Monitoring Metabolic Status Predicting Decrements in Physiological and Cognitive Performance (2004) / Chapter Skim
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6 Conclusions and Recommendations
6 Conclusions and Recommendations
Pages 195-208
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From page 195... ...
Clearly, improvement in monitoring metabolic status requires significant research investments in the identification and validation of new biomarkers, the field validation of existing sensor technologies, the development of new sensor devices, and the enhancement of bioinformatics to evaluate the data. For example, in the last two decades biotechnology has provided great benefits to medicine, agriculture, criminology, and environmental sciences and holds great promise for future advancements in these fields.
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From page 196... ...
This chapter provides suggestions on which research efforts for monitoring metabolic status should take priority, along with the committee's answers to the five questions posed by the military. QUESTION 1 What are the most promising biomarkers for the prediction of: (aJ excessive rates of bone loss and muscle turnover, (by reduced glucose and energy metabolism (e.g., bioelectrical indicators of muscle and mentalfatigueJ, (cJ debydration, and (d)
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From page 197... ...
This decrease in oxygen availability may result from, for example, decreases in cardiovascular function, decreased hemoglobin concentrations, or inadequate intravascular volume due to excessive water loss (dehydration)
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From page 198... ...
The military should consider providing and training personnel in the use of simple urine dipstick-type test strips that would provide information on levels of urine protein (a marker for potential kidney damage) , ketones and glucose (potential markers for energy metabolism)
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From page 199... ...
The assessment of weight loss or loss of body mass, plasma sodium or plasma osmolality, urinary specific gravity, fluid balance, and the recovery of weight 24 hours after dehydration can be used for the identification of extent and type of dehydration. In the military setting, where dehydration is the most common condition, weight changes over a short period of time reflect fluid changes and loss of body water coupled with measures of serum sodium or serum osmolality can define the degree of concomitant salt loss.
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From page 200... ...
In summary, the major obstacles likely to be encountered in the implementation of future monitoring technologies will be the selection of variables and the building of models that truly predict health performance status. QUESTION 3 What tools currently exist for monitoring metabolic status that could be useful inthefeld?
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From page 201... ...
The combination of doubly labeled water, as a measure of total energy expenditure, and hand-held indirect calorimetry to assess resting energy expenditure could be used to monitor metabolic status and assess energy metabolism over periods of up to 2 weeks. Self-selected pace, foot-strike devices, and activity monitors that integrate pulse, temperature, and movement can estimate activity and total energy expenditure and may be useful in the field.
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From page 202... ...
Immunological evaluation could include measuring the numbers, maturity, activation, and function of immune cells, including such measures as macrophage phagocytosis, lymphocyte proliferation in stimulation test, natural killercell activity, cytokine production patterns, expression of genes and receptors, antibody production, skin delayed-type hypersensitivity, antibody response to vaccine, wound healing, and infection rate Indicators of stress and immune responses that are currently in use and in development include cortisol levels (measured from saliva, sweat, or urine) , and heart-rate variability as measured with high-impedance electrocardiogram (ECG)
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From page 203... ...
Other models, such as the Acute Physiologic and Chronic Health Evaluation Scores and the simpler Simplified Applied Physiological Score, also use physiological variables to predict health outcomes. Although these tools have worked quite well in the intensive care unit setting where pathological changes in physiological parameters are the rule, there is little compelling evidence that similar algorithms would be equally effective in the military setting where such parameters vary over a narrower range.
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From page 204... ...
Last, it is crucial to develop baseline data for each individual (combat service member) in order to implement effective field strategies for monitoring metabolic status.
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From page 205... ...
Optimization of Markers to Monitor Stress and Immune Function A limited battery of selected stress-response and immune markers should be validated to monitor physiological adaptations to changes in the environment and to evaluate the readiness of individuals for impending deployment. Odors as Biomarkers Since odors evolved to communicate distinct information about individuals, it would seem to be an ideal system for monitoring organic states of individual combat service members in the field.
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From page 206... ...
This is an area where little research has been done, but one that may have significant potential as a noninvasive monitoring technology for a variety of physiological biomarkers. New Algorithms to Integrate Complex Biological Information The use of technology and "smart systems" are required to bridge the cognitive gap created by the lack of skilled clinicians in the field to provide individualized recommendations to support end users.
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From page 207... ...
These should include studies of markers of bone loss, especially related to fracture risk and the prevention of lost duty time during initial entry training, advanced training, and combat operations · To continue to study cortisol levels during training and operations to ensure that its elevation is not a contributor to bone loss.
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From page 208... ...
in the field as indicators of fatigue and cognitive ability. · To continue research on the use of NIRS to monitor muscle oxygenation and deoxygenation, intramuscular pH, and skin hydration status concurrently.
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