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Nutrition factors associated with rib stress injury history in elite rowers

Published:August 30, 2022DOI:https://doi.org/10.1016/j.jsams.2022.08.017

      Abstract

      Objectives

      To investigate associations between nutrition factors (diet restriction, menstrual status, calcium intake, vitamin D and K status), bone mineral density (BMD) and rib stress injury (RSI) history.

      Design

      Cross-sectional.

      Methods

      133 elite rowers completed a self-report questionnaire to collect information regarding training and injury history, menstrual status and diet restriction, and a calcium intake questionnaire (SCQ2002). BMD and body composition were assessed by dual-energy X-ray absorptiometry. A sub-group (n = 68) had vitamin D and K status assessed from fasted morning blood. History of RSI was self-reported and verified against medical records. Characteristics of injured and uninjured rowers were compared (one-way ANOVA), while relationships with BMD (multiple linear regression) and RSI (multiple logistic regression) were modelled.

      Results

      Diet restriction was inversely related to spine BMD and rib BMD. Within sex, vitamin D and K status, and calcium intake were not associated with injury. Among rowers with RSI history, lightweight males had lower total bone mass, femur BMD and rib BMD, whereas heavyweight females had lower rib BMD. In relation to RSI history, the best models included rib, spine or femur BMD with age, body fat and sex. A female-specific model included rib BMD, current menstrual dysfunction, age and body fat levels.

      Conclusions

      BMD, including that of the rib, diet restriction, menstrual function and weight category were associated with rib injury history and should be considered in the management of elite rowers.

      Keywords

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      References

        • Abbott A.
        • Bird M.L.
        • Wild E.
        • et al.
        Part I: epidemiology and risk factors for stress fractures in female athletes.
        Phys Sportsmed. 2020; 48: 17-24https://doi.org/10.1080/00913847.2019.1632158
        • Trease L.
        • Wilkie K.
        • Lovell G.
        • et al.
        Epidemiology of injury and illness in 153 Australian international-level rowers over eight international seasons.
        Br J Sports Med. 2020; 54: 1288-1293https://doi.org/10.1136/bjsports-2019-101402
        • Harris R.
        • Trease L.
        • Wilkie K.
        • et al.
        Rib stress injuries in the 2012-2016 (Rio) Olympiad: a cohort study of 151 Australian Rowing Team athletes for 88 773 athlete days.
        Br J Sports Med. 2020; 54: 991-996https://doi.org/10.1136/bjsports-2019-101584
        • Vinther A.
        • Kanstrup I.L.
        • Christiansen E.
        • et al.
        Exercise-induced rib stress fractures: influence of reduced bone mineral density.
        Scand J Med Sci Sports. 2005; 15: 95-99https://doi.org/10.1111/j.1600-0838.2004.00400.x
        • Dimitriou L.
        • Weiler R.
        • Lloyd-Smith R.
        • et al.
        Bone mineral density, rib pain and other features of the female athlete triad in elite lightweight rowers.
        BMJ Open. 2014; 4e004369https://doi.org/10.1136/bmjopen-2013-004369
        • Baker B.S.
        • Buchanan S.R.
        • Bemben D.A.
        Skeletal health and associated injury risk in collegiate female rowers.
        J Strength Cond Res. 2022; 36: 1125-1133https://doi.org/10.1519/JSC.0000000000003588
        • Tenforde A.S.
        • Sayres L.C.
        • Sainani K.L.
        • et al.
        Evaluating the relationship of calcium and vitamin D in the prevention of stress fracture injuries in the young athlete: a review of the literature.
        PM R. 2010; 2: 945-949https://doi.org/10.1016/j.pmrj.2010.05.006
        • Ruohola J.P.
        • Laaksi I.
        • Ylikomi T.
        • et al.
        Association between serum 25(OH)D concentrations and bone stress fractures in Finnish young men.
        J Bone Miner Res. 2006; 21: 1483-1488https://doi.org/10.1359/jbmr.060607
        • Nieves J.W.
        • Melsop K.
        • Curtis M.
        • et al.
        Nutritional factors that influence change in bone density and stress fracture risk among young female cross-country runners.
        PM R. 2010; 2 (quiz 94): 740-750
        • Booth S.L.
        • Tucker K.L.
        • Chen H.
        • et al.
        Dietary vitamin K intakes are associated with hip fracture but not with bone mineral density in elderly men and women.
        Am J Clin Nutr. 2000; 71: 1201-1208https://doi.org/10.1093/ajcn/71.5.1201
        • Braam L.A.
        • Knapen M.H.
        • Geusens P.
        • et al.
        Factors affecting bone loss in female endurance athletes: a two-year follow-up study.
        Am J Sports Med. 2003; 31: 889-895https://doi.org/10.1177/03635465030310062601
        • Craciun A.M.
        • Wolf J.
        • Knapen M.H.
        • et al.
        Improved bone metabolism in female elite athletes after vitamin K supplementation.
        Int J Sports Med. 1998; 19: 479-484https://doi.org/10.1055/s-2007-971948
        • Mountjoy M.
        • Sundgot-Borgen J.
        • Burke L.
        • et al.
        International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 update.
        Int J Sport Nutr Exerc Metab. 2018; 28: 316-331https://doi.org/10.1123/ijsnem.2018-0136
        • Thein-Nissenbaum J.M.
        • Rauh M.J.
        • Carr K.E.
        • et al.
        Menstrual irregularity and musculoskeletal injury in female high school athletes.
        J Athl Train. 2012; 47: 74-82
        • Lebenstedt M.
        • Platte P.
        • Pirke K.M.
        Reduced resting metabolic rate in athletes with menstrual disorders.
        Med Sci Sports Exerc. 1999; 31: 1250-1256https://doi.org/10.1097/00005768-199909000-00004
        • Rauh M.J.
        • Nichols J.F.
        • Barrack M.T.
        Relationships among injury and disordered eating, menstrual dysfunction, and low bone mineral density in high school athletes: a prospective study.
        J Athl Train. 2010; 45: 243-252https://doi.org/10.4085/1062-6050-45.3.243
        • Friedl K.E.
        • Moore R.J.
        • Martinez-Lopez L.E.
        • et al.
        Lower limit of body fat in healthy active men.
        J Appl Physiol. 1994; 77: 933-940https://doi.org/10.1152/jappl.1994.77.2.933
        • Sebring N.G.
        • Denkinger B.I.
        • Menzie C.M.
        • et al.
        Validation of three food frequency questionnaires to assess dietary calcium intake in adults.
        J Am Diet Assoc. 2007; 107: 752-759https://doi.org/10.1016/j.jada.2007.02.007
        • Nana A.
        • Slater G.J.
        • Hopkins W.G.
        • et al.
        Importance of standardized DXA protocol for assessing physique changes in athletes.
        Int J Sport Nutr Exerc Metab. 2016; 26: 259-267https://doi.org/10.1123/ijsnem.2013-0111
        • Farrell C.J.
        • Martin S.
        • McWhinney B.
        • et al.
        State-of-the-art vitamin D assays: a comparison of automated immunoassays with liquid chromatography-tandem mass spectrometry methods.
        Clin Chem. 2012; 58: 531-542https://doi.org/10.1373/clinchem.2011.172155
        • Paroni R.
        • Faioni E.M.
        • Razzari C.
        • et al.
        Determination of vitamin K1 in plasma by solid phase extraction and HPLC with fluorescence detection.
        J Chromatogr B Analyt Technol Biomed Life Sci. 2009; 877: 351-354https://doi.org/10.1016/j.jchromb.2008.12.044
        • De Souza M.J.
        • Nattiv A.
        • Joy E.
        • et al.
        2014 Female Athlete Triad Coalition consensus statement on treatment and return to play of the Female Athlete Triad: 1st international conference held in San Francisco, California, May 2012 and 2nd international conference held in Indianapolis, Indiana, May 2013.
        Br J Sports Med. 2014; 48: 289https://doi.org/10.1136/bjsports-2013-093218
        • Jonvik K.L.
        • Torstveit M.K.
        • Sundgot-Borgen J.K.
        • et al.
        Do we need to change the guideline values for determining low bone mineral density in athletes?.
        J Appl Physiol (1985). 2022; https://doi.org/10.1152/japplphysiol.00851.2021
        • Heikura I.A.
        • Uusitalo A.L.T.
        • Stellingwerff T.
        • et al.
        Low energy availability is difficult to assess but outcomes have large impact on bone injury rates in elite distance athletes.
        Int J Sport Nutr Exerc Metab. 2018; 28: 403-411https://doi.org/10.1123/ijsnem.2017-0313
        • VanHeest J.L.
        • Mahoney C.E.
        Female athletes: factors impacting successful performance.
        Curr Sports Med Rep. 2007; 6: 190-194https://doi.org/10.1007/s11932-007-0027-6
        • International Society for Clinical Densitometry
        Official Positions Adult 2019.
        (Available from)
        • Klungland Torstveit M.
        • Sundgot-Borgen J.
        Are under- and overweight female elite athletes thin and fat? A controlled study.
        Med Sci Sports Exerc. 2012; 44: 949-957https://doi.org/10.1249/MSS.0b013e31823fe4ef
        • Fredericson M.
        • Kussman A.
        • Misra M.
        • et al.
        The Male Athlete Triad-A consensus statement from the Female and Male Athlete Triad Coalition Part II: diagnosis, treatment, and return-to-play.
        Clin J Sport Med. 2021; 31: 349-366https://doi.org/10.1097/JSM.0000000000000948
      1. National Health and Medical Research Council Nutrient Reference Values for Australia and New Zealand: Calcium. National Health and Medical Research Council, Canberra2006: 155-163
        • Ogan D.
        • Pritchett K.
        Vitamin D and the athlete: risks, recommendations, and benefits.
        Nutrients. 2013; 5: 1856-1868https://doi.org/10.3390/nu5061856