Paediatr. 1995;  84 273-277
    PubMedSearch in Google Scholar
  • 22 Litt I F, Glader L. Anorexia nervosa, athletics and amenorrhea.  J Ped. 1986;  109 150-153
    PubMedSearch in Google Scholar
  • 23 MacConnie S E, Barkan A, Lampman R M. Decreased hypothalamic gonadotropin-releasing hormone secretion in male marathon runners.  N Engl J Med. 1986;  315 411-417
    PubMedSearch in Google Scholar
  • 24 Malina R M. Menarche in athletes: a synthesis and hypothesis.  Ann Hum Biol. 1983;  10 1-24
    PubMedSearch in Google Scholar
  • 25 Marshall W A, Tanner J M. Variations in pattern of pubertal changes in girls.  Arch Dis Child. 1969;  44 291
    CrossrefPubMedSearch in Google Scholar
  • 26 Marshall W A. The relationship of puberty to other maturity indicators and body composition in men.  J Reprod Fertil. 1978;  52 437-443
    PubMedSearch in Google Scholar
  • 27 Nattiv A, Mandelbaum B R. Injuries and special concerns in female gymnasts: detecting, treating, and preventing common problems.  Physician Sportsmed. 1993;  21 66-82
    PubMedSearch in Google Scholar
  • 28 Rees M. Menarche when and why.  Lancet. 1993;  342 1375-1376
    CrossrefPubMedSearch in Google Scholar
  • 29 Rosenfield R L. Puberty and its disorders in girls.  Endo Metab Clin N Am. 1991;  20 15-42
    PubMedSearch in Google Scholar
  • 30 Ryan J. Litte Girls in Pretty Boxes: The Making and Breaking of Elite Gymnasts and Figure Skaters. New York; Doubleday 1995
  • 31 Schäfer F, Georgi M, Zieger A, Schärer K. Usefulness of bioelectric impedance and skinfold measurements in predicting fat free mass derived from total body potassium in children.  Ped Res. 1994;  35 617-624
    PubMedSearch in Google Scholar
  • 32 Slaughter M H, Lohmann T G, Boileau R A, Horsevill C A, Stillman R J, Van Loan M D, Bemben D A. Skinfold equations for estimations of body fatness in children and youth.  Hum Biol. 1988;  60 709-734
    PubMedSearch in Google Scholar
  • 33 Sundgot-Borgen J. Prevalence of eating disorders in elite female gymnasts.  Int J Sport Nutr. 1993;  3 29-40
    PubMedSearch in Google Scholar
  • 34 Sundgot-Borgen J. Eating disorders in female athletes.  Sports Med. 1994;  17 176-188
    PubMedSearch in Google Scholar
  • 35 Sutton J R, Coleman M J, Casey J, Lazarus L. Androgen response during physical exercise.  Br Med J. 1973;  1 520-522
    PubMedSearch in Google Scholar
  • 36 Tanner J M, Goldstein H, Whitehouse L H. Standards for children's heights at ages 2 - 9 years allowing for height of parents.  Arch Dis Child. 1970;  45 755-762
    PubMedSearch in Google Scholar
  • 37 Theintz G E, Howald H, Weiss U, Sizonenko P C. Evidence for a reduction of growth potential in adolescent female gymnasts. J Pediatr 122: 306 - 312; Editor's column: Growth in female gymnasts: Should training decrease during puberty?.  J Pediatr. 1993;  122 237-240
    PubMedSearch in Google Scholar
  • 38 Theintz G E, Howald H, Weiss U, Sizonenko P C. Evidence for a reduction of growth potential in adolescent female gymnasts.  J Pediatr. 1993;  122 306-312
    PubMedSearch in Google Scholar
  • 39 Tippurainen M, Krofer H, Saarikoski S, Honkanen R, Alhava E. The effect of gynecological risk factors on lumbar and femoral bone mineral density in peri- and postmenopausal women.  Maturitas. 1995;  21 137-145
    CrossrefPubMedSearch in Google Scholar
  • 40 Tofler I, Stryer B K, Micheli L J, Herman L R. Physical and emotional problems of elite female gymnasts.  N Engl J Med. 1996;  335 281-283
    CrossrefPubMedSearch in Google Scholar
  • 41 Veldhuis J D, Evans W A, Demers L M, Thorner M O, Wakat D, Rogol A D. Altered neuroendocrine regulation of gonadotropin secretion in women distance runners.  J Clin Endocrin Metab. 1985;  60 810-812
    PubMedSearch in Google Scholar
  • 42 Vigersky R A, Andersen A E, Thompson R H. Hypothalamic dysfunction in secondary amenorrhea associated with simple weight loss.  N Engl J Med. 1977;  297 1141-1145
    PubMedSearch in Google Scholar
  • 43 Warren M P, Jewelewicz R, Dyrenfurt I. The significance of weight loss in the evaluation of pituitary response to LHRH in women with secondary amenorrhea.  J Clin Endocrin Metab. 1975;  40 601-611
    PubMedSearch in Google Scholar
  • 44 Weimann E, Witzel C, Schwidergall S, Böhles H J. The effect of high intensity training on pubertal development of female and male elite gymnasts.  Wien Med Wschr. 1998;  148 231-234
    PubMedSearch in Google Scholar

Dr. Priv.-Doz. Edda Weimann

Medical Center for Child Health Clinic for Pediatric Endocrinology and Metabolism

Theodor-Stern-Kai 7

60590 Frankfurt/Main

Germany

Phone: + 49 (69) 63016689

Fax: + 49 (69) 63017159

Email: eweimann@zki.uni-frankfurt.de