Abstract
Hincapié CA, Cassidy JD. Disordered eating, menstrual disturbances, and low bone mineral
density in dancers: a systematic review.
Objective
To assemble and synthesize the best evidence on the epidemiology, diagnosis, prognosis,
treatment, and prevention of disordered eating, menstrual disturbances, and low bone
mineral density in dancers.
Data Sources
Medline, CINAHL, PsycINFO, Embase, and other electronic databases were searched from
1966 to 2010 using key words such as “dance,” “dancer,” “dancing,” “eating disorders,”
“menstruation disturbances,” and “bone density.” In addition, the reference lists
of relevant studies were examined, specialized journals were hand-searched, and the
websites of major dance associations were scanned for relevant information.
Study Selection
Citations were screened for relevance using a priori criteria, and relevant studies
were critically reviewed for scientific merit by the best evidence synthesis method.
After 2748 abstracts were screened, 124 articles were reviewed, and 23 (18.5%) of
these were accepted as scientifically admissible (representing 19 unique studies).
Data Extraction
Data from accepted studies were abstracted into evidence tables relating to prevalence
and associated factors; incidence and risk factors; diagnosis; and prevention of disordered
eating, menstrual disturbances, and/or low bone mineral density in dancers.
Data Synthesis
The scientifically admissible studies consisted of 13 (68%) cross-sectional studies
and 6 (32%) cohort studies. Disordered eating and menstrual disturbances are common
in dancers. The lifetime prevalence of any eating disorder was 50% in professional
dancers, while the point prevalence ranged between 13.6% and 26.5% in young student
dancers. In their first year of intensive dance training, 32% of university-level
dancers developed a menstrual disturbance. The incidence of disordered eating and
low bone mineral density in dancers is unknown. Several potential risk factors are
suggested by the literature, but there is little compelling evidence for any of these.
There is preliminary evidence that multifaceted sociocultural prevention strategies
may help decrease the incidence of disordered eating.
Conclusions
The dance medicine literature is heterogeneous. The best available evidence suggests
that disordered eating, menstrual disturbances, and low bone mineral density are important
health issues for dancers at all skill levels. Future research would benefit from
clear and relevant research questions being addressed with appropriate study designs
and better reporting of studies in line with current scientific standards.
Key Words
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References
- Physical benefits of dancing for healthy older adults: a review.J Aging Phys Act. 2009; 17: 479-500
- Systematic review of the health benefits of physical activity and fitness in school-aged children and youth.Int J Behav Nutr Phys Act. 2010; 7: 40
- Osteopenia in exercise-associated amenorrhea using ballet dancers as a model: a longitudinal study.J Clin Endocrinol Metab. 2002; 87: 3162-3168
- Eating disorders and body image disturbances among ballet dancers, gymnasium users and body builders.Psychopathology. 2003; 36: 247-254
- Musculoskeletal injuries and pain in dancers: a systematic review.Arch Phys Med Rehabil. 2008; 89: 1819-1829
- American College of Sports Medicine position stand: the female athlete triad.Med Sci Sports Exerc. 2007; 39: 1867-1882
- The female athlete triad: the inter-relatedness of disordered eating, amenorrhea, and osteoporosis.Clin Sports Med. 1994; 13: 405-418
- The female athlete triad: are elite athletes at increased risk?.Med Sci Sports Exerc. 2005; 37: 184-193
- Methods for the best evidence synthesis on neck pain and its associated disorders: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S33-S38
- Clinical epidemiology: the essentials.4th ed. Lippincott Williams & Wilkins, Baltimore2005
- Modern epidemiology.2nd ed. Lippincott-Raven, Philadelphia1998
- The sensitivity of review results to methods used to appraise and incorporate trial quality into data synthesis.Spine. 2007; 32: 796-806
- Best evidence synthesis: an alternative to meta-analytic and traditional reviews.Educ Res. 1986; 15: 5-11
- Best evidence synthesis: an intelligent alternative to meta-analysis.J Clin Epidemiol. 1995; 48: 9-18
- Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 84-105
- Methodological challenges in the evaluation of prognostic factors in breast cancer.Breast Cancer Res Treat. 1998; 52: 289-303
- The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine. 2008; 33: S60-S74
- Approximate is better than “exact” for interval estimation of binomial proportions.Am Stat. 1998; 52: 119-126
- Adolescent ballet school students: their quest for body weight change.Psychopathology. 1998; 31: 153-159
- Physiologic Screening Test for eating disorders/disordered eating among female collegiate athletes.J Athl Train. 2003; 38: 286-297
- The effects of delayed menarche in different contexts: dance and nondance students.J Youth Adolesc. 1985; 14: 285-300
- Attitudes toward eating and body weight in different groups of female adolescent athletes.Int J Eat Disord. 1988; 7: 749-757
- Mother-daughter differences in menarcheal age in adolescent girls attending national dance company schools and non-dancers.Ann Hum Biol. 1988; 15: 35-43
- Retired elite female ballet dancers and nonathletic controls have similar bone mineral density at weightbearing sites.J Bone Miner Res. 1996; 11: 1566-1574
- Self-reported ballet classes undertaken at age 10-12 years and hip bone mineral density in later life.Osteoporos Int. 1998; 8: 165-173
- Physical signs and symptoms of eating disorders and disordered eating: development of a screening test for female college athletes [dissertation].Purdue Univ, West Lafayette1999
- Implications of a diagnosis of anorexia nervosa in a ballet school.Int J Eat Disord. 1994; 15: 369-376
- Gender role, eating disorder symptoms, and body image concern in ballet dancers.J Psychosom Res. 2006; 61: 529-535
- Risk behaviors for eating disorders in Brazilian dancers.Int J Sports Med. 2010; 31: 283-288
- Bone mineral density differences between adolescent dancers and non-exercising adolescent females.J Pediatr Adolesc Gynecol. 2005; 18: 337-342
- Comparison of quality of life scores among non-exercising adolescent females and adolescent dancers with oligomenorrhea and amenorrhea.J Pediatr Adolesc Gynecol. 2007; 20: 83-88
- The effect of dance training on menstrual function in collegiate dancing students.Aust N Z J Obstet Gynaecol. 1995; 35: 304-309
- Two-phase survey of eating disorders in gifted dance and non-dance high-school students in Taiwan.Psychol Med. 2007; 37: 1085-1096
- Prevalence of the female athlete triad in the Norwegian National Ballet.J Dance Med Sci. 2005; 9: 63
- Factors contributing to the attrition rate in elite ballet students.J Dance Med Sci. 1997; 1: 131-138
- Leisure physical activity and age at menarche.Med Sci Sports Exerc. 1991; 23: 1170-1175
- Eating disorders: a trial of prevention in a high risk school setting.J Prim Prev. 1999; 20: 75-90
- Hormonal predisposition to menstrual dysfunction in collegiate dance students.Acta Obstet Gynecol Scand. 2000; 79: 1117-1123
- The effects of exercise on pubertal progression and reproductive function in girls.J Clin Endocrinol Metab. 1980; 51: 1150-1157
- The Eating Attitudes Test: an index of the symptoms of anorexia nervosa.Psychol Med. 1979; 9: 273-279
- The Eating Attitudes Test: psychometric features and clinical correlates.Psychol Med. 1982; 12: 871-878
- Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/P), patient version.Biometrics Research Department, New York State Psychiatric Institute, New York2002
- Diagnostic and statistical manual of mental disorders: DSM-III-R.3rd ed. American Psychiatric Association, Washington (DC)1987
- The Eating Disorder Examination, 12.0D.in: Fairburn C.G. Wilson G.T. Binge eating: nature, assessment, and treatment. Guilford Pr, New York1993: 317-360
- Structured clinical interview for DSM-IV axis I disorders (SCID-I), clinical version.American Psychiatric Publishing Inc, Washington (DC)1995
- Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report.Osteoporos Int. 1994; 4: 368-381
- Diagnostic and statistical manual of mental disorders: DSM-IV.American Psychiatric Association, Washington (DC)1994
- A self-rating scale for bulimia: the “BITE.”.Br J Psychiatry. 1987; 150: 18-24
- Eating disorders: considerations about the Eating Attitudes Test (EAT) [Portuguese].Revista ABP-APAL. 1994; 6: 7-10
- O “BITE”: instrumento para avaliaçao da bulimia nervosa-versao para o português [Portuguese].J Bras Psiquiatr. 1993; 42: 141-144
- Initial consultation for patients with bulimia and anorexia nervosa.in: Garner D.M. Garfinkel P.E. Handbook of psychotherapy for anorexia nervosa and bulimia. Guilford Pr, New York1985: 19-51
Article info
Footnotes
Supported in part by the University Health Network Artists' Health Centre Foundation, the Canadian Memorial Chiropractic College, and the Canadian Institutes of Health Research through a Fellowship Award in the Area of Knowledge Translation.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
