12-months of increased dietary intake does not exacerbate disordered eating-related attitudes, stress, or depressive symptoms in women with exercise-associated menstrual disturbances: The REFUEL randomized controlled trial

Nicole C A Strock; Mary Jane De Souza; Rebecca J Mallinson; Marion Olmsted; Heather C M Allaway; Emma O'Donnell; Franziska Plessow; Nancy I Williams

doi:10.1016/j.psyneuen.2023.106079

12-months of increased dietary intake does not exacerbate disordered eating-related attitudes, stress, or depressive symptoms in women with exercise-associated menstrual disturbances: The REFUEL randomized controlled trial

Psychoneuroendocrinology. 2023 Jun:152:106079. doi: 10.1016/j.psyneuen.2023.106079. Epub 2023 Mar 8.

Authors

Nicole C A Strock¹, Mary Jane De Souza¹, Rebecca J Mallinson², Marion Olmsted³, Heather C M Allaway⁴, Emma O'Donnell⁵, Franziska Plessow⁶, Nancy I Williams⁷

Affiliations

¹ Penn State University, University Park, PA, USA.
² Penn State University, University Park, PA, USA; Penn State Harrisburg, Middletown, PA, USA.
³ University of Toronto, Toronto, Ontario, Canada.
⁴ Penn State University, University Park, PA, USA; Louisiana State University, Baton Rouge, LA, USA.
⁵ University of Toronto, Toronto, Ontario, Canada; Loughborough University, Loughborough, Leicestershire, UK.
⁶ Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA.
⁷ Penn State University, University Park, PA, USA. Electronic address: niw1@psu.edu.

PMID: 36947969
DOI: 10.1016/j.psyneuen.2023.106079

Abstract

Disordered eating-related attitudes are a leading cause of energy deficiency and menstrual disturbances in exercising women. Although treatment recommendations include psychological counseling with increases in dietary intake, a key concern is whether increased dietary intake may exacerbate negative eating behaviors.

Objective: To determine the effects of a 12-month nutritional intervention on eating-related attitudes and psychological characteristics in exercising women with oligomenorrhea/amenorrhea (Oligo/Amen).

Methods: Intent-to-treat analysis of the REFUEL randomized controlled trial (#NCT00392873) in 113 exercising women (age [mean±SEM]:] 21.9 ± 0.4 yrs; BMI: 20.9 ± 0.2 kg/m²). Women were randomized to increase energy intake 20-40% above baseline energy needs (Oligo/Amen+Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36) while maintaining their exercise behaviors. A reference group of ovulatory women (OVref, n = 37) maintained diet and exercise behaviors. Body composition, eating attitudes, stress, and depressive symptoms were assessed at baseline and every 3 months.

Results: At baseline, the Oligo/Amen groups had higher drive for thinness, cognitive restraint, and eating disorder risk than OVref group (p < 0.001). Increased energy intake led to increases in percent body fat and fat mass (p < 0.010), but not psychobehavioral outcomes, in the Oligo/Amen+Cal compared to Oligo/Amen Control group. Independent of group, cognitive restraint decreased (p < 0.001) and resilient coping increased (p < 0.007) over 12-months, while perceived stress (p = 0.143) and depressive symptoms (p = 0.344) were unchanged.

Discussion: Long-term nutritional intervention consisting of modest increases in dietary intake with guidance from a registered dietician and a psychologist increases body and fat mass without increasing disordered eating-related attitudes, stress, or depressive symptoms in exercising women with Oligo/Amen.

Keywords: Depressive symptoms; Eating attitudes; Energy deficiency; Female athlete triad; Psychological stress.

Publication types

Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Depression*
Eating
Energy Intake
Exercise / psychology
Feeding and Eating Disorders*
Female
Humans
Menstruation Disturbances
Young Adult

Associated data

ClinicalTrials.gov/NCT00392873