1
|
W Constantini N, Alves E, L Mountjoy M, E Ackerman K. Relative energy deficiency in military (RED-M). BMJ Mil Health 2024; 170:191-192. [PMID: 36702526 DOI: 10.1136/military-2022-002341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Naama W Constantini
- Orthopaedics, Heidi Rothberg Sport Medicine Center, Jerusalem, Israel
- Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Alves
- Medicina Física e de Reabilitação, Centro Hospitalar Universitário de Lisboa Norte EPE, Lisboa, Portugal
| | - M L Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
- International Olympic Committee Games Group, Lausanne, Switzerland
| | - K E Ackerman
- Wu Tsai Female Athlete Program, Boston, Massachusetts, USA
- Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
O'Leary TJ, Gifford RM, Knight RL, Wright J, Handford S, Venables MC, Reynolds RM, Woods D, Wardle SL, Greeves JP. Sex differences in energy balance, body composition, and metabolic and endocrine markers during prolonged arduous military training. J Appl Physiol (1985) 2024; 136:938-948. [PMID: 38385180 DOI: 10.1152/japplphysiol.00864.2023] [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: 12/01/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
This study investigated sex differences in energy balance, body composition, and metabolic and endocrine markers during prolonged military training. Twenty-three trainees (14 women) completed 44-wk military training (three terms of 14 wk with 2-wk adventurous training). Dietary intake and total energy expenditure were measured over 10 days during each term by weighed food and doubly labeled water. Body composition was measured by dual-energy X-ray absorptiometry (DXA) at baseline and at the end of each term. Circulating metabolic and endocrine markers were measured at baseline and at the end of terms 2 and 3. Absolute energy intake and total energy expenditure were higher, and energy balance was lower, for men than women (P ≤ 0.008). Absolute energy intake and balance were lower, and total energy expenditure was higher, during term 2 than terms 1 and 3 (P < 0.001). Lean mass did not change with training (P = 0.081). Fat mass and body fat increased from term 1 to terms 2 and 3 (P ≤ 0.045). Leptin increased from baseline to terms 2 and 3 in women (P ≤ 0.002) but not in men (P ≥ 0.251). Testosterone and free androgen index increased from baseline to term 3 (P ≤ 0.018). Free thyroxine (T4) decreased and thyroid-stimulating hormone (TSH) increased from baseline to term 2 and term 3 (P ≤ 0.031). Cortisol decreased from baseline to term 3 (P = 0.030). IGF-I and total triiodothyronine (T3) did not change with training (P ≥ 0.148). Men experienced greater energy deficits than women during military training due to higher total energy expenditure.NEW & NOTEWORTHY Energy deficits are common in military training and can result in endocrine and metabolic disturbances. This study provides first investigation of sex differences in energy balance, body composition, and endocrine and metabolic markers in response to prolonged and arduous military training. Men experienced greater energy deficits than women due to higher energy expenditure, which was not compensated for by increased energy intake. These energy deficits were not associated with decreases in fat or lean mass or metabolic or endocrine function.
Collapse
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
| | - Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca L Knight
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Jennifer Wright
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Sally Handford
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
| | - Michelle C Venables
- Medical Research Council, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, United Kingdom
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom
- Division of Surgery and Interventional Science, UCL, London, 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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Rawcliffe AJ, Ogden HB, Rushmere J, Morgan ASL, Jacka K, Struszczak L, Chapman S, Roberts A. Nutritional knowledge in British Army recruits during basic training. BMJ Mil Health 2024; 170:15-19. [PMID: 35577397 DOI: 10.1136/bmjmilitary-2021-002036] [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: 11/02/2021] [Accepted: 04/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Appropriate nutritional intake is essential to optimise both general health and performance in military recruits. General nutritional knowledge is a significant and modifiable determinant of dietary behaviour; however, the level of nutritional knowledge in British Army recruits undertaking basic training is poorly understood. METHODS The Nutritional Knowledge Questionnaire for Athletes was completed by 29 male (age: 22.3±3.8 years) and 26 female (age: 22.0±3.0 years) standard-entry recruits at the end of basic training, and 15 male (age: 20.7±3.2 years) infantry recruits both at the start and end of basic training for the British Army. Between-group and within-group differences in total and subcomponent (ie, carbohydrate, protein, fat, vitamins and minerals, general nutrition, fluid intake, and sporting performance) scores were analysed. RESULTS Standard-entry male recruits had more correct answers (52%) than standard-entry female recruits (38%) and male infantry recruits (40%) at the end of training. Infantry recruits had similar levels of nutritional knowledge at the start (39% correct) and end (40% correct) of training. Nutritional knowledge related to protein (range: 53%-75% correct answers) and vitamins and minerals (range: 42%-63% correct answers) were the two highest scoring subcomponents within each group. CONCLUSION British Army recruits, in particular standard-entry female and infantry recruits, have poor nutritional knowledge, which did not improve throughout basic training. Better nutritional intervention, especially surrounding carbohydrate and fluid education, is required during British Army basic training to optimise career-long dietary behaviour.
Collapse
Affiliation(s)
- Alex J Rawcliffe
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
| | - H B Ogden
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
| | - J Rushmere
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
| | - A S L Morgan
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
| | - K Jacka
- Workplace Analytics, HQ Air Command, Royal Air Force, High Wycombe, UK
| | - L Struszczak
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
| | - S Chapman
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge Centre for Sport and Exercise Sciences, Cambridge, UK
| | - A Roberts
- Medical Branch, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Army Recruit Health and Performance Research, Upavon, UK
| |
Collapse
|
5
|
Chapman S, Roberts J, Roberts AJ, Ogden H, Izard R, Smith L, Chichger H, Struszczak L, Rawcliffe AJ. Pre-sleep protein supplementation does not improve recovery from load carriage in British Army recruits (part 2). Front Nutr 2023; 10:1264042. [PMID: 38130446 PMCID: PMC10733965 DOI: 10.3389/fnut.2023.1264042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
British Army basic training (BT) is physically demanding with new recruits completing multiple bouts of physical activity each day with limited recovery. Load carriage is one of the most physically demanding BT activities and has been shown to induce acute exercise-induced muscle damage (EIMD) and impair muscle function. Protein supplementation can accelerate muscle recovery by attenuating EIMD and muscle function loss. This study investigated the impact of an additional daily bolus of protein prior to sleep throughout training on acute muscle recovery following a load carriage test in British Army recruits. Ninety nine men and 23 women (mean ± SD: age: 21.3 ± 3.5 yrs., height: 174.8 ± 8.4 cm, body mass 75.4 ± 12.2 kg) were randomized to dietary control (CON), carbohydrate placebo (PLA), moderate (20 g; MOD) or high (60 g; HIGH) protein supplementation. Muscle function (maximal jump height), perceived muscle soreness and urinary markers of muscle damage were assessed before (PRE), immediately post (POST), 24-h post (24 h-POST) and 40-h post (40 h-POST) a load carriage test. There was no impact of supplementation on muscle function at POST (p = 0.752) or 40 h-POST (p = 0.989) load carriage but jump height was greater in PLA compared to HIGH at 24 h-POST (p = 0.037). There was no impact of protein supplementation on muscle soreness POST (p = 0.605), 24 h-POST (p = 0.182) or 40 h-POST (p = 0.333). All groups had increased concentrations of urinary myoglobin and 3-methylhistidine, but there was no statistical difference between groups at any timepoint (p > 0.05). We conclude that pre-sleep protein supplementation does not accelerate acute muscle recovery following load carriage in British Army recruits during basic training. The data suggests that consuming additional energy in the form of CHO or protein was beneficial at attenuating EIMD, although it is acknowledged there were no statistical differences between groups. Although EIMD did occur as indicated by elevated urinary muscle damage markers, it is likely that the load carriage test was not arduous enough to reduce muscle function, limiting the impact of protein supplementation. Practically, protein supplementation above protein intakes of 1.2 g⸱kg-1⸱day-1 following load carriage over similar distances (4 km) and carrying similar loads (15-20 kg) does not appear to be warranted.
Collapse
Affiliation(s)
- Shaun Chapman
- Army Recruit Health and Performance Research, HQ Army Recruiting and Initial Training Command, Medical Branch, UK Ministry of Defence, Upavon, United Kingdom
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Justin Roberts
- Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Andrew J. Roberts
- Army Recruit Health and Performance Research, HQ Army Recruiting and Initial Training Command, Medical Branch, UK Ministry of Defence, Upavon, United Kingdom
| | - Henry Ogden
- Army Recruit Health and Performance Research, HQ Army Recruiting and Initial Training Command, Medical Branch, UK Ministry of Defence, Upavon, United Kingdom
| | - Rachel Izard
- Defence Science and Technology, UK Ministry of Defence, Salisbury, United Kingdom
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Havovi Chichger
- Biomedical Science Research Group, School of Life Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lauren Struszczak
- Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom
| | - Alex J. Rawcliffe
- Army Recruit Health and Performance Research, HQ Army Recruiting and Initial Training Command, Medical Branch, UK Ministry of Defence, Upavon, United Kingdom
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, United Kingdom
| |
Collapse
|
6
|
Burbage J, Rawcliffe AJ, Saunders S, Corfield L, Izard R. The incidence of breast health issues and the efficacy of a sports bra fit and issue service in British Army recruits. ERGONOMICS 2021; 64:1052-1061. [PMID: 33709872 DOI: 10.1080/00140139.2021.1895324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
Increasing retention of female recruits throughout Basic Training (BT) is a key priority for the British Army. The aims of this study were two-fold; (i) quantify breast health issues and sports bra usage within female British Army recruits, and (ii) assess the influence of professionally fitted sports bras on breast health and bra fit issues across 13 weeks of BT. A survey was completed by 246 female recruits that identified the incidence of breast health issues during BT. Subsequently, 33 female recruits were provided with professionally fitted sports bras during Week-1 of BT. Recruits completed a survey in Week-1 (Pre) and Week-13 (Post). There was a high incidence of bra issues during BT, which did not reduce following the implementation of professionally fitted sports bras. The authors recommend further research into the specific functional requirements of breast support relative to the demands of BT and the needs of the female recruit. Practitioner Summary: The British Army have a duty of care to ensure female recruits are equipped sufficiently for the demands of training. Despite the implementation of a sports bra fitting and issue service bra fit issues remained high. Further research into the specific functional requirements of breast support during training is recommended. Abbreviations: BT: Basic Training; ATR(W): Army Training Regiment Winchester; ATC(P): Army Training Centre Pirbright; BMI: Body Mass Index; NRS: Numeric Rating Scale; FET: Fisher's Exact Test.
Collapse
Affiliation(s)
- Jenny Burbage
- School of Sport, Health and Exercise Science, University of Portsmouth, Hampshire, UK
| | - Alex J Rawcliffe
- Department of Occupational Medicine, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Uphaven, UK
| | - Samantha Saunders
- Human Performance, Defence Security Analysis, Defence Science and Technology Laboratory, Porton Down, UK
| | - Louise Corfield
- Department of Occupational Medicine, HQ Army Recruiting and Initial Training Command, Ministry of Defence, Uphaven, UK
| | - Rachel Izard
- Science and Technology Commissioning, Defence Science and Technology, Ministry of Defence, Salisbury, UK
| |
Collapse
|
7
|
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: 2] [Impact Index Per Article: 0.7] [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.
Collapse
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
| |
Collapse
|
8
|
Vyas N, Cialdella-Kam L. Comparison of Energy and Nutrient Intake vs. Estimated Needs in Warfighters: an Update. Curr Nutr Rep 2020; 9:405-413. [PMID: 33118099 DOI: 10.1007/s13668-020-00336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Active members of the military must perform optimally under conditions of thermal stress and/or energy deficiency. Military dietary reference intakes (MDRIs) provide guidelines for energy and nutrient intakes but is based studies largely conducted in Army. Needs may vary by service branch and/or position. New protein recommendations have emerged, which are not reflected in MDRIs. PURPOSE OF REVIEW: Compare reported dietary intake in active duty members to MDRIs and 2016 American College of Sports Medicine (ACSM) sports nutrition guidelines. RECENT FINDINGS: Active duty members are not meeting their energy and carbohydrate needs with low-to-adequate protein intake and adequate-to-high fat intake. Other nutrients of concern are vitamin D, calcium, iron, B-vitamins, and fiber. Thermal stress increases energy needs and suppresses appetite and thus increase risk for energy and nutrition deficiencies. Energy and nutrients needs can vary by branch of armed service, job responsibility, and external stressors.
Collapse
Affiliation(s)
- Neil Vyas
- Department of Nutrition, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lynn Cialdella-Kam
- Department of Nutrition, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA. .,Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
| |
Collapse
|
9
|
Chapman S, Rawcliffe AJ, Smith L, Izard R, Roberts J. Evaluation of the current methods used for assessing dietary intake in military research settings: a scoping review. BMJ Mil Health 2020; 167:126-130. [PMID: 32859652 DOI: 10.1136/bmjmilitary-2020-001436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION It is important to collate the literature that has assessed dietary intake within military settings to establish which methods are commonly used and which are valid so that accurate nutrition recommendations can be made. This scoping review aims to identify which methods are typically used to assess dietary intake in military settings and which of these have been validated. This review also aims to provide a recommendation as to which method(s) should be used in military settings. METHODS This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in PubMed, Web of Science and SPORTDiscus with the most recent search executed on 12th June 2020. Eligible studies had to report original data, assess and quantify dietary intake and have been published in peer-reviewed academic journals. The reporting bias was calculated for each study where possible. RESULTS Twenty-eight studies used a single method to assess dietary intake and seven studies used a combination of methods. The most commonly used methods were the gold standard food intake/waste method, Food Frequency Questionnaire (FFQ) or a food diary (FD). The only method to date that has been validated in military settings is weighed food records (WFR). CONCLUSIONS The food intake/waste method or WFR should be used where feasible. Where this is not practical the FFQ or FD should be considered with control measures applied. There is currently not sufficient evidence to state that using multiple methods together improves validity.
Collapse
Affiliation(s)
- Shaun Chapman
- HQ Army Recruiting and Initial Training Command, UK Ministry of Defence, Upavon, UK
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - A J Rawcliffe
- HQ Army Recruiting and Initial Training Command, UK Ministry of Defence, Upavon, UK
| | - L Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - R Izard
- Defence Science and Technology, Porton Down, UK Ministry of Defence, Salisbury, Wiltshire, UK
| | - J Roberts
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| |
Collapse
|
10
|
O'Leary TJ, Wardle SL, Greeves JP. Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military. Front Nutr 2020; 7:142. [PMID: 32984399 PMCID: PMC7477333 DOI: 10.3389/fnut.2020.00142] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Military personnel experience energy deficit (total energy expenditure higher than energy intake), particularly during combat training and field exercises where exercising energy expenditures are high and energy intake is reduced. Low energy availability (energy intake minus exercising energy expenditure expressed relative to fat free mass) impairs endocrine function and bone health, as recognized in female athletes as the Female Athlete Triad syndrome. More recently, the Relative Energy Deficiency in Sport (RED-S) syndrome encompasses broader health outcomes, physical and cognitive performance, non-athletes, and men. This review summarizes the evidence for the effect of low energy availability and energy deficiency in military training and operations on health and performance outcomes. Energy availability is difficult to measure in free-living individuals but doubly labeled water studies demonstrate high total energy expenditures during military training; studies that have concurrently measured energy intake, or measured body composition changes with DXA, suggest severe and/or prolonged energy deficits. Military training in energy deficit disturbs endocrine and metabolic function, menstrual function, bone health, immune function, gastrointestinal health, iron status, mood, and physical and cognitive performance. There are more data for men than women, and little evidence on the chronic effects of repeated exposures to energy deficit. Military training impairs indices of health and performance, indicative of the Triad and RED-S, but the multi-stressor environment makes it difficult to isolate the independent effects of energy deficiency. Studies supplementing with energy to attenuate the energy deficit suggest an independent effect of energy deficiency in the disturbances to metabolic, endocrine and immune function, and physical performance, but randomized controlled trials are lacking.
Collapse
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
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, 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
| |
Collapse
|
11
|
Dietary Intake and Nitrogen Balance in British Army Infantry Recruits Undergoing Basic Training. Nutrients 2020; 12:nu12072125. [PMID: 32709021 PMCID: PMC7400853 DOI: 10.3390/nu12072125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/21/2022] Open
Abstract
We assessed dietary intake and nitrogen balance during 14 weeks of Basic Training (BT) in British Army Infantry recruits. Nineteen men (mean ± SD: age 19.9 ± 2.6 years, height: 175.7 ± 6.5 cm, body mass 80.3 ± 10.1 kg) at the Infantry Training Centre, Catterick (ITC(C)) volunteered. Nutrient intakes and 24-h urinary nitrogen balance were assessed in weeks 2, 6 and 11 of BT. Nutrient intake was assessed using researcher-led weighed food records and food diaries, and Nutritics professional dietary software. Data were compared between weeks using a repeated-measures analysis of variance (ANOVA) with statistical significance set at p ≤ 0.05. There was a significant difference in protein intake (g) between weeks 2 and 11 of BT (115 ± 18 vs. 91 ± 20 g, p = 0.02, ES = 1.26). There was no significant difference in mean absolute daily energy (p = 0.44), fat (p = 0.79) or carbohydrate (CHO) intake (p = 0.06) between weeks. Nitrogen balance was maintained in weeks 2, 6 and 11, but declined throughout BT (2: 4.6 ± 4.1 g, 6: 1.6 ± 4.5 g, 11: -0.2 ± 5.5 g, p = 0.07). A protein intake of 1.5 g·kg-1·d-1 may be sufficient in the early stages of BT, but higher intakes may be individually needed later on in BT.
Collapse
|