Committee on Military Nutrition Research: Activity Report 1992-1994 (1994)

The Committee on Military Nutrition Research (CMNR, the Committee) was established in October 1982 in response to a request from the Assistant Surgeon General of the United States Army. It was first organized within the Food and Nutrition Board (FNB) of the National Research Council's Commission on Life Sciences and in 1988 moved with the FNB to its new administrative home in the Institute of Medicine.

The Committee's mission is to advise the U.S. Department of Defense on the need for and conduct of nutrition research and related issues. Specifically it is charged with identifying nutritional factors that could critically influence the physical and mental performance of military personnel under environmental extremes, with identifying deficiencies in the existing relevant data base, with recommending approaches for studying the relationship of diet to physical and mental performance, and with reviewing and advising on nutritional standards for military feeding systems.

Within this context the CMNR was asked to focus on nutrient requirements 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 11-member Committee changes through a three year rotation policy, the disciplines represented have consistently included human nutrition, nutritional biochemistry, performance physiology, food science, and psychology. During this reporting period, scientists with expertise in immunology and

neuropsychology were added to the CMNR to augment the Committee expertise in response to increased activities of the Army in these areas.

Meetings have been of three types. Full Committee meetings are scheduled at the request of the Army to review nutrition programs, food products, and specific research projects in various stages of development. At these meetings oral presentations by Army personnel are augmented by written background material on one or more specific items for the Committee on Military Nutrition Research to review. The CMNR subsequently meets in executive session to discuss the materials and write a report to the Army that includes a summary of findings and recommendations. These reports are in the form of letters with attached supporting materials or brief, bound reports. Subcommittee meetings are convened by the Committee Chair either to plan future work, write reports, or, at the request of the Army, provide on-site review of research projects where the expertise of the entire Committee membership is not required. Reports drafted by subcommittees of the CMNR are subject to the review and approval of the entire Committee membership prior to completion. Workshop meetings are planned when issues have been presented to the CMNR by the Army that require broader expertise than exists within the Committee, or for which the Committee would like additional information or opinions. A CMNR workshop includes presentations from Army and other experts in nutrition and related sciences on an issue relevant to military nutrition research. The invited speakers are chosen for their specific expertise in the topic areas of concern and are asked to provide in-depth reviews of their area of expertise as it directly applies to a series of questions drafted by the sponsor. Speakers subsequently submit written versions of their presentations. These workshops thus provide additional state-of-the-art scientific information for the Committee to consider in their evaluation of the issues at hand. At the conclusion of the presentations, the Committee meets in executive session to discuss the issues and prepare conclusions and recommendations to be included as part of a book-style workshop report for subsequent release to the sponsors and the public.

If a topic is presented by the military where the Committee membership does not feel that they can adequately cover the scientific range required, guest specialists may be invited to augment the Committee expertise and interact with the membership as special consultants for a specific report. If the Committee Chair sees that expertise continues to be needed in a specific

scientific area, a new member with expertise in that scientific discipline may be added to the Committee through the normal three year rotation process.

In 1993 the CMNR was selected by the NRC to participate in a pilot study on the use of laptop computers and electronic communication to reduce Committee costs in time and money. All members of the CMNR received a laptop computer with a modem and communications and word processing software on loan from the NRC for their use on Committee business. Committee members are able to access the NRC computer network system via modem and a free telephone line and directly transfer reports or comments to the CMNR staff or each other. The experiment has been very successful as it has enabled Committee members to revise and transmit parts of reports to one another and staff.

In 1992, the CMNR formalized the document format types that they used for their reports and developed a standardized report cover. This standardized cover presents a “series effect” to the CMNR reports and makes them readily identifiable as Committee projects. Currently there are four document formats used by the CMNR that reflect the specific needs of the Army.

1. letter with attachments. This type of document is prepared in response to a specific request from the Army for a review of a research project or program which requires a rapid response to be effective. The document must be a short, specific statement of recommendations directed to the Army command for rapid action. These items are research projects that are in progress or specific nutritional concerns that have abruptly arisen. The CMNR is presented orally with the findings and provided with the limited documentation available. The timeliness as well as the concise, highly specific and confidential nature of these documents is specified by the Army when the item is presented to the CMNR. Several examples of letter reports are included in this activity report.

2. brief report with documentation. This document format is typically used in response to a request for review of a food product, packaging process, completed research project, or planned educational program. The Army provides an oral presentation as well as extensive documentation or product specifications. The time frame for the Committee deliberations is several months and the summary and recommendations are bound to the specifications to provide a clear understanding of the iteration of the product, process, project, or program that was reviewed. The 1993 CMNR report: Review of the

Results of Nutritional Intervention, Ranger Training Class 11/92 (Ranger II) is an example of a brief report (see p. 27 and Appendix G).

3. workshop proceedings with summary and recommendations. The Army identifies for the Committee at least one topic each year for which they require a thorough review of the current literature by experts in the scientific field coupled with the Committee's recommendations. This requirement is met with a workshop at which experts are asked to make oral presentations that include an overview of the literature and address specific questions posed by the Army. IOM staff compile literature reviews and organize these meetings in close collaboration with the sponsor. The CMNR reviews these presentations and writes a detailed summary and recommendations to the Army. The resulting document includes the Committee's findings with the presentations. The expected turn-around-time for this document type is within 9 to 12 months. An example of a workshop report is the book released in September, 1992: Body Composition and Physical Performance (see p. 9 and Appendix E).

4. periodic activities reports. The CMNR is also expected to prepare a bound report at variable intervals (3–5 years) that is a summation of the activities undertaken. No new information is presented in these reports. Typically these reports reflect contract periods and serve as a final report for the contract or contract renewal. This report is an example of the periodic activity report of the CMNR.

Subsequent to approval of the final draft of a report by the Committee, and the Food and Nutrition Board, in accordance with National Research Council guidelines, each report, with the exception of the activity reports, is reviewed in confidence by a separate, anonymous scientific review group. In 1992 the CMNR established a separate Review Panel to facilitate the rapid review of Committee reports. This nine-member panel has been initially appointed for a 3-year period. When a report is begun the panel members are alerted and polled as to who among them would be available to review the report. Typically each report has been reviewed by five to seven panel members. The review panel members all have some experience with military nutrition and health issues and therefore have a basic understanding of the concepts under consideration. None are military personnel or have contracts with the military. The review panel has facilitated the speed of report review because the participants are interested and knowledgeable about the issues that

come before the Committee. In addition, as panel members they are prepared to consider reviewing reports with a rapid turn around time. As with all NRC report reviews, the comments of the review panel are anonymous.

The Committee then reviews the anonymous comments of this review panel and incorporates their suggestions where appropriate. Staff then write a response to the reviewers with the final report draft and obtain final approval of the report from the review panel. Each Committee on Military Nutrition Research report is thus a thoughtfully developed presentation that incorporates the scientific opinion of the CMNR and the comments of anonymous National Research Council reviewers.

This summary of the activity of the Committee on Military Nutrition Research (CMNR) reflects the period of performance from April 1, 1992, through May 31, 1994, and also includes activities during a six-month no-cost extension of performance through November 30, 1994, as supported by grant no. DAMD17-92-J-2003 from the U.S. Army Medical Research and Development Command to the Food and Nutrition Board for the CMNR program. This report has been organized in topical fashion because the Committee was requested on occasion to participate in reviews of research projects or products during several stages of their development over the course of this grant period. Topics are organized in a quasi-chronological fashion within the overall reports and activities are ordered in chronological order within topics.

A full listing of all Committee meetings and Committee members during the grant period are included as Appendix A and Appendix B. At a number of meetings the CMNR was presented with oral and written reports of research projects in progress or products under development. In a number of instances the Committee deferred a full review of these items until the project was complete. Summaries are provided in the body of the report of all activities in which the Committee was requested to participate from April 1, 1992, through November 30, 1994, regardless of whether a report with recommendations was developed. The Committee typically prepares three styles of reports that correspond with their project requests and meetings: letter reports, brief reports, and workshop reports. In the appendixes full copies of each letter report are included in the order mentioned in the text. For the brief reports and workshop reports, due to length, only the Committee conclusions and recommendations have been included in the appendixes.