knowledge, and a subgroup of the CMNR met in August 1993 to identify the key topics for review and the speakers with expertise in these topics. The workshop was convened on January 31 to February 1, 1994 and included presentations from individuals familiar with or having expertise in cold and in high-altitude topics, as well as from military commanders familiar with working and training personnel in these environments. Speakers were asked to provide reviews of their area of expertise, which in turn assisted the committee in responding to a series of 15 questions, which have been summarized into the following two overriding questions:

1. Aside from increased energy demands, do cold or high-altitude environments elicit an increased demand or requirement for specific nutrients?
2. Can performance be enhanced in cold or high-altitude environments by the provision of increased amounts of specific nutrients?

On the day after the workshop, the CMNR met in executive session to review the issues and draw some tentative conclusions. Committee members subsequently met in a series of working sessions to draft the summary and recommendations. The committee's report, Nutritional Needs in Cold and in High-Altitude Environments, Applications for Military Personnel in Field Operations (IOM, 1996a), was originally released in March 1996 as a preliminary report in response to troop deployment to Bosnia, and in May 1996, the full report, including 22 papers presented at the workshop, was released.

The energy requirement for work both in the cold and at high altitudes is increased. However, the increased requirement is adequately met by the cold weather operational rations currently in use. Energy in these rations is primarily provided in the form of carbohydrate. There is insufficient evidence at this time to support providing an increased amount of any specific nutrient in the cold or at high altitudes beyond that already provided in current operational rations.

Additionally, the CMNR emphasizes the critical importance of water discipline, availability of safe fluids for drinking, and a clear understanding on the part of all troops involved in operations or training in cold and in high-altitude environments of the importance of maintaining fluid intake. An impressive body of evidence has already been generated to define the nutritional needs of troops required to engage in military operations under environmental conditions of extreme cold and/or high altitudes.