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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

NUTRIENT COMPOSITION OF RATIONS FOR SHORT-TERM, HIGH-INTENSITY COMBAT OPERATIONS

Committee on Optimization of Nutrient Composition of Military Rations for Short-Term, High-Stress Situations

Committee on Military Nutrition Research

Food and Nutrition Board

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by the United States Army (award number DAMD17-99-1-9478 with the National Academy of Sciences). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsoring agency that provided support for the project.

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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

COMMITTEE ON OPTIMIZATION OF NUTRIENT COMPOSITION OF MILITARY RATIONS FOR SHORT-TERM, HIGH-STRESS SITUATIONS

JOHN W. ERDMAN (Chair),

Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign

BRUCE R. BISTRIAN,

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

PRISCILLA M. CLARKSON,

School of Public Health and Health Sciences, University of Massachusetts, Amherst

JOHANNA T. DWYER,

Office of Dietary Supplements, National Institutes of Health, Washington, DC

BARBARA P. KLEIN,

Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign

HELEN W. LANE,

Johnson Space Center, National Aeronautics and Space Administration, Houston, TX

MELINDA M. MANORE,

Department of Nutrition, Oregon State University, Corvallis

PATRICK M. O’NEIL,

Weight Management Center, Institute of Psychiatry, Medical University of South Carolina, Charleston

ROBERT M. RUSSELL,

Human Nutrition Research Center on Aging, Tufts University, Boston, MA

BEVERLY J. TEPPER,

Department of Food Sciences, Cook College of Rutgers University, New Brunswick, NJ

KEVIN D. TIPTON,

School of Sport and Exercise Sciences, University of Birmingham, Birmingham, England

ALLISON A. YATES,

Environ Health Sciences Institute, Arlington, VA

Staff

MARIA P. ORIA, Study Director

JON Q. SANDERS, Senior Program Assistant

LESLIE J. SIM, Research Associate

IOM boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the reports rests with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

FOOD AND NUTRITION BOARD

CATHERINE E. WOTEKI (Chair),

College of Agriculture, Iowa State University, Ames

ROBERT M. RUSSELL (Vice-Chair),

Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA

LARRY R. BEUCHAT,

Center for Food Safety, University of Georgia, Griffin

MICHAEL P. DOYLE,

Center for Food Safety, University of Georgia, Griffin

SUSAN FERENC,

Food Products Association, Washington, DC

NANCY F. KREBS,

Department of Pediatrics, University of Colorado Health Sciences Center, Denver

SHIRIKI KUMANYIKA,

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia

REYNALDO MARTORELL,

Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA

J. GLENN MORRIS, JR.,

Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore

SUZANNE P. MURPHY,

Cancer Research Center of Hawaii, University of Hawaii, Honolulu

JOSE M. ORDOVAS,

Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA

LYNN PARKER,

Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington

NICHOLAS J. SCHORK,

Department of Psychiatry, Polymorphism Research Laboratory, University of California, San Diego

REBECCA J. STOLTZFUS,

Division of Nutritional Sciences, Cornell University, Ithaca, NY

JOHN W. SUTTIE,

Department of Biochemistry, University of Wisconsin, Madison

WALTER C. WILLETT,

Department of Nutrition, Harvard School of Public Health, Harvard University, Boston, MA

BARRY L. ZOUMAS,

Department of Agricultural Economics and Rural Sociology, Pennsylvania State University, University Park

Staff

LINDA D. MEYERS, Director

GERALDINE KENNEDO, Administrative Assistant

ELIZABETH RIMAUD, Financial Associate

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

E. Wayne Askew, University of Utah, Salt Lake City

Barry Braun, Energy Metabolism Laboratory, University of Massachusetts, Amherst

William J. Evans, University of Arkansas for Medical Sciences, Little Rock

William C. Franke, Rutgers, State University of New Jersey, New Brunswick

Marc K. Hellerstein, University of California, Berkeley

Janet R. Hunt, USDA-ARS Grand Forks Human Nutrition Research Center, ND

Molly Kretsch, United States Department of Agriculture, Beltsville, MD

Ron J. Maughan, School of Sport and Exercise Science, Loughborough University, UK

Robert Nesheim, Salinas, CA

Michael D. Sitrin, Western New York Veterans Administration Medical Center, Buffalo, NY

Douglas W. Wilmore, Ilauea, HI

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recom-

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

mendations nor did they see the final draft of the report before its release. The review of this report was overseen by Richard N. Miller, M.D. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

Preface

This report, titled Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations, is the product of the work of the Committee on Optimization of Nutrient Composition of Military Rations for Short-Term, High-Stress Situations under the auspices of the Standing Committee on Military Nutrition Research (CMNR). The CMNR was established in 1982 to advise the US Department of Defense on the need for and conduct of nutrition research and related issues. This report was produced in response to a request by the US Army Medical Research and Materiel Command to the Institute of Medicine (IOM) to convene a committee to review and recommend the nutritional composition of rations for short-term, high-stress situations. The specific questions posed to the committee evolved from discussions between the standing CMNR and the Military Nutrition Division of the US Army Research Institute of Environmental Medicine (USARIEM) at Natick, Massachusetts.

A 12-member committee was formed that had expertise on micronutrients, protein, energy balance and sports nutrition, gastroenterology, clinical medicine, food processing and technology, eating behavior and intake regulation, clinical nutrition, dietetics, and psychology. The committee’s task was to conduct a study to determine the optimal nutrient content of a new combat ration. The committee first discussed the limitations of the current rations for use during future military deployments and combat operations and the expected impact of combat operations on nutrient status, health, and performance. Operating within specific design constrains, the committee then recommended nutritional composition of a new ration designed for short-term use by soldiers during high-tempo, stressful combat missions. The nutritional composition of this new ration was optimized to best sustain physical and cognitive performance and to prevent possible adverse health consequences, despite limitations imposed by ration design and mission constraints. The committee focused on dehydration, the gastrointestinal gut processes, and the function of the immune system as health issues of highest concern. Also, the committee considered the potential health and performance

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

impact of subsistence on this ration during its intended use in combat operations. Although it was not stated in the questions posed, the committee found that some of the answers to the questions needed further confirmation with research that particularly addresses the unique circumstances of combat missions, that is, a combination of multiple stressors that rarely occurs in nonmilitary operations. Therefore, the committee proposed very specific areas of research that are critical to continue improvement of the assault rations.

Among the chief design constraints of this daily ration are that it must fit within 0.12 cubic feet and weigh 3 lb or less. The ration would be targeted for use by average male soldier of 80 kg body mass, 16 percent fat, relatively fit, age range 18–45 years (probably average < 25 years), with no chronic metabolic disease, but potential incidence of some common food allergies. During combat operations, the expected daily energy expenditure is 4,000–4,500 kcal/per day, achieved through intermittent periods of high energy expenditure (> 50 percent VO2 max) mixed with longer periods of low-intensity movement sustained for 20 hours per day. Soldiers will rely on this ration for three to seven days followed by one to three days of recovery when they will have access to more nutritionally complete meals (i.e., ad lib food availability served in field kitchen setting). These three- to seven-day missions might be repeated several times for up to a month. To provide context for the recommendations, assumptions of the characteristics of the soldiers’ diets and health, the missions, and other issues were formulated that were based on information gathered at open sessions with sponsor representatives and other military personnel.

The committee carried out its work over 15 months and held three meetings. The first meeting of the committee was held in conjunction with a two-day workshop. The workshop was hosted by the USARIEM and the Natick Soldier Center (NSC) in Natick, Massachusetts, August 11–13, 2004. Speakers addressed the issues brought to the committee by the USARIEM. These presentations were the basis for the committee’s deliberations and recommendations and are included in this report as individually authored papers in Appendix B. Two additional meetings of the committee were held on October 21–22 and November 18–19, 2004.

Throughout the project, the committee had the privilege of having access to information collected directly in the field where soldiers were deployed to military missions of the type relevant to its task. For example, a survey that was designed to collect information on various aspects of eating behavior was conducted in Afghanistan. This very recent data collection was the basis for the committee’s outlining of the assumptions and, consequently, the development of the recommendations. The committee would like to express its most sincere appreciation for the work and professionalism of CPT Chad Koenig, Research Dietitian of the Military Nutrition Division (MND) at USARIEM. He not only incorporated the committee’s suggestions into the survey and conducted it, but

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

also summarized the survey data for the committee and presented the conclusions at the November meeting.

The committee expresses its appreciation to Douglas Dauphinee, Research Program Coordinator of the MND at USARIEM, for all the help provided during the preparations stages of the workshop at USARIEM. Special thanks go also to Andrew Young, Chief of the MND and representative from the Department of Defense for this task, for generously giving his time and help and for being available to clarify the task of the committee. Special thanks are extended to Scott Montain, Research Physiologist at MND, USARIEM. His assistance was truly invaluable during the committee’s work. He helped delineate the task and provided numerous reports and other data to the committee in a timely manner. In addition, the committee thanks COL Karl Friedl who continues to support the work of the CMNR and was readily available to provide the appropriate contacts needed to gather information for the committee.

On behalf of the committee, I sincerely thank the workshop participants and speakers for addressing topics critical to the completion of the committee’s work. Each speaker not only provided an excellent presentation, but was available for multiple interactions during the workshop, prepared a manuscript of the presentation (see Appendix B), and worked with IOM staff throughout the revision process. These presentations were important reference sources for the committee and have been used as scientific basis throughout the report.

The committee expresses its deepest appreciation to other staff members at the Combat Feeding Directorate (CFD), Research, Development and Engineering Command, NSC, who offered their insights about the multiple questions on food development at the CFD: Betty Davis, Team Leader of Performance Enhancement and Food Safety; Matthew Kramer, Research Psychologist at Product Optimization and Evaluation Team; and Patrick Dunne, Senior Advisor at the CFD.

In addition, the military leaders that answered and clarified the committee’s concerns on health issues during current deployments deserve the committee’s most sincere appreciation. They are Mr. Terry Phelps, Deputy Director of the Special Operations Command Surgeon; LTC Christopher, Division Surgeon of the 82nd Airborne Division; and MAJ Steve Lewis, Social Work Officer of the 82nd Airborne Division. Without their contributions many of the health considerations that drove the recommendations would have eluded the committee. We thank MAJ Lolita Burrell for providing such valuable contacts.

The committee owes a strong debt of gratitude to the Food and Nutrition Board (FNB) staff for their professionalism and effectiveness in ensuring that our committee adhered to its task statement, for providing discipline and experience in helping to assemble the report and effectively respond to reviewers, and for providing background research support and organizing our meetings. In particular, we thank Senior Program Officer Maria Oria, who worked tirelessly on numerous drafts and revisions. Ably assisting Dr. Oria in her efforts were

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
×

Senior Program Assistant Jon Sanders and Research Associate Leslie Sim. Finally, the committee is also grateful to the overall guidance and continuous support of Linda Meyers, FNB Director. I also extend my deep gratitude to my fellow committee members, who participated in our discussions in this study in a professional and collegial manner, and who approached its task statement with great seriousness and intellectual curiosity. I appreciated the opportunity to work with these colleagues from several disciplines, several of whom I would never have met in my professional research and administration circles.

John W. Erdman, Jr., Chair

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Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
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APPENDIXES

 

 

A

 

WORKSHOP AGENDA

 

157

B

 

WORKSHOP PAPERS

 

162

   

 Specifying Optimal Nutrient Composition for Military Assault Rations
Andrew J. Young and Gerald A. Darsch

 

162

   

 Physiological Demands of Combat Operations
Scott J. Montain

 

169

   

 Carbohydrate and Fat Intake: What is the Optimal Balance?
Jørn Wulff Helge

 

180

   

 Carbohydrate–Protein Balance for Physical Performance
Kevin D. Tipton

 

191

   

 Carbohydrate Ingestion During Intense Activity
Edward F. Coyle

 

201

   

 Macronutrient Composition of Military Rations for Cognitive Performance in Short-Term, High-Stress Situations
Randall J. Kaplan

 

208

   

 Do Structured Lipids Offer Advantages for Negative Energy Balance Stress Conditions?
R. J. Jandacek

 

227

   

 Optimum Protein Intake in Hypocaloric States
L. John Hoffer

 

235

   

 Vitamins C and E in the Prevention of Oxidative Stress, Inflammation, and Fatigue from Exhaustive Exercise
Maret G. Traber and Angela Mastaloudis

 

243

   

 Zinc, Magnesium, Copper, Iron, Selenium, and Calcium in Assault Rations: Roles in Promotion of Physical and Mental Performance
Henry C. Lukaski and James G. Penland

 

256

   

 Effect of Inadequate B Vitamin Intake and Extreme Physical Stress
Lynn B. Bailey and Kristina von Castel-Dunwoody

 

270

   

 Optimization of the Nutrient Composition of Military Rations for Short-Term, High-Stress Situations: Sodium, Potassium, and Other Electrolytes
Susan Shirreffs

 

280

   

 Other Bioactive Food Components and Dietary Supplements
Rebecca B. Costello and George P. Chrousos

 

289

   

 Effect of Physical Activity and Other Stressors on Appetite: Overcoming Underconsumption of Military Operational Rations, Revisited
R. James Stubbs, Stephen Whybrow, Neil King, John E. Blundell, and Marinos Elia

 

307

Suggested Citation:"Front Matter." Institute of Medicine. 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. doi: 10.17226/11325.
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Recognizing the importance of good nutrition for physical and mental status, the Department of Defense asked the Institute of Medicine to guide the design of the nutritional composition of a ration for soldiers on short-term, high-stress missions. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations considers military performance, health concerns, food intake, energy expenditure, physical exercise, and food technology issues. The success of military operations depends to a large extent on the physical and mental status of the individuals involved. Appropriate nutrition during assault missions is a continuous challenge mainly due to diminished appetites of individuals under stress. Many less controllable and unpredictable factors, such as individual preferences and climate, come into play to reduce appetite. In fact, soldiers usually consume about half of the calories needed, leaving them in a state called “negative energy balance.” The consequences of being in negative energy balance while under these circumstances range from weight loss to fatigue to mental impairments. An individual’s physiological and nutritional status can markedly affect one’s ability to maximize performance during missions and may compromise effectiveness. With the number of these missions increasing, the optimization of rations has become a high priority.

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