Lipid Profiles And Pro-inflammatory Markers Among Female Adolescent Athletes With And Without Menstrual Irregularities

Amenorrhea in pre-menopausal adult female athletes is associated with suboptimal lipid profiles, but relationships between amenorrhea and pro-inflammatory markers are inconsistent. Furthermore, data on these relationships are limited in the adolescent population. Purpose: Examine differences in lipid profiles and pro-inflammatory markers between female adolescent athletes with and without menstrual irregularities. METHODS: We recruited 13-18 year old female athletes who were normal weight (CDC BMI-for-age 5-95%), ≥1 years post-menarchal, and not using hormonal contraceptives. Participants who reported ≥9 menstrual periods in the prior year underwent 3 months of menstrual cycle tracking, 1 month of urinary ovulation testing, and blood hormonal testing 1-7 days after the last day of their period to be classified as eumenorrheic or menstruating but anovulatory. Participants who reported no period for at least the prior 3 consecutive months were classified as amenorrhoeic. Lipid profiles (total cholesterol, triglycerides, HDLc, LDLc) and pro-inflammatory markers (VCAM-1, IL-6, hsCRP, TNF-a) were obtained for all participants. We compared outcomes between eumenorrheic/anovulatory and amenorrhoeic groups. RESULTS: There were 31 athletes (n = 16 eumenorrheic/n = 5 anovulatory, n = 10 amenorrhoeic) from a variety of sports included. The amenorrhoeic group had significantly lower average % body fat (23.1% vs. 28.4%, p = 0.03), but no significant differences in age, BMI or weekly training volume between groups. The amenorrhoeic group had significantly higher HDLc, higher total cholesterol (moderate effect size), and lower CRP (moderate effect size) (Table 1). There were no other significant differences in lipid or inflammatory markers between groups. CONCLUSION: Our findings are not consistent with dyslipidemia or a pro-inflammatory state associated with amenorrhea in female adolescent athletes, as has been observed in prior studies of adult athletes. Table 1. - Comparison between groups for hormonal, lipid, and inflammatory markers. Eumenorrheic/Anovulatory Group (N = 21) Amenorrhoeic Group (N = 10) P value (*p < 0.05) Cohen’s d (a = d > 0.5) Luteinizing hormone (mlU/mL) 10.4 (9.1) 6.0 (4.8) 0.19 0.53a Follicle stimulating hormone (mlU/mL) 5.9 (2.2) 5.2 (1.7) 0.39 0.33 Estradiol (pg/mL) 101.0 (14.3) 58.9 (48.1) 0.09 0.69a Progesterone (ng/mL) 0.58 (0.72) 0.25 (0.21) 0.17 0.54a High density lipoprotein cholesterol (HDLc) (mg/dL) 51.5 (10.2) 60.8 (9.0) 0.02* 0.94a Low density lipoprotein cholesterol (LDLc) (mg/dL) 90.8 (29.6) 89.0 (20.6) 0.86 0.07 Triglycerides (mg/dL) 80.3 (35.9) 66.2 (19.7) 0.26 0.45 Total cholesterol (mg/dL) 145.1 (28.3) 159.3 (24.9) 0.19 0.51a C-reactive protein (CRP) (mg/L) 1.50 (1.7) 0.43 (0.56) 0.06 0.76a Interleukin-6 (IL-6) (pg/mL): Detectable presence 8 (38%) 1 (10%) 0.11 Vascular cell adhesion molecule-1 (VCAM-1) (pg/mL) Low: 6 (32%)Medium: 8 (42%)High: 5 (26%) Low: 3 (38%)Medium: 1 (13%)High: 4 (50%) 0.44 Tumor necrosis factor-alpha (TNF-a) (pg/mL) Low: 9 (50%)Medium: 5 (28%)High: 4 (22%) Low: (13%)Medium: 3 (38%)High: 4 (50%) 0.17 Supported by: Funding for this study was provided by the Colorado Specialized Centers of Research Excellence on Sex Differences and the Ludeman Family Center for Women’s Health Research at the University of Colorado.