Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes

Jane Sharon Akinyemi; Grace Olapeju Otinwa

doi:doi:10.11648/j.ajss.20251304.11

Research Article |

| Peer-Reviewed

Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes

Jane Sharon Akinyemi^*

, Grace Olapeju Otinwa

Published in American Journal of Sports Science (Volume 13, Issue 4)

Received: 20 September 2025 Accepted: 9 October 2025 Published: 30 October 2025

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Abstract

The Female Athlete Triad syndrome describes three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and poor bone health, inclusive of low bone density and bone stress injury. Sports participation for female athletes has risen exponentially; however, investigations into the health and wellbeing of female athletes from Africa are extremely limited because these groups are noticeably absent from the Triad literature. This research gap can have negative health implications, on the Female Athletes in Nigerian athletes. Purpose: To investigate the prevalence of Triad components in competitive Nigerian female university athletes as well as explore hematological markers. Methods: n=71, (21.8±0.3yrs) and BMI (22.5±0.6 kg/m²) female athletes from the University of Lagos, during the Nigeria University Games Competition, completed a Health, Exercise Nutritional Survey questionnaire to provide demographics, medical history, exercise, and dietary practices. Athletes consented to a complete blood count (CBC) assessment: white blood cell (WBC), hematocrit (HCT), red blood cell (RBC), hemoglobin (HGB) and platelets. Results: Exercise frequency was 4.6±0.3 days/wk., overtraining, 6.8%, age at menarche 12.8±0.1 yrs., and gynecological age 9.2 ±0.5 yrs. Factors reflecting energetic status include (20/71): 28% reported eating a low-fat diet, (27/71) 38% dieted to lose weight to change their body composition and to improve performance, (2/71) 3% reported a history of anorexia and Bulimia. Prevalence of oligomenorrhea was (11/71) 15% while amenorrhea was (14/71) 19%. Stress fracture was reported to be (9/71) 13% and (3/71) 4%, had a family history of osteoporosis. (24/71) 34% refrained from training due to injuries during the past year and (7/71) 9.8% reported illness due to exercise. CBC measures showed RBC (3.95±0.06 10¹²/L), HGB (10.64±0.11 g/dL), HCT (32.68±0.31%) WBC (5.20±0.14 10⁹/L) and platelets (245.17±8.2 *10⁹/L), demonstrating that RBC and WBC are within the normal range while HGB, HCT and platelets are abnormal. Athletes in endurance sports had a decreased hematocrit (HCT). Conclusion: A significant percentage of Nigerian female athletes participating in the NUGA Games demonstrated factors reflective of poor energy intake, menstrual dysfunction and bone health including a history of stress fractures and absence from sport due to injury. The prevalence of factors observed suggests the need to advance screening tools and education efforts to include randomized clinical trials, optimize health of athletes and provide information for future investigation into the Triad among Nigerian athletes.

Published in	American Journal of Sports Science (Volume 13, Issue 4)
DOI	10.11648/j.ajss.20251304.11
Page(s)	85-94
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Female Athlete, Energy Deficiency, Amenorrhea, Bone Health, Menstrual Irregularity

1. Introduction

Sports participation for female athletes has risen exponentially; however, investigations into the health and wellbeing of female athletes from Africa are extremely limited. This research gap can have negative health implications, as, a study in Kenyan runners reported that the athletes tested had lower energy availability than non-athlete controls, demonstrating undernutrition and energy deficiency

[10]

. A few recently published studies in Nigerian athletes investigated the self-reported level of knowledge about physiological health and wellbeing in sport. The authors also reported social, cultural, and religious restraints on the acquisition of knowledge among athletes

[13]

. One study hypothesized higher prevalence of the Triad among athletes compared to non-athletes, which was accepted

[6]

. In a prevalence study of 306 South Africa female runners, LEAF-Q scores classified 44.1% of participants at risk for the triad with a correlation between faster races and higher triad risk

[5]

. There is an established need for sports science professionals to employ evidence-based guidelines to enhance athletes’ health and physiological wellbeing. It is imperative to provide applied sport science research targeted at female athletes in Africa, so that evidence informed approaches can be developed. However, in the quest to ensure that exercise and sport science practices are developed and supported among female athletes in Africa, further research is needed to determine the true prevalence of the Triad and identify which females are at risk

[5]

. The level of awareness and education of the triad components among athletes, coaches, parents, and health care professionals should be at the frontline, especially with regards to athletes' energy level and the review of athletes' menus to reduce risk of energy and nutrient deficiencies, and its associated health and performance consequences need

[10]

. The Female Athlete Triad is a medical condition often observed in physically active girls and women. It involves three components: (1) energy deficiency with or without disordered eating, (2) menstrual dysfunction and (3) poor bone mineral density. Female athletes often experience one or more of the three Triad components, and an early intervention is essential to prevent its progression to serious endpoints which include clinical eating disorders, amenorrhea, and osteoporosis

[7]

. This condition is now considered a spectrum disorder characterized by relative dysfunction in energy availability (with or without disordered eating), menstrual function, and bone mineral density

[3]

. Low energy stores increase an athlete’s risk of developing the remaining components of the triad

[11]

. Barrack et al, recommended that runners be periodically screened and monitored during competition in their sport to detect disturbances in their menstrual patterns. Because a history of long-distance running might indicate a history of a chronic energy deficit

[1]

. With the modified guidelines for diagnosis of this condition, more education is crucial for early diagnosis to prevent athletes from reaching more advanced stages of pathology. Although the triad poses a great health risk, the benefits of exercise outweigh the potential risks

[2]

. The 2007 ACSM positional stand looks at each disorder as a point on a continuous spectrum rather than as a severe pathologic endpoint,: “Disordered eating” has been replaced by a spectrum ranging from “optimal energy availability” to “low energy availability with or without an eating disorder” “Amenorrhea” has been replaced by a spectrum ranging from “eumenorrhea” to “functional hypothalamic amenorrhea” “Osteoporosis” has been replaced by a spectrum ranging from “optimal bone health” to “osteoporosis”

[11]

. Studies examining long-term effects of energy deficiency in the female athlete have demonstrated deleterious effect on menstrual health bone mineral density, cognitive outcomes and eating behaviors. These effects are particularly problematic during the critical adolescent and young adult years of peak bone accrual and brain maturation. Evidence points to these effects being secondary to hormonal changes adaptive to the low energy availability status; thus, normalizing latter is essential to improving menstrual function, bone, cognitive and eating outcomes

[9]

. In a 2008 study, markers of bone formation were suppressed, and markers of bone resorption were elevated when hypoestrogenism presented with energy deficiency; an energy replete environment was not associated with perturbations of bone formation and bone resorption, regardless of estrogen status does not completely compensate for an energy deficiency since alteration in bone formation continue to be apparent in nutritionally compromised environment

[4]

. These findings underscore the importance of achieving adequate nutritional intake in exercising women to avoid clinical sequel associated with energy deficiency, particularly menstrual cycle disturbance, such as amenorrhea which result in hypoestrogenism and exacerbate skeletal demineralization

[4]

. Efforts have been made to include (i) cross-sectional studies of exercising women with varying menstrual cycle status

[12]

and (ii) randomized controlled trials examining the effects of exercise expenditure and energy restriction on the induction of menstrual disturbances during three consecutive menstrual cycles in previously ovulatory women

[14, 8]

In a cross-sectional study, 91 exercising women’s menstrual status was categorized as either amenorrheic, oligomenorrheic, or eumenorrheic. Eumenorrheic women were further subdivided into subclinical menstrual groups as either ovulatory, inconsistent, or anovulatory

[12]

. There is a particular need to close the research gap by studying female athletes who are from African countries, and these groups are noticeably absent from the Triad literature. It was hypothesized in this study that many female athletes will present with at least one Triad related condition of energy deficiency, reproductive dysfunction, or poor bone health and that female athletes with amenorrhoeic condition will have significantly compromised bone health, also energy deficient female athletes will experience disordered eating behavior. This study aimed to investigate the Female Athlete Triad in competitive Nigerian University Female Athletes and evaluate it from the perspective of self-reported factors reflective of energy deficiency, menstrual dysfunction, and bone stress injury; this was intended to be a preliminary study for providing optimal support to female athletes in the future. Also, to identify individuals at risk of earlier onset of Triad symptoms.

2. Materials and Methods

2.1. Sample Recruitment

2.1.1. Population

The target population included competitive female athletes aged 17-35 years actively participating in organized sports at the 26th Nigeria University Games (NUGA) competition.

2.1.2. Sampling Technique

A purposive sampling method was used to recruit participants from the University of Lagos team. Selection was based on criteria such as training frequency (minimum 5 sessions /week, competition history and willingness to participate. Female athletes were selected because they were found more appropriate, and they belong to teams that were readily accessible. Recruitment of participants was made possible by contacting coaches, explaining the purpose of the study and seeking their assistance to get the athletes assembled at a single location. The aims and the demands of the study were explained to the athletes to solicit their consent. Consent forms were further distributed to those who met the study criteria and are willing to participate.

2.1.3. Sample Size

A total of Eighty-eight (88) female athletes with a mean age 21.8±0.3 years, were recruited from various sports (Table 1). They were invited to participate in the study through a study information letter. Apparently, healthy Female athletes of reproductive age that are part of a team during the competition, were found appropriate for the study. A follow up process was initiated by creating WhatsApp group to elicit information about the research. After obtaining written informed consent from the study participants, we documented detailed demographics and medical history of each participant. including age, weight and height.

2.1.4. Eligibility Criteria

Inclusion criteria include female athletes aged 17-35 years with minimum of 2 years of competitive experience. Neither pregnant nor lactating, consent to participate provided they rested for at least 3 hours after morning training. The use of oral contraceptives was not an exclusion criterium but was documented if deemed necessary for elucidating result. Exclusion criteria include athlete with known chronic illnesses or on medication affecting bone health or menstrual function and pregnant or postpartum athletes.

Table 1. Number of Female Athletes According to Various Sports.

Sports	No of Athletes	Study Participants
Foot Ball	16	18.22
Hand Ball	10	11.36
Badminton	4	4.54
Volleyball	10	11.36
Hockey	18	20.45
Taekwondo	12	13.63
Swimming	3	3.41
Scrabble	4	4.54
Judo	6	6.81
Runners	5	5.68
TOTAL	88	100

Table 2. Racial Category.

Racial category	Frequency	Participants proportion %
American Indian / Native America	0	0
Alaskan Native	0	0
Black/ African-American	62	70.46
Asian	0	0
Hispanic	0	0
Latin America	0	0
Middle Eastern	0	0
others	26	29.54
Total	88	100

Table 2. Racial Category.

Racial category	Frequency	Participants proportion %
American Indian/ Native America	0	0
Alaskan Native	0	0
Black/ African-American	62	70.46
Asian	0	0
Hispanic	0	0
Latin America	0	0
Middle Eastern	0	0
others	26	29.54
Total	88	100

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Figure 1. Types of sports (n=88).

2.2. Data Collection

The study was a mixed design of survey and single case pre-experimental design. It entails filling in a questionnaire and hematological assessment. Athletes that responded positively by giving their signed consent having met the requirements for inclusion criteria were included in the study. However, seventy-one (71) athletes completed the questionnaire and consented to the blood draw process and assessment.

2.2.1. Instruments

Structured questionnaire: Adapted from validated tools such as the Health Exercise Nutrition Survey (HENS) questionnaire, from the Women’s Health and Exercise Laboratory (WHEL) Pennsylvania State University was used to assess energy deficiency and eating disorder risk, menstrual irregularities and poor bone mineral density. HENS is a self-reported questionnaire used internationally to screen eating disorders in high schools, colleges, and other special risk samples such as athletes. HENS is sectioned into (i) Demographic and Medical History that comprised 35 questions itemized as weight, height, age, gender, types of sports and racial categories. The Medical History section comprised questions about current and past weight history, eating disorder episodes, treatment and counselling. (ii) Current and Past Physical Activity Survey, consisting of 7 questions structured in form of charts to be completed for determining types, frequency, intensity, duration, dose and years of exercise. (iii) Bone Health and Stress Fracture History comprised 8 questions consisting of “yes or no” short answers and charts to be completed. (iv) Medication and Supplement History consisting of 2 charts regarding the types and dosage of medication and supplements taken (v) Menstrual Cycle Status and Menstrual Cycle History contains 34 questions of “yes or no” and short answers to determine menstrual irregularities. The HENS questionnaire has demonstrated adequate reliability in athletes’ population in previous studies, the reliability for this study was 0.86.

Table 3. Demographic Data, Exercise Frequency, Duration & Intensity. Gynecological Age & Age of Menarche.

Variables	N	Mean±SD
Age (years)	88	21.83±0.33
Weight (kg)	88	60.91±1.1.18
Height (cm)	88	166.46±0.90
BMI (kg/m)	88	22.47±0.49
Exercise Frequency (days)	88	4.85±0.20
Exercise Duration (min)	88	85.34±6.21
Exercise Intensity (low/moderate/vigorous)	88	1.95±0.70
Gynecological age	88	9.17±0.15
Age of Menarche (years)	88	12.81±0.53

2.2.2. Measurements

Athletes completed a demographic, health and sports questionnaire for the attainment of socio-demographic information, facts on training volume and to provide a history of medically diagnosed stress fractures. Body weight and height were measured according to the international society for the advancement of Kinanthropometry’s International Standards of Anthropometric Assessment criteria

[23]

. Weight and height were recorded to the nearest decimal point. Assessment took place at the testing room of the University of Lagos Sports Center. Nurses and Lab Technicians at the Medical Laboratory of the University of Lagos Medical Center conducted the blood draw process and analysis within three days. The participants were asked to report 3 hours after training session to allow time for recovery, refueling and to prevent muscle fatigue because they trained from 6am – 8am, having rested for at least 3 hours. Blood samples were taken through intra-venous at the arm. Urine samples were also taken on the same day, and urine pH was determined. All the samples were taken between 11:00 am - 12:00 noon for consistency. Also, the samples were analyzed immediately after collection to avoid any variations due to storage. Three milliliter venous blood was collected for Complete Blood Count analysis using Unicel DxH 800 coulter hematology analyzer. The following hematological assessments were taken: Red Blood cell, White Blood Cell, Hemoglobin, Hematocrit and Platelet. Screening at health center (lasted for 3 days). Seventy-one (71) athletes were available for the blood test. HENS questionnaire with reliability index of 0.90 was adapted to test variables of energetic, menstrual and bone health status. The HENS questionnaire was converted to an online questionnaire and administered to the athletes through WhatsApp group, created for the purpose of this research study.

2.2.3. Statistical Analysis

Data was analyzed using the IBM Statistics SPSS 22. Descriptive statistics: Frequencies, percentages, means and standard deviations were calculated to summarize demographic and clinical characteristics, including complete questionnaires, and complete blood count.

Table 4. Complete Blood Analysis (CBC) Values.

Variables	N	Mean±SD	Range
Red Blood Cells (1012/L)	71	3.95±0.05	3.50 – 5.50
Haemoglobin (g/dl)	71	10.64±0.11	11.0 – 16.0
Haematocrit (%)	71	32.66±0.31	37.0 – 54.0
White Blood Cells	71	5.20±0.14	4.0 – 10.0
Platelets	71	245.17±8.2	100 -133

Download: Download full-size image

Figure 2. Triad Components.

Table 5. Components of the Triad Components.

Variables	N	Percentage
Low fat diet	20	28
Diet to lose weight	27	38
Anorexia	2	3
Bulimia	2	3
Amenorrhea	11	15
Oligomenorrhea	14	19
Stress Fracture	11	15
Absent from training due to injury	24	34
Family History of Osteoporosis	3	4

3. Results

Participants were drawn from different types of sports, Figure 1 shows 25% of hockey players as the largest group and 4% of swimmers as the smallest group. The age range among the total sample size (n=88) was 17-33 years. Table 3 illustrated that the mean age of the study participants was 21.84±0.36, the average BMI was calculated as 22.47±0.49, exercise frequency was 4.85±0.20, duration of exercise and intensity were 85.34±6.21 and 1.95±0.07 respectively. The gynecological age and age of menarche were calculated as 9.17±0.47 and 12.81±0.15 respectively. Table 2 shows the racial category of most participants to be 70% of Black/African American while 30% indicated to be from other races. Our intent in examining the Complete Blood Counts (CBC) was to confirm that the female athletes were healthy and not suffering any illness or displaying signs of dehydration. Table 4 shows Complete Blood Count (CBC) measures showed Red Blood Cell (RBC) as 3.95±0.06 10¹²/L, Hemoglobin (HGB) was 10.64±0.11 g/dL, Hematocrit (HCT) was assessed to be 32.68±0.31%, White Blood Cells (WBC) was 5.20±0.14 10⁹/L and platelets was 245.17±8.2 *10⁹/L. The result shows that RBC and WBC are within the normal range while HGB, HCT and platelets are abnormal. Trained athletes, particularly in endurance sports, had a decreased hematocrit (HCT). Figure 2 shows data of participants collected by Health Exercise Nutrition Survey (HENS) to determine the risk of Female Athlete Triad which is the interrelated condition of energy deficiency (with or without disordered eating), menstrual dysfunction (Amenorrhea & Oligomenorrhea) and poor bone mineral density (BMD). HENS elucidated the reported factors reflecting poor energy intake to include: 28% eating a low-fat diet, 38% dieted to lose weight in order to change their body composition and to improve performance, 3% reported a history of anorexia and bulimia, which shows a significant portion of participants were at risk of having energy deficiency during sports training and possible subclinical disordered eating, with 3% of sample falling into a clinical eating disorder. Factors reflective of menstrual health reported that prevalence of oligomenorrhea was 19% while amenorrhea was 15%. Factors indicative of bone health reported stress fracture to be 13% and 4%, had a family history of osteoporosis. 34% refrained from training due to injuries during the past year and 9.4% reported illness due to exercise.

4. Discussion

Efforts have been made to include cross-sectional studies of exercising women with varying menstrual cycle status

[12]

. To our knowledge, this present survey study is the first among Nigerian athletes. This study aimed to investigate the Female Athlete Triad in competitive Nigerian University Female Athletes and evaluate it from the perspective of self-reported factors reflective of energy deficiency, menstrual dysfunction, and bone stress injury

[13]

. Competitive athletes are prone to higher prevalence of the Female Athlete Triad

[6]

. This study recruited 88 female athletes of reproductive-age, apparently healthy and belong to a type of sport during the Nigeria University Games competition. Demographic characteristics of age, BMI, age of menarche and gynecological age, exercise frequency, duration and intensity were all obtained from participants. Out of 88 athletes, 71 completed the Health Exercise and Nutrition Survey (HENS) which was used to determine the TRIAD conditions in athletes.

The research aimed to illuminate health-related issues in the stated results, with the expectation of a higher prevalence of TRIAD conditions of energy deficiency (with or without disorders eating), menstrual dysfunction and poor bone mineral density among participants

[7]

. In line with expectation that many female athletes will present with at least one Triad related condition of energy deficiency, reproductive dysfunction, or poor bone health and that female athletes with amenorrhoeic condition will have significantly compromised bone health, also energy deficient female athletes will experience disordered eating behavior. HENS elucidated the reported factors reflecting poor energy intake which was indicated as 28% eating a low-fat diet and 38% dieted to lose weight for change of body composition and to improve performance. The prevalence of disordered eating among athletes varies widely in the literature and is ascribed to differences in the type of sport investigated, measurement tools, sample size and differences in the level at which athletes compete

[11]

. We made use of three heavy training days to determine energy deficiency, which may have resulted in the estimation of low energy availability. If more rest days or lighter training days were put into consideration, average energy availability may have resulted. Calculating and using estimated energy availability is a valuable tool to employ as a rough estimate by which to identify possible athletes who are at risk of being energy-deficient, and with which to further investigate possible underlying subclinical disorders that are associated with low energy availability

[18-20]

. The main contributing factor to the energy deficit in these athletes seemed to be an insufficient energy intake and because of an increase in exercise energy expenditure. Researchers face many challenges when trying to calculate estimated energy availability. Challenges include acquiring accurate dietary data, choosing the best tools with which to measure dietary intake and exercise energy expenditure, what days to include (training and /or non-training days) and the number of days, limiting subject burden and fatigue, and establish the exact cut-off point with which to classify an athlete with low energy availability, given that, energy availability may easily be under-or overestimated owing to measurement or recording errors

[21]

Overtraining was also highlighted as 6.8% and a low number of participants (3%) reported history of clinical eating disorders without a clear diagnosis of anorexia and bulimia nervosa, which shows a significant portion of participants were at risk of having energy deficiency during sports training and the probability of having subclinical disordered eating with a significant sample falling into a clinical eating disorder

[3, 11]

. The main purpose of nutrition for athletes is to ensure the compensation of increased energy consumption and the need for nutrients in the athlete’s body, thereby enabling maximum adaptation to physical loads

[15]

. The diet of highly trained endurance athletes does not fully meet their requirements and in this situation cannot ensure maximum adaptation to very intense and long duration physical load. Highly trained female athletes, require a diet that is well optimized, adjusted and individualized. One of the most important dietary requirements for endurance athletes is an optimum supply of carbohydrates. Carbohydrate intake per day should amount to 7-12g/kg of body weight

[16]

. In the context of existing literature, a study, examined long-term effects of energy deficiency in the female athlete which demonstrated deleterious effect on menstrual health, bone mineral density, cognitive outcomes and eating behaviors. According to these researchers, these effects are particularly problematic during the critical adolescent and young adult years of peak bone accrual and brain maturation. Evidence points to these effects being secondary to hormonal changes adaptive to the low energy availability status; thus, normalizing the latter is essential to improving menstrual function, bone health, cognitive and eating outcomes

[9]

. This finding aligns with an established position that low energy stores increase an athlete’s risk of developing the remaining components of the triad

[11]

. This present study’s use of the HENS questionnaire provided comprehensive insight into the Female Athlete Triad. While this tool showed a low prevalence of clinical disorder, they indicated that a significant minority (15-19%) of the population experienced moderate to severe menstrual disturbance (oligomenorrhea and amenorrhea). This finding was expected, given the anticipated high prevalence suggesting that influencing variables played a critical role in the outcome. One key observation is that the prevalence of stress fracture, as determined by the study, is relatively significant (13%). However, a considerable proportion (34%) of the population exhibited red flags for refraining from training due to injury during the past year. According to HENS questionnaire (9.4%) reported illness due to exercise which is likely traceable to overtraining (6.8%). An important observation was that 4% of the population reported having a family history of osteoporosis. These findings highlight the need for timely interventions to address these health risks.

To further ensure optimal wellbeing of athletes, we conducted hematological assessments owning to the fact that when engaging in regular exercise, research has shown to support the association between blood flow and hematologic parameters during and after physical activity. In this present study, the assessment showed RBC and WBC to be within the normal range while HGB, HCT and platelets were abnormal. Trained athletes, particularly in endurance sports, had a decreased hematocrit (HCT). Abnormal hemoglobin and hematocrit typically indicate anemia, which reduces the blood’s ability to carry oxygen. The implication of this condition may include chronic iron deficiency, often due to poor diet and chronic blood loss (e.g. Menstruation, ulcers or malabsorption). Platelets are indispensable for the formation of atheromatous plaques; abnormal platelets may result in clotting risk. According to reports, athletes need an excessive quantity of oxygen for bodily function as well as appropriate amounts of hemosiderin inside muscle tissues to perform effectively

[17, 22]

. Regular blood screening may help detect early signs of overtraining, nutritional gaps or systemic issues. In the event of deficiency, the recovery plans could be tailored to adjust rest, diet and supplementation depending on body need. Policy reforms could advance inclusion of hematological monitoring in athlete health programs, especially for female athletes who may face unique physiological challenges In comparison to earlier studies, which focused on female elite athletes at national and international levels. This research provides novel insight into the Female Athlete Triad trends among university athletes in Nigeria.

Despite the valuable insight provided by this study, several limitations should be acknowledged to contextualize the finding:

Firstly, sample size and representativeness were conducted among a limited number of competitive female athletes, primarily from select regions and sports disciplines, which may restrict the generalizability of the result to the broader population of Nigerian female athletes, especially those in recreational or no elite setting. Secondly, self- reported data was relied upon, particularly regarding menstrual history, dietary habits and exercise patterns. This introduces the possibility of recall bias, social desirability bias, and underreporting, especially in disordered eating. Thirdly, the study employed a cross-sectional design, which captured data at a single point in time. As a result, it could not establish causal relationship between the components of the Female Athletes Triad and track changes overtime. Fourthly, while efforts were made to assess key attributes of the Triad, such as menstrual dysfunction and low energy availability, the study did not include direct clinical evaluations (e.g., bone mineral density scans or hormonal assays), which could have strengthened diagnostic accuracy. Lastly, Socio-cultural norms, stigma around menstruation, and limited access to sports nutrition and medical support may have influenced both the prevalence and reporting of Female Athlete Triad attributes. These contextual factors were not deeply explored in this study.

5. Conclusion

This preliminary study seeks to explore the feasibility, design, or potential outcomes of a largerand more comprehensive study. This study seeks to understand basic trends, relationships, or concepts that haven’t been deeply studied among female athletes in Nigeria. We intend to build foundational knowledge that offers initial insights that can spark deeper investigation. This present study concluded that in Nigerian competitive athletes, a significant percentage demonstrated factors reflective of poor energy intake, menstrual dysfunction and bone health problems including a history of stress fractures and absence from sport due to injury. This study sheds light on the significant level of energy deficiency menstrual dysfunction and stress fracture among competitive athletes. These findings are pivotal in understanding the complex interplay of factors such as eating a low-fat diet, dieting to lose weight, history of anorexia and bulimia, which may have significantly impacted on prevalence of oligomenorrhea, amenorrhea and stress fracture. The implications of this research are far reaching, highlighting the necessity for increased awareness and targeted interventions to address energy deficiency, menstrual dysfunction and poor bone mineral density in female athletes and active women. This understanding is crucial for promoting overall health and wellbeing in this demographic; emphasizing the need for comprehensive education efforts to optimize health and provide information, supportive environments in fitness/sports settings. Future research should consider longitudinal designs, larger and more diverse samples, and incorporate clinical assessments, using advance screening tools to include randomized clinical trials (RCTs): Bone & Body Composition determined by DEXA scan and hormonal assays. Future studies should expand upon these findings, exploring the broader impact of exercise and physical activity-related TRIAD conditions on fertility, cognitive function, mental health and bone mineral density. Reinforcing the importance of holistic health approach in athletic training and lifestyle management to deepen understanding of the female athlete triad in Nigeria context.

Despite the limitations of the cross-sectional study design and small purposive sample, the results obtained in this study are important. Exercise physiologists, dietitians, nutritionists, coaches, parents and athletes should be fully informed about the female athlete triad and its associated health risk, to prevent the development and progression of subclinical conditions into clinical manifestations, which could result in athlete being injured or kept absence from field of play. It is imperative that female athletes competing at all levels should be advised to undergo routine screening for the components of the female athlete triad to enable early detection for those who are at risk. It is very important to create sufficient awareness about athletes’ energy and nutritional needs to prevent poor energy status, preserve bone health and support reproductive function. Female athletes, particularly those of African descent should be educated on healthy weight control measures and be closely supervised by experts during a weight loss program.

Innovatively, this study addressed unique challenges faced by Nigerian athletes, such as limited access to sports medicine and nutrition, inadequate training infrastructure and sociocultural factors affecting performance, which are underrepresented in global literature. The study may introduce new biometric, physiological, or psychological data specific to Nigerian populations, helping to refine athlete profiling and performance benchmarks. In policy integration, the study could propose framework and bridge the gap between sports science and public health policy, a relatively unexplored intersection in Nigeria. The study may help to develop sport-specific rehabilitation protocols informed by physiological trends in Nigerian athlete. This data could be used to inform policy decisions on funding, resource allocation and medical staffing.

Abbreviations

BMD	Bone Mineral Density
BMI	Body Mass Index
CBC	Complete Blood Count
EA	Energy Availability
LEAF-Q	Low Energy Availability Questionnaire
Hb	Hemoglobin
Hct	Hematocrit
HENS	Health Exercise and Nutrition Survey
RBC	Red Blood Cell
WBC	White Blood cell

Acknowledgments

The authors would like to thank Blessing Akindele for assistance in data collection, Dr. Victor Ademola for coordination of questionnaire collection and the female participants who took the time to complete the questionnaires. Thanks to Dr. Oluwayemi Banjoko for coordinating the hematological assessment and with data capturing and analysis. We thank all team members at the Women’s Health Exercise Laboratory Pennsylvania State University and the Exercise Physiology Unit of the Department of Human Kinetics and Health Education, University of Lagos for the important contributions that they made to this research.

Author Contributions

Jane Sharon Akinyemi: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Writing – original draft

Nancy Williams: Conceptualization, Supervision, Validation, Visualization, Writing – review & editing

Ana Carla Salamunes: Formal Analysis, Software

Mary Jame De Souza: Conceptualization, Methodology, Supervision, Visualization, Writing – review & editing

Grace Olapeju Otinwa: Conceptualization, Data curation, Investigation, Project administration, Supervision, Validation, Visualization

Funding

The project was supported in part from the discretionary funds allocated by the President Postdoctoral fellowship Pennsylvania State University and in part by individual donations.

Data Availability Statement

The data that supports the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare that they have no known competing interest or personal relationship that could have appeared to influence the work reported in this paper.

Supplementary Material

Below is the link to the supplementary material:

Supplementary Material 1

References

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Akinyemi, J. S., Otinwa, G. O. (2025). Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes. American Journal of Sports Science, 13(4), 85-94. https://doi.org/10.11648/j.ajss.20251304.11

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Akinyemi, J. S.; Otinwa, G. O. Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes. Am. J. Sports Sci. 2025, 13(4), 85-94. doi: 10.11648/j.ajss.20251304.11

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Akinyemi JS, Otinwa GO. Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes. Am J Sports Sci. 2025;13(4):85-94. doi: 10.11648/j.ajss.20251304.11

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@article{10.11648/j.ajss.20251304.11,
  author = {Jane Sharon Akinyemi and Grace Olapeju Otinwa},
  title = {Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes
},
  journal = {American Journal of Sports Science},
  volume = {13},
  number = {4},
  pages = {85-94},
  doi = {10.11648/j.ajss.20251304.11},
  url = {https://doi.org/10.11648/j.ajss.20251304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajss.20251304.11},
  abstract = {The Female Athlete Triad syndrome describes three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and poor bone health, inclusive of low bone density and bone stress injury. Sports participation for female athletes has risen exponentially; however, investigations into the health and wellbeing of female athletes from Africa are extremely limited because these groups are noticeably absent from the Triad literature. This research gap can have negative health implications, on the Female Athletes in Nigerian athletes. Purpose: To investigate the prevalence of Triad components in competitive Nigerian female university athletes as well as explore hematological markers. Methods: n=71, (21.8±0.3yrs) and BMI (22.5±0.6 kg/m2) female athletes from the University of Lagos, during the Nigeria University Games Competition, completed a Health, Exercise Nutritional Survey questionnaire to provide demographics, medical history, exercise, and dietary practices. Athletes consented to a complete blood count (CBC) assessment: white blood cell (WBC), hematocrit (HCT), red blood cell (RBC), hemoglobin (HGB) and platelets. Results: Exercise frequency was 4.6±0.3 days/wk., overtraining, 6.8%, age at menarche 12.8±0.1 yrs., and gynecological age 9.2 ±0.5 yrs. Factors reflecting energetic status include (20/71): 28% reported eating a low-fat diet, (27/71) 38% dieted to lose weight to change their body composition and to improve performance, (2/71) 3% reported a history of anorexia and Bulimia. Prevalence of oligomenorrhea was (11/71) 15% while amenorrhea was (14/71) 19%. Stress fracture was reported to be (9/71) 13% and (3/71) 4%, had a family history of osteoporosis. (24/71) 34% refrained from training due to injuries during the past year and (7/71) 9.8% reported illness due to exercise. CBC measures showed RBC (3.95±0.06 1012/L), HGB (10.64±0.11 g/dL), HCT (32.68±0.31%) WBC (5.20±0.14 109/L) and platelets (245.17±8.2 *109/L), demonstrating that RBC and WBC are within the normal range while HGB, HCT and platelets are abnormal. Athletes in endurance sports had a decreased hematocrit (HCT). Conclusion: A significant percentage of Nigerian female athletes participating in the NUGA Games demonstrated factors reflective of poor energy intake, menstrual dysfunction and bone health including a history of stress fractures and absence from sport due to injury. The prevalence of factors observed suggests the need to advance screening tools and education efforts to include randomized clinical trials, optimize health of athletes and provide information for future investigation into the Triad among Nigerian athletes.
},
 year = {2025}
}

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TY  - JOUR
T1  - Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes

AU  - Jane Sharon Akinyemi
AU  - Grace Olapeju Otinwa
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ajss.20251304.11
DO  - 10.11648/j.ajss.20251304.11
T2  - American Journal of Sports Science
JF  - American Journal of Sports Science
JO  - American Journal of Sports Science
SP  - 85
EP  - 94
PB  - Science Publishing Group
SN  - 2330-8540
UR  - https://doi.org/10.11648/j.ajss.20251304.11
AB  - The Female Athlete Triad syndrome describes three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and poor bone health, inclusive of low bone density and bone stress injury. Sports participation for female athletes has risen exponentially; however, investigations into the health and wellbeing of female athletes from Africa are extremely limited because these groups are noticeably absent from the Triad literature. This research gap can have negative health implications, on the Female Athletes in Nigerian athletes. Purpose: To investigate the prevalence of Triad components in competitive Nigerian female university athletes as well as explore hematological markers. Methods: n=71, (21.8±0.3yrs) and BMI (22.5±0.6 kg/m2) female athletes from the University of Lagos, during the Nigeria University Games Competition, completed a Health, Exercise Nutritional Survey questionnaire to provide demographics, medical history, exercise, and dietary practices. Athletes consented to a complete blood count (CBC) assessment: white blood cell (WBC), hematocrit (HCT), red blood cell (RBC), hemoglobin (HGB) and platelets. Results: Exercise frequency was 4.6±0.3 days/wk., overtraining, 6.8%, age at menarche 12.8±0.1 yrs., and gynecological age 9.2 ±0.5 yrs. Factors reflecting energetic status include (20/71): 28% reported eating a low-fat diet, (27/71) 38% dieted to lose weight to change their body composition and to improve performance, (2/71) 3% reported a history of anorexia and Bulimia. Prevalence of oligomenorrhea was (11/71) 15% while amenorrhea was (14/71) 19%. Stress fracture was reported to be (9/71) 13% and (3/71) 4%, had a family history of osteoporosis. (24/71) 34% refrained from training due to injuries during the past year and (7/71) 9.8% reported illness due to exercise. CBC measures showed RBC (3.95±0.06 1012/L), HGB (10.64±0.11 g/dL), HCT (32.68±0.31%) WBC (5.20±0.14 109/L) and platelets (245.17±8.2 *109/L), demonstrating that RBC and WBC are within the normal range while HGB, HCT and platelets are abnormal. Athletes in endurance sports had a decreased hematocrit (HCT). Conclusion: A significant percentage of Nigerian female athletes participating in the NUGA Games demonstrated factors reflective of poor energy intake, menstrual dysfunction and bone health including a history of stress fractures and absence from sport due to injury. The prevalence of factors observed suggests the need to advance screening tools and education efforts to include randomized clinical trials, optimize health of athletes and provide information for future investigation into the Triad among Nigerian athletes.

VL  - 13
IS  - 4
ER  -

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Jane Sharon Akinyemi

Department of Sport and Movement Science, Salem State University, Salem, USA

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http://orcid.org/0009-0004-4473-2315
Grace Olapeju Otinwa

Department of Human Kinetics and Health Education, University of Lagos, Lagos, Nigeria

Contact Email

http://orcid.org/0000-0002-8983-8103

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APA Style

Akinyemi, J. S., Otinwa, G. O. (2025). Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes. American Journal of Sports Science, 13(4), 85-94. https://doi.org/10.11648/j.ajss.20251304.11

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ACS Style

Akinyemi, J. S.; Otinwa, G. O. Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes. Am. J. Sports Sci. 2025, 13(4), 85-94. doi: 10.11648/j.ajss.20251304.11

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AMA Style

Akinyemi JS, Otinwa GO. Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes. Am J Sports Sci. 2025;13(4):85-94. doi: 10.11648/j.ajss.20251304.11

Copy | Download

@article{10.11648/j.ajss.20251304.11,
  author = {Jane Sharon Akinyemi and Grace Olapeju Otinwa},
  title = {Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes
},
  journal = {American Journal of Sports Science},
  volume = {13},
  number = {4},
  pages = {85-94},
  doi = {10.11648/j.ajss.20251304.11},
  url = {https://doi.org/10.11648/j.ajss.20251304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajss.20251304.11},
  abstract = {The Female Athlete Triad syndrome describes three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and poor bone health, inclusive of low bone density and bone stress injury. Sports participation for female athletes has risen exponentially; however, investigations into the health and wellbeing of female athletes from Africa are extremely limited because these groups are noticeably absent from the Triad literature. This research gap can have negative health implications, on the Female Athletes in Nigerian athletes. Purpose: To investigate the prevalence of Triad components in competitive Nigerian female university athletes as well as explore hematological markers. Methods: n=71, (21.8±0.3yrs) and BMI (22.5±0.6 kg/m2) female athletes from the University of Lagos, during the Nigeria University Games Competition, completed a Health, Exercise Nutritional Survey questionnaire to provide demographics, medical history, exercise, and dietary practices. Athletes consented to a complete blood count (CBC) assessment: white blood cell (WBC), hematocrit (HCT), red blood cell (RBC), hemoglobin (HGB) and platelets. Results: Exercise frequency was 4.6±0.3 days/wk., overtraining, 6.8%, age at menarche 12.8±0.1 yrs., and gynecological age 9.2 ±0.5 yrs. Factors reflecting energetic status include (20/71): 28% reported eating a low-fat diet, (27/71) 38% dieted to lose weight to change their body composition and to improve performance, (2/71) 3% reported a history of anorexia and Bulimia. Prevalence of oligomenorrhea was (11/71) 15% while amenorrhea was (14/71) 19%. Stress fracture was reported to be (9/71) 13% and (3/71) 4%, had a family history of osteoporosis. (24/71) 34% refrained from training due to injuries during the past year and (7/71) 9.8% reported illness due to exercise. CBC measures showed RBC (3.95±0.06 1012/L), HGB (10.64±0.11 g/dL), HCT (32.68±0.31%) WBC (5.20±0.14 109/L) and platelets (245.17±8.2 *109/L), demonstrating that RBC and WBC are within the normal range while HGB, HCT and platelets are abnormal. Athletes in endurance sports had a decreased hematocrit (HCT). Conclusion: A significant percentage of Nigerian female athletes participating in the NUGA Games demonstrated factors reflective of poor energy intake, menstrual dysfunction and bone health including a history of stress fractures and absence from sport due to injury. The prevalence of factors observed suggests the need to advance screening tools and education efforts to include randomized clinical trials, optimize health of athletes and provide information for future investigation into the Triad among Nigerian athletes.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Prevalence of the Attributes of the Female Athlete Triad in Competitive Nigerian Female Athletes

AU  - Jane Sharon Akinyemi
AU  - Grace Olapeju Otinwa
Y1  - 2025/10/30
PY  - 2025
N1  - https://doi.org/10.11648/j.ajss.20251304.11
DO  - 10.11648/j.ajss.20251304.11
T2  - American Journal of Sports Science
JF  - American Journal of Sports Science
JO  - American Journal of Sports Science
SP  - 85
EP  - 94
PB  - Science Publishing Group
SN  - 2330-8540
UR  - https://doi.org/10.11648/j.ajss.20251304.11
AB  - The Female Athlete Triad syndrome describes three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and poor bone health, inclusive of low bone density and bone stress injury. Sports participation for female athletes has risen exponentially; however, investigations into the health and wellbeing of female athletes from Africa are extremely limited because these groups are noticeably absent from the Triad literature. This research gap can have negative health implications, on the Female Athletes in Nigerian athletes. Purpose: To investigate the prevalence of Triad components in competitive Nigerian female university athletes as well as explore hematological markers. Methods: n=71, (21.8±0.3yrs) and BMI (22.5±0.6 kg/m2) female athletes from the University of Lagos, during the Nigeria University Games Competition, completed a Health, Exercise Nutritional Survey questionnaire to provide demographics, medical history, exercise, and dietary practices. Athletes consented to a complete blood count (CBC) assessment: white blood cell (WBC), hematocrit (HCT), red blood cell (RBC), hemoglobin (HGB) and platelets. Results: Exercise frequency was 4.6±0.3 days/wk., overtraining, 6.8%, age at menarche 12.8±0.1 yrs., and gynecological age 9.2 ±0.5 yrs. Factors reflecting energetic status include (20/71): 28% reported eating a low-fat diet, (27/71) 38% dieted to lose weight to change their body composition and to improve performance, (2/71) 3% reported a history of anorexia and Bulimia. Prevalence of oligomenorrhea was (11/71) 15% while amenorrhea was (14/71) 19%. Stress fracture was reported to be (9/71) 13% and (3/71) 4%, had a family history of osteoporosis. (24/71) 34% refrained from training due to injuries during the past year and (7/71) 9.8% reported illness due to exercise. CBC measures showed RBC (3.95±0.06 1012/L), HGB (10.64±0.11 g/dL), HCT (32.68±0.31%) WBC (5.20±0.14 109/L) and platelets (245.17±8.2 *109/L), demonstrating that RBC and WBC are within the normal range while HGB, HCT and platelets are abnormal. Athletes in endurance sports had a decreased hematocrit (HCT). Conclusion: A significant percentage of Nigerian female athletes participating in the NUGA Games demonstrated factors reflective of poor energy intake, menstrual dysfunction and bone health including a history of stress fractures and absence from sport due to injury. The prevalence of factors observed suggests the need to advance screening tools and education efforts to include randomized clinical trials, optimize health of athletes and provide information for future investigation into the Triad among Nigerian athletes.

VL  - 13
IS  - 4
ER  -

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