Prevalence of female athlete triad (FAT) in rhythmic gymnastics, an aesthetic sport, and its association with risks of body-image distortion and eating disorders

BackgroundFemale athlete triad (FAT), a syndrome linking low energy availability (LEA), menstrual dysfunction (MD), and impaired bone health, has serious potential consequences for sports performance and health. In this cross-sectional study, we investigated prevalences of each FAT component in female athletes of aesthetic and non-aesthetic sports and in non-athlete females, and its association with body image (BI) distortion and eating behaviors. MethodsGoogle Forms was used to examine self-reported height and weight, menstruation conditions, history of stress fractures (HSF), BI, the Eating Attitude Test (EAT)-26 (indicator of eating disorder) scores, and eating behaviors; these attributes were compared between 3 groups (athletes of aesthetic sports [rhythmic gymnasts, n=40] and non-esthetic sports [volleyball players, n=46]; other females of the same age group [non-athletes, n=108]). To identify risk factors for each FAT component, multivariate logistic-regression analyses were used. LEA, MD, and HSF were dependent variables; rhythmic gymnasts, distorted BI, and EAT-26 scores were independent variables. ResultsRhythmic gymnasts had a lower body mass index (p<0.001), higher LEA and MD prevalence (both p<0.001), and greater percentage of participants with [&ge;]2 FAT criteria (p<0.05) compared with other groups; exhibited higher distorted BI scores (p<0.05) than volleyball players; and tended to overestimate their body shape. Regarding eating behaviors, rhythmic gymnasts had higher EAT-26 scores (p<0.001) than other groups and significantly tended to skip breakfast (p<0.05) than non-athletes. Multivariate logistic-regression analysis revealed that rhythmic gymnasts and body-shape overestimation were independently associated with LEA; rhythmic gymnasts and high EAT-26 scores were independently associated with MD. ConclusionsFAT prevalence was approximately 1.5 times higher among rhythmic gymnasts than among volleyball players and non-athletes. These findings suggest that rhythmic gymnasts are at a higher risk of FAT and being an athlete in aesthetic sports, body-shape overestimation, and higher EAT-26 scores are risk factors for FAT.