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Biomedical subjects

M P Warren

Publications and source records attributed to M P Warren.

At least 19 recordsLinked to original sources
PubMed1998

Primary dysmenorrhea and physical activity.

It has been widely claimed that exercise is beneficial to dysmenorrhea, yet solid evidence is lacking. Studies investigating this relationship have been reviewed for this paper. Most showed decreased prevalence and/or improved symptomatology with exercise. However, controlled longitudinal studies involving women with confirmed primary dysmenorrhea who are sufficiently blinded to the study objectives are necessary before a definite relationship between exercise and dysmenorrhea can be established.

Adolescent↗
PubMed1995

The antecedents of menarcheal age: heredity, family environment, and stressful life events.

Variations in pubertal timing, specifically age at menarche, have been associated with several antecedents, both genetic and environmental. Recent research has considered a broader range of environmental stressors and their influence on the development of the reproductive system. In this investigation, the following possible antecedents were considered: (a) hereditary transmission, (b) weight and weight for height, (c) stressful life events, (d) family relations, (e) absence or presence of an adult male in the household, and (f) psychological adjustment. Subjects were 75 premenarcheal girls between the ages of 10 and 14 drawn from a larger longitudinal investigation of adolescent development. Girls were from white, well-educated, middle- to upper-middle-class families and attended private schools in a northeastern urban area. While breast development, weight, family relations, and depressive affect were predictive of age at menarche, family relations predicted age at menarche above the influence of breast development or weight. A trend for maternal age at menarche to predict adolescent's age at menarche was found. Weight for height, presence of an adult male in the household, and stressful events were not predictive of age at menarche. These complex interactions of biological and psychosocial development demonstrated here may account to some extent for the inter- and intraindividual variation observed in pubertal development.

Adolescent↗
PubMed1995

Menstrual dysfunction in swimmers: a distinct entity.

Menstrual dysfunction is common among athletes with very low body mass, such as long distance runners and dancers, and is usually associated with hypothalamic dysfunction. The purpose of this study was to investigate the menstrual status of swimmers, in whom exercise is nonweight bearing and thinness is, thus, not essential. Questionnaires recording the menstrual history of 69 young competitive swimmers (aged 16.4 +/- 0.5) were compared to those of 279 age-matched controls. Age of menarche (M) was significantly (P < 0.005) delayed among swimmers (13.8 +/- 0.2 yr) compared to controls (13.0 +/- 0.1 yr). Eighty-two percent of swimmers had menstrual irregularities after M compared to 40% of control, with longer duration of these irregularities (16 vs. 4 months; P < 0.005). A subset of 24 swimmers was studied further for body composition, pubertal stage, and reproductive hormone levels. Estradiol levels were normal in all post-M swimmers (273 +/- 20 pmol/L) and higher than average in pre-M (383 +/- 44 pmol/L). FSH levels were normal in all subjects (10.7 +/- 1.6 IU/L), LH was mildly elevated (17.1 +/- 1.2 IU/L), and the LH/FSH ratio was 1.7. Levels of dehydroepiandrostenedione sulfate and androstenedione, but not testosterone, were higher than average in all groups of swimmers. The results of this study indicate that female competitive swimmers are vulnerable to delayed puberty and menstrual irregularities, but the associated hormonal profile is very different from the hypothalamic amenorrhea described in dancers and runners. We, therefore, suggest a different mechanism for reproductive dysfunction in swimmers that is associated not with hypoestrogenism, but, rather, with mild hyperandrogenism. A distinction among the various types of athletic amenorrhea should be made based on hormonal profiles with attention to their weight and somatotype.

Adolescent↗
PubMed1994

Co-morbidity of eating disorders and substance abuse review of the literature.

The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and "bulimic" behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder-substance use/abuse link are considered, and suggestions for future research made.

Adolescent↗
PubMed1994

Evolving self-image, pubertal manifestations, and pubertal hormones: preliminary findings in young adolescent girls.

PURPOSE: Recent studies indicate that negative self-image increases in white females during early adolescence. This study was designed to examine the effects of physical and hormonal change during puberty on evolving self-image. METHODS: The study sample consisted of 54 girls aged 10-14 yrs (mean 12.2 +/- 0.9). Evaluations at baseline and one-year follow-up included the Self-Image Questionnaire for Young Adolescents (SIQYA), physical examination, and assays of serum FSH, LH, estradiol, testosterone, and DHEAS. Tanner stage was assessed separately for breast and pubic hair, and the girls were classified as early-, mid-, or late-maturers for each. RESULTS: Pearson correlations between baseline and follow-up scores on the nine SIQYA scales ranged from 0.28-0.72 (P < 0.05); three scales demonstrated declining function (P < 0.05). At baseline, 39 girls (72%) were pre-menarcheal compared to 27 (50%) at follow-up. Mean body mass index (BMI) increased from 18.62 +/- 2.38 to 19.01 +/- 1.84 (P < 0.001), Tanner stages each increased by one, and pubertal timing did not change. LH and testosterone increased (P < 0.05) over the year, DHEAS decreased (P < 0.01), and FSH and estradiol did not change. Stepwise linear regression revealed that change in breast stage was positively correlated with change in Body Image score and change in Adjustment score (beta weights 0.46 and 0.41, respectively). Change in testosterone was negatively correlated with change in Adjustment score (beta weight of -0.46). After controlling for baseline score, change in breast stage was positively correlated and FSH was negatively correlated with follow-up Body Image score (beta weights of 0.40 and -0.24, respectively). CONCLUSION: We conclude that the rate of breast development and FSH level have independent, opposite effects on body image during early adolescence.

Adolescent↗
PubMed1994

Special problems of the female athlete.

The number of women of all ages participating in physical activity is consistently increasing. Although there are numerous benefits to physical activity, specific problems may occur along the various stages of the female athlete's life, which need special attention. A remarkably late menarche, exaggerated beyond the expected genetic predisposition and a high prevalence of abnormal or absent menstrual cycles is seen in athletes, especially in dancers and long distance runners. Reproductive system dysfunction is associated with multiple factors, of which nutritional intake and caloric balance seem to be of a special importance. A high proportion of athletes suffer from pathological eating behaviours and there is an overlap between many features of anorexic patients and highly active athletes. The pathophysiology seen in most cases is hypo-oestrogenism due to suppression of the GnRH pulse generator. The mechanism(s) causing this reversible hypothalamic dysfunction are yet unknown. Of major concern are the skeletal abnormalities, including failure to reach peak bone mass, reduced bone density, scoliosis and stress fractures as a result of prolonged hypo-oestrogenism. Hormone replacement may be indicated in cases in which reduction of exercise or weight gain is not feasible or unsuccessful. Other populations that need special precautions are pregnant athletes and older women.

Adolescent↗
PubMed1994

Eating disorders and substance use: a dancing vs a nondancing population.

The association between eating disorders, substance use, and emotional distress is well recognized in the literature. To determine whether dancers who are known to be at risk for eating disorders were also at risk for other emotional disorders, the co-occurrence of eating disorders, substance use, and emotional distress among dancers (N = 50) and nondancers (N = 56) was examined. These young adult women were part of a longitudinal study of the complications of decreased bone density. Participants filled out questionnaires about eating behavior, substance use, and emotional functioning. A clinical interview determined the existence of eating disorders (DSM-III-R). Physiological data, including an assessment of current health, also were collected. There were no differences in disordered eating between the two subject groups. Associations existed within each group, however. Many associations including substance use and emotional distress were found among the nondancers, while no associations were found among the dancers. Thus, eating disorders in a group of subjects at risk because of professional pressures to remain thin revealed a profile which differed significantly from that of women developing eating disorders in the general population.

Adolescent↗
PubMed1993

Bone density is compromised in amenorrheic women despite return of menses: a 2-year study.

OBJECTIVE: To determine the effects of estrogen deprivation on bone mass in young women in whom large bone mass increases are known to occur. METHODS: Over 2 years, nine amenorrheic and 21 normal women were studied, classified into exercising (dancers) and sedentary subjects. An integrated estrogen exposure score was used to determine estrogen response during the 2 years of study. Bone mineral density was measured by single and dual photon absorptiometry in the spine, wrist, and foot (metatarsus). RESULTS: Hypoestrogenism was present in all amenorrheic women in the first year, and mean estrogen exposure scores were lower in these subjects during the 2 years. Mean spine, wrist, and metatarsal bone mineral density measurements were lower in the amenorrheic women and remained below the levels in controls, despite changing clinical indices and return of menses in some of the subjects. Amenorrheic dancers showed the greatest increase in spine bone mineral density, gaining 9.65% in the first year, 4.49% in the second, and an increase of 14.43% (P < .05) over the total period. Their bone mineral density values, however, remained significantly below those of normal controls during the duration of the study. The most significant gains were seen in two subjects with weight gain and return of irregular periods (three periods in 12 months). CONCLUSION: Young amenorrheic exercising women appear to increase bone mass before the return of normal menses; however, bone mass remained below control values during 2 years of study, possibly because of long-term adolescent hypoestrogenism.

Absorptiometry, Photon↗
PubMed1992

Total body bone density in amenorrheic runners.

Many studies have suggested that the positive effect of running on bone mass does not fully compensate for the negative effects of athletic amenorrhea. These studies have made this conclusion based on measurements of bone at a limited number of sites. This study used dual-photon absorptiometry to measure bone mineral content and bone mineral density in the total body as well as in several regions in amenorrheic runners (N = 13), eumenorrheic runners (N = 13), and sedentary controls (N = 12). The subjects were 21-35 years old. Runners had run at least 40 km/week for at least the past 3 years. Controls had body mass indices similar to those of the runners. The amenorrheic women had significantly lower values for total bone mineral content (P = .01), total bone mineral density (P = .04), and total bone mineral content as a percent of normal values (P = .04) than eumenorrheic women, but they were not significantly different from the controls. When total bone mineral content and total bone mineral density were adjusted for body weight, there were no significant differences among the groups. The eumenorrheic subjects had significantly greater bone mineral density in the trunk than the amenorrheic women; eumenorrheics and controls had significantly greater bone mineral density in the spine compared with amenorrheics. Lumbar spine bone mineral density showed a trend toward greatest values for controls and lowest for amenorrheic women (P = .069), although this measurement is relatively imprecise. Arms and legs showed no significant differences among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1991

Lack of bone accretion and amenorrhea: evidence for a relative osteopenia in weight-bearing bones.

Bone mineral density (BMD) was studied in young exercising amenorrheic girls to determine if density was compromised and the change related to injury. Ninety-eight volunteers (professional ballet dancers and controls) were studied in a cross-sectional study. Dancers and controls were further subdivided into normally cycling and amenorrheic subjects. Amenorrhea significantly lowered bone density of the spine (P less than 0.0001), wrist (P less than 0.03), and metatarsal (P less than 0.01); effects on the wrist were eliminated by controlling for age while controlling for weight eliminated all effects of amenorrhea at three sites. BMD of the metatarsal, a weight-bearing bone, showed an interaction between amenorrhea and dancing (exercising) P less than 0.035); surprisingly, dancing was associated with a further lowering of bone density. This interaction was eliminated when controlling for age, but not when controlling for weight. With multiple comparisons of the groups, spine, wrist, and metatarsal bone density was significantly lower in amenorrheic dancers when compared to normal dancers (P less than 0.05), even when controlling for age and weight in the metatarsal (P less than 0.05), and age in the spine (P less than 0.05). Estradiol levels correlated with bone density of both the wrist and the spine (r = 0.25, r = 0.23, P less than 0.02). Metatarsal density correlated with estradiol levels only in the dancers (r = 0.34, P less than 0.02). The only variable found to correlate with the occurrence of stress fractures was age of menarche. This was also the only variable of 9 (BMD of the wrist, spine or foot, calories ingested and expended, amount of calcium ingested, involvement in high energy activity, age of menarche or presence of amenorrhea) to predict stress fractures. Thus, BMD is significantly affected by the presence of amenorrhea but the effects are generally weight dependent. The compensatory increase in bone density generally seen in stressed bones, such as the metatarsal in ballet dancers, is deficient in amenorrheic premenopausal women even when controlling for weight but this effect may be age and estrogen dependent. Bone mass may not accumulate in the same manner in adolescents as in the mature women, thus putting them at risk for injury.

Adolescent↗
PubMed1991

Changes in salivary antipyrine pharmacokinetics during adolescence, correlated with age, hormonal levels and Tanner stage.

To evaluate the effect of puberty on antipyrine metabolism, we measured antipyrine pharmacokinetics in 17 healthy subjects aged 6-21 years. The subjects received a single oral dose of antipyrine, 18 mg/kg. Salivary antipyrine levels were determined 3, 6, 9, 12 and 24 h after dosing. Age, weight, body surface area and Tanner stage were highly intercorrelated. Volume of distribution (liters) was highly correlated with all of these factors. The weight-corrected clearance of antipyrine declined significantly with age (r = 0.55, p less than 0.025). Patients were classified as immature and other based on serum hormone levels (immature = females with serum estradiol less than 25 pg/ml and males with serum testosterone less than 25 ng/dl). The uncorrected antipyrine clearance was significantly lower in the immature group (mean +/- SD 22.65 +/- 6.04 ml/min) than in others (mean +/- SD 41.30 +/- 13.26; p less than 0.01). This difference disappeared when the weight-corrected antipyrine clearance was compared for these two groups. The change in uncorrected antipyrine clearance with sexual maturation appeared to be due to increased body size, probably related to the adolescent growth spurt.

Adolescent↗
PubMed1991

Resting metabolic rate and energy balance in amenorrheic and eumenorrheic runners.

This study investigated metabolic and nutritional factors in association with athletic menstrual dysfunction (AMD). Three groups of women were studied: amenorrheic runners (amenorrheic), eumenorrheic runners (eumenorrheic), and eumenorrheic sedentary controls (sedentary). Amenorrheic and eumenorrheic were similar in age, weight, percent body fat by hydrodensitometry, training pace and mileage, best 10 km race time, years running, and maximal oxygen consumption. When adjusted for body weight or for fat-free mass by analysis of covariance, RMR was significantly lower in amenorrheic than in eumenorrheic and sedentary. The daily caloric intakes of the groups did not differ significantly, but the amenorrheic scored significantly higher than the eumenorrheic and sedentary on a scale of aberrant eating patterns. Amenorrheic high mileage runners seem to have a less adequate diet than eumenorrheic runners but appear to maintain energy balance and stable weight through a reduction in RMR.

Adaptation, Physiological↗
PubMed1991

Exercise in women. Effects on reproductive system and pregnancy.

Exercise may have a significant effect on the reproductive system in women; however, it is doubtful if exercise alone causes the hypothalamic amenorrhea, which is probably multifactorial in origin. Pregnancy is also affected by exercise, although long-term or deleterious effects have not been documented.

Bone Diseases↗