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Committee on Military Nutrition Research

Activity Report

April 1, 1992 through November 30, 1994

Food and Nutrition Board

INSTITUTE OF MEDICINE

Prepared by

Bernadette M. Marriott and Paul Thomas

NATIONAL ACADEMY PRESS
Washington, D.C.
1994



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Committee on Military Nutrition Research: Activity Report Committee on Military Nutrition Research Activity Report April 1, 1992 through November 30, 1994 Food and Nutrition Board INSTITUTE OF MEDICINE Prepared by Bernadette M. Marriott and Paul Thomas NATIONAL ACADEMY PRESS Washington, D.C. 1994

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Committee on Military Nutrition Research: Activity Report NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W.Washington, DC 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 competencies and with regard for appropriate balance. This report presents a summary of activities of the Committee on Military Nutrition Research (CMNR) from April 1, 1992, through November 30, 1994. Many of the activities mentioned here have resulted in reports that were previously published or submitted as letter reports to the sponsor and as such were 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 Engineering, and the Institute of Medicine. This activities summary has not been separately reviewed and represents an overview of all activities during the project period as designated. The Institute of Medicine was chartered 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 Academy'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. Dr. Kenneth I. Shine is president of the Institute of Medicine. The activities of the Committee on Military Nutrition Research (CMNR) from April 1, 1992, through November 30, 1994, were supported by Grant no. DAMD17-92-J-2003 from the U.S. Army Medical Research and Development Command. The preparation of this report and partial funding for reports produced from October 20, 1994 through November 30, 1994 were supported by Grant No. DAMD17-94-J-4046 from the U.S. Army Medical Research and Development Command through the U.S. Army Medical Research Acquisition Activity. A limited supply of additional copies of this report are available from: Food and Nutrition Board Institute of Medicine (FO-3046) 2101 Constitution Avenue, N.W. Washington, DC 20418 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 logotype 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: Activity Report COMMITTEE ON MILITARY NUTRITION RESEARCH (in April, 1992) ROBERT O. NESHEIM (Chair), Monterey, California RICHARD ATKINSON, Department of Internal Medicine, Veterans Administration Medical Center, Hampton, Virginia WILLIAM R. BEISEL, Department of Immunology and Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health JOEL A. GRINKER, Program in Human Nutrition, School of Public Health, University of Michigan, Ann Arbor EDWARD HORTON, Department of Medicine, University of Vermont, College of Medicine, Burlington RICHARD JANSEN, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins GILBERT LEVEILLE, Nabisco Brands Incorporated, East Hanover, New Jersey JOHN A. MILNER, Department of Nutrition, Pennsylvania State University, State College, Pennsylvania JAMES G. PENLAND, U.S. Department of Agriculture Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota JOHN 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 Grant Officer Representative COL. ELDON W. ASKEW, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts Staff BERNADETTE M. MARRIOTT, Program Director VALERIE McCADDON BREEN, Project Assistant

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Committee on Military Nutrition Research: Activity Report COMMITTEE ON MILITARY NUTRITION RESEARCH (current) ROBERT O. NESHEIM (Chair), Monterey, California RICHARD L. ATKINSON, Department of Nutritional Science, University of Wisconsin, Madison WILLIAM R. BEISEL, Department of Immunology and Infectious Diseases, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland GAIL E. BUTTERFIELD, Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine; and Geriatric Research, Education, and Clinical Center, Veterans Administration Medical Center, Palo Alto, California JOHN D. FERNSTROM, Department of Psychiatry, Pharmacology, and Neuroscience, University of Pittsburgh School of Medicine, Pennsylvania JOËL A. GRINKER, Program in Human Nutrition, School of Public Health, University of Michigan, Ann Arbor G. RICHARD JANSEN, Department of Food Science and Human Nutrition, Colorado State University, Fort Collins ORVILLE A. LEVANDER, Vitamin and Mineral Nutrition Laboratory, U.S. Department of Agriculture, Beltsville, Maryland GILBERT A. LEVEILLE, Nabisco Brands Incorporated, East Hanover, New Jersey JOHN E. VANDERVEEN, Division of Nutrition, Food and Drug Administration, Washington, D.C. 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 JAMES A. VOGEL, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts Staff BERNADETTE M. MARRIOTT, Program Director DONNA F. ALLEN, Project Assistant

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Committee on Military Nutrition Research: Activity Report FOOD AND NUTRITION BOARD (in April, 1992) M.R.C. GREENWOOD (Chair), University of California, Davis, California DONALD B. McCORMICK (Vice Chair), Emory University School of Medicine, Atlanta, Georgia PERRY L. ADKISSON, Department of Entomology,Texas A&M University, College Station, Texas LINDSAY H. ALLEN, Nutritional Sciences, University of Connecticut, Storrs, Connecticut DENNIS M. BIER, Pediatric Endocrinology and Metabolism, Washington University School of Medicine, St. Louis, Missouri EDWIN L. BIERMAN, University of Washington School of Medicine, Seattle, Washington MICHAEL P. DOYLE, Department of Food Science and Technology, University of Georgia, Griffin, Georgia JOHANNA T. DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts JOHN W. ERDMAN, Jr., University of Illinois, Urbana, Illinois NANCY FOGG-JOHNSON, Consumer Healthcare Division, Miles Incorporated, 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, University of California, Davis, California LAURENCE N. KOLONEL, Cancer Center of Hawaii, University of Hawaii, Honolulu, Hawaii SANFORD MILLER, Graduate School of Biomedical Sciences, University of Texas, 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, University of California, Los Angeles, California STEVE L. TAYLOR (Ex Officio), Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska

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Committee on Military Nutrition Research: Activity Report Staff CATHERINE E. WOTEKI, Director MARCIA LEWIS, Administrative Assistant SUSAN WYATT, Financial Associate

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Committee on Military Nutrition Research: Activity Report FOOD AND NUTRITION BOARD (November, 1994) JANET C. KING (Chair), Department of Nutritional Sciences, University of California, Berkeley EDWIN L. BIERMAN (Vice-Chair), Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle JOHN W. ERDMAN, JR. (Vice-Chair), Division of Nutritional Sciences, University of Illinois, Urbana CUTBERTO GARZA (Vice-Chair), Division of Nutritional Sciences, Cornell University, Ithaca, New York PERRY L. ADKISSON, Department of Entomology, Texas A&M University, College Station LINDSAY H. ALLEN, Department of Nutrition, University of California, Davis DENNIS M. BIER, Children's Nutrition Research Center, Baylor College of Medicine Houston, Texas FERGUS M. CLYDESDALE, Department of Food Science and Nutrition, University of Massachusetts, Amherst HECTOR F. DeLUCA, Department of Biochemistry, University of Wisconsin, Madison MICHAEL P. DOYLE, Department of Food Science and Technology, University of Georgia, Griffin JOHANNA T. DWYER, Tufts University Schools of Medicine and Nutrition, Boston, Massachusetts SCOTT M. GRUNDY, University of Texas, Center for Human Nutrition, Southwestern Medical Center, Dallas K. MICHAEL HAMBIDGE, Center for Human Nutrition, University of Colorado Health Sciences Center, Denver LAURENCE N. KOLONEL, Epidemiology Program, Cancer Center of Hawaii, University of Hawaii, Honolulu SANFORD A. MILLER, Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio ALFRED SOMMER, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland VERNON R. YOUNG, Laboratory of Human Nutrition, School of Science, Massachusetts Institute of Technology, Cambridge STEVE L. TAYLOR (Ex-Officio), Department of Food Science and Technology, University of Nebraska, Lincoln ARTHUR H. RUBENSTEIN (IOM Council Liaison), Department of Medicine, the University of Chicago, Chicago, Illinois

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Committee on Military Nutrition Research: Activity Report Staff ALLISON A. YATES, Director BERNADETTE M. MARRIOTT, Associate Director GAIL E. SPEARS, Administrative Assistant JAMAINE L. TINKER, Financial Associate

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Committee on Military Nutrition Research: Activity Report Preface The issues addressed in this report as well as in the previous 5 year report, Committee Military Nutrition Research: Activity Report 1986–1992, (Marriott and Earl, 1992), illustrate the diversity of activities addressed by the Committee on Military Nutrition Research (CMNR). This diversity has required the use of a broad range of expertise to respond to the issues brought to the CMNR. The range of scientific disciplines represented on the CMNR has been augmented as necessary through the use of workshops or special advisors to enable the CMNR to bring the degree and breadth of expertise necessary to properly respond to the subject under review. The committee has been pleased with and is very appreciative of the willing participation of the invited participants in these sessions and of their providing written papers which have constituted a major part of the CMNR reports. Many of these workshops have included experts from within the military who have shared their research activities and information. They have been excellent representatives of the quality of research that the military has been conducting on many of these problems. The military is to be commended for continuing to ensure that the nutritional needs of its personnel are adequately met during the stress of military operations through its support of nutrition and related research. There has also been interest and support for modifications of rations of military personnel consistent with the advice provided by the nutrition and public health leadership in the United States. The CMNR is cognizant of the desire

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Committee on Military Nutrition Research: Activity Report to balance long-term health considerations with the demands of maintaining performance under the environmental extremes of military operations. The ability of operational rations to help sustain military performance has been the subject of CMNR review since 1982. Field studies have shown the adequacy of nutrient intake other than calories sufficient to maintain the weight and performance of troops in the field. Complex interactions involving palatability of the ration components, convenience, fluid intake, socialization, and physical and psychological stresses that influence the consumption of operational rations are discussed in the publication, Not Eating Enough, Overcoming Underconsumption of Operational Rations (CMNR, in press). Further evaluation of these complex factors will undoubtedly continue to be of interest to the military and the CMNR. We have appreciated the close working relationships with COL David Schnakenberg and Colonel Wayne Askew, who have now retired, and the excellent liaison they provided between the military and the Committee. They greatly assisted the work of the Committee by bringing issues forward for consideration and helping to identify expertise familiar with these problems, particularly from within the armed forces. We look forward to continued close association and guidance from Dr. James A. Vogel and his group at USARIEM. As Committee Chair, I express my deep appreciation to all of the Committee members who have given their time, dedication, and expertise to the careful analysis of the issues and to developing the conclusions and recommendations of the Committee. I also thank all participants in the many workshops who have greatly aided our activities and assured that the appropriate expertise has been available to the Committee. Finally I wish to express my appreciation to the staff of the Food and Nutrition Board assigned to this activity over the past 3 years. In particular I acknowledge for myself and the entire committee the outstanding support presently provided to this activity by Bernadette Marriott, Ph.D., Associate Director, Food and Nutrition Board, Institute of Medicine, and her assistant, Donna Allen. They have worked with extreme dedication to update and complete publication of several pending CMNR reports and to assure a timely response to the issues currently under consideration by the Committee. The additional assistance of Paul Thomas and Susan Knasiak with this activity report is gratefully acknowledged. Robert O. Nesheim, Ph.D. Chair

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Committee on Military Nutrition Research: Activity Report Contents     PREFACE   ix     SUMMARY   1     BACKGROUND AND INTRODUCTION   3     THE RELATIONSHIP OF SOLDIER BODY COMPOSITION TO PHYSICAL PERFORMANCE   9     NUTRITIONAL REQUIREMENTS FOR WORK IN HOT ENVIRONMENTS   13     MILITARY NUTRITION RESEARCH AT THE PENNINGTON BIOMEDICAL RESEARCH CENTER   17     MILITARY RECOMMENDED DIETARY ALLOWANCES   23     PROJECT REVIEW OF THE NUTRITIONAL INTERVENTION STUDY OF THE RANGER TRAINING CLASS, 11/92 RANGER II   27     MILITARY NUTRITION RESEARCH IN HISTORICAL PERSPECTIVE   31

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Committee on Military Nutrition Research: Activity Report     CAN FOOD COMPONENTS BE USED TO ENHANCE SOLDIER PERFORMANCE?   33     UNDERCONSUMPTION OF MILITARY FIELD RATIONS: WHAT STRATEGIES CAN BE EMPLOYED TO OVERCOME THIS PROBLEM?   37     USE OF CARBOHYDRATE-ELECTROLYTE SOLUTIONS FOR FLUID REPLACEMENT   41     NUTRITIONAL REQUIREMENTS FOR WORK IN COLD AND HIGH ALTITUDE ENVIRONMENTS   45     REFERENCES   49     APPENDIXES   51     A  Meetings of the Committee on Military Nutrition Research, April 1, 1992–November 30, 1994   53     B  Biographical Sketches of Members of the Committee on Military Nutrition Research, April 1, 1992–November 30, 1994   57     C  Letter Report: Research Progress Review of the Pennington Biomedical Research Center, Submitted May 1992   67     D  Letter Report: Committee on Military Nutrition Research Review of Three Research Proposals from the Pennington Biomedical Research Center, Submitted December 1992   77     E  Conclusions and Recommendations from the Workshop Report: Body Composition and Physical Performance, Submitted August 1992   97     F  Conclusions and Recommendations from the Workshop Report: Nutritional Needs in Hot Environments, Submitted March 1993   103

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Committee on Military Nutrition Research: Activity Report     G  Conclusions and Recommendations from the Brief Report: Review of the Results of Nutritional Intervention, Ranger Training Class 11/92 (Ranger II), Submitted June 1993   115     H  Summary and Recommendations from the Workshop Report: Fluid Replacement and Heat Stress, Third Printing, Submitted January 1994   137     I  Conclusions and Recommendations from the Workshop Report: Food Components to Enhance Performance, Submitted May 1994   145

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