Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page R1
Mineral Requirements
for Military Personnel
Levels Needed for Cognitive and Physical
Performance During Garrison Training
Committee on Mineral Requirements for Cognitive and
Physical Performance of Military Personnel
Committee on Military Nutrition Research
Food and Nutrition Board
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
OCR for page R2
THE NATIONAL ACADEMIES PRESS ˇ 500 Fifth Street, N.W. ˇ Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the
National Research Council, whose members are drawn from the councils of the National Academy
of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of
the committee responsible for the report were chosen for their special competences and with regard
for appropriate balance.
This study was supported by contract number DAMD17-99-1-9478 between the National Academy
of Sciences and the United States Army. Any opinions, findings, conclusions, or recommendations
expressed in this publication are those of the authors and do not necessarily reflect the views of the
sponsoring agency that provided support for the project.
International Standard Book Number: 0-309-10126-3 (book)
International Standard Book Number: 0-309-65790-3 (PDF)
Additional copies of this report are available from the National Academies Press, 500 Fifth Street,
N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington
metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2006 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and
religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute
of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
OCR for page R3
"Knowing is not enough; we must apply.
Willing is not enough; we must do."
--Goethe
Advising the Nation. Improving Health.
OCR for page R4
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon the
authority of the charter granted to it by the Congress in 1863, the Academy has a mandate
that requires it to advise the federal government on scientific and technical matters. Dr.
Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the
National Academy of Sciences, as a parallel organization of outstanding engineers. It is
autonomous in its administration and in the selection of its members, sharing with the
National Academy of Sciences the responsibility for advising the federal government.
The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of
Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences
to secure the services of eminent members of appropriate professions in the examination
of policy matters pertaining to the health of the public. The Institute acts under the re-
sponsibility given to the National Academy of Sciences by its congressional charter to be
an adviser to the federal government and, upon its own initiative, to identify issues of
medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute
of Medicine.
The National Research Council was organized by the National Academy of Sciences in
1916 to associate the broad community of science and technology with the Academy's
purposes of furthering knowledge and advising the federal government. Functioning in
accordance with general policies determined by the Academy, the Council has become
the principal operating agency of both the National Academy of Sciences and the Na-
tional Academy of Engineering in providing services to the government, the public, and
the scientific and engineering communities. The Council is administered jointly by both
Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are
chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
OCR for page R5
COMMITTEE ON MINERAL REQUIREMENTS FOR COGNITIVE
AND PHYSICAL PERFORMANCE OF MILITARY PERSONNEL
ROBERT M. RUSSELL, (Chair) Human Nutrition Research Center on
Aging, Tufts University, Boston, MA
JOHN L. BEARD, Department of Nutrition, Pennsylvania State University,
University Park
MELINDA BECK, School of Public Health and Medicine, University of
North Carolina, Chapel Hill
BRUCE R. BISTRIAN, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, MA
JOSEPH G. CANNON, Medical College of Georgia, Augusta
GERALD F. COMBS, JR., Grand Forks Human Nutrition Research Center,
Grand Forks, ND
JOHANNA T. DWYER, Office of Dietary Supplements, National Institutes of
Health, Baltimore, MD
JOHN W. ERDMAN, Department of Food Science and Human Nutrition,
University of Illinois, Urbana-Champaign
EMILY M. HAYMES, Department of Nutrition, Food and Exercise Sciences,
Florida State University, Tallahassee
JANET R. HUNT, Grand Forks Human Nutrition Research Center, Grand
Forks, ND
HELEN W. LANE, Johnson Space Center, National Aeronautics and Space
Administration, Houston, TX
JAMES G. PENLAND, Grand Forks Human Nutrition Research Center,
Grand Forks, ND
SUSAN S. PERCIVAL, Department of Food Science and Human Nutrition,
University of Florida, Gainesville
CONNIE M. WEAVER, Department of Food Science and Nutrition, Purdue
University, West Lafayette, IN
Staff
MARIA P. ORIA, Study Director
LESLIE J. SIM, Research Associate
JON Q. SANDERS, Senior Program Assistant
v
OCR for page R6
FOOD AND NUTRITION BOARD*
ROBERT M. RUSSELL (Chair), Jean Mayer U.S. Department of Agriculture
Human Nutrition Research Center on Aging, Tufts University, Boston, MA
LARRY R. BEUCHAT, Center for Food Safety, University of Georgia,
Griffin
MICHAEL P. DOYLE, Center for Food Safety, University of Georgia,
Griffin
SUSAN FERENC, Food Products Association, Washington, DC
NANCY F. KREBS, Department of Pediatrics, University of Colorado Health
Sciences Center, Denver
REYNALDO MARTORELL, Department of Global Health, Rollins School
of Public Health, Emory University, Atlanta, GA
J. GLENN MORRIS, JR., Department of Epidemiology and Preventive
Medicine, School of Medicine and School of Public Health, University of
Maryland, Baltimore
SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of
Hawaii, Honolulu
JOSE M. ORDOVAS, Jean Mayer U.S. Department of Agriculture Human
Nutrition Research Center on Aging, Tufts University, Boston, MA
LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food
Research and Action Center, Washington
NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism Research
Laboratory, University of California, San Diego
REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell
University, Ithaca, NY
JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin,
Madison
WALTER C. WILLETT, Department of Nutrition, Harvard School of Public
Health, Harvard University, Boston, MA
BARRY L. ZOUMAS, Department of Agricultural Economics and Rural
Sociology, Pennsylvania State University, University Park
Staff
LINDA D. MEYERS, Director
GERALDINE KENNEDO, Administrative Assistant
ANTON BANDY, Financial Associate
*IOM boards do not review or approve individual reports and are not asked to endorse conclusions
and recommendations. The responsibility for the content of the reports rests with the authoring
committee and the institution.
vi
OCR for page R7
Reviewers
This report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures ap-
proved by the National Research Council's Report Review Committee. The pur-
pose of this independent review is to provide candid and critical comments that
will assist the institution in making its published report as sound as possible and
to ensure that the report meets institutional standards for objectivity, evidence,
and responsiveness to the study charge. The review comments and draft manu-
script remain confidential to protect the integrity of the deliberative process. We
wish to thank the following individuals for their review of this report:
Mary R. L'Abbé, Bureau of Nutritional Sciences Food Directorate,
Health Canada, Ottawa
Ronni Chernoff, University of Arkansas Medical School, Little Rock
Felicia Cosman, Columbia-Presbyterian Medical Center, New York
Susanna Cunningham-Rundles, Cornell University Weill Medical
College, Ithaca, NY
Marc K. Hellerstein, University of California, Berkeley
Orville Levander, USDA Human Nutrition Research Center,
Beltsville, MD
Joan Lyon, USDA Center for Nutritional Policy and Promotion,
Alexandria, VA
Stacey L. Mobley, Purdue University, Lafayette, IN
Harold H. Sandstead, The University of Texas Medical Branch, Galveston
Richard J. Wood, Jean Mayer USDA Human Nutrition Research Center
on Aging at Tufts University, Boston, MA
Although the reviewers listed above have provided many constructive com-
ments and suggestions, they were not asked to endorse the conclusions or recom-
mendations nor did they see the final draft of the report before its release. The
vii
OCR for page R8
viii REVIEWERS
review of this report was overseen by Michael P. Doyle, University of Georgia.
Appointed by the Institute of Medicine, he was responsible for making certain
that an independent examination of this report was carried out in accordance
with institutional procedures and that all review comments were carefully con-
sidered. Responsibility for the final content of this report rests entirely with the
authoring committee and the institution.
OCR for page R9
Preface
The Committee on Military Nutrition Research (CMNR) was established in
October 1982 following a request by the Assistant Surgeon General of the Army
that the Board on Military Supplies of the National Academy of Sciences (NAS)
set up a special committee to advise the U.S. Department of Defense (DoD) on
the need for and conduct of nutrition research and related issues. The CMNR, a
standing committee, was eventually transferred to the Food and Nutrition Board
of the Institute of Medicine, National Academies. The standing committee's
primary tasks are to identify factors that may critically influence the physical and
mental performance of combat military personnel under all environmental ex-
tremes, to identify knowledge gaps, to recommend research that would remedy
these deficiencies, to identify approaches for studying the relationship of diet to
physical and mental performance, and to review and advise on military feeding
standards. It is customary that for each specific task, an ad hoc committee com-
posed with the appropriate expertise is formed. For example, under the oversight
of the CMNR, an ad hoc committee of experts provided recommendations for
nutrient composition of assault rations for short-term, high intensity sustained
operations in a recent report.
This report entitled, Mineral Requirements for Military Personnel results
from the work of an ad hoc Committee on Mineral Requirements for Cognitive
and Physical Performance of Military Personnel under the auspices of the
CMNR. This report was produced in response to the request by the Commander,
U.S. Army Medical Research and Materiel Command (USAMRMC) to the Insti-
tute of Medicine (IOM) to convene a committee to review and recommend the
mineral requirements for military personnel on military garrison training, not
only by considering excess losses due to physical and environmental stress, but
also by considering potential enhancements of performance (e.g., mental, physical,
immune). These are the personnel that, while living at military bases, engage in
military training or in daily operations that entail high physical and mental
demands. The specific questions posed to the committee evolved from discussions
ix
OCR for page R10
x PREFACE
between the standing CMNR, and the Military Nutrition Division of the U.S.
Army Research Institute of Environmental Medicine (USARIEM) in Natick,
Massachusetts. The CMNR also provided input during the initial stages of expert
selection for potential ad hoc committee members and workshop speakers.
A 14-member committee was formed with expertise on calcium, copper,
iron, magnesium, selenium, and zinc, and with specific attention to areas of
nutrient absorption, metabolism and functions particularly important to the mili-
tary, such as immune function, physical and cognitive performance. Experts on
food technology, clinical nutrition, dietetics, and psychology were also included
in the committee. The committee's task was to assess the current Military Refer-
ence Dietary Intakes (MDRIs) and if needed, recommend, new mineral intakes
for soldiers in garrison training. The committee was also asked to review the
mineral levels of the current operational rations i.e., Meals, Ready to-Eat and
First Strike Rations and determine if they are adequate. Because the committee's
expertise was strong in the area of essential minerals, it was also requested that
they comment on the recommendations for mineral levels in assault rations.
The committee discussed the limitations of the data, regarding minerals.
First, even though there is a reasonable amount of data on mineral levels of
rations, data on mineral intake by military personnel is scanty. In order to assess
the adequacy of mineral levels in rations, the committee had to assume that the
complete rations were consumed, which might not be the case. It is therefore a
challenge to assess whether or not the intakes of military personnel are adequate.
Second, there is a lack of information regarding changes in metabolism or re-
quirements due to the unique demands arising from physical or mental stressors
during military operations. The committee based its recommendations on the
best available data from studies done on civilians under circumstances that paral-
leled the military situation as closely as possible. For example, higher mineral
requirements due to sweat losses in soldiers were based on studies in exercising
civilians. The committee also reviewed studies which suggested that a higher
intake of minerals might improve immune function, the ability to perform physi-
cal or mental tasks, or mood states. In this case, the data were suggestive only,
and no definitive conclusions were reached. Although the committee was able to
recommend intakes for certain selected minerals of importance, additional data
from studies performed under the circumstances encountered by soldiers in gar-
rison training are needed, so that requirements are updated with new, more ap-
propriate data, including data on potential improvements of functions of military
importance. Undoubtedly, the committee's important recommendations relate to
specific research need priorities.
The committee carried out its work over 12 months and met twice. The first
meeting of the committee was held in conjunction with a two-day workshop.
This workshop, designed to address this task, was hosted by The National Acad-
emies in Washington DC, June 1315, 2004. Speakers addressed the issues
brought to the committee by the USARIEM. These presentations formed the
OCR for page R11
PREFACE xi
basis for the committee's deliberations and recommendations, and are included
in this report as individually authored papers in Appendix B.1
One additional meeting of the committee was held on August 2425, 2005.
Prior to this second meeting, the committee took part in a series of conference
calls to deliberate the scientific basis for the recommendations for each of the
minerals. Further, additional conference calls were held to discuss and finalize
recommendations. Finally, a research agenda was set forth through numerous
face to face and phone interactions by committee members.
The committee wishes to express its special thanks to Andrew J. Young, Chief
Nutritionist of the Nutrition Division and representative from the Department of
Defense for this report, for generously giving his time and help and for being
available to clarify the task of the committee. Special thanks are extended to Angus
G. Scrimgeour, Research Physiologist, and James P. McClung, Nutritional
Biochemist at the Nutrition Division of USARIEM. Their assistance was invalu-
able during the committee's work in that they helped delineate the task and pro-
vided numerous reports and other data to the committee in a timely manner. The
committee wants to express its deepest appreciation to Carol J. Baker-Fulco, nutri-
tionist at USARIEM, who offered her valuable help on numerous occasions to
address the multiple questions regarding the nature of the military food and min-
eral intake and ration composition data. The committee wishes to extend thanks
also to LTC John E. Kent, Chief, Nutrition Care Division at Darnall Army Com-
munity Hospital and LTC Sonya J.C. Corum, TRADOC Dietitian at Fort Jackson,
South Carolina for their assistance in describing nutritional and environmental
factors in the field. Thanks also go to COL Maria A. Worley, Nutrition Program
Director and Chief Dietitian of the U.S. Army, for her frank description of practi-
cal uses of MDRIs for rations by the military. Finally, the committee wishes to
thank COL Karl E. Friedl who tirelessly supports the work of the CMNR in so
many different ways, from his participation in workshops to provision of appropri-
ate contacts.
On behalf of the committee, I wish to sincerely thank the workshop partici-
pants and speakers for addressing topics critical to the completion of the com-
mittee's work. Each speaker not only provided an excellent presentation, but was
available for multiple interactions during and after the workshop, and prepared a
manuscript of their presentations (see Appendix B), working with IOM staff
throughout the revision process. These presentations were important reference
sources for the committee and, as already mentioned, were used as the scientific
basis throughout the report.
The committee owes a strong debt of gratitude to the FNB staff for its
professionalism and effectiveness in ensuring that our committee adhered to its
task statement, for providing discipline and experience in helping to assemble
1The authored papers have undergone limited editorial changes, have not been reviewed by the
report reviewers, and represent the views of the individual authors.
OCR for page R12
xii PREFACE
the report, for providing background research support, and for organizing our
meetings. In particular, we would like to thank Senior Program Officer Maria P.
Oria of the FNB, who worked tirelessly on numerous drafts and revisions. Ably
assisting Maria in her efforts were Senior Program Assistant Jon Q. Sanders and
Research Associate Leslie J. Sim. The committee is also grateful to the overall
guidance and continuous support of Linda D. Meyers, Director of the FNB.
I also extend my deep gratitude to my fellow committee members, who
participated in our discussions in this study in a professional and collegial man-
ner, and who approached their task statement with great seriousness and intellec-
tual curiosity.
Robert M. Russell, M.D., Chair
OCR for page R13
Contents
SUMMARY 1
1 INTRODUCTION 13
2 MILITARY DIETARY REFERENCE INTAKES: 36
PROCESS TO ESTABLISH, USES, AND
DELIVERY METHODS
3 MINERAL RECOMMENDATIONS FOR MILITARY 58
PERFORMANCE
4 RESEARCH NEEDS 191
5 ANSWERS TO THE MILITARY'S QUESTIONS 219
APPENDIXES
A WORKSHOP AGENDA 235
B WORKSHOP PAPERS 240
Introduction to Combat Rations
Concerns About the Effects of Military Environments on Mineral 240
Metabolism and Consequences of Marginal Deficiencies to
Performance
Karl E. Friedl
Derivation of the Military Dietary Reference Intakes and the 249
Mineral Content of Military Rations
Carol J. Baker-Fulco
xiii
OCR for page R14
xiv CONTENTS
Mineral Metabolism
Bioavailability of Iron, Zinc, and Copper as Influenced by Host 265
and Dietary Factors
Janet R. Hunt
Functional Metabolism of Copper, Zinc, and Iron 277
Cathy W. Levenson
Absorption Mechanisms, Bioavailability, and Metabolism of 285
Calcium and Magnesium
Connie M. Weaver
Drinking Water as a Source of Mineral Nutrition 295
Gerald F. Combs, Jr.
Assessment of Zinc, Copper, and Magnesium Status:
Current Approaches and Promising New Directions 304
Carl L. Keen and Janet Y. Uriu-Adams
Stress Factors Affect Homeostasis
Environmental Stressors During Military Operations 315
Robert Carter III, Samuel Cheuvront, Andrew J. Young,
and Michael N. Sawka
Mineral Sweat Losses During Exercise 323
Emily M. Haymes
Stress Factors Affecting Homeostasis: Weight Loss and Mineral Status 329
Steven B. Heymsfield
Protein Turnover and Mineral Metabolism 338
Henry C. Lukaski
Minerals and the Immune System
Physical Activity and Tyrosine Supplementation: Two Effective 343
Interventions Against Stress-Induced Immunosuppression
Monika Fleshner
Mineral Intake Needs and Infectious Diseases 357
Davidson H. Hamer
Copper, Zinc, and Immunity 370
Susan S. Percival
Impact of Nutritional Deficiencies and Psychological Stress 378
on the Innate Immune Response and Viral Pathogenesis
John F. Sheridan, Patricia A. Sheridan, and Melinda A. Beck
Injury and Optimization of Recovery
The Influence of Minerals on Muscle Injury and Recovery 384
Joseph G. Cannon
Physical Activity and Nutrition: Effects on Bone Turnover, 390
Bone Mass, and Stress Fracture
Jeri W. Nieves
OCR for page R15
CONTENTS xv
Minerals and Cognition and Behavior
Evaluating Nutritional Effects on Cognitive Function in 398
Warfighters: Lessons Learned
Harris R. Lieberman
Iron and Cognitive Performance 410
John L. Beard and Laura E. Murray-Kolb
Zinc and Other Mineral Nutrients Required for Cognitive 419
Function and Behavior in Military Personnel
James G. Penland
Minerals and Physical Performance
Zinc, Magnesium, and Copper Requirements and Exercise 436
Henry C. Lukaski
The Effects of Iron Deficiency on Physical Performance 451
Jere D. Haas
C TABLES 462
D BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS 470
E BIOGRAPHICAL SKETCHES OF COMMITTEE 479
MEMBERS AND STAFF
F ACRONYMS AND ABBREVIATIONS 486
G GLOSSARY 493
OCR for page R16
