Energetic efficiency, menstrual irregularity, and bone mineral density in elite professional female ballet dancers.

Sports that emphasize low body weight for optimal performance, such as ballet, are associated with an increased prevalence of the female athlete triad (FT). Previous research in this area that involves dancers has been limited; the majority of studies have been performed on adolescents training in classical ballet, and not professional adult dancers. The purpose of this study is to compare the physical and behavioral characteristics of female elite ballet dancers to sedentary, recreationally active non-dancing controls, with regard to characteristics of the FT and energetic efficiency. Women aged 18 to 35 years were recruited as participants. The dancers (N = 15) and non-dancing controls (N = 15) were pair-matched via age (dancers: 24.3 ± 1.3 years; controls: 23.7 ± 0.9 years), body mass index (dancers: 18.9 ± 0.2; controls: 19.4 ± 0.2 kg/m 2 ), and fat-free mass (dancers: 44.3 ± 0.8; controls: 44.1 ± 0.9 kg). Assessments included habitual dietary intake using 4-day food records, self-reported physical activity, psychometric measures of eating behaviors, health and menstrual history, body composition and bone density (dual energy x-ray absorptiometry), and resting metabolic rate (RMR) assessed by indirect calorimetry. Characteristics of the FT, specifically menstrual irregularities (6 of 15 dancers reported irregular or no menses; 1 of 15 controls reported irregular menses) and low energy availability, were more prevalent in dancers than in pair-matched controls. Despite having a similar fat-free mass (FFM), dancers had a significantly lower absolute RMR (dancers: 1367 ± 27; controls: 1454 ± 34 kcal/d; p ≤ 0.05) and significantly lower RMR relative to FFM (dancers: 30.9 ± 0.6; controls: 33.1 ± 0.8 kcal/kg fat-free mass/d; p ≤ 0.05). Energy intake between dancers (1577 ± 89 kcal/d) and pair-matched controls (2075 ± 163 kcal/d) also differed significantly (p ≤ 0.01). Six of the 15 dancers met the criteria for the FT (including low bone mineral density, menstrual irregularities, and eating pathology accompanied by low energy availability) and, therefore, represent a population of individuals afflicted with this disorder. These findings provide insight as to the metabolic impact of chronic energy restriction, and suggest that alterations in RMR (i.e., energetic efficiency) may be an indicator of low energy availability. Future larger-scale studies are warranted to address this possibility. Interventions aimed at increasing energy availability in elite female ballet dancers may be needed to promote optimal health status.