ArticleNutrients2014
Dietary intervention restored menses in female athletes with exercise-associated menstrual dysfunction with limited impact on bone and muscle health.
Article in Nutrients, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 93 citations in OpenAlex.
- The Effect of Diet and Dietary Supplements on Iron Status of Active Females: A Systematic Review and Meta-analysis of Interventional Trials.Sports medicine (Auckland, N.Z.) · 2026Pooled it
- 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 2: Clinical Guidelines for Screening, Diagnosis, Treatment, and Return to Play for Adolescents and Adults.Sports medicine (Auckland, N.Z.) · 2026Guideline
- Multiple eumenorrheic cycles are necessary to observe a significant increase in estrogen exposure and ovulation in exercising women with functional hypothalamic oligo/amenorrhea undergoing a nutritional intervention: Insights from the REFUEL study.PM & R : the journal of injury, function, and rehabilitation · 2026Trial
- The effect of nutrition education sessions on energy availability, body composition, eating attitude and sports nutrition knowledge in young female endurance athletes.Frontiers in public health · 2024Trial
- Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea/amenorrhea: the REFUEL randomized controlled trial.The American journal of clinical nutrition · 2022Trial
- Randomised controlled trial of the effects of increased energy intake on menstrual recovery in exercising women with menstrual disturbances: the 'REFUEL' study.Human reproduction (Oxford, England) · 2021Trial
- Adaptation or Maladaptation? Rethinking How Energy Restriction Outcomes Are Monitored.Sports medicine (Auckland, N.Z.) · 2026Article
- Differences in female athlete triad risk factors between Japanese and American female runners: A comparative study.PM & R : the journal of injury, function, and rehabilitation · 2026Observational
- 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 1: State of the Science and Introduction of a New Adolescent Model.Sports medicine (Auckland, N.Z.) · 2026Review
- Protecting women's health in sport: the role of low energy availability in the Female Athlete Triad and RED-S.Frontiers in sports and active living · 2026Review
- Pharmacological vs. Non-Pharmacological Treatment in the Management of Relative Energy Deficiency in Sport (REDs): A Systematic Review and Meta-Analysis.Sports (Basel, Switzerland) · 2025Review
- The Women's Tennis Association (WTA) Multidisciplinary Education and Treatment Protocol for the Female Athlete Triad (1996-2022).Sports (Basel, Switzerland) · 2025Article
- Exploring different interventions for Relative Energy Deficiency in Sport (REDs): A systematic review.JSAMS plus · 2025Review
- Iron's True Weight: Does the Amount of Iron in the Body Equate to the Amount of Iron on the Bar in Australian Football League Women's Players?Nutrients · 2025Article
- Putting the Fe into Female Athletes: Insights into Heightened Iron Status and Women's Australian Football Performance-A Case Study.Sports (Basel, Switzerland) · 2025Article
- Multi-organ transcriptome atlas of a mouse model of relative energy deficiency in sport.Cell metabolism · 2024Article
- Gene-environment interaction in functional hypothalamic amenorrhea.Frontiers in endocrinology · 2024Review
- The Influence of Energy Balance and Availability on Resting Metabolic Rate: Implications for Assessment and Future Research Directions.Sports medicine (Auckland, N.Z.) · 2023Review
- Article
- Short-term effects and long-term changes of FUEL-a digital sports nutrition intervention on REDs related symptoms in female athletes.Frontiers in sports and active living · 2023Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Exercise-related menstrual dysfunction (ExMD) is associated with low energy availability (EA), decreased bone mineral density (BMD), and increased risk of musculoskeletal injury. We investigated whether a 6-month carbohydrate-protein (CHO-PRO) supplement (360 kcal/day, 54 g CHO/day, 20 g PRO/day) intervention would improve energy status and musculoskeletal health and restore menses in female athletes (n = 8) with ExMD. At pre/post-intervention, reproductive and thyroid hormones, bone health (BMD, bone mineral content, bone markers), muscle strength/power and protein metabolism markers, profile of mood state (POMS), and energy intake (EI)/energy expenditure (7 day food/activity records) were measured. Eumenorrheic athlete controls with normal menses (Eumen); n = 10) were measured at baseline. Multiple linear regressions were used to evaluate differences between groups and pre/post-intervention blocking on participants. Improvements in EI (+382 kcal/day; p = 0.12), EA (+417 kcal/day; p = 0.17) and energy balance (EB; +466 kcal/day; p = 0.14) were observed with the intervention but were not statistically significant. ExMD resumed menses (2.6 ± 2.2-months to first menses; 3.5 ± 1.9 cycles); one remaining anovulatory with menses. Female athletes with ExMD for >8 months took longer to resume menses/ovulation and had lower BMD (low spine (ExMD = 3; Eumen = 1); low hip (ExMD = 2)) than those with ExMD for <8 months; for 2 ExMD the intervention improved spinal BMD. POMS fatigue scores were 15% lower in ExMD vs. Eumen (p = 0.17); POMS depression scores improved by 8% in ExMD (p = 0.12). EI, EA, and EB were similar between groups, but the intervention (+360 kcal/day) improved energy status enough to reverse ExMD despite no statistically significant changes in EI. Similar baseline EA and EB between groups suggests that some ExMD athletes are more sensitive to EA and EB fluctuations.
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