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C Tables NUTRIENT COMPOSITION OF RATIONS FOR SHORT-TERM, HIGH-INTENSITY COMBAT OPERATIONS SUMMARY TABLES TABLE C-1 Ration Nutrient Composition Recommended by the Committee on Optimization of Nutrient Composition of Military Rations for Short-Term, High-Stress Situations Nutrient or Recommended Energy Intake Amount Comments Energy Intake 2,400 kcal in Additional 400 kcal should be supplemented basic ration as carbohydrate in form of candy, gels, or powder to add to fluids, or all three. Macronutrients Protein 100120 g Protein should be of high biological value Preferable to add sources of protein with low sulfur amino acids and low oxalate levels to minimize risk of kidney stone formation. Carbohydrate 350 g Additional 100 g should be supplemented as 100 g as a carbohydrate in form of candy, gels, or powder supplement to add to fluids, or all three. Amount of fructose as a monosaccharide should be limited to < 25 g. Fiber 1517 g Naturally occurring or added. A mix of viscous, nonfermentable and nonviscous fermentable fiber should be in the ration for gastrointestinal tract function. 462

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APPENDIX C 463 TABLE C-1 continued Nutrient or Recommended Energy Intake Amount Comments Fat 2225% kcal Fat added to the ration should have a balanced 5867 g mix of saturated, polyunsaturated, and mono- unsaturated fatty acids with palatability and stability the prime determinants of the specific mixture. Fat should contain 510% linoleic acid and 0.61.2% -linolenic acid. Vitamins Vitamin A 300900 g RAEa Could be added as preformed vitamin A or provitamin A carotenoids. Vitamin C 180400 mg Highly labile in processed food. If added to foods, encapsulation should be considered to prevent degradation through interaction with pro-oxidants. Vitamin D 12.515 g Estimates of dietary intake are not available. Range based on ensuring serum levels of 25 hydroxy vitamin D. Vitamin E 1520 mg Should be added to foods since natural foods are (-tocopherol) mainly sources of - rather than -tocopherol. Vitamin K No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods.b Thiamin 1.63.4 mg Dependent on energy use and intake. Amount in foods would be adequate provided ration is at least 50% whole foods. Riboflavin 2.86.5 mg Dependent on energy use. Niacin 2835 mg Dependent on energy use. The amount added to the ration should not be over 35 mg. Vitamin B6 2.73.9 mg Dependent on negative energy balance and loss of lean tissue. If a higher protein level is provided, the amount of vitamin B6 should be increased proportionally. Folate 400560 g Fortification may be needed. Vitamin B12 No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods. Biotin No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods. Pantothenic Acid No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods. Choline No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods.

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464 MINERAL REQUIREMENTS FOR MILITARY PERSONNEL TABLE C-1 continued Nutrient or Recommended Energy Intake Amount Comments Minerals Calcium 750850 mg Major concern for higher levels is the potential formation of kidney stones. Chromium No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods. Copper 9001,600 g If added to foods, encapsulation should be considered due to its pro-oxidant activity. Iodine 150770 g Could be added as iodized salt. Iron 818 mg If added to foods, encapsulation should be considered due to its pro-oxidant activity. Palatability should determine the amount in ration foods. Magnesium 400550 mg No more than 350 mg of magnesium salts should be present to meet the minimum daily amount of magnesium recommended. The rest should come from food sources. Also, if it needs to be added and taste problems result, encapsulation should be considered. Manganese No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods. Molybdenum No recommended Amount in foods would be adequate provided level ration is at least 50% whole foods. Phosphorus 7002,500 mg Because inorganic phosphates may cause diarrhea, it is recommended that they are added only up to 700 mg. Intakes above this amount should come from food sources only. Potassium Aim to 3.34.7 g Foods naturally high in potassium should be included in ration; if added to foods to achieve recommended levels, taste problems might be encountered. Selenium 55230 g No clear evidence of effects as an enhancer of immune function or performance Sodium 3 or more g For individuals who lose salt in excess or when in up to 12 g as extremely hot or strenuous situations, sodium supplement could be supplemented up to 12 g total. Part of this amount should be included in the form of candy, gels, or powder to add to fluids. Palatability will limit addition of sodium to these products; therefore, salt tablets should also be provided under medical guidance. Zinc 1125 mg If it needs to be added and taste problems result, encapsulation should be considered.

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APPENDIX C 465 TABLE C-1 continued Nutrient or Recommended Energy Intake Amount Comments Ergogenics Caffeine 100600 mg Not more than 600 mg in a single dose There is no evidence of dehydration at this level. aRAE: retinol activity equivalents. bWhole foods = food items prepared to preserve natural nutritive value. SOURCE: IOM (2006). BOX C-1 General Design of the Recommended Ration: Approximate Energy and Macronutrient Content of the Assault Ration Protein 100120 g (400480 kcal; 1720% kcal) Carbohydrate 350 g (1,400 kcal; 58% kcal) Fat 5867 g (520600 kcal; 2225% kcal) Water 105 g (assuming an average of 17% moisture) Total weight (kcal) 613642 g (2,400 kcal) Carbohydrate (and Electrolyte) Supplement: Carbohydrate 100 g (400 kcal) Water 17 g (assuming an average of 17% moisture) Sodium up to 12 g (based on palatability) Potassium up to 3.34.7 g (based on palatability) Total Weight (kcal) 117 g (400 kcal) Salt Tablets (available through medical personnel): Sodium up to 12 g Potassium up to 4.7 g Total Weight 8.716.7 g Packaging: 181 g Total Weight 0.95 kg Total Energy Content 2,800 kcal NOTE: This ration is intended for use over 3- to 7-day missions for up to a month. Prolonged and continuous use of these rations as a sole source of sustenance may lead to substantial weight loss. Constraints: weight of 1.36 kg and volume of 0.12 cubic feet. SOURCE: IOM (2006).

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466 Zinc (mg) 4.20 5.00 84% Zinc (mg) 4.17 5.00 83% TABLES Sodium (mg) 2045.90 2334.00 88% Sodium (mg) 2050.80 2334.00 88% Selenium (g) 10.10 18.33 55% Menus* Menus* Selenium (g) 11.89 18.30 65% COMPOSITION XXII XXIII 2005. 2005. Magnesium (mg) 114.16 133.00 86% Magnesium (mg) 177.15 140.00 127% MINERAL October, October, Iron (mg) 7.92 6.00 132% Iron (mg) 8.62 5.00 172% Ready-to-Eat Ready-to-Eat AND Medicine, Medicine, Meal, Meal, of Calcium (mg) 511.13 267.00 191% of Calcium (mg) 526.62 333.00 158% (g) (g) Environmental Environmental Fat 49.88 53.30 94% of Fat 49.70 50.00 99% of MACRONUTRIENT Composition Composition CHO (g) Institute Institute 165.47 147.00 113% CHO (g) 170.09 165.00 103% MENU Research Research Protein (g) 44.95 33.30 135% Protein (g) 43.88 30.30 145% Macronutrient Army Macronutrient Army and U.S. and U.S. AVERAGE Calories 1279.70 1200.00 107% Calories 1284.54 1200.00 107% Mineral Mineral Weight (g) 513.53 NA NA C.Baker-Fulco, Weight (g) 515.74 NA NA C.Baker-Fulco, Average applicable. Average applicable. READY-TO-EAT not not C-2 average average = C-3 = communication, communication, NA NA XXII NSOR XXIII MEAL, NSOR /3 1 MDRI TABLE 3 MRE 1/ % NOTE: *Personal TABLE MRE MDRI % NOTE: *Personal

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467 Zinc (mg) 4.71 5.00 94% Sodium (mg) 2181.06 2334.00 93% Menus* Selenium (g) 12.50 18.30 68% XXIV Magnesium (mg) 2005. 140.55 140.00 100% October, Iron (mg) 9.02 5.00 180% Ready-to-Eat Medicine, Meal, of Calcium (mg) 557.45 333.00 167% (g) Environmental Fat 50.94 50.00 102% of Composition Institute CHO (g) 174.01 165.00 105% Research Protein (g) 44.26 30.30 146% Macronutrient Army and U.S. Calories 1311.16 1200.00 109% Mineral Weight (g) 522.51 NA NA C.Baker-Fulco, Average applicable. Average not C-4 = communication, NA XXIV MDRI TABLE MRE MDRI % NOTE: *Personal

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468 MINERAL REQUIREMENTS FOR MILITARY PERSONNEL TABLE C-5 Summary and Comparison to Military Standards of the Average Meal, Ready-to-Eat Mineral and Macronutrient Menu Composition 1/3 NSORb (operational MRE XXIIa MRE XXIIIa MREXXIVa rations) MDRIb Weight (g) 513.53 515.74 522.51 NA NA Calories 1,279.70 1,284.54 1,311.16 1,200 1,200 Protein (g) 44.95 43.88 44.26 33.3 30.30 Carbohydrate (g) 165.47 170.09 174.01 147.00 165.00 Fat (g) 49.88 49.70 50.94 53.3 50.00 Calcium (mg) 511.13 526.62 557.45 267.00 333.00 Iron (mg) 7.92 8.62 9.02 6.00 5.00 Magnesium (mg) 114.16 177.15 140.55 133.00 140.00 Selenium (g) 10.10 11.89 12.50 18.33 18.30 Sodium (mg) 2,045.90 2,050.80 2,181.06 2,334.00 2,334.00 Zinc (mg) 4.20 4.17 4.71 5.00 5.00 NOTE: Average meal should meet one-third of the Nutrition Standards for Operational Rations (NSOR). MDRI = military dietary reference intakes; NA = not applicable. aPersonal communication, C.Baker-Fulco, U.S. Army Research Institute of Environmental Medicine, October, 2005. bU.S. Departments of the Army, Navy, and Air Force (2001). FIRST STRIKE RATION AVERAGE MENU MACRONUTRIENT AND MINERAL COMPOSITION TABLE C-6 Average Mineral and Macronutrient Composition in First Strike Ration Menus Menu Averagea 1/3 NSOR (restricted rations)b Weight (g) 915 NA Calories 2961 500 Protein (g) 105.1 16.67 Carbohydrate (g) 375.8 66.67 Fat (g) 112.2 Should not exceed 35% of total calories Calcium (mg) 673 166.67 Iron (mg) 16.97 2.67 Magnesium (mg) 386 70 Selenium (g) 100.2 9.33 Zinc (mg) 11.86 2.67 NOTE: Average meal should meet one-third of the Nutrition Standards for Operational Rations (NSOR). NA = not applicable. aPersonal communication, C.Baker-Fulco, U.S. Army Research Institute of Environmental Medicine, October, 2005. bU.S. Departments of the Army, Navy, and Air Force (2001).

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INTRODUCTION 469 UNITIZED GROUP RATIONS AVERAGE MENU MACRONUTRIENT AND MINERAL COMPOSITION TABLE C-7 Average Mineral and Macronutrient Composition in Unitized Group Rations Heat and Serve Menus Breakfast Lunch and 1/3 NSORb Menu Dinner Menu (operational Averagea Averagea rations) MDRIb Weight (g) 1,203.70 1,358.65 NA NA Calories 1,391.33 1,325.72 1,200 1,200 Protein (g) 49.46 50.18 33.3 30.30 Carbohydrate (g) 178.48 181.18 147.00 165.00 Fat (g) 56.75 47.70 53.3 50.00 Calcium (mg) 466.91 472.39 267.00 333.00 Iron (mg) 7.21 9.68 6.00 5.00 Magnesium (mg) 110.63 189.81 133.00 140.00 Selenium (g) 9.19 16.14 18.33 18.30 Sodium (mg) 2,579.62 2,464.98 2,334.00 2,334.00 Zinc (mg) 6.91 7.63 5.00 5.00 NOTE: Average meal should meet one-third of the Nutrition Standards for Operational Rations (NSOR). MDRI = military dietary reference intakes; NA = not applicable. aPersonal communication, C.Baker-Fulco, U.S. Army Research Institute of Environmental Medicine, October, 2005. bU.S. Departments of the Army, Navy, and Air Force (2001). REFERENCES IOM (Institute of Medicine). 2006. Nutrient Composition of Rations for Short-Term, High-Intensity Combat Operations. Washington, DC: The National Academies Press. U.S. Departments of Army NaAF. 2001. Nutrition Standards and Education. AR 40-25/BUMEDINST 10110.6/AFI 44-141. Washington, DC: U.S. Department of Defense Headquarters.