Average weight and waist circumference were slightly higher in deployed (84.2 kg and 90.2 cm, respectively) than in nondeployed veterans (81.9 kg and 88.3 cm).

In the study of Australian Gulf War veterans (Sim et al., 2003), researchers obtained direct measures of BMI and waist circumference in a sample of 1384 male and 30 female deployed veterans and 1379 male and 32 female nondeployed controls examined in 2002. BMI was comparable in deployed and nondeployed groups. Comparisons were adjusted for service type, rank, age, education, and marital status. In deployed men, the mean (standard deviation) of BMI was 28.1 kg/m2 (sd = 4.1) while in nondeployed men it was 28.3 kg/m2 (sd = 4.1) (adjusted difference: −0.3, 95% CI −0.6-0.02). Their corresponding mean waist circumference was 97.7 cm (sd = 10.7) and 98.2 cm (sd = 10.7) (adjusted difference: −0.6, 95% CI −1.4-0.2). Among female veterans, both deployed and nondeployed had an average body mass index of 26 kg/m2, and similar waist circumferences (86.3 cm in deployed and 83.4 cm in nondeployed). Given the small sample size in this group, the authors did not conduct statistical comparisons among women.

Secondary Studies

A small study of 111 deployed and 133 nondeployed UK veterans compared different clinical parameters, objectively measured, in the two groups (Ismail et al., 2008). These parameters included BMI, glycemia, and blood levels of thyroxine-stimulating hormone. No differences were observed between the groups. These veterans were selected from a group of approximately 12,000 UK veterans who were contacted by mail and reported physical disability according to the Short Form 36 (SF-36) Physical Functioning Scale. Being a selected subgroup of deployed and nondeployed veterans, it is unclear how these results apply to the entire veteran population.

Hospitalization Studies

Summary of Volume 4

A DoD study examined hospitalizations in relation to possible exposure to sarin and cyclosarin as a result of demolishing weapons at Khamisiyah, Iraq, in March 1991 (Smith et al., 2003). As an update to a previous report (Gray et al., 1999b), the investigators analyzed hospitalizations from 1991 to 2000 among 431,762 active-duty military deployed to the Gulf War theater during the time of the Khamisiyah demolition. Investigators studied discharge diagnoses from 15 ICD-10 categories, including “endocrine, nutritional, and metabolic diseases.” The incidence of hospitalizations for endocrine and metabolic diseases was the same in veterans exposed and nonexposed to the Khamisiyah plume (risk ratio 1.00, 95% CI 0.94-1.06). Limitations of this study include: diagnoses not severe enough to require hospitalization would not be captured in these data, lack of outpatient data, restriction to DoD hospitals in those on active duty, and limited adjustment for potential confounding exposures.

Updated and Supplemental Literature

Since the publication of Volume 4, four additional primary studies reporting hospitalizations for endocrine and metabolic disorders have been identified (Gray et al., 1996, 2000; Smith et al., 2002, 2006). Like Smith et al. (2003), however, these studies evaluated hospitalizations for major diagnostic categories, and thus were limited to assessing events serious enough to warrant hospitalization.

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