簡易檢索 / 詳目顯示

研究生: 賴淑萍
Shu-Ping Lai
論文名稱: 大學生「女運動員三症候群」之相關探討
Related Studies in ‘Female Athlete Triad’ of University Students
指導教授: 湯馥君
Tang, Fu-Chun
學位類別: 碩士
Master
系所名稱: 人類發展與家庭學系
Department of Human Development and Family Studies
論文出版年: 2006
畢業學年度: 94
語文別: 中文
論文頁數: 135
中文關鍵詞: 女運動員三症候群體型意識飲食行為身體組成骨骼代謝
英文關鍵詞: female athlete triad, body image, dietary behavior, body composition, bone turnover
論文種類: 學術論文
相關次數: 點閱:186下載:13
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 本研究目的是探討女學生運動員體型意識、運動訓練與「女運動員三症候群」之相關。研究對象為大學女生(18~22歲),依運動訓練及月經週期之規律性分四組:經期規律運動組20人、經期不規律運動組20人、經期規律靜態組21人及經期不規律靜態組20人;分別進行「飲食、運動與生活習慣問卷」、飲食態度問卷調查、身體組成、跟骨廣頻超音波衰減率之測量、血清雌激素濃度分析、維生素D 受器基因BsmI多型性,及尿液羥基脯胺酸、3-甲基組胺酸、鈣等濃度及其酸鹼值檢測。
    結果發現,長期從事運動訓練對女學生運動員之雌激素濃度並未造成干擾,但有延遲初經年齡之趨勢。運動組之期望體型較靜態組纖細,體型不滿意度較高 (p<.05),飲食態度得分≧20分者之比例也高於靜態組 (15% vs. 4.8%)。四組受試者之熱量攝取皆未達建議量,但對自我食量有高估之錯誤認知。受試者食物攝取及身體組成之差異,源於運動訓練 (p<.05)。運動組非正餐之熱量攝取高於靜態組 (p<.05),但三餐之熱量攝取則低於靜態組 (p<.005),並有較多飲食異常之行為。同體重下,運動組之除脂體重較高,而靜態組則是體脂重較高。運動組之跟骨廣頻超音波衰減率顯著高於不規律靜態組 (p<.05),顯示運動對雌激素濃度低下者之骨骼具有保護作用。本研究受試者之BsmI基因多型性頻度分配為BB (4.9%)、Bb (1.2%)與bb (93.8%),故無法藉由統計探討基因與骨骼健全之關連性。尿液之羥基脯胺酸、3-甲基組胺酸、鈣等濃度,於各組之間無顯著差異。
    受試者之體型意識影響其飲食態度,但不影響飲食攝取;長期運動訓練影響身體組成,但不影響血清雌激素濃度。儘管飲食攝取不當,飲食態度扭曲,但本研究受試者目前並未有明顯之「女運動員三症候群」症狀。

    The purpose of this study was to explore the correlation among body image, exercise training, and ‘female athlete triad’ of university students. Based on exercise training and menstrual status, the university female students (aged 18~22 years) were divided into four groups: regular menstruation/exercise subjects (n=20), irregular menstruation/exercise subjects (n=20), regular menstruation/sedentary subjects (n=21), and irregular menstruation/sedentary subjects (n=20). We examined dietary behavior and exercise habits, Eating Attitudes Test (EAT-26), body composition, calcaneus broadband ultrasound attenuation (BUA), serum estradiol concentration, BsmI polymorphism at the vitamin D receptor (VDR) gene locus, urinary concentrations of hydroxyproline (HP), 3-methylhistidine (3-MH), and calcium, and urinary pH value.
    We found that serum estradiol concentration was not affected by exercise training which was supposed to delay the age at menarche in athletes. The desire for being slender in the exercise subjects was significantly stronger than the sedentary subjects (p<.05). The body dissatisfaction in the exercise subjects was significantly higher than the sedentary subjects (p<.05). Number of subjects with EAT greater than 20 was found to be more in the exercise groups than in the sedentary groups (15% vs. 4.8%). Although self-perceived food intake was overestimated, the energy intake of the female subjects was below the recommendation. The differences in food intake and body composition among the groups were primarily due to exercise effect (p<.05). The energy intakes from snack and drinks in the exercise subjects were significantly higher than those in the sedentary subjects (p<.05), whereas the energy intake from meals was significantly lower (p<.005). Within the same body weight, the fat-free mass in the exercise subjects tended to be higher than that in the sedentary subjects, whereas the fat mass was lower. The BUA of the exercise subjects was significantly higher than that of the irregular menstruation/sedentary subjects (p<.05). At a low serum concentration of estradiol, exercise demonstrated a protective role on bone mass and bone quality. Since the genotype distribution found in this study was 4.9% BB; 1.2% Bb; and 93.8% bb, the genetic impact on the bone integrity of our subjects could not be explored statistically. There was no significant difference in the urinary HP, 3-MH, and calcium concentrations among the four groups.
    The body image of the female subjects affected their eating attitudes, but did not affect their dietary intake. Exercise training influenced the body composition, but not the serum estradiol concentration. Although the food intake was inadequate, along with poor eating attitudes, the ‘Female athlete triad’, however, was not observed in the present study.

    目次 第一章 緒論……………………………………………………………… 1 第一節 研究動機………………………………………………………… 1 第二節 研究目的………………………………………………………… 2 第三節 研究問題………………………………………………………… 3 第四節 名詞定義………………………………………………………… 4 第二章 文獻探討………………………………………………………… 6 第一節 運動概述………………………………………………………… 6 一、運動與能量系統……………………………………………… 6 二、相關運動簡介………………………………………………… 7 第二節 運動員飲食狀況………………………………………………… 9 ㄧ、營養問題……………………………………………………… 9 二、飲食狀況與行為……………………………………………… 11 三、營養需求……………………………………………………… 16 第三節 生理狀況與運動訓練…………………………………………… 21 ㄧ、身體組成.……………………………………………………… 21 二、肌肉與骨骼…………………………………………………… 23 三、血液、荷爾蒙與月經狀況…………………………………… 29 第四節 文獻探討總結…………………………………………………… 32 第三章 研究方法………………………………………………………… 34 第一節 研究流程………………………………………………………… 34 第二節 研究對象………………………………………………………… 35 第三節 研究工具與方法………………………………………………… 36 一、檢體與數據收集……………………………………………… 36 二、檢體生化分析………………………………………………… 40 第四節 統計分析………………………………………………………… 46 第四章 研究結果………………………………………………………… 47 第一節 基本資料………………………………………………………… 47 一、生理參數……………………………………………………… 47 二、運動習慣……………………………………………………… 47 三、月經週期狀況………………………………………………… 47 第二節 自我體型認知…………………………………………………… 48 第三節 飲食行為………………………………………………………… 49 一、飲食態度調查………………………………………………… 49 二、飲食攝取……………………………………………………… 50 第四節 身體組成分析…………………………………………………… 52 第五節 生化分析………………………………………………………… 53 一、維生素D受器基因鑑定……………………………………… 53 二、尿液分析……………………………………………………… 53 第五章 討論……………………………………………………………… 54 第一節 月經週期狀況…………………………………………………… 54 第二節 自我體型認知…………………………………………………… 55 第三節 飲食行為………………………………………………………… 57 一、飲食態度調查………………………………………………… 57 二、飲食攝取……………………………………………………… 58 第四節 身體組成分析…………………………………………………… 62 第五節 生化分析………………………………………………………… 64 一、維生素D受器基因鑑定……………………………………… 64 二、尿液分析……………………………………………………… 65 第六節 相關性探討……………………………………………………… 66 一、體型意識、熱量攝取與身體組成之相關性探討…………… 66 二、身體組成之相關性探討……………………………………… 67 三、骨代謝之相關性探討………………………………………… 67 第六章 結論與建議……………………………………………………… 71 第一節 結論……………………………………………………………… 71 第二節 建議……………………………………………………………… 73 第三節 研究限制………………………………………………………… 75 第四節 未來研究之建議………………………………………………… 75 參考文獻 一、中文部份……………………………………………………………… 108 二、西文部份……………………………………………………………… 111 附錄 附錄一 受試者同意書…………………………………………………… 125 附錄二 研究活動海報內容……………………………………………… 126 附錄三 人體試驗審查通過書…………………………………………… 127 附錄四 「飲食、運動與生活習慣問卷」……………………………… 128 附錄五 飲食態度問卷…………………………………………………… 134 表次 表3.1 尿液胺基酸代謝物混合標準液中各胺基酸代謝物stock標準液之取 量………………………………………………………………………… 42 表3.2 肌酸酐稀釋標準液、尿液稀釋液及反應試劑鹼性苦味酸之取 量………………………………………………………………………… 45 表4.1.1 運動訓練與月經週期規律性對受試者生理參數之主要效果及交互作 用效果分析…………………………………………………………… 77 表4.1.2 各組受試者之生理參數……………………………………………… 77 表4.2 各組受試者之運動習慣………………………………………………… 78 表4.3 各組受試者之血清雌激素濃度與初經年齡調查……………………… 78 表4.4.1 運動訓練與月經週期規律性對受試者自我體型認知之主要效果及交 互作用效果分析…………………………………………………… 79 表4.4.2 各組受試者之自我體型認知……………………………………… 80 表4.4.3 各組受試者自我體型(somatotype)認知之分布…………… 81 表4.4.4 各組受試者自我體型(BMI)認知之分布……………………… 82 表4.4.5 各組受試者自我體型(WHR)認知之分布……………………… 83 表4.5.1 運動訓練與月經週期規律性對受試者飲食態度之主要效果及交互作 用效果分析………………………………………………………… 84 表4.5.2 各組受試者之飲食態度…………………………………………… 84 表4.6.1 運動訓練與月經週期規律性對受試者食物攝取調查之主要效果及交 互作用效果分析…………………………………………………… 85 表4.6.2 各組受試者之食物攝取調查……………………………………… 86 表4.6.3 運動訓練與月經週期規律性對受試者熱量分配調查之主要效果及交 互作用效果分析…………………………………………………… 87 表4.6.4 各組受試者之熱量分配調查……………………………………… 88 表4.7.1 運動訓練與月經週期規律性對受試者身體組成之主要效果及交互作 用效果分析………………………………………………………… 89 表4.7.2 各組受試者之身體組成分析……………………………………… 90 表4.8 各組受試者之維生素D受器基因型頻度……………………………… 91 表4.9.1 運動訓練與月經週期規律性對受試者尿液分析之主要效果及交互作 用效果分析………………………………………………………… 92 表4.9.2 各組受試者之尿液分析…………………………………………… 92 表4.10.1 運動組體型意識、熱量攝取與身體組成之相關分析…………… 93 表4.10.2 靜態組體型意識、熱量攝取與身體組成之相關分析…………… 94 表4.11.1 運動組骨量、骨質與運動習慣、飲食攝取、身體組成之相關分 析…………………………………………………………………… 95 表4.11.2 靜態組骨量、骨質與運動習慣、飲食攝取、身體組成之相關分 析…………………………………………………………………… 96 表4.11.3 受試者骨量、骨質與運動習慣、飲食攝取、身體組成之相關分 析…………………………………………………………………… 97 表4.12 各組受試者初經年齡與骨量、骨質、身體組成之相關分析……… 98 圖次 圖4.1 運動組之初經年齡分布……………………………………………… 99 圖4.2 運動組之經期狀況…………………………………………………… 99 圖4.3 受試者最常食用之烹調方式………………………………………… 100 圖4.4 受試者雞鴨魚皮之攝食調查………………………………………… 100 圖4.5 受試者食用乳品含脂量之比較……………………………………… 101 圖4.6 受試者食用肉類含脂量之比較……………………………………… 101 圖4.7 受試者之自我認知食量……………………………………………… 102 圖4.8 受試者觀賞電視時之零食攝食狀況………………………………… 103 圖4.9 受試者使用電腦時之零食攝食狀況………………………………… 103 圖4.10 受試者營養補充劑之使用狀況…………………………………… 104 圖4.11 受試者特殊藥物之使用與自我催吐………………………………… 105 圖4.12 體重與體脂重、除脂體重之相關…………………………………… 106 圖4.13 運動持續年日與跟骨廣頻衰減率之相關…………………………… 107

    ㄧ、中文部份

    1.山岡誠一、沼尻幸吉(1975)。運動營養學。(郭玉鶴、蘇雄飛譯)。臺北市:體育學術研究會。

    2.王順正(1993)。運動訓練對骨骼肌蛋白質的影響-以尿中3甲基組胺酸的變化來評量,中華體育,25,54-64頁。

    3.文星蘭(2004)。高中職學生身體意象與減重意圖之研究。國立臺北護理學院醫護教育研究所碩士論文,未出版,臺北市。

    4.甘龍醫用生理學下冊(白禮源編譯)(1995)。臺北市:藝軒。(原著出版年﹕1991年)。

    5.古琪雯(2003)。青少女體型不滿意、社會體型焦慮與飲食異常傾向之關係研究。國立臺灣師範大學衛生教育研究所,碩士論文,未出版,臺北市。

    6.行政院衛生署(1998)。臺灣常見食品營養圖鑑(編號:016099860023)。臺北市:行政院衛生署。

    7.行政院衛生署(1999)。中華民國飲食手冊(編號:103137553051)。臺北市:行政院衛生署。

    8.行政院衛生署(2002)。國人膳食營養素參考攝取量及其說明。臺北市:行政院衛生署。

    9.行政院衛生署(2003)。關懷別人也要疼惜自己-婦女營養參考手冊。臺北市:行政院衛生署。

    10.杜瑞克(1987)。骨科學原理及應用。(傅宇輝等譯)。臺北市:大中國圖書公司。(原著出版年﹕1985年)

    11.沈淑貞、姚承義(1997)。女性芭蕾舞者體型與身體組成之探討,體育學報,24,181-192。

    12.沈進益(2003)。不同助跑角度足球定位踢遠之運動學分析。國立臺灣師範大學體育研究所碩士論文,未出版,臺北市。

    13.洪嘉謙(2002)。大專女生性別角色與身體形象關係之研究。靜宜大學青少年兒童福利研究所碩士論文,未出版,臺中縣。

    14.李亦寬(2004)。臺灣地區舞蹈專長學生之舞蹈傷害調查研究。國立臺灣師範大學體育研究所碩士論文,未出版,臺北市。

    15.林正常(1997)。運動生理學。臺北市:師大書苑。

    16.林宜親(1998)。青少年體型意識與節制飲食行為之研究。國立臺灣師範大學家政教育研究所碩士論文,未出版,臺北市。

    17.林興中(1995)。骨質疏鬆症之成因。臺灣醫界,38,34-38。

    18.林麗娟(2002)。肌力和耐力性運動與身體活動程度對鈣離子調節激素及骨骼指標之影響。國立臺灣師範大學體育研究所碩士論文,未出版,臺北市。

    19.邱正芬(2003)。論壇健康促進與疾病預防委員會第三期文獻回顧研析計畫(編號:FO-HPDP03-05)。臺北市:國家衛生研究院。

    20.邱麗曇(2003)。技職院校護生身體質量指數與月經之相關性研究。國立臺北護理學院護理研究所碩士論文,未出版,臺北市。

    21.高美丁、曾明淑、葉文婷、張瑛韶、潘文涵(1999)。臺灣地區居民體位及肥胖狀況。載於國民營養現況1993-1996國民營養健康狀況變遷調查結果修訂版(145-164頁),行政院衛生署。

    22.唐妍蕙(2004)。社會壓力對身體意象與飲食障礙問題影響之探討。國立成功大學公共衛生研究所碩士論文,未出版,臺南市。

    23.陳玉欣(1999)。國中生飲食行為及相關因子的流行病學研究。國立臺灣大學流行病學研究所碩士論文,未出版,臺北市。

    24.陳定雄、曾媚美、謝志君(2000)。健康體適能。臺中市:華格那企業。

    25.陳依瀅、張翠珍、吳至行、王如雪、楊宜青、盧豐華、張智仁(2003)。成年男性吸煙習慣與超音波骨密度測量值之相關性,家醫研究,1,40-48。

    26.陳家徽(1999)。談貧血與運動之相關問題探討,學校體育,54,40-44。

    27.陳啟明(1995)。運動醫學與科學。香港:中文大學出版社。

    28.陳國群(2001)。最新內分泌學。臺北縣:藝軒圖書出版社。

    29.陳慧君、蕭寧馨(2005)。大骨湯之礦物質含量,中華民國營養學會雜誌,30,28-35。

    30.郭志輝(1999)。舞蹈應用生理解剖學。臺北市:五南圖書出版公司。

    31.張育甄(2003)。高中女生病態飲食相關的心態行為及其營養攝取量和營養狀況之調查。中山醫學大學營養科學研究所碩士論文,未出版,臺中市。

    32.連珮茹(2004)。臺中市國中生病態飲食相關的心態行為及其營養攝取量和飲食狀況之調查。中山醫學大學營養科學研究所碩士論文,未出版,臺中市。

    33.黃心怡(1998)。舞蹈。國立體育學院運動教練研究所碩士論文,未出版,桃園縣。

    34.黃雅婷(2000)。國中女生早晚熟與身體意象,自尊及生活適應之相關研究。國立彰化師範大學教育研究所,碩士論文,未出版,彰化市。

    35.曾媚美(2001)。舞者身體組成之研究。國立臺灣體育學院體育研究所碩士論文,未出版,臺中市。

    36.廖焜福(2002)。羽球運動。國立體育學院教練研究所碩士論文,未出版,臺北市。

    37.潘文涵、章雅惠、陳正義、吳幸娟、曾明淑、高美丁(1999)。以二十四小時飲食回顧法評估國人膳食營養狀況。載於國民營養現況1993-1996國民營養健康狀況變遷調查結果修訂版(29-52頁),行政院衛生署。

    38.鄭小嵐(2004)。高齡者飲食習慣與規律運動對其身體組成及血液、液生化指標相關性之探討。國立臺灣師範大學人類發展與家庭研究所碩士論文,未出版,臺北市。

    39.劉兆惠(1998)。不同體脂肪測量法評估高中女生身體組成之研究。國立臺灣師範大學體育研究所碩士論文,未出版,臺北市。

    40.劉昉青(2000)。舞蹈學生體脂肪分布之探討--使用雙能量X光吸收測定儀,國立臺灣體育學院學報,6,199-213。

    41.賴玉釧(2001)。青少年體操選手營養、生理及生化狀況之探討。臺北醫學大學保健營養研究所碩士論文,未出版,臺北市。

    42.賴金鑫(1983)。運動醫學講座。臺北市:健康世界雜誌社。

    43.賴靖薇(2002)。青少年異常飲食行為傾向與內外控人格特質之相關研究。國立陽明大學社區護理研究所碩士論文,未出版,臺北市。

    44.蕭芳惠(1995)。臺北市高中女生的體型意識與心因性厭食症、暴食症傾向之相關研究。國立臺灣師範大學家政教育研究所碩士論文,未出版,臺北市。

    45.薛慧玲(2002)。足球選手爆發力與踢遠、踢準能力相關之研究。國立體育學院教練研究所碩士論文,未出版,臺北市。

    46.顏惠芷(2004)。生殖生理學。載於盧敏吉(主編),新編生理學(477-499頁)。臺中市:華格那企業。

    47.龔憶琳(1991)。低熱量飲食與運動對休息代謝率的影響。國立臺灣師範大學體育研究所碩士論文,未出版,臺北市。

    二、西文部份

    1.Anshel, M. H. (2004). Sources of disordered eating patterns between ballet dancers and non-dancers. Journal of Sport Behavior, 27(2), 115-133.

    2.Ballard, F. J., & Tomas, F. M. (1983). 3-Methylhistidine as a measure of skeletal muscle protein breakdown in human subjects: the case for its continued use. Clinical Science, 65(3), 209-215.

    3.Bauer, D. C., Gluer, C. C., Genant, H. K., & Stone, K. (1995). Quantitative ultrasound and vertebral fracture in postmenopausal women. Journal of Bone and Mineral Research, 10(3), 353-358.

    4.Beals, K. A. (2002). Eating behaviors, nutritional status, and menstrual function in elite female adolescent volleyball players. Journal of the American Dietetic Association, 102(9), 1293-1296.

    5.Berning, J. R., & Steen, S. N. (1998). Nutrition for Sports and Exercise. Gaithersburg, MD: Aspen.

    6.Berry, T. R., & Howe, B. L. (2000). Risk factors for disordered eating in female university athletes. Journal of Sport Behavior, 23(3), 207-218.

    7.Bischoff, H., Stahelin, H. B., Vogt, P., Friderich, P., Vonthein, R., Tyndall, A., & Theiler, R. (1999). Immobility as a major cause of bone remodeling in residents of a long-stay geriatric ward. Calcified Tissue International, 64(6), 485-489.

    8.Blanchet, C., Giguere, Y., Prud’homme, D., Dumont, M., Rousseau, F., & Dodin, S. (2002). Association of physical activity and bone: influence of vitamin D receptor genotype. Medicine and Science in Sports and Exercise, 34(1), 24-31.

    9.Boyden, T. W., Pamenter, R. W., Grosso, D., Stanforth, P., Rotkis, T., & Wilmore, J. H. (1982). Prolactin responses, menstrual cycles and body composition of women runners. Journal of Clinical Endocrinology and Metabolism, 54, 711-714.

    10.Braisted, J. R., Mellin, L., Gong, E. J., & Irwin, C. E. (1985). The adolescent ballet dancers. Nutritional practices and characteristics associated with anorexia nervosa. Journal of Adolescent Health Care, 6(5), 365-371.

    11.Brooks-Gunn, J., Burrow, C., & Warren, M. (1988). Attitudes toward eating and body weight in different groups of female adolescent athletes. International Journal of Eating Disorders, 7(6), 749-757.

    12.Brownell, K. D. (1995). Eating disorders in athletes. In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders and obesity: a comprehensive handbook (pp. 191-196). New York, NY: Guilford.

    13.Brownell, K. D., Steen, S. N., & Wilmore, J. H. (1987). Weight regulation practices in athletes: analysis of metabolic and health effects. Medicine and Science in Sports and Exercise, 19(6), 546-556.

    14.Burrows, M., & Bird, S. (2000). The physiology of the highly trained female endurance runner. Sports Medicine, 30(4), 281-300.

    15.Butler, A. R. (1975). The jaffe reaction. Identification of the coloured species. Clinica Chimica Acta, 59(2), 227-232.

    16.Calabrese, L. H., Kirkendall, D. T., Floyd, M., Rapoport, S., & Williams, G. W. (1983). Menstrual abnormalities, nutritional patterns, and body composition in female classical ballet dancers. The Physician and Sportsmedicine, 11(2), 86-98.

    17.Chen, H. Y., Chen, W. C., Hsu, C. D., Tsai, F. J., Tsai, C. H., & Li, C. W. (2001). Relation of BsmI vitamin D receptor gene polymorphism to bone mineral density and occurrence of osteoporosis in postmenopausal Chinese women in Taiwan. Osteoporosis International, 12(12), 1036-1041.

    18.Christiansen, C. (1995). Osteoporosis: diagnosis and management today and tomorrow. Bone, 17(5), S513-S516.

    19.Clark, N. (1993). Athletes with amenorrhea: nutrition to the rescue. The Physician and Sportsmedicine, 21(4), 45-48.

    20.Clough, M., & Wilson, B. (1993). The relationship between eating disorder characteristics and perfectionism among 22 dance students 17-21 years. Sport Health, 11(2), 5-8.

    21.Cooper, G. S., & Umbach, D. M. (1996). Are vitamin D receptor polymorphisms associated with bone mineral density? A meta-analysis. Journal of Bone and Mineral Research, 11(12), 1841-1849.

    22.Cureton, K. J., Hensley, L. D., & Tiburzi, A. (1979). Body fatness and performance differences between men and women. Research Quarterly, 50(3), 333-340.

    23.Dalsky, G. P., Stocke, K. S., Ehsani, A. A., Slatopolsky, E., Lee, W. C., & Birge, S. J. (1988). Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Annals of Internal Medicine, 108(6), 824-828.

    24.Davis, C. (1992). Body image, dieting behaviors, and personality factors: a study of high-performance female. International Journal of Sport Psychology, 23(3), 179-192.

    25.Dohm, G. L., Israel, R. G., Breedlove, R. L., Williams, R. T., & Askew, E. W. (1985). Biphasic changes in 3-methylhistidine excretion in human after exercise. American Journal of Physiology: Endocrinology and Metabolism, 284, E588-E592.

    26.Dolgener, F. A., Spasoff, T. C., & John, W. E. (1980). Body build and body composition of high ability female dancers. Research Quarterly for Exercise and Sport, 51(4), 599-607.

    27.Eichner, E. R. (1992). General health issues of low body weight and undereating in athletes. In K. D. Brownell., J. Rodin & J. H. Wilmore (Eds.), Eating, body weight and performance in athletes: disorders of modern society (pp. 191-201). Philadelphia, PA: Lea & Febiger.

    28.Falk, B., Bronshtein, Z., Zigel, L., Constantini, N., & Eliakim, A. (2004). Higher tibial quantitative ultrasound in young female swimmers. British Journal of Sports Medicine, 38, 461-465.

    29.Fay, M., & Price, C. (1993). The shape and weight of advertising models, and the prevalence of eating disorders among young women. Proceedings of the Nutrition Society of New Zealand, 18, 59-74.

    30.Ferrari, S. L., Rizzoli, R., Slosman, D. O., & Bonjour, J. P. (1998). Do dietary calcium and age explain the controversy surrounding the relationship between bone mineral density and vitamin D receptor gene polymorphisms? Journal of Bone and Mineral Research, 13(3), 363-370.

    31.Feskanich, D., Willett, W. C., Stampfer, M. J., & Colditz, G. A. (1996). Protein consumption and bone fractures in women. American Journal of Epidemiology, 143(5), 472-479.

    32.Flicker, L., Hopper, J. L., Rodgers, L., Kaymakci, B., Green, R. M., & Wark, J. D. (1995). Bone density determinants in elderly women: a twin study. Journal of Bone and Mineral Research, 10(11), 1607-1613.

    33.Fox, E. L., Bowers, R.W., & Foss, M. L. (1993). The physiological basis for exercise and sport (5th ed.). Madison, WI: Brown & Benchmark.

    34.Frisch, R. E., Gotz-Welbergen, A.V., McArthur, J. W., Albright, T., Witschi, J., Bullen, B., Birnholz, J., Reed, R. B., & Hermann, H. (1981). Delayed menarche and amenorrhea of college athletes in relation to age of onset of training. The Journal of the American Medical Association, 246(14), 1559-1563.

    35.Frost, M. I., Blake, G. M., & Fogelman, I. (2001). Quantitative ultrasound and bone mineral density are equally strongly associated with risk factors for osteoporosis. Journal of Bone and Mineral Research, 16(2), 406-416.

    36.Garner, D. M., & Garfinkel, P. E. (1978). Sociocultural factors in anorexia nervosa. Lancet, 11, 674.

    37.Garner, D. M., & Garfinkel, P. E. (1980). Socio-cultural factors in the development of anorexia nervosa. Psychological Medicine, 10, 647-656.

    38.Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.

    39.Genuth, S. M. (1983). The endocrine system: the reproductive glands. In: R. M. Berne & M. N. Levy (Eds.), Physiology (pp. 1069-1115). St. Louis, MO: Mosby.

    40.Grange, D. I., Tibbs, J., & Noakes, T. D. (1994). Implications of a diagnosis of anorexia nervosa in a ballet school. International Journal of Eating Disorders, 15(4), 369-376.

    41.Gross, C., Eccleshall, T. R., Malloy, P. J., Villa, M. L., Marcus, R., & Feldman, D. (1996). The presence of a polymorphism at the translation initiation site of the vitamin D receptor gene is associated with low bone mineral density in postmenopausal Mexican-American women. Journal of Bone and Mineral Research, 11(12), 1850-1855.

    42.Hamilton, L. H., Brooks-Gunn, J., & Warren, M. P. (1986). Nutritional intake of female dancers: a reflection of eating problems. International Journal of Eating Disorders, 5(5), 925-934.

    43.Harris, C. I. (1981). Reappraisal of the quantitative importance of non-skeletal- muscle source of N-methylhistidine in urine. The Biochemical Journal, 194, 1011-1014.

    44.Hassapidou, M. N., & Manstrantoni, A. (2001). Dietary intakes of elite female athletes in Greece. Journal of Human Nutrition and Dietetics, 14(5), 391-396.

    45.Hausenblas, H. A., & Carron, A. V. (1999). Eating disorder indices and athletes: an integration. Journal of Sport and Exercise Psychology, 21(3), 230-258.

    46.Heffner, J. L., Ogles, B. M., Gold, E., Marsden, K., & Johnson, M. (2003). Nutritional and eating in female college athletes: a survey of coaches. Eating Disorders, 11, 209-220.

    47.Hillman, L. S. (1990). Nutritional factors affecting mineral homeostasis and mineralization in the term and preterm ingant. In D. J. Simmons (Eds.), Nutrition and bone development (pp. 55-67). New York, NY: Oxford University.

    48.Jackson, A. S., Pollock, M. L., & Ward, A. (1980). Generalized equations for predicting body density of women. Medicine and Science in Sports and Exercise, 12(3), 175-181.

    49.Jakes, R. W., Khaw, K., Day, N. E., Bingham, S., Welch, A., Oakes, S., Luben, R., Dalzell, N., Reeve, J., & Wareham, N. J. (2001). Patterns of physical activity and ultrasound attenuation by heel bone among Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): population based study. British Medical Journal, 322, 1-5.

    50.Jarvinen, T. L. N., Jarvinen, T. A. H., Sievanen, H., Heinonen, A., Tanner, M., Huang, X. H., Nenonen, A., Isola, J. J., Jarvinen, M., & Kannus, P. (1998). Vitamin D Receptor Alleles and Bone’s Response to Physical Activity. Calcified Tissue International, 62, 413-417.

    51.Joseph, A., Wood, I. K., & Goldberg, S. C. (1982). Determining populations at risk for developing anorexia nervosa based on selection of college major. Psychiatry Research, 7, 53-58.

    52.Kadel, N. J., Teitz, C. C., & Kronmal, R. A. (1992). Stress fractures in ballet dancers. American Journal of Sports Medicine, 20(4), 445-449.

    53.Kalkwarf, H. J., Khoury, J. C., & Lanphear, B. P. (2003). Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. The American Journal of Clinical Nutrition, 77(1), 257-265.

    54.Katch, F. I., & McArdle, W. D. (1993). Introduction to nutrition, exercise, and health (4th ed.). Philadelphia, PA: Lea & Febiger.

    55.Kelly, P. J., Morrison, N. A., Sambrook, P. N., Nguyen, T. V., & Eisman, J. A. (1995). Genetic influences on bone turnover, bone density and fracture. European Journal of Endocrinology, 133(3), 265-271.

    56.Kerstetter, J. E., Mitnick, M. E., Gundberg, C. M., Caseria, D. M., Ellison, A. F., Carpenter, T. O., & Insogna, K. L. (1999). Changes in bone turnover in young women consuming different levels of dietary protein. The Journal of Clinical Endocrinology & Metabolism, 84(3), 1052-1055.

    57.Kiel, D. P., Myers, R. H., Cupples, L. A., Kong, X. F., Zhu, X. H., Ordovas, J., Schaefer, E. J., Felson, D. T., Rush, D., Wilson, P. W., Eisman, J. A., & Holick, M. F. (1997). The BsmI vitamin D receptor restriction fragment length polymorphism (bb) influences the effect of calcium intake on bone mineral density. Journal of Bone and Mineral Research, 12(7), 1049-1057.

    58.Kim, S. H., Kim, H. Y., Kim, W. K., & Park, O. J. (2002). Nutritional status, iron-deficiency-related indices, and immunity of female athletes. Nutrition, 18(1), 86-90.

    59.Kirk, G., Singh, K., & Getz, H. (2001). Risk of eating disorders among female college athletes and nonathletes. Journal of College Counseling, 4(2), 122-132.

    60.Kuno, M., Fukunaga, T., Hirano, Y., & Miyashita, M. (1996). Anthropometric variables and muscle properties of Japanese female ballet dancers. International Journal of Sports Medicine, 17(2), 100-105.

    61.Langton, C. M. (1994). The role of ultrasound in the assessment of osteoporosis. Clinical Rheumatology, 13(1), S13-S17.

    62.Lemon, P. W. R. (1997). Dietary protein requirements in athletes. Nutritional biochemistry, 8, 52-60.

    63.Leung, F., Geller, J., & Katzman, M. (1996). Issues and concerns associated with different risk models for eating disorders. International Journal of Eating Disorders, 19(3), 249-256.

    64.Long, C. L., Haverberg, L. N., Young, V. R., Kinney, J. M., Munro, H. N., & Geiger, J. W. (1975). Metabolism of 3-methylhistidine in man. Metabolism, 24(8), 929-935.

    65.Lohman, T. G. (1982). Body composition methodology in sports medicine. The Physician and Sportsmedicine, 10(12), 47-58.

    66.Loud, K. J., Gordon, C. M., Micheli, L. J., & Field, A. E. (2005). Correlates of stress fractures among preadolescent and adolescent girls. Pediatrics, 115(4), 399-406.

    67.Maloney, M. J. (1983). Anorexia nervosa and bulimia in dancers. Accurate diagnosis and treatment planning. Clinics in Sports Medicine, 2(3), 549-555.

    68.Marken, W. D., Fogelholm, M., Ottenheijm, R., & Westerterp, K. R. (1995). Physical activity, body composition and bone density in ballet dancers. British Journal of Nutrition, 74(4), 439-451.

    69.Mayhew, J. L., & Salm, P. C. (1990). Gender differences in anaerobic power tests. European Journal of Applied Physiology and Occupational Physiology, 60(2), 133-138.

    70.Millward, D. J., Bates, P. C., Brown, J. G., & Rennie, M. J. (1980). Quantitative importance of non-skeletal-muscle sources of N-methylhistidine in urine. The Biochemistry Journal, 190(1), 225-228.

    71.Morrison, N. A., Qi, J. C., Tokita, A., Kelly, P. J., Crofts, L., Nguyen, T. V., Sambrook, P. N., & Eisman, J. A. (1994). Prediction of bone density from vitamin D receptor alleles. Nature, 367(6460), 284-287.

    72.Myburgh, K. H., Berman, C., Novick, I., Noakes, T. D., & Lambert, E. V. (1999). Decreased resting metabolic rate in ballet dancers with menstrual irregularity. International Journal of Sport Nutrition, 9, 285-294.

    73.Nelson, M. E., Fisher, E. C., Catsos, P. D., Meredith, C. N., Turksoy, R. N., & Evans, W. J. (1986). Diet and bone status in amenorrheic runners. American Journal of Clinical Nutrition, 43(6), 910-916.

    74.Njeh, C. F., Boivin, C. M., & Langton, C. M. (1997). The role of ultrasound in the assessment of osteoporosis: a review. Osteoporosis International, 7(1), 7-22.

    75.O'Dea, J. (2002). Can body image education programs be harmful to adolescent females? Eating Disorders: Journal of Treatment & Prevention, 10, 1-13.

    76.O’Mahony, J. F., & Hollwey, S. (1995). Eating problems and interpersonal functioning among several groups of women. Journal of Clinical Psychology, 51(3), 345-351.

    77.Omasu, F., Kitagawa, J., Koyama, K., Asakawa, K., Yokouchi, J., Ando, D., & Nakahara, Y. (2004). The influence of VDR genotype and exercise on ultrasound parameters in young adult Japanese women. Journal of Physiological Anthropology and Applied Human Science, 23(2), 49-55.

    78.Paul, G. L, DeLany, J. P., Snook, J. T., Seifert, J. G., & Kirby, T. E. (1989). Serum and urinary markers of skeletal muscle tissue damage after weight lifting exercise. European Journal of Applied Physiology and Occupational Physiology, 58(7), 786-790.

    79.Pocock, N. A., Eisman, J. A., Hopper, J. L., Yeates, M. G., Sambrook, P. N., & Eberl, S. (1987). Genetic determinants of bone mass in adults: a twin study. Journal of Clinical Investigation, 80(3), 706-710.

    80.Poehlman, E. T., Turturro, A., Bodkin, N., Cefalu, W., Heymsfield, S., Holloszy, J., & Kemnitz, J. (2001). Caloric restriction mimetics: physical activity and body composition changes. The Journals of Gerontology Series, 56A (Special Issue I), 45-54.

    81.Reilly, T. (2000). The menstrual cycle and human performance: an overview. Biological Rhythm Research, 31(1), 29–40.

    82.Rennie, M.J., & Millward, D.J. (1983). 3-methylhistidine excretion and the urinary 3-methylhistidine/creatinine ratio are poor indicators of skeletal muscle protein breakdown. Clinical Science, 65, 217-225.

    83.Riendeau, R. P., Welch, B. E., Crisp, C. E., Crowley, L. V., & Brockett, J. E. (1958). Relationships of body fat to motor fitness test scores. Research Quarterly, 29, 200-203.

    84.Rippon, C., Nash, J., Myburgh, K. H., & Noakes, T. D. (1988). Abnormal eating attitude test scores predict menstrual dysfunction in lean females. International Journal of Eating Disorders, 7(5), 617-624.

    85.Robinson, K., & Ferraro, F. R. (2004). The relationship between types of female athletic participation and female body type. Journal of Psychology, 138(2), 115-128.

    86.Ronsky, J. L., Nigg, B. M., & Fisher, V. (1995). Correlation between physical activity and the gait characteristics and ankle joint flexibility of the elderly. Clinical Biomechanics, 10, 41-49.

    87.Schatzkin, A., Kipnis, V., Carroll, R. J., Midthune, D., Subar, A. F., Bingham, S., Schoeller, D. A., Troiano, R. P., & Freedman, L. S. (2003). A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study. International Journal of Epidemiology, 32(6), 1054-1062.

    88.Shaw, C. K., Chen, C. H., & Tzen, K. Y. (1998). Vitamin D receptor alleles and bone mineral density of Chinese in Taiwan. Tzu Chi Medical Journal, 10(2), 81-86.

    89.Simko, M. D., Cowell, C., & Gilbride, J. A. (1984). Nutrition assessment: a comprehensive guide for planning intervention. Rockville, MD: Aspen.

    90.Sinning, W. E. (1978). Anthropometric estimation of body density, fat, and lean body weight in women gymnasts. Medicine and Science in Sports, 10(4), 243-249.

    91.Sizer, F. S., & Whitney, E. N. (2003). Nutrition concepts and controversies. (9th ed.). Belmont, CA: Wadsworth Thomson Learning.

    92.Slemenda, C. W., Turner, C. H., Peacock, M., Christian, J. C., Sorbel, J., Hui, S. L., & Johnston, C. C. (1996). The genetics of proximal femur geometry, distribution of bone mass and bone mineral density. Osteoporosis International, 6(2), 178-182.

    93.Smith, D. M., Nance, W. E., Kang, K. W., Christian, J. C., & Johnston, C. C. (1973). Genetic factors in determining bone mass. Journal of Clinical Investigation, 52(11), 2800-2808.

    94.Smolak, L., Murnen, S.K., & Ruble, A. E. (2000). Female athletes and eating problems: a meta-analysis. The International Journal of Eating Disorders, 27(4), 371-380.

    95.Stewart, T. L., & Ralston, S. H. (2000). Role of genetic factors in the pathogenesis of osteoporosis. Journal of Endocrinology, 166(2), 235-245.

    96.Suleiman, S., Nelson, M., Li, F., Buxton, T. M., & Moniz, C. (1997). Effect of calcium intake and physical activity level on bone mass and turnover in healthy, white, postmenopausal women. The American Journal of Clinical Nutrition, 66(4), 937-943.

    97.Sundgot-Borgen, J. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Clinical Journal of Sport Medicine, 14(1), 25-32.

    98.Swaminathan, R. (1999). Nutritional factors in osteoporosis. International Journal of Clinical Practice, 53(7), 540-548.

    99.Szmukler, G. I., Eisler, I., Gillies, C., & Hayward, M. E. (1985). The implications of anorexia nervosa in a ballet school. Journal of Psychiatric Research, 19(2), 177-181.

    100.Szmukler, G. I., & Patton, G. (1995). Sociocultural models of eating disorders. In G. Szmukler, C. Dare & J. Treasure (Eds.), Handbook of eating disorders: theory, treatment and research (pp. 177-194). Chichester, NY: Wiley.

    101.Tang, F. C. (1996). Plasma branched- chain amino acid changes during energetic stress. Journal of Chinese Nutrition Society, 21(1), 27-36.

    102.Tang, F. C., Kung, I. L., Hsieh, S. Y., Sheu, W. H. H., & Chang, J. B. (1995). Effects of a very-low-calorie diet and aerobic exercise on the metabolism of skeletal muscle. Journal of Chinese Nutrition Society, 20(3), 239-248.

    103.Thein, L. A., & Thein, J. M. (1996). The female athlete. The Journal of Orthopaedic and Sports Physical Therapy, 23(2), 134-148.

    104.Thompson, M. A., & Gray, J. J. (1995). Development and validation of a new body-image assessment scale. Journal of Personality Assessment, 64(2), 258-269.

    105.Torstveit, M. K., & Sundgot-Borgen, J. (2005a). Participation in leanness sports but not training volume is associated with menstrual dysfunction: a national survey of 1276 elite athletes and controls. British Journal of Sports Medicine, 39, 141-147.

    106.Torstveit, M. K., & Sundgot-Borgen, J. (2005b). Low bone mineral density is two to three times more prevalent in non-athletic premenopausal women than in elite athletes: a comprehensive controlled study. British Journal of Sports Medicine, 39, 282-287.

    107.Tsai, K. S., Hsu, S. H., Cheng, W. C., Chen, C. K., Chieng, P. U., & Pan, W. H. (1996). Bone mineral density and bone markers in relation to vitamin D receptor gene polymorphisms in Chinese men and women. Bone, 19(5), 513-518.

    108.Tsuritani, I., Brooke-Wavell, K. S. F., Mastana, S. S., Jones P. R. M., Hardman, A. E., & Yamada, Y. (1998). Dose vitamin D receptor polymorphism influence the response of bone to brisk walking in postmenopausal women? Hormone Research, 50, 315-319.

    109.Warren, M. P. (1980). The effects of exercise on pubertal progression and reproductive function in girls. Journal of Clinical Endocrinology and Metabolism, 51(5), 1150-1157.

    110.Warren, B. J., Stanton, A. L., & Blessing, D. L. (1990). Disordered eating patterns in competitive female athletes. International Journal of Eating Disorders, 9(5), 565-569.

    111.Watts, N. B. (1999). Clinical utility of biochemical markers of bone remodeling. Clinical Chemistry, 45, 1359-1368.

    112.Weight, L. M. (1993). “Sports anaemia”, Does it exit? Sports Medicine, 16(1), 1-4.

    113.Wilfley, D. E., & Rodin, J. (1995). Cultural influences on eating disorders. In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders and obesity: a comprehensive handbook (pp. 78-82). New York, NY: Guilford.

    114.Williams, M. H. (2005). Nutrition for health, fitness and sport (7th ed.). New York, NY: McGraw Hill.

    115.Wilmore, J. H. (1986). Body composition: a roundtable. The Physician and Sportsmedicine, 14, 144-162.

    116.World Health Organization: Assessment of fracture risk and its application to screening for postmenopausal osteoporosis report of a WHO Study Group. World Health.

    117.Yannakoulia, M., Keramopoulos, A., Tsakalakos, N., & Matalas, A. L. (2000). Body composition in dancers: the bioelectrical impedance method. Medicine and Science in Sports and Exercise, 32(1), 228-234.

    118.Zanker, C. L., & Swaine, I. L. (1998). Relation between bone turnover, oestradiol, and energy balance in women distance runners. British Journal of Sports Medicine, 32(2), 167-171.

    119.Zellner, D. A., Harner, D. E., & Adler, R. L. (1989). Effects of eating abnormalities and gender on perceptions of desirable body shape. Journal of Abnormal Psychology, 98(1), 93-96.

    120.Zierath, J., Kaiserauer, S., & Synder, A. C. (1986). Dietary patterns of amenorrheic and regularly menstruating runners. Medicine and Science in Sports and Exercise, 18, S55-S56.

    121.Zhu, Y. I., & Haas, J. D. (1997). Iron depletion without anemia and physical performance in young women. American Journal of Clinical Nutrition, 66(2), 334-341.

    QR CODE