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O'Leary TJ, Jackson S, Izard RM, Walsh NP, Carswell AT, Oliver SJ, Tang JCY, Fraser WD, Greeves JP. Iron status is associated with tibial structure and vitamin D metabolites in healthy young men. Bone 2024; 186:117145. [PMID: 38838798 DOI: 10.1016/j.bone.2024.117145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/16/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024]
Abstract
The influence of iron on collagen synthesis and vitamin D metabolism has implications for bone health. This cross-sectional observational study investigated associations between markers of iron status and tibial structure, vitamin D metabolites, and circulating biochemical markers of bone metabolism in young healthy men. A total of 343 male British Army recruits participated (age 22 ± 3 y, height 1.77 ± 0.06 m, body mass 75.5 ± 10.1 kg). Circulating biochemical markers of iron status, vitamin D metabolites, and bone metabolism, and tibial structure and density by high-resolution peripheral quantitative computed tomography scans (HRpQCT) were measured in participants during week 1 of basic military training. Associations between markers of iron status and HRpQCT outcomes, bone metabolism, and vitamin D metabolites were tested, controlling for age, height, lean body mass, and childhood exercise volume. Higher ferritin was associated with higher total, trabecular, and cortical volumetric bone mineral density, trabecular volume, cortical area and thickness, stiffness, and failure load (all p ≤ 0.037). Higher soluble transferrin receptor (sTfR) was associated with lower trabecular number, and higher trabecular thickness and separation, cortical thickness, and cortical pore diameter (all p ≤ 0.033). Higher haemoglobin was associated with higher cortical thickness (p = 0.043). Higher ferritin was associated with lower βCTX, PINP, total 25(OH)D, and total 24,25(OH)2D, and higher 1,25(OH)2D:24,25(OH)2D ratio (all p ≤ 0.029). Higher sTfR was associated with higher PINP, total 25(OH)D, and total 24,25(OH)2D (all p ≤ 0.025). The greater density, size, and strength of the tibia, and lower circulating concentrations of markers of bone resorption and formation with better iron stores (higher ferritin) are likely as a result of the direct role of iron in collagen synthesis.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom; Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Sarah Jackson
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Rachel M Izard
- Defence Science and Technology, Ministry of Defence, Porton Down, United Kingdom
| | - Neil P Walsh
- Faculty of Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Alexander T Carswell
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Samuel J Oliver
- College of Human Sciences, Bangor University, Bangor, United Kingdom
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom; Division of Surgery and Interventional Science, UCL, London, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
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Sekel NM, Lovalekar M, Koltun KJ, Bird MB, Forse JN, Martin BJ, Nindl BC. Micronutrient Status During Military Training and Associations With Musculoskeletal Health, Injury, and Readiness Outcomes. Int J Sport Nutr Exerc Metab 2024:1-9. [PMID: 39168457 DOI: 10.1123/ijsnem.2024-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Micronutrient status, specifically vitamin D and iron, represent modifiable factors for optimizing military readiness. The primary purpose of this investigation was to determine associations between micronutrient deficiency (i.e., iron status and 25-hydroxy-vitamin D [25(OH)D]) and operationally relevant outcomes (i.e., skeletal health, musculoskeletal injury) at baseline and post-10 weeks of arduous military training. METHODS A total of 227 (177 men, 50 women) Marine Officer Candidates School (OCS) candidates who completed OCS training with complete data sets were included in this analysis. Vitamin D and iron status indicators were collected at two timepoints, pre (baseline) and post OCS. Musculoskeletal outcomes at the mid- and proximal tibial diaphysis were assessed via peripheral quantitative computed tomography. RESULTS Micronutrient status declined following OCS training in men and women and was associated with musculoskeletal outcomes including greater bone strength (strength strain index) at the mid-diaphysis site in those with optimal status (M = 38.26 mm3, SE = 15.59) versus those without (M = -8.03 mm3, SE = 17.27). In women (p = .037), endosteal circumference was greater in the deficient group (M = 53.26 mm, SE = 1.19) compared with the optimal group (M = 49.47 mm, SE = 1.31) at the proximal diaphysis. In men, greater baseline hepcidin concentrations were associated with an increased likelihood of suffering musculoskeletal injury during training. CONCLUSIONS Vitamin D and iron status declined over the course of training, suggesting impaired micronutrient status. Differences in musculoskeletal outcomes by micronutrient group suggests optimal vitamin D and ferritin concentrations may exert beneficial effects on bone fatigability and fracture reduction during military training.
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Affiliation(s)
- Nicole M Sekel
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kristen J Koltun
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew B Bird
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer N Forse
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian J Martin
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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Scantlebury S, Costello N, Owen C, Chantler S, Ramirez C, Zabaloy S, Collins N, Allen H, Phillips G, Alexander M, Barlow M, Williams E, Mackreth P, Barrow S, Parelkar P, Clarke A, Samuels B, Roe S, Blake C, Jones B. Longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players. PLoS One 2024; 19:e0298709. [PMID: 38743656 PMCID: PMC11093382 DOI: 10.1371/journal.pone.0298709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
This is the first study to assess longitudinal changes in anthropometric, physiological, and physical qualities of international women's rugby league players. Thirteen forwards and 11 backs were tested three times over a 10-month period. Assessments included: standing height and body mass, body composition measured by dual x-ray absorptiometry (DXA), a blood panel, resting metabolic rate (RMR) assessed by indirect calorimetry, aerobic capacity (i.e.,[Formula: see text]) evaluated by an incremental treadmill test, and isometric force production measured by a force plate. During the pre-season phase, lean mass increased significantly by ~2% for backs (testing point 1: 47 kg; testing point 2: 48 kg) and forwards (testing point 1: 50 kg; testing point 2: 51 kg) (p = ≤ 0.05). Backs significantly increased their [Formula: see text] by 22% from testing point 1 (40 ml kg-1 min-1) to testing point 3 (49 ml kg-1 min-1) (p = ≤ 0.04). The [Formula: see text] of forwards increased by 10% from testing point 1 (41 ml kg-1 min-1) to testing point 3 (45 ml kg-1 min-1), however this change was not significant (p = ≥ 0.05). Body mass (values represent the range of means across the three testing points) (backs: 68 kg; forwards: 77-78 kg), fat mass percentage (backs: 25-26%; forwards: 30-31%), resting metabolic rate (backs: 7 MJ day-1; forwards: 7 MJ day-1), isometric mid-thigh pull (backs: 2106-2180 N; forwards: 2155-2241 N), isometric bench press (backs: 799-822 N; forwards: 999-1024 N), isometric prone row (backs: 625-628 N; forwards: 667-678 N) and bloods (backs: ferritin 21-29 ug/L, haemoglobin 137-140 g/L, iron 17-21 umol/L, transferrin 3 g/L, transferring saturation 23-28%; forwards: ferritin 31-33 ug/L, haemoglobin 141-145 g/L, iron 20-23 umol/L, transferrin 3 g/L, transferrin saturation 26-31%) did not change (p = ≥ 0.05). This study provides novel longitudinal data which can be used to better prepare women rugby league players for the unique demands of their sport, underpinning female athlete health.
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Affiliation(s)
- Sean Scantlebury
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
| | - Nessan Costello
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Cameron Owen
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
| | - Sarah Chantler
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
| | - Carlos Ramirez
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Santiago Zabaloy
- Faculty of Physical Activity and Sports, University of Flores, Buenos Aires, Argentina
| | - Neil Collins
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
| | - Hayden Allen
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Gemma Phillips
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
- Hull Kingston Rovers, Hull, United Kingdom
| | - Marina Alexander
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Matthew Barlow
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Emily Williams
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Peter Mackreth
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Stuart Barrow
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
| | - Parag Parelkar
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Anthony Clarke
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Benjamin Samuels
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Stephanie Roe
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Cameron Blake
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
| | - Ben Jones
- Carnegie School of Sports, Leeds Beckett University, Leeds, United Kingdom
- England Performance Unit, Rugby Football League, Manchester, United Kingdom
- Division of Physiological Sciences and Health through Physical Activity, Lifestyle and Sport Research Centre, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
- Premiership Rugby, London, United Kingdom
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Taube F, Larsson I, Navren M, Ekblom Ö. Changes in haemoglobin and ferritin levels during basic combat training: relevance for attrition and injury frequency. BMJ Mil Health 2024:e002656. [PMID: 38688678 DOI: 10.1136/military-2023-002656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/30/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION The primary aim of the present study was to assess interindividual and intraindividual variations in haemoglobin and ferritin concentrations in Swedish recruits over 5 months of basic combat training (BCT). The secondary aim was to find predictors for missing training (a precursor for attrition) and overuse injuries during BCT. METHODS In a cohort design, a total of 58 female and 104 male recruits provided complete data. We assessed the ferritin concentrations and haemoglobin concentrations at baseline and after 5 months of BCT and physical work capacity at baseline. RESULTS During BCT, haemoglobin concentrations increased significantly in both females and males. Ferritin concentrations decreased significantly in both sexes and the prevalence of iron deficiency (ID) (ie, ferritin levels <30 µg/L) increased significantly in females. The physical work capacity at baseline was related to the risk of missing training in fully adjusted models. In gender-adjusted analyses, baseline ferritin was related to the risk of overuse injury, but neither baseline nor change in iron status was related to injuries or risk of missing training when controlling for confounders. Body mass increased significantly in both genders, but we found no correlation between individual change in body mass and change in haemoglobin or ferritin nor was change in body mass related to the risk of overuse injury or missing training. CONCLUSION In the present study, the prevalence of ID increased over the course of 5 months, while haemoglobin concentrations increased. As baseline physical work capacity was related to missing training, there are reasons to support preparatory physical training before BCT. These findings may inform future preventive interventions aimed at preventing detrimental effects of ID.
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Affiliation(s)
- Fabian Taube
- Research Centre for Disaster Medicine, Institute for Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Joint Centre for Defence Medicine, Swedish Armed Forces Göta Älvsgatan 426 05, Gothenburg, Sweden
| | - I Larsson
- Unit of Clinical Nutrition, Regional Obesity Centre, Sahlgrenska University Hospital, Blå Stråket 5, 413 4, Gothenburg, Sweden
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Navren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Defence Health, Command and Control Regiment, Enköping, Enköping, Sweden
| | - Ö Ekblom
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursin, Karolinska Institutet, Stockholm, Sweden
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Timpmann S, Rips L, Olveti I, Mooses M, Mölder H, Varblane A, Lille HR, Gapeyeva H, Ööpik V. Seasonal Variation in Vitamin D Status Does Not Interfere with Improvements in Aerobic and Muscular Endurance in Conscripts during Basic Military Training. Nutrients 2024; 16:1306. [PMID: 38732553 PMCID: PMC11085734 DOI: 10.3390/nu16091306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Considering a lack of respective data, the primary objective of this study was to assess whether seasonal variation in vitamin D status (D-status) affects the extent of improvement in physical performance (PP) in conscripts during basic military training (BMT). D-status, PP and several blood parameters were measured repeatedly in conscripts whose 10-week BMT started in July (cohort S-C; n = 96) or in October (cohort A-C; n = 107). D-status during BMT was higher in S-C compared to A-C (overall serum 25(OH)D 61.4 ± 16.1 and 48.5 ± 20.7 nmol/L, respectively; p < 0.0001). Significant (p < 0.05) improvements in both aerobic and muscular endurance occurred in both cohorts during BMT. Pooled data of the two cohorts revealed a highly reliable (p = 0.000) but weak (R2 = 0.038-0.162) positive association between D-status and PP measures both at the beginning and end of BMT. However, further analysis showed that such a relationship occurred only in conscripts with insufficient or deficient D-status, but not in their vitamin D-sufficient companions. Significant (p < 0.05) increases in serum testosterone-to-cortisol ratio and decreases in ferritin levels occurred during BMT. In conclusion, a positive association exists between D-status and PP measures, but seasonal variation in D-status does not influence the extent of improvement in PP in conscripts during BMT.
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Affiliation(s)
- Saima Timpmann
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia; (S.T.); (M.M.)
| | - Leho Rips
- Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, 1a L. Puusepa St., 50406 Tartu, Estonia;
- Department of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia
- Centre of Military Disaster Medicine, Estonian National Defense College, 12 Riia St., 51010 Tartu, Estonia;
| | - Indrek Olveti
- 2nd Infantry Brigade, Estonian Defense Forces, Sirgu Village, Luunja Parish, 62216 Tartu, Estonia;
| | - Martin Mooses
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia; (S.T.); (M.M.)
| | - Hanno Mölder
- Medical Centre of the 2nd Infantry Brigade CSS Battalion, Estonian Defense Forces, 3a Kose Road, 65603 Võru, Estonia;
| | - Ahti Varblane
- Joint Headquarters of the Estonian Defense Forces, 58 Juhkentali St., 15007 Tallinn, Estonia;
| | - Hele-Reet Lille
- Centre of Military Disaster Medicine, Estonian National Defense College, 12 Riia St., 51010 Tartu, Estonia;
| | - Helena Gapeyeva
- Clinic of Medical Rehabilitation, II Rehabilitation Department, East Tallinn Central Hospital, 104 Pärnu St., 11312 Tallinn, Estonia;
| | - Vahur Ööpik
- Institute of Sport Sciences and Physiotherapy, University of Tartu, 18 Ülikooli St., 50090 Tartu, Estonia; (S.T.); (M.M.)
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O’Leary TJ, Jackson S, Izard RM, Walsh NP, Coombs CV, Carswell AT, Oliver SJ, Tang JCY, Fraser WD, Greeves JP. Sex differences in iron status during military training: a prospective cohort study of longitudinal changes and associations with endurance performance and musculoskeletal outcomes. Br J Nutr 2024; 131:581-592. [PMID: 37732392 PMCID: PMC10803825 DOI: 10.1017/s0007114523001812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
This study investigated sex differences in Fe status, and associations between Fe status and endurance and musculoskeletal outcomes, in military training. In total, 2277 British Army trainees (581 women) participated. Fe markers and endurance performance (2·4 km run) were measured at the start (week 1) and end (week 13) of training. Whole-body areal body mineral density (aBMD) and markers of bone metabolism were measured at week 1. Injuries during training were recorded. Training decreased Hb in men and women (mean change (-0·1 (95 % CI -0·2, -0·0) and -0·7 (95 % CI -0·9, -0·6) g/dl, both P < 0·001) but more so in women (P < 0·001). Ferritin decreased in men and women (-27 (95 % CI -28, -23) and -5 (95 % CI -8, -1) µg/l, both P ≤ 0·001) but more so in men (P < 0·001). Soluble transferrin receptor increased in men and women (2·9 (95 % CI 2·3, 3·6) and 3·8 (95 % CI 2·7, 4·9) nmol/l, both P < 0·001), with no difference between sexes (P = 0·872). Erythrocyte distribution width increased in men (0·3 (95 % CI 0·2, 0·4)%, P < 0·001) but not in women (0·1 (95 % CI -0·1, 0·2)%, P = 0·956). Mean corpuscular volume decreased in men (-1·5 (95 % CI -1·8, -1·1) fL, P < 0·001) but not in women (0·4 (95 % CI -0·4, 1·3) fL, P = 0·087). Lower ferritin was associated with slower 2·4 km run time (P = 0·018), sustaining a lower limb overuse injury (P = 0·048), lower aBMD (P = 0·021) and higher beta C-telopeptide cross-links of type 1 collagen and procollagen type 1 N-terminal propeptide (both P < 0·001) controlling for sex. Improving Fe stores before training may protect Hb in women and improve endurance and protect against injury.
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Affiliation(s)
- Thomas J. O’Leary
- Army Health and Performance Research, Army Headquarters, Andover, MA, UK
- Division of Surgery and Interventional Science, UCL, London, UK
| | - Sarah Jackson
- Army Health and Performance Research, Army Headquarters, Andover, MA, UK
| | - Rachel M. Izard
- Defence Science and Technology, Ministry of Defence, Porton Down, Porton, UK
| | - Neil P. Walsh
- Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | | | - Alexander T. Carswell
- Norwich Medical School, University of East Anglia, Norwich, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Jonathan C. Y. Tang
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | - William D. Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Julie P. Greeves
- Army Health and Performance Research, Army Headquarters, Andover, MA, UK
- Division of Surgery and Interventional Science, UCL, London, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Vinke JSJ, Gorter AR, Eisenga MF, Dam WA, van der Meer P, van den Born J, Bakker SJ, Hoes MF, de Borst MH. Iron deficiency is related to lower muscle mass in community-dwelling individuals and impairs myoblast proliferation. J Cachexia Sarcopenia Muscle 2023; 14:1865-1879. [PMID: 37386912 PMCID: PMC10401536 DOI: 10.1002/jcsm.13277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Loss of muscle mass is linked with impaired quality of life and an increased risk of morbidity and premature mortality. Iron is essential for cellular processes such as energy metabolism, nucleotide synthesis and numerous enzymatic reactions. As the effects of iron deficiency (ID) on muscle mass and function are largely unknown, we aimed to assess the relation between ID and muscle mass in a large population-based cohort, and subsequently studied effects of ID on cultured skeletal myoblasts and differentiated myocytes. METHODS In a population-based cohort of 8592 adults, iron status was assessed by plasma ferritin and transferrin saturation, and muscle mass was estimated using 24-h urinary creatinine excretion rate (CER). The relationships of ferritin and transferrin saturation with CER were assessed by multivariable logistic regression. Furthermore, mouse C2C12 skeletal myoblasts and differentiated myocytes were subjected to deferoxamine with or without ferric citrate. Myoblast proliferation was measured with a colorimetric 5-bromo-2'-deoxy-uridine ELISA assay. Myocyte differentiation was assessed using Myh7-stainings. Myocyte energy metabolism, oxygen consumption rate and extracellular acidification rate were assessed using Seahorse mitochondrial flux analysis, and apoptosis rate with fluorescence-activated cell sorting. RNA sequencing (RNAseq) was used to identify ID-related gene and pathway enrichment in myoblasts and myocytes. RESULTS Participants in the lowest age- and sex-specific quintile of plasma ferritin (OR vs middle quintile 1.62, 95% CI 1.25-2.10, P < 0.001) or transferrin saturation (OR 1.34, 95% CI 1.03-1.75, P = 0.03) had a significantly higher risk of being in the lowest age- and sex-specific quintile of CER, independent of body mass index, estimated GFR, haemoglobin, hs-CRP, urinary urea excretion, alcohol consumption and smoking status. In C2C12 myoblasts, deferoxamine-induced ID reduced myoblast proliferation rate (P-trend <0.001) but did not affect differentiation. In myocytes, deferoxamine reduced myoglobin protein expression (-52%, P < 0.001) and tended to reduce mitochondrial oxygen consumption capacity (-28%, P = 0.10). Deferoxamine induced gene expression of cellular atrophy markers Trim63 (+20%, P = 0.002) and Fbxo32 (+27%, P = 0.048), which was reversed by ferric citrate (-31%, P = 0.04 and -26%, P = 0.004, respectively). RNAseq indicated that both in myoblasts and myocytes, ID predominantly affected genes involved in glycolytic energy metabolism, cell cycle regulation and apoptosis; co-treatment with ferric citrate reversed these effects. CONCLUSIONS In population-dwelling individuals, ID is related to lower muscle mass, independent of haemoglobin levels and potential confounders. ID impaired myoblast proliferation and aerobic glycolytic capacity, and induced markers of myocyte atrophy and apoptosis. These findings suggest that ID contributes to loss of muscle mass.
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Affiliation(s)
- Joanna Sophia J. Vinke
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Alan R. Gorter
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Michele F. Eisenga
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Wendy A. Dam
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Peter van der Meer
- Department of CardiologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Jacob van den Born
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Stephan J.L. Bakker
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Martijn F. Hoes
- Department of Clinical GeneticsMaastricht University Medical Center+MaastrichtThe Netherlands
- CARIM School for Cardiovascular DiseasesMaastrichtThe Netherlands
| | - Martin H. de Borst
- Departments of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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Phillips AK, Keller MF, McClung JP, Steele N, Witkop CT, Wu TJ. Physical Health and Well-being: Updates and the Way Ahead. Mil Med 2023; 188:9-18. [PMID: 37490559 DOI: 10.1093/milmed/usac370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 02/24/2022] [Accepted: 11/14/2022] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION The Women in Combat Summit 2021 "Forging the Future: How Women Enhance the Fighting Force" took place during February 9-11, 2021, via a virtual conference platform. The third and final day of the Summit regarded the physical health and well-being of military women and included the topics of urogenital health, nutrition and iron-deficiency anemia, unintended pregnancy and contraception, and traumatic brain injury. MATERIALS AND METHODS After presentations on the topics earlier, interested conference attendees were invited to participate in focus groups to discuss and review policy recommendations for physical health and well-being in military women. Discussions centered around the topics discussed during the presentations, and suggestions for future Women in Combat Summits were noted. Specifics of the methods of the Summit are presented elsewhere in this supplement. RESULTS We formulated research and policy recommendations for urogenital health, nutrition and iron-deficiency anemia, contraception and unintended pregnancy, and traumatic brain injury. CONCLUSIONS In order to continue to develop the future health of military women, health care providers, researchers, and policymakers should consider the recommendations made in this supplement as they continue to build on the state of the science and forge the future.
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Affiliation(s)
- Angela K Phillips
- Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Margaux F Keller
- Henry Jackson Foundation at the Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, MD 20814, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Nancy Steele
- School of Nursing, University of North Florida, Jacksonville, FL 32224, USA
| | - Catherine T Witkop
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
| | - T John Wu
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University, Bethesda, MD 20814, USA
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Martin NM, von Hurst PR, Conlon CA, Smeele RJM, Mugridge OAR, Beck KL. Body Fat Percentage and Blood Donation are the Strongest Determinants of Iron Stores in Premenopausal Women Joining the New Zealand Army. Mil Med 2023; 188:e2550-e2556. [PMID: 36794880 PMCID: PMC10363006 DOI: 10.1093/milmed/usad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Suboptimal iron status is an issue for women joining the military because of its association with impaired aerobic performance, yet no studies have investigated dietary and non-dietary determinants of iron status simultaneously in this population. The purpose of this study was to explore associations between iron stores, dietary patterns (DPs), and potential non-dietary determinants of iron status in premenopausal women at the commencement of basic military training (BMT) in the New Zealand Army. METHODS During week 1 of BMT, demographic, body composition, lifestyle, medical history, and dietary data were measured as potential determinants of serum ferritin (SF) in 101 participants. Following univariate analysis, age, body fat percentage, previous blood donation, at least 6 h of exercise per week that raised the heart rate, and a vegetarian DP were analyzed using a multiple linear regression model. RESULTS An increase in body fat percentage was associated with increased SF (P < .009), although blood donation in the past year decreased SF (P < .011) compared to those participants who did not donate blood. There was no association between SF and a vegetarian DP or hours of exercise per week. The model explained 17.5% of the variance in SF at the commencement of BMT. CONCLUSION Body fat percentage and blood donation in the past year were the strongest determinants of iron stores in healthy premenopausal women commencing BMT. It is recommended that women joining the New Zealand Army are provided information to maintain or improve their iron status based on these findings. This includes clinical screening of iron status, advice for women considering blood donation, and dietary advice regarding total energy requirements and iron bioavailability.
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Affiliation(s)
- Nicola M Martin
- New Zealand Defence Force, Defence House, Wellington 6011, New Zealand
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | - Pamela R von Hurst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | - Cathryn A Conlon
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | | | - Owen A R Mugridge
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Sir Neil Waters Lecture Theatres, Auckland 0632, New Zealand
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10
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Grijota FJ, Toro-Román V, Siquier-Coll J, Robles-Gil MC, Muñoz D, Maynar-Mariño M. Total Iron Concentrations in Different Biological Matrices-Influence of Physical Training. Nutrients 2022; 14:nu14173549. [PMID: 36079807 PMCID: PMC9460040 DOI: 10.3390/nu14173549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Iron (Fe) is one of the most widely studied trace mineral elements. Fe metabolism and homeostasis could be altered by physical training. The aim of this study was to analyze the influence of long-term physical training on serum, plasma, urine (extracellular), erythrocyte and platelet (intracellular) Fe concentrations. Forty men from the same geographical area divided into a training group (TG; n = 20; 18.15 ± 0.27 years) and a control group (CG; n = 20; 19.25 ± 0.39 years) participated in this study. The TG was composed of soccer players of the highest youth category. The CG consisted of young people who did not follow any training routine and had not practiced any sport for at least the previous six months. The TG showed higher plasma and serum Fe concentrations (p < 0.05), but lower concentrations in erythrocytes and platelets compared to the CG (p < 0.01). Due to the differences observed in the extracellular and intracellular compartments, it seems necessary to perform a global Fe analysis to assess Fe status.
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Affiliation(s)
- Francisco J. Grijota
- Faculty of Life and Nature Sciences, University of Nebrija, Campus La Berzosa, Calle del Hostal, 28248 Hoyo de Manzanares, Madrid, Spain
| | - Víctor Toro-Román
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Extremadura, Spain
- Correspondence: ; Tel.: +34-(927)-257-460 (ext. 57833)
| | - Jesús Siquier-Coll
- SER Research Group, Center of Higher Education Alberta Giménez, Comillas Pontifical University, Costa de Saragossa 16, 07013 Palma Mallorca, Islas Baleares, Spain
| | - María C Robles-Gil
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Extremadura, Spain
| | - Diego Muñoz
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Extremadura, Spain
| | - Marcos Maynar-Mariño
- Faculty of Sport Sciences, University of Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Extremadura, Spain
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11
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Kuwabara AM, Tenforde AS, Finoff JT, Fredericson M. Iron Deficiency in Athletes: A Narrative Review. PM R 2022; 14:620-642. [DOI: 10.1002/pmrj.12779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Anne M. Kuwabara
- Stanford University, Department of Physical Medicine and Rehabilitation, 450 Broadway Street, Pavilion C, 4th Floor Redwood City California United States
| | - Adam S. Tenforde
- Harvard Medical School, Department of Physical Medicine and Rehabilitation Assistant Professor of Physical Medicine and Rehabilitation
| | | | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation Stanford University Medical Center
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12
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Beck KL, von Hurst PR, O'Brien WJ, Badenhorst CE. Micronutrients and athletic performance: A review. Food Chem Toxicol 2021; 158:112618. [PMID: 34662692 DOI: 10.1016/j.fct.2021.112618] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 08/04/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Optimising nutrition intake is a key component for supporting athletic performance and supporting adaption to training. Athletes often use micronutrient supplements in order to correct vitamin and mineral deficiencies, improve immune function, enhance recovery and or to optimise their performance. The aim of this review was to investigate the recent literature regarding micronutrients (specifically iron, vitamin C, vitamin E, vitamin D, calcium) and their effects on physical performance. Over the past ten years, several studies have investigated the impacts of these micronutrients on aspects of athletic performance, and several reviews have aimed to provide an overview of current use and effectiveness. Currently the balance of the literature suggests that micronutrient supplementation in well-nourished athletes does not enhance physical performance. Excessive intake of dietary supplements may impair the body's physiological responses to exercise that supports adaptation to training stress. In some cases, micronutrient supplementation is warranted, for example, with a diagnosed deficiency, when energy intake is compromised, or when training and competing at altitude, however these micronutrients should be prescribed by a medical professional. Athletes are encouraged to obtain adequate micronutrients from a wellbalanced and varied dietary intake.
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Affiliation(s)
- Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, New Zealand, Private Bag 102904, North Shore, Auckland, 0745, New Zealand.
| | - Pamela R von Hurst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, New Zealand, Private Bag 102904, North Shore, Auckland, 0745, New Zealand.
| | - Wendy J O'Brien
- School of Sport, Exercise and Nutrition, College of Health, Massey University, New Zealand, Private Bag 102904, North Shore, Auckland, 0745, New Zealand.
| | - Claire E Badenhorst
- School of Sport, Exercise and Nutrition, College of Health, Massey University, New Zealand, Private Bag 102904, North Shore, Auckland, 0745, New Zealand.
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13
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Wardle SL, O'Leary TJ, McClung JP, Pasiakos SM, Greeves JP. Feeding female soldiers: Consideration of sex-specific nutrition recommendations to optimise the health and performance of military personnel. J Sci Med Sport 2021; 24:995-1001. [PMID: 34452842 DOI: 10.1016/j.jsams.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/25/2021] [Accepted: 08/11/2021] [Indexed: 12/25/2022]
Abstract
Appropriate nutrition recommendations are required to optimise the health and performance of military personnel, yet limited data are available on whether male and female military personnel have different nutrition requirements. OBJECTIVES To consider the evidence for sex-specific nutrition requirements to optimise the health and performance of military personnel. DESIGN Narrative review. METHODS Published literature was reviewed, with a focus on sex-specific requirements, in the following areas: nutrition for optimising muscle mass and function, nutrition during energy deficit, and nutrition for reproductive and bone health. RESULTS There are limited data on sex differences in protein requirements but extant data suggest that, despite less muscle mass, on average, in women, sex-specific protein feeding strategies are not required to optimise muscle mass in military-aged individuals. Similarly, despite sex differences in metabolic and endocrine responses to energy deficit, current data do not suggest a requirement for sex-specific feeding strategies during energy deficit. Energy deficit impairs health and performance, most notably bone and reproductive health and these impairments are greater for women. Vitamin D, iron and calcium are important nutrients to protect the bone health of female military personnel due to increased risk of stress fracture. CONCLUSIONS Women have an increased incidence of bone injuries, less muscle mass and are more susceptible to the negative effects of energy deficit, including compromised reproductive health. However, there are limited data on sex differences in response to various nutrition strategies designed to improve these elements of health and performance. Future studies should evaluate whether sex-specific feeding recommendations are required.
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Affiliation(s)
- Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom.
| | - Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, United States of America
| | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, United States of America
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, United Kingdom; Division of Surgery and Interventional Science, University College London, United Kingdom; Norwich Medical School, University of East Anglia, United Kingdom
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14
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Knapik JJ, Farina EK, Fulgoni VL, Lieberman HR. Clinically diagnosed iron and iodine deficiencies and disorders in the entire population of US military service members from 1997 to 2015. Public Health Nutr 2021; 24:3187-3195. [PMID: 33541462 PMCID: PMC8314918 DOI: 10.1017/s1368980021000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/24/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Iron and/or iodine deficiencies can have multiple serious adverse health outcomes, but examination of incidence rates of these deficiencies has rarely been conducted in any large population. This study examined incidence rates, temporal trends and demographic factors associated with medically diagnosed iron and iodine deficiencies/disorders in US military service members (SM). DESIGN The Defense Medical Epidemiological Database (DMED) was queried for medical visits of active duty SM to obtain specific International Classification of Diseases, Version 9, codes involving clinically diagnosed iron and iodine deficiencies/disorders. SETTING Analysis of existing database (DMED). PARTICIPANTS Entire population of US military SM from 1997 to 2015 (average n per year = 1 382 266, 15 % women). RESULTS Overall incidence rates for iron and iodine were 104 and 36 cases/100 000 person-years, respectively. Over the 19-year period, rates for iron disorders increased steadily (108 % for men, 177 % for women). Rates for iodine disorders also increased steadily for men (91 %), but, for women, there was an initial rise followed by a later decline. Overall, women's rates were 12 and 10 times higher than men's for iron and iodine, respectively. Compared with whites, blacks and those of other races had higher rates of deficiencies of both minerals. Incidence rates for iodine deficiency increased substantially with age. CONCLUSIONS The overall incidence of clinically diagnosed iron and iodine deficiency among SM was low, but increased over the 19 years examined, and certain demographic groups were at significantly greater risk. Given the unexpected increases in incidence of these mineral disorders, increased surveillance may be appropriate.Clinical Trial Registration No. ISRCTN58987177 (http//:www.isrctn.com/ISRCTN58987177).
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
| | - Victor L Fulgoni
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
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15
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Karl JP, Margolis LM, Fallowfield JL, Child RB, Martin NM, McClung JP. Military nutrition research: Contemporary issues, state of the science and future directions. Eur J Sport Sci 2021; 22:87-98. [PMID: 33980120 DOI: 10.1080/17461391.2021.1930192] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The importance of diet and nutrition to military readiness and performance has been recognized for centuries as dietary nutrients sustain health, protect against illness, and promote resilience, performance and recovery. Contemporary military nutrition research is increasingly inter-disciplinary with emphasis often placed on the broad topics of (1) determining operational nutrition requirements in all environments, (2) characterizing nutritional practices of military personnel relative to the required (role/environment) standards, and (3) developing strategies for improving nutrient delivery and individual choices. This review discusses contemporary issues shared internationally by military nutrition research programmes, and highlights emerging topics likely to influence future military nutrition research and policy. Contemporary issues include improving the diet quality of military personnel, optimizing operational rations, and increasing understanding of biological factors influencing nutrient requirements. Emerging areas include the burgeoning field of precision nutrition and its technological enablers.
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Affiliation(s)
- J Philip Karl
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Lee M Margolis
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Joanne L Fallowfield
- Environmental Medicine and Science Division, Institute of Naval Medicine, Alverstoke, Hampshire, UK
| | - Robert B Child
- School of Chemical Engineering, University of Birmingham, Birmingham, UK
| | - Nicola M Martin
- New Zealand Army, New Zealand Defence Force, Upper Hutt, New Zealand
| | - James P McClung
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA
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