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Agradecemos a compreensão. on 2016-09-19T20:42:31Z (GMT) / Submitted by CAROLINE bernardino (caa.bernardino@hotmail.com) on 2016-11-01T13:18:02Z No. of bitstreams: 1 Caroline Bernardino Mestrado.pdf: 1776975 bytes, checksum: 634e6060780785a6707896f1d1e9307a (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-11-03T12:49:05Z (GMT) No. of bitstreams: 1 bernardino_c_me_bot.pdf: 1776975 bytes, checksum: 634e6060780785a6707896f1d1e9307a (MD5) / Made available in DSpace on 2016-11-03T12:49:06Z (GMT). No. of bitstreams: 1 bernardino_c_me_bot.pdf: 1776975 bytes, checksum: 634e6060780785a6707896f1d1e9307a (MD5) Previous issue date: 2016-02-26 / A baixa disponibilidade energética, apresenta direta relação com problemas de saúde, podendo afetar desde sistema imunológico, muscular, ósseo, endócrino e reprodutor. Geralmente a preocupação com peso corporal por atletas, freqüentemente verificada em dançarinas, leva a mudanças no comportamento alimentar, sendo este considerado como principal fator desencadeador desde quadro. OBJETIVO: O presente estudo teve como objetivo avaliar a influência do ingestão alimentar, composição corporal e indicadores bioquímicos sobre disponibilidade energética em dançarinas de ballet. MÉTODOS: Em estudo de delineamento transversal, 17 dançarinas de ballet (19,1+7,1 anos) foram inicialmente submetidas a avaliação do consumo alimentar, de forma quantitativa e qualitativa (Recordatório de 24 horas e Questionário de Frequência Alimentar), para posterior cálculo dietético e da disponibilidade energética. Adicionalmente foram submetidas a avaliação de composição corporal (Impedância Bioelétrica), do gasto energético de repouso (Fitmate) e análise de indicadores sanguíneos-bioquímicos. Os dados contínuos foram apresentados em média, mediana e desvio padrão e os categóricos em frequências e percentual. Para análise estatística foi utilizada correlação de Pearson e Regressão Múltipla Stepwise. (p<0,05). RESULTADOS: As dançarinas relataram auto percepção do estado de saúde classificada como boa, sendo que 52,9% já apresentaram quadros de amenorréia. Em relação a composição corporal apresentaram % de gordura elevado para dançarinas (24,5%) e sarcopenia (IMM=6,62kg/m²). 50% da amostra apresentou preocupação com o corpo, sujeitas a transtornos alimentares. A ingestão energética (1248±385 kcal/d) equivaleu a 56% do gasto energético total e a disponibilidade energética inadequada em 82,3% delas (22,48±13,1 kcal/kgMLG/d). A ingestão de carboidrato e a proteína apresentaram as maiores inadequações (94,8% e 83,2% respectivamente), a dieta pode ser considerada como variada (12,3) e de baixa qualidade (67,9 pontos pelo IAS). A disponibilidade energética apresentou correlação positiva com Massa muscular (kg), Valor calórico total (kcal), carboidrato, gorduras e proteína (p<0,05). As variáveis dietéticas mais influentes na disponibilidade energética foram carboidrato e proteína (g/kg) (r²= 0,88 e 0.95; p<0,05). Das variáveis bioquímicas, houve correlação positiva entre densidade calórica com ferro e colesterol (p<0,005), enquanto a variedade da dieta apresentou correlação negativa com Alanina aminotransferase e Índice de Alimentação Saudável com Aspartato aminotransferase (p<0.05). Assim, temos que a adequação nutricional, para suporte a modalidade esportiva, é de extrema importância. O ajuste na ingestão de macronutrientes, principalmente carboidrato e proteína, bem como na qualidade global da dieta, apresentam influencia direta na melhoria da disponibilidade energética e indicadores bioquímicos, otimizando desempenho físico e saúde das dançarinas. / The low energy availability status is directly related to health problems, affecting immune system, muscular, skeletal, endocrine and reproductive systems. Now a days, the athletes used to control the body weight focused on sports performance, commonly verified in dancers, and this behavior is often related to eating disorders. This practice is considered the most important trigger to the worst clinical outcomes. OBJECTIVE: This study aimed to assess the influence of food intake, body composition and biochemical indicators on energy availability in ballet dancers. METHODS: In a cross-sectional study, 17 ballet dancers (19.1+ 7.1 years) were submmited to food consumption assessment, quantitatively and qualitatively (24-hour dietary recall and Food Frequency Questionnaire) followed by diet composition calculation and energy availability determination. The subjects were submitted to Body composition analysis (Bioelectrical Impedance) and resting energy expenditure measurement (Fitmate®). After night fasting period, blood samples was collected to biochemistry indicators analysis. Continuous data were presented as mean, median and standard deviation and categorical data as frequencies and percentages. Statistical analysis was perfomed by Pearson's correlation and Multiple Stepwise Regression. (p <0.05). RESULTS: The dancers reported self-perception of health status rated as good, and 52.9% already had amenorrhea's episodes. In relation to body composition they presented high %fat to dancers (24.5%) and sarcopenia's diagnosis (MMI= 6,62kg/m²). 50% of the sample showed concern with the body, suggesting eating disorders development. Energy intake (1248 ± 385 kcal/d) were equivalent to 56% of total energy expenditure and was detected 82.3% of inadequate energy availability (22.48 ± 13.1 kcal/kgFFM/d). The carbohydrate and protein intake presented the highest inadequacies (94.8% and 83.2% respectively), the diet can be considered as varied (12.3) and low quality (67.9 points by HEI). Energy availability was positively correlated with muscle mass (kg), total caloric intake (kcal), carbohydrate, fat and protein (p <0.05). The dietary energy availability were most influencied by carbohydrate and protein (g/kg) (r²=0.88 and 0.95; p<0.05). There was a positive correlation between caloric density and iron with cholesterol (p <0.005), while dietary variety were negatively correlated with Alanine aminotransferase, as well as Healthy Eating Index with Aspartate aminotransferase (p <0.05). So, we known that food adequacy, based on sports modality, is the major key point. The adjustment of macronutrient intake, especially carbohydrates and protein, as well as the overall quality of the diet, promotes the energy availability and biochemical indicators improvement, optimizing exercise performance and health of the ballet dancers.

Orientador: Roberto Carlos Burini / Resumo: A baixa disponibilidade energética, apresenta direta relação com problemas de saúde, podendo afetar desde sistema imunológico, muscular, ósseo, endócrino e reprodutor. Geralmente a preocupação com peso corporal por atletas, freqüentemente verificada em dançarinas, leva a mudanças no comportamento alimentar, sendo este considerado como principal fator desencadeador desde quadro. OBJETIVO: O presente estudo teve como objetivo avaliar a influência do ingestão alimentar, composição corporal e indicadores bioquímicos sobre disponibilidade energética em dançarinas de ballet. MÉTODOS: Em estudo de delineamento transversal, 17 dançarinas de ballet (19,1+7,1 anos) foram inicialmente submetidas a avaliação do consumo alimentar, de forma quantitativa e qualitativa (Recordatório de 24 horas e Questionário de Frequência Alimentar), para posterior cálculo dietético e da disponibilidade energética. Adicionalmente foram submetidas a avaliação de composição corporal (Impedância Bioelétrica), do gasto energético de repouso (Fitmate) e análise de indicadores sanguíneos-bioquímicos. Os dados contínuos foram apresentados em média, mediana e desvio padrão e os categóricos em frequências e percentual. Para análise estatística foi utilizada correlação de Pearson e Regressão Múltipla Stepwise. (p<0,05). RESULTADOS: As dançarinas relataram auto percepção do estado de saúde classificada como boa, sendo que 52,9% já apresentaram quadros de amenorréia. Em relação a composição corporal apresentaram % de ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

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Ballet dancers are a unique population of athletes in that, unlike other sports, their success strictly depends on both physical capabilities and aesthetic factors. While the physical demands of the performing sport are strenuous, ballet dancers are often required to exhibit a thin physique, frequently resulting in weights 10-12% below the ideal. These low weights are commonly achieved by low energy intakes which increase dancers' susceptibility to the development of various health conditions. Research investigating the health of dancers, however, is limited and hampered by methodological limitations. To address these issues, we tested the hypothesis that dancers would report a low habitual energy intake and, therefore, be subject to conditions comprising the Female Athlete Triad, including low energy availability, suboptimal bone density and menstrual irregularities. In addition, we hypothesized that elite female dancers would have lower than expected resting metabolic rate (RMR) based upon their fat-free mass, and thus greater energetic efficiency as a result of chronic energy deficiency. As hypothesized, dancers reported a significantly lower energy intake and exhibited a lower RMR as compared to lean, pair-matched controls. Because treatment of these metabolic abnormalities is challenging, prevention of adverse health outcomes among adolescent pre-professional dancers is key in promoting overall health and optimal performance. Through our subsequent 'formative work', we determined that the current availability of nutrition education offered to both professional and pre-professional dancers is minimal and of questionable quality. Thus, we developed, implemented, and evaluated a DVD-based educational program, entitled "Nutrition for Optimal Performance", aimed at improving health knowledge and behaviors of pre-professional adolescent ballet dancers. Our findings indicate that participants increased their knowledge of basic nutrition principles and self-efficacy for adopting healthier dietary habits, as compared to pre-program and control group scores, and that knowledge gains were sustained at a six-week follow-up assessment. Collectively, these studies provide the field of dance medicine with novel findings related to the characteristics and health conditions of professional ballet dancers, and the effectiveness of a low-resource, disseminable nutrition education program which promotes the health and optimal performance of pre-professional adolescent ballet dancers. / Ph. D.

The female athlete triad (FAT or the TRIAD) is a complex syndrome arising from associations among the trio of energy availability (EA), menstrual function (MF) and bone mineral density (BMD) along their respective continuums from health to disease state. It has been recognized that women whose energy intake (EI) does not meet the energy requirements for physiological functions subsequent to participation in exercise and physical activity could have low EA. In the TRIAD, low EA, an initiator in menstrual dysfunction (MD) and concomitant hypoestrogenism, indirectly results in low BMD. Therefore, the purpose of this study was to: (i) establish the status of EA, MF and BMD among elite Kenyan female athletes and non-athletes, (ii) explore associations between EA and MF in elite Kenyan female athletes and non-athletes, (iii) determine the relationships of EA and MF to BMD in elite Kenyan female athletes and non-athletes, and (iv) to determine the profile of the female athlete triad in elite Kenyan distance athletes and in non-athletes. Measurements of EA, MF and BMD were undertaken in 39 female participants (Middle distance athletes =12, Long distance athletes=13, Non-athletes=14). Energy intake minus exercise energy expenditure (EEE) and the remnant normalized to fat free mass (FFM) determined EA. Energy availability was determined through weight of all food and liquid consumed over three consecutive days. Exercise energy expenditure was determined after isolating and deducting energy expended in exercise or physical activity above lifestyle level from the total energy expenditure output as measured by Actigraph GT3X+. Fat free mass and BMD were assessed using dual energy x-ray absorptiometry (DXA). A nine-month daily temperature-menstrual diary was used to evaluate menstrual status. In addition, since psychological eating behaviour practice (EBP) contributes to low EA, the Eating Disorder Examination Questionnaire (EDE-Q) was used to determine presence of such practice among the participants and their relationship to EA. Overall, EA below 45 kcal.kgFFM-1.d-1 was found in 61.53% of the participants (athletes=28.07±11.45kcal.kgFFM-1.d-1, non-athletes=56.97±21.38kcal.kgFMM-1.d-1). The ANOVA showed that there was a significant difference (p<0.001) in EA among the long and middle distance runners and non-athletes; and the Tukey‘s HSD revealed that the source of the difference were the non-athletes. Results of the EDE-Q showed almost negligible presence of psychopathological eating behaviour practice among the Kenyan participants. None of the TRIAD components showed significant relationship with EBP. Results of MF showed that whereas none of the athletes presented with amenorrhea, oligomenorrhea was present among 40% athletes and 14.3% non-athletes, and amenorrhea among 14.3% non-athletes. However, there was no significant difference between athletes and non-athletes in MF. Low BMD was seen in 76% of the athletes and among 86% of the non-athletes. The analysis did not show significant difference in BMD Z-scores between athletes and non-athletes. The analysis did not show any significant association between EA and MF among the participants. The only significant relation of EA to any BMD dimension measured was between EA and total BMD in the long distance runners (r=0.560; p=.046). Significant relationship (rho=0.497; p=.001) was found between MF and BMD Z-scores among the athletes with middle distance highlighting the relationship further (rho=0.632; p=.027). Overall, the binary logistic regression revealed that MF did not predict BMD (OR=4.07, 95% CI, 0.8-20.7, p=.091). Overall, 10% of the participants (athletes=4, long distance athletes =3, middle distance athletes=1, non-athletes=0) showed simultaneous presence of all three components of the TRIAD. The independent sample t-test showed a significant difference (t=5.860; p=<.001) in the prevalence of the TRIAD between athletes and non-athletes. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

The female athlete triad (FAT or the TRIAD) is a complex syndrome arising from associations among the trio of energy availability (EA), menstrual function (MF) and bone mineral density (BMD) along their respective continuums from health to disease state. It has been recognized that women whose energy intake (EI) does not meet the energy requirements for physiological functions subsequent to participation in exercise and physical activity could have low EA. In the TRIAD, low EA, an initiator in menstrual dysfunction (MD) and concomitant hypoestrogenism, indirectly results in low BMD. Therefore, the purpose of this study was to: (i) establish the status of EA, MF and BMD among elite Kenyan female athletes and non-athletes, (ii) explore associations between EA and MF in elite Kenyan female athletes and non-athletes, (iii) determine the relationships of EA and MF to BMD in elite Kenyan female athletes and non-athletes, and (iv) to determine the profile of the female athlete triad in elite Kenyan distance athletes and in non-athletes. Measurements of EA, MF and BMD were undertaken in 39 female participants (Middle distance athletes =12, Long distance athletes=13, Non-athletes=14). Energy intake minus exercise energy expenditure (EEE) and the remnant normalized to fat free mass (FFM) determined EA. Energy availability was determined through weight of all food and liquid consumed over three consecutive days. Exercise energy expenditure was determined after isolating and deducting energy expended in exercise or physical activity above lifestyle level from the total energy expenditure output as measured by Actigraph GT3X+. Fat free mass and BMD were assessed using dual energy x-ray absorptiometry (DXA). A nine-month daily temperature-menstrual diary was used to evaluate menstrual status. In addition, since psychological eating behaviour practice (EBP) contributes to low EA, the Eating Disorder Examination Questionnaire (EDE-Q) was used to determine presence of such practice among the participants and their relationship to EA. Overall, EA below 45 kcal.kgFFM-1.d-1 was found in 61.53% of the participants (athletes=28.07±11.45kcal.kgFFM-1.d-1, non-athletes=56.97±21.38kcal.kgFMM-1.d-1). The ANOVA showed that there was a significant difference (p<0.001) in EA among the long and middle distance runners and non-athletes; and the Tukey‘s HSD revealed that the source of the difference were the non-athletes. Results of the EDE-Q showed almost negligible presence of psychopathological eating behaviour practice among the Kenyan participants. None of the TRIAD components showed significant relationship with EBP. Results of MF showed that whereas none of the athletes presented with amenorrhea, oligomenorrhea was present among 40% athletes and 14.3% non-athletes, and amenorrhea among 14.3% non-athletes. However, there was no significant difference between athletes and non-athletes in MF. Low BMD was seen in 76% of the athletes and among 86% of the non-athletes. The analysis did not show significant difference in BMD Z-scores between athletes and non-athletes. The analysis did not show any significant association between EA and MF among the participants. The only significant relation of EA to any BMD dimension measured was between EA and total BMD in the long distance runners (r=0.560; p=.046). Significant relationship (rho=0.497; p=.001) was found between MF and BMD Z-scores among the athletes with middle distance highlighting the relationship further (rho=0.632; p=.027). Overall, the binary logistic regression revealed that MF did not predict BMD (OR=4.07, 95% CI, 0.8-20.7, p=.091). Overall, 10% of the participants (athletes=4, long distance athletes =3, middle distance athletes=1, non-athletes=0) showed simultaneous presence of all three components of the TRIAD. The independent sample t-test showed a significant difference (t=5.860; p=<.001) in the prevalence of the TRIAD between athletes and non-athletes. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

Objective: This study investigated the behaviors and characteristics of the adult female endurance runner and potential components of the female athlete triad (FAT). The FAT consists of three components that are interrelated: low energy availability, menstrual dysfunction, and low bone mineral density. Low energy availability may occur with or without disordered eating. Reproduction becomes non-essential leading to irregular menstrual cycles. A reduction in estrogen levels may contribute to low bone mineral density which may lead to stress fractures. Research investigating the FAT has primarily focused on adolescent and young adult females. Adult females training for endurance events may also be at risk for the FAT. Method: A survey was constructed and distributed to females in a local half-marathon and marathon training group in Central Florida. The data was collected at one point in time and no additional follow-up was required. The survey aimed to identify specific behaviors and characteristics related to components of the FAT and determine the potential prevalence in a small sample of female endurance athletes aged 18 and older. Results: 72 females with a mean age of 40.92(± 9.61) years completed the survey. Subjects had an average height of 163.60(±6.41) cm, weighed an average of 62.24(±10.05) kg and had 10 years of running experience. Conclusion: Adult female endurance runners demonstrate behaviors and characteristics that may be indicative of the FAT. Participants demonstrated signs of inadvertent or intentional low energy availability. These characteristics can be due to either body dissatisfaction or wanting to increase performance.

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