The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review
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REVIEW ARTICLE
The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review Dylan L. Petkus1 • Laura E. Murray-Kolb2 • Mary Jane De Souza1
Published online: 13 March 2017 Ó Springer International Publishing Switzerland 2017
Abstract Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the ‘female athlete triad.’ This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.
& Mary Jane De Souza [email protected] 1
Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA 16802, USA
2
Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
Key Points Iron deficiency interacts with energy deficiency to perturb thyroid function and plays a role in metabolic fuel availability. Iron deficiency is associated with reproductive dysfunction related to the female athlete triad secondary to the relationship of iron deficiency to infertility and hyperprolactinemia. Iron deficiency may play a role in bone loss associated with the female athlete triad secondary to the relationship of iron deficiency to suppression of the GH/IGF-1 axis, increased hypoxia-induced bone resorption, and impaired thyroid function.
1 Introduction With 24–47% of exercising women experiencing iron deficiency without anemia [1], exercising women are prone to several health and sports performance detriments. Iron deficiency compromises immune function, decreases metabolic efficiency, and impairs cognitive function [2, 3], with several of these detrimental consequences occurring even in the absence of overt anemia [4–6]. Despite the high prevalence and severe consequences of iron deficiency, a term that encompasses iron deficiency with and without anemia in this review unless specified otherwise, little has been described about how iron deficiency may interact with another prevalent and severe condition in exercising women: The ‘female athlete triad’ (triad). The triad is a syndrome of three interrelated conditions: poor energy
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Fig. 1 Summary of consequences of iron deficiency in
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