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BODY COMPOSITION AND PHYSICAL PERFORMANCE Applications for the Military Services Committee on Military Nutrition Research Food and Nutrition Board Institute of Medicine Bernadette M. Marriott and Judith Grumstrup-Scott, Editors NATIONAL ACADEMY PRESS Washington, D.C. 1992

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 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 compe- tences and with regard for appropriate balance. Part I of this report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engi- neering, and the Institute of Medicine. The Institute of Medicine was established in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Acade- my's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. This report was produced under grants DAMD17-86-G-6036/R and DAMD17-92-J-2003 between the National Academy of Sciences and the U.S. Army Medical Research and Develop- ment Command. The views, opinions, and/or findings contained in chapters in Part II authored by U.S. Army personnel are those of the authors and should not be construed as official Department of the Army position, policy, or decision, unless so designated by other official documentation. Human subjects who participated in studies described in those chapters gave their free and informed voluntary consent. Investigators adhered to U.S. Army regulation 25 and United States Army Medical Research and Development Command regulation 70-25 on use of volunteers in research. The chapters are approved for public release; distribution is unlimited. Library of Congress Catalog Card No. 92-60574 International Standard Book Number 0-309-04586-X Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue, N.W. Washington, D.C. 20418 S450 Copyright 1992 by the National Academy of Sciences Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logo- type by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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COMMITTEE ON MILITARY NUTRITION RESEARCH ROBERT O. NESHEIM, (Chair), Monterey, California RICHARD L. ATKINSON, Department of Internal Medicine, Veterans Administration Medical Center, Hampton, Virginia ANDRE BENSADOUN, Division of Nutrition Science, Cornell University, Ithaca, New York WILLIAM J. EVANS, Human Physiology Division, U.S. Department of Agriculture, Human Nutrition Center on Aging, Tufts University, Boston, Massachusetts JOEL A. GRINKER, Program in Human Nutrition, Schoo] of Public Health, University of Michigan, Ann Arbor EDWARD S. HORTON, Department of Medicine, University of Vermont, College of Medicine, Burlington G. RICHARD JANSEN, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins GILBERT A. LEVEILLE, Nabisco Brands Incorporated, East Hanover, New Jersey JOHN A. MILNER, Department of Nutrition, Pennsylvania State University, State College, Pennsylvania JOHN E. VANDERVEEN, Division of Nutrition, Food and Drug Administration, Washington, D.C. ALLISON A. YATES, College of Health and Human Sciences, University of Southern Mississippi, Hattiesburg Food and Nutrition Board Liaison: JOHANNA T. DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts Committee on Military Nutrition Research U.S. Army Grant Officer Representative: COL ELDON W. ASKEW, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts Stay BERNADETTE M. MARRIOTT, Program Director JUDITH GRUMSTRUP-SCOTT, Editor VALERIE McCADDON BREEN, Project Assistant . . .

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FOOD AND NUTRITION BOARD M. R. C. GREENWOOD (Chair), Office of Graduate Studies, Un California, Davis, California DONALD B. McCORMICK (Vice Chair), Department of Biochemistry, Emory University School of Medicine, Atlanta, Georgia DeWITT S. GOODMAN (Vice Chair) (deceased)," Institute of Human Nutrition, Columbia University, New York, New York PERRY L. ADKISSON,* Department of Entomology, Texas A&M University, College Station, Texas LINDSAY ALLEN, Department of Nutritional Sciences, University of Connecticut, Storrs, Connecticut DENNIS M. BIER, Pediatric Clinical Research Center, Washington University School of Medicine, St. Louis, Missouri EDWIN L. BIERMAN,t Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington MICHAEL P. DOYLE, Department of Food Science and Technology, Georgia Experiment Station, University of Georgia, Griffin, Georgia JOHANNA T. DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts JOHN W. ERDMAN, Jr., Department of Food Science and Division of Nutritional Sciences, College of Agriculture, University of Illinois, Urbana, Illinois NANCY FOGG-JOHNSON, Consumer Healthcare Division, Miles, Inc., Elkhart, Indiana CUTBERTO GARZA, Division of Nutritional Sciences, Cornell University, Ithaca, New York K. MICHAEL HAMBIDGE, Department of Pediatrics, University of Colorado Medical Center, Denver, Colorado JANET C. KING, Department of Nutritional Sciences, University of California, Berkeley, California JOHN E. KINSELLA, School of Agriculture and Environmental Sciences University of California, Davis, California LAURENCE N. KOLONEL, Cancer Center of Hawaii, University of Hawaii, Honolulu, Hawaii SANFORD A. MILLER, Graduate Studies and Biological Sciences, University of Texas Health Science Center, San Antonio, Texas MALDEN C. NESHEIM, Office of the Provost, Cornell University, Ithaca, New York ROY M. PITKIN (Ex Officio, Department of Obstetrics and Gynecology, School of Medicine, University of California, Los Angeles, California . . ~ Verity of IV

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STEVE L. TAYLOR (Ex Officio), Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska Staff CATHERINE E. WOTEKI, Director MARCIA S. LEWIS, Administrative Assistant SUSAN M. WYATT, Financial Associate *Member, National Academy of Sciences "Member, Institute of Medicine v

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Preface This publication on body composition and physical performance is an- other from a series of workshops that have been sponsored by the Commit- tee on Military Nutrition Research (CMNR, the Committee) of the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. Other workshops or mini-symposia have included such topics as nutrition and physical performance, cognitive testing methodology, and fluid replacement and heat stress. These workshops are a part of the response the CMNR provides to the Assistant Surgeon General of the U.S. Army (U.S. Army Medical Research and Development Command, Frederick, Maryland) to is- sues that are brought to the Committee through the Military Nutrition Divi- sion of the U.S. Army Institute of Environmental Medicine (USARIEM) at Natick, Massachusetts. FOCUS OF THE REPORT The relationship of body composition to performance of physical tasks is of major interest to the military. Not only is it important in the decisions of acceptance or rejection of recruits for military service, but it also has significant implications for the individual relating to retention and advance- ment while in the services. There are financial implications as well for the military services, due to the high cost of training replacements when indi- viduals are discharged for failure to meet the established standards. The discharge of highly trained and experienced specialists has significant addi- tional implications concerning unit readiness and performance. The application of body composition standards in the military on a . . V11

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. . . V111 PREFACE rational and equitable basis based on ethnicity, gender, and age is therefore an important issue. A perspective on the current outcome of the applica- tions of height, weight, and body composition standards for entrance or retention in the military services was succinctly stated by James A. Vogel, Director, Occupational Health and Performance, USARIEM, in his intro- ductory remarks to the workshop, which was held February 6, 1990 at the National Academy of Sciences, Washington, D.C. Every day potential new Army recruits are turned away at the recruiter's door for the reason of overweight or overfatness. Ironically, they often go next door to the Navy or Air Force recruiter where they are accepted. I am referring to young women who are unable to meet the Army's entry stan- dard for body weight. An outsider might assume that the services have weight-fat standards to ensure that personnel can meet the physical demands of military service, that is, that they are performance driven. This may only be partially true. In the Army, at least, it is apparent that an important factor in the Army's fat standards is appearance. The Navy, on the other hand, has established health criteria as important for its body fat standards. Are appearance and health criteria compatible with physical performance criteria? These ques- tions lead us to our goals for this workshop: 1. What is the relationship between body composition and physical per- formance in terms of the military's needs? 2. Can the service's needs in performance, appearance, and health be blended together in a body composition standard? 3. When the services already have performance standards (various fitness and occupational tests), do we also need a body composition standard? Those of us within the services who are dealing with weight and fat standards need to revisit this issue-at a theoretical and mechanistic level, at a practical or job task level, and at a population and policy level. We cannot look at this body composition issue in isolation. So in ad- dress~ng our goals, we must consider them in the military context where other factors come into play. The proceedings of this workshop are published here to provide a) a review of current knowledge on the relationship of body composition to physical performance, b) a discussion of the application of this data base to accession and retention standards in the military services, and c) an evalua- tion and recommendations for consideration by the military in relating body composition to physical performance. While the Committee on Military Nutrition Research recognizes that body composition, physical performance, and health status are closely linked to the amounts and types of foods ingested, a comprehensive discussion of nutrition as related to body com- position and performance was deemed to be beyond the scope of this workshop. The CMNR has limited the report to a review of the scientific

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PREFACE IX evidence relating physical performance to body weight and composition. It is anticipated that this information will aide the military in establishing body composition standards that are more appropriate to the task perfor- mance requirements of military personnel. In addition, the information from this workshop may be of more general interest to those civilians concerned with establishing physical testing criteria for jobs requiring minimum physical performance standards. HISTORY OF THE COMMITTEE The Committee on Military Nutrition Research (CMNR) was estab- lished in October, 1982 when the Assistant Surgeon General of the U.S. Army requested the Food and Nutrition Board (FNB), National Academy of Sciences, to establish a committee to advise on the need for and conduct of nutrition research and related issues for the U.S. Department of Defense. The overall tasks of the Committee are to identify nutritional factors that may critically influence the physi- cal and mental performance of military personnel under all environmental extremes, to identify deficiencies in the existing database, to recommend research that would remedy these deficiencies, to recommend approaches for studying the relationship of diet to physical and mental performance, and to review and advise on standards for military feeding systems. Within this context the CMNR was asked to focus on nutrient require- ments for performance during combat missions rather than requirements for military personnel in garrison, because the latter were judged not to differ significantly from those of the civilian population. Although the Committee membership has changed periodically, the dis- ciplines represented have consistently included human nutrition, nutritional biochemistry, performance physiology, food science, and psychology. When issues have been presented to the CMNR by the Army that require broader expertise than what exists within the Committee, or for which the Committee would like additional information or opinions, workshops have been con- vened. These workshops provide additional state-of-the-art scientific informa- tion for the Committee to consider in their evaluation of the issues at hand. COMMITTEE TASK AND PROCEDURES In 1989, personnel from USARIEM raised the question with the CMNR of the relationship of body composition to physical performance. Of partic- ular interest was the application of then current height-weight standards in

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x PREFACE recruitment and retention of military personnel to the performance of mili- tary tasks. Although the tasks of military personnel are increasingly di- verse, the Army contends that all individuals need to maintain a certain level of physical fitness to preserve the combat readiness of the services in general. However, with the increasing diversity of military personnel in terms of gender, ethnicity, and age, there was a concern whether current standards were appropriate and were uniformly applied in recruitment and retention. The applicability of these standards to the mission requirements of the services was also questioned. The CMNR reviewed these issues and concluded that a workshop was needed to review the literature, provide additional information on military standards, provide the most current re- search findings from within the Army related to this issue, and hear inter- pretation of this issue from experts in related fields. A small planning group was given the task of identifying the pertinent topics and the participants. This task force, comprised of Cot. E. Wayne Askew and James A. Vogel of USARIEM and CMNR members Ed Horton, Richard Atkinson, Robert O. Nesheim, and FNB Staff Officer Susan Berkow, met at USARIEM in the fall of 1989 to plan the workshop. The workshop outline and participants were reviewed by the CMNR at its December 1989 meeting, and the workshop was held February 6, 1990, at the National Academy of Sciences in Washington, D.C. The invited speakers were chosen for their specific expertise in the areas of body composition, performance, and obesity. They were asked to provide in-depth reviews of their area of expertise as it directly applied to a series of questions prepared by the CMNR and make recommendations on the issues. Speakers subsequently submitted written versions of their presentations. The workshop format was a formal presentation by a speaker followed by questions and a brief discussion with Committee members and other participants. At the end of the presentations, a general discussion of the overall issues was held. The next day, the CMNR met in; executive session to review the various issues, draw some tentative conclusions, and make assignments for draft reviews and summaries of specific topics by various Committee members. An initial summary paper discussing some of the issues was prepared by one of the Committee members, Joel Grinker, to aide the CMNR in focusing the draft recommendations (See Part III). A subcommittee composed of Joel Grinker, Richard Atkinson, and Richard Jansen worked separately and together using the authored papers and addi- tional reference material to draft the summary and recommendations that were reviewed and approved by the CMNR. The summary and recommendations of the CMNR are included as Part I, and the papers presented at the workshop are included as Part II of this book. Part I has been reviewed anonymously by an outside group with expertise in the topic area and experience in military issues. The authored papers in Part II and Joel A. Grinker's paper in Part III have undergone

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PREFACE Xl limited editorial change, have not been reviewed by the outside group, and represent the views of the individual authors. ACKNOWLEDGMENTS As Committee chair I wish to acknowledge the assistance of the FNB staff: Susan Berkow, who participated in planning and organizing the work- shop prior to her leaving the FNB, Al Lazen, Ph.D., former acting director of the FNB for his considerable contribution acting as staff officer during the workshop and in the interim before Bernadette Marriott joined the FNB as program officer for the CMNR. Bernadette's strong technical assistance and organizational skills have been a major factor in pulling the proceed- ings together and bringing them to publication. I appreciate the extensive work of Joel Grinker in preparing the discussion paper that focused Com- mittee discussion on essential areas of concern. I particularly want to ac- knowledge the major inputs by Richard Atkinson in drafting an initial re- view of the proceedings and Richard Jansen in bringing together the various sections provided by Committee members into a consistent format. The Committee is grateful for their joint effort in drafting, reviewing, and edit- ing the summary, conclusions, and recommendations. I also wish to acknowledge on behalf of the Committee, the assistance of James Vogel and others from his division at USARIEM and Cot. Askew and his group at USARIEM. The insightful comments of Cot. David Schnaken- berg during the workshop were also useful to the Committee in summarizing the proceedings. Major Karl E. Friedl was particularly helpful in providing the Committee with current information on recent changes in Army regula- tions. The critiques of the reviewers, Cathie Woteki, and FNB CMNR liaison, Johanna Dwyer, provided helpful insight to the development of this final document. The editorial efforts of Judith Grumstrup-Scott are gratefully ac- knowledged. The Committee is also grateful to Vicki L. Friedl, History Bibli- ographer, Mugar Library, Boston University, for her research and suggestions about reference styles for government documents. The assistance of Connie Rosemont, FNB research assistant, and Valerie Breen, CMNR project assis- tant, in word processing, editing, and proofreading this report is greatly appre ciated. Finally, I wish to acknowledge the individual and collective contribu- tions of the Committee members. They represent a fine, unselfish example of busy professionals volunteering their limited time for the consideration of issues important to our national defense. I am stimulated by the exper- tise and dedication of this group as we work together on CMNR business. ROBERT O. NESHEIM, Chairman Committee on Military Nutrition Research (CMNR)

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Contents I O VERVIE W 1 1 Introduction and Background........ 2 Conclusions and Recommendations II INVITED PAPERS.................................. 3 Body Composition and Military Performance: Origins of the Army Standards ................................. Karl E. Friedl 4 Body Composition in the Military Services: Standards and Methods................................... James A. Hodgdon 5 Effects of Experimental Alterations in Excess Weight on Physiological Responses to Exercise and Physical Performance ................................... Kirk J. Cureton 6 Army Data: Body Composition and Physical Capacity James A. Vogel and Karl E. Friedl The Relationship of Body Size and Composition to the Performance of Physically Demanding Military Tasks ................................ Everett A. Harman and Peter N. Frykman 8 New Approaches to Body Composition Evaluation and Some Relationships to Dynamic Muscular Strength. Frank I. Katch 9 Associations Among Body Composition, Physical Fitness, and Injury in Men and Women Army Trainees Bruce H. Jones, Matthew W. Bovee, and Joseph J. Knapik . . . xz'' 3 25 29 31 ...57 89 ..105 ....... 119 ....141

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XlV 10 Body Composition, Morbidity, and Mortality William Cameron Chumlea and Richard N. Baumgartner 11 Critique of the Military's Approach to Body Composition Assessment and Evaluation....... Henry C. Lukaski 12 Body Composition and Performance in Relation to Environment ................................ Roy J. Shephard 13 Sex Differences and Ethnic/Racial Differences in Body Size and Body Composition ................... Stanley M. Garn III COMMITTEE DISCUSSION PAPER ......................... 14 Body Composition Measurement: Accuracy, Validity, and Comparability........................... Joel A. Grinker APPENDIXES .................................. A Accession Standards for the Military Services B Retention Standards for the Military Services. C Weight-for-Height Tables .......................... D Proposed Revisions to Accession (AR 40-501) and Reten- tion (AR 600-9), Body Weight and Body Fat Standards Recent Changes to the U.S. Army Standards for Accession and Retention Biographical Sketches...... CONTENTS 175 185 195 207 221 223 237 ...... 239 247 341 345 ...... 347 ............................. 351