Evidence map›Paper›PMID 35170727›Full record

Trial reportThe American journal of clinical nutrition2022

Bone mineral density in response to increased energy intake in exercising women with oligomenorrhea/amenorrhea: the REFUEL randomized controlled trial.

Mary Jane De Souza, Emily A Ricker, Rebecca J Mallinson, Heather C M Allaway, Kristen J Koltun, Nicole C A Strock, Jenna C Gibbs, Prabhani Kuruppumullage Don, Nancy I Williams

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The American journal of clinical nutrition, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00392873 ("REFUEL" Active Women's Study II), which is not on this map. Cited by 19 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 2 pooled it
4.1field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

NCT00392873 nacompletednot on this map

"REFUEL" Active Women's Study II: Increased Caloric Intake to Reverse Energy Deficiency in Exercising Women: Impact on Bone and Menstrual Cyclicity

TypeinterventionalSponsorPenn State UniversityRan2006 to 2014Enrolled233ConditionsMenstrual IrregularityArmsEAMD+Calories
3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 39 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

Mary Jane De SouzaDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Emily A RickerDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Rebecca J MallinsonDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Heather C M AllawayDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Kristen J KoltunDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Nicole C A StrockDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Jenna C GibbsDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Prabhani Kuruppumullage DonDepartment of Statistics, Pennsylvania State University, University Park, PA, USA.
Nancy I WilliamsDepartment of Kinesiology, Pennsylvania State University, University Park, PA, USA.
Pennsylvania State University · US

Funding

Penn State Clinical and Translational Science InstituteUL1TR002014 · NCATS · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI KRASCHNEWSKI, JENNIFER L. · 2016 to 2025
$33.7M
NCATS NIH HHS UL1 TR002014
6 · The paper itself

Abstract

backgroundEnergy deficiency can result in menstrual disturbances and compromised bone health in women, a condition known as the Female Athlete Triad.

objectivesThe REFUEL randomized controlled trial assessed the impact of increased energy intake on bone health and menstrual function in exercising women with menstrual disturbances.

methodsExercising women with oligomenorrhea/amenorrhea (Oligo/Amen) were randomly assigned to an intervention group (Oligo/Amen + Cal, n = 40, mean ± SEM age: 21.3 ± 0.5 y; weight: 55.0 ± 1.0 kg; BMI: 20.4 ± 0.3 kg/m2) who increased energy intake 20%-40% above baseline energy needs for 12 mo or a control group (Oligo/Amen Control, n = 36; mean ± SEM age: 20.7 ± 0.5 y; weight: 59.1 ± 1.3 kg; BMI: 21.3 ± 0.4 kg/m2). Energy intake and expenditure, metabolic and reproductive hormones, body composition, and areal bone mineral density (aBMD) were assessed.

resultsOligo/Amen + Cal improved energy status [increased body mass (2.6 ± 0.4 kg), BMI (0.9 ± 0.2 kg/m2), fat mass (2.0 ± 0.3 kg), body fat percentage (2.7% ± 0.4%), and insulin-like growth factor 1 (37.4 ± 14.6 ng/mL)] compared with Oligo/Amen Control and experienced a greater likelihood of menses (P < 0.05). Total body and spine aBMD remained unchanged (P > 0.05). Both groups demonstrated decreased femoral neck aBMD at month 6 (-0.006 g/cm2; 95% CI: -0.011, -0.0002 g/cm2 ; time main effect P = 0.043) and month 12 (-0.011 g/cm2; 95% CI: -0.021, -0.001 g/cm2; time main effect P = 0.023). Both groups demonstrated a decrease in total hip aBMD at month 6 (-0.006 g/cm2; 95% CI: -0.011, -0.002 g/cm2; time main effect P = 0.004).

conclusionsAlthough higher dietary energy intake increased weight, body fat, and menstrual frequency, bone mineral density was not improved, compared with the control group. The 12-mo intervention may have been too short and the increase in energy intake (∼352 kcal/d), although sufficient to increase menstrual frequency, was insufficient to increase estrogen or improve aBMD. Future research should refine the optimal nutritional and/or pharmacological interventions for the recovery of bone health in athletes and exercising women with Oligo/Amen.This trial was registered at clinicaltrials.gov as NCT00392873.

Indexed as

AmenorrheaOligomenorrheaAdultBone DensityEnergy IntakeFemaleFemur NeckHumansYoung Adultamenorrheabone mineral densityexercising womenFemale Athlete Triadnutrition

Identifiers

PMID35170727
PMCPMC9170471
OpenAlexW4211069294

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.