National Academies Press: OpenBook

Committee on Military Nutrition Research: Activity Report 1994-1999 (1999)

Chapter: A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training

« Previous: A Review of the Revision of the Medical Services Nutrition Allowances, Standards, and Education
Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×

A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training

At a planning meeting on October 30, 1995, the Committee on Military Nutrition Research (CMNR) was asked by the Military Nutrition Division (MND, currently the Military Nutrition and Biochemistry Division), U.S. Army Research Institute of Environmental Medicine (USARIEM) and the U.S. Army Medical Research and Materiel Command (USAMRMC) to provide additional scientific guidance to the MND staff in reviewing their recent research related to iron deficiency in military women during U.S. Army Basic Combat Training (BCT). The committee's task was to review the previously published Army technical reports and new material presented at the subsequent meeting on November 13, 1995. The committee was asked to evaluate, comment upon, and make specific recommendations regarding these studies and proposed research plans, as well as to write a formal report that included responses to the following nine questions:

  1. Do the data from recent research studies indicate that there is a problem related to iron deficiency in Army women in BCT?
  2. Do the data indicate that the incidence of iron deficiency or low iron stores among military women is different from what exists in women with the same demographic characteristics in the civilian population?
  3. In terms of military readiness, would military women benefit from a nutritional intervention?
  4. Are there additional medical considerations related to iron status in military women that need to be addressed?
  5. Should there be periodic screening of military women for anemia or iron deficiency?
Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×
  1. In military personnel with low iron stores as well as anemia, is there an impairment of military readiness that is gender specific?
  2. Are there additional analyses that should be conducted with the data in Friedl et al. (1990), Klicka et al. (1993), Westphal et al. (1995), or Westphal et al. (draft manuscript, 1995) on iron status issues in women in BCT? For future studies, are there additional specific analyses that should be considered?
  3. What are the CMNR recommendations regarding the proposed intervention study?
  4. Emphasis of the meeting on November 13, 1995 was on data collected during BCT, should there be additional research with military women dealing with iron status in military women in general?

To assist the CMNR in developing responses to these questions, John L. Beard, Department of Nutrition, The Pennsylvania State University, University Park, and Sean Lynch, Hematology and Oncology, Veterans Administration Medical Center, Hampton, Virginia, served as special consultants, who participated in the meeting and the initial discussion with the committee regarding this report. The report was drafted by the CMNR in executive session on the day following the meeting and was delivered to the sponsor in December 1995. It is a thoughtfully developed presentation incorporating the scientific opinion of the CMNR and the comments of the anonymous peer review panel of the National Research Council.

Conclusions

It is the view of the CMNR that iron status is an important issue for military women. From the preliminary data presented at this meeting, the potential for some compromise in physical performance has been demonstrated with low iron stores. Of equal military concern are the possible effects on cognitive performance that may result from impaired iron nutrition. Therefore, additional research should be conducted on the most susceptible groups of military women. It is important to determine whether the compromised iron status observed in women in BCT affects performance; therefore, initial studies should emphasize this issue, using an iron supplement that has the greatest potential for preventing or correcting decrements in iron status with appropriate nutrition counseling stressing the importance of taking such supplements, to help assure compliance with the study design. Following this determination, it then will be important to determine whether appropriate nutrition education methods can achieve similar results.

Since the stresses of military training are an approximation of the anticipated stresses of actual combat, it is important to collect and evaluate broadly all pertinent information from women involved in rigorous, physically stressful military training.

Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×

Any analysis of iron status must take into consideration the possible presence of any concurrent infectious or inflammatory processes, which are known to affect rapidly the results of clinical laboratory parameters used to measure iron status.

Recommendations

  • Intervention studies be conducted with women in BCT to identify cognitive and physical performance decrements that may be related to iron status.
  • An evaluation of the most appropriate approaches to correcting deficits in iron status be made (i.e., nutrition education versus iron supplements).
  • An analysis of existing data be conducted using models of iron deficiency previously recommended for the NHANES II and III studies.
  • A screening program for military women be established to identify the extent of deficits in iron status and periods of greatest vulnerability, in order that remedial steps can be instituted where appropriate.
  • Enlistment of any individual with iron deficiency anemia be delayed until this medically-reversible condition has been corrected.

Future Research Considerations

  • Evaluate the effectiveness of dietary intervention using nutrition education in maintaining iron status.
  • Evaluate the impact of dieting measures to meet weight standards on iron status and the potential for nutrition educational approaches to assist women in maintaining iron status when restricting calorie consumption.
  • If a relationship between iron status and physical and cognitive performance is found, determine the measure of iron deficiency that best correlates with performance and the extent of iron deficiency that results in a compromised performance.
  • In conjunction with monitoring iron status of military women, survey the impact of iron (and other macro- and micronutrient) status on immune function and the impact of iron status on the cardiovascular and pulmonary systems.
  • If studies confirm instances of compromised iron status (in individuals who are free of active infections or inflammatory processes), evaluate various delivery systems to minimize or eliminate deficits in iron status such as:
    • a diet naturally high in iron (along with nutrition education), and
    • periodic nutritional supplements of iron (e.g., daily, weekly) (following a review of the dosage and effectiveness [as well as risk of complications such as gastrointestinal side-effects] as reported in the scientific literature).
Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×
  • If such delivery systems prove to be ineffective, consider the evaluation of other interventions, such as:
    • iron delivered orally in a hydrodynamically balanced solution (Cook et al., 1990), and
    • the safety and effectiveness of oral heme iron.

<><><><><><><><><><><><>

The full text of this letter report plus the responses to the questions are included in Appendix E.

Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×
Page 17
Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×
Page 18
Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×
Page 19
Suggested Citation:"A Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training." Institute of Medicine. 1999. Committee on Military Nutrition Research: Activity Report 1994-1999. Washington, DC: The National Academies Press. doi: 10.17226/9633.
×
Page 20
Next: Nutritional Needs in Cold and in High-Altitude Environments »
Committee on Military Nutrition Research: Activity Report 1994-1999 Get This Book
×
Buy Paperback | $70.00 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The activities of the Food and Nutrition Board's Committee on Military Nutrition Research (CMNR, the committee) have been supported since 1994 by grant DAMD17-94-J-4046 from the U.S. Army Medical Research and Materiel Command (USAMRMC). This report fulfills the final reporting requirement of the grant, and presents a summary of activities for the grant period from December 1, 1994 through May 31, 1999. During this grant period, the CMNR has met from three to six times each year in response to issues that are brought to the committee through the Military Nutrition and Biochemistry Division of the U.S. Army Research Institute of Environmental Medicine at Natick, Massachusetts, and the Military Operational Medicine Program of USAMRMC at Fort Detrick, Maryland. The CMNR has submitted five workshop reports (plus two preliminary reports), including one that is a joint project with the Subcommittee on Body Composition, Nutrition, and Health of Military Women; three letter reports, and one brief report, all with recommendations, to the Commander, U.S. Army Medical Research and Materiel Command, since September 1995 and has a brief report currently in preparation. These reports are summarized in the following activity report with synopses of additional topics for which reports were deferred pending completion of military research in progress. This activity report includes as appendixes the conclusions and recommendations from the nine reports and has been prepared in a fashion to allow rapid access to committee recommendations on the topics covered over the time period.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!