Military Strategies for Sustainment of Nutrition and Immune Function in the Field (1999) / Chapter Skim
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Executive Summary
Executive Summary
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National Academy Press Executive Summary This report, Military Strategies for Sustainment of Nutrition and Immune Function in the Field, is a review of nutrition and immune function and its application to military operational missions. It is the latest in a series of reports by the Institute of Medicine's Committee on Military Nutrition Research (CMNR)
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3. The proinflammatory cytokines have been proposed to decrease lean body mass, mediate thermoregulatory mechanisms, and increase resistance to infectious disease by reducing metabolic activity in a way that is similar to the reduction seen in malnutrition and other catabolic conditions.
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Every aspect of immunity and host defense is dependent upon a proper supply and balance of nutrients (Chandra, 1 988; Cunningham-Rundles, 1 993; Forse, 1994; Gershwin et al., 1985; Watson, 1984~. Severe protein-energy malnutrition can cause significant alterations in the immune response, but even subclinical deficits may be associated with a catabolic response, an impaired immune response, and an altered risk of infection (Beisel, 1982; Keusch and Farthing, 1986~.
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Cell-mediated immunity is the antigen-specific and nonspecific immunity provided by the direct localized cellular activity of T-lymphoeytes and natural killer cells. Cytokines play a role in cellular communication, function as intercellular signals and mediators, and are active participants in nonspecific immune responses such as acute-phase reactions.
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Researchers found that with the increased energy intake, there was less suppression of T-lymphocyte cell proliferation in response to an applied mitogenic stimulus, indicating an improvement in immune response. The depression in T-cell proliferative response that was demonstrated at the midpoint of the training phases of Ranger I was found to occur in the later testing phases of Ranger II.
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Although significant improvements were noted in the maintenance of normal nutritional status of the Ranger trainees with the Ranger II intervention study many questions remained regarding the impact and intensity of Ranger training with respect to body composition changes and host defense mechanisms. In order to delineate further some of the mechanisms and stresses contributing to these alterations, the CMNR conducted a focused review of current information pertaining to: (1)
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Weight loss in the range of 10 percent in operations extending over 4 weeks raisee the concern of reduced physical and cognitive performance and has potential health consequences for some individuals (IOM, 1995~. The nutritional status of soldiers should be optimized prior to deployment, engagement in any exercise or training course, or even brief encounters with anything that would present a potential immune challenge (disease, toxic agent, or environmental stress)
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The problem of compromised iron status in female personnel is a matter of concern because it may impact immune function, physical performance, and cognitive function. It is important to maintain adequate iron status in female soldiers and to do so without causing excess iron intake by males.
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· Additionally, the CMNR recommends the use of methods to minimize psychological stresses, including training, conditioning, and structured briefing and debriefing. Optimizing Nutritional Status · In view of the compromised immune function noted in studies of Ranger trainees, the CMNR recommends that, where possible, individuals who have lost significant lean body mass should not be redeployed until this lean mass is regained.
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· As a means of reducing the number of stresses encountered by military personnel, the committee encourages the development and implementation of nutrition education programs targeted at high-risk military groups, such as Special Forces troops and female soldiers, to communicate information regarding healthy eating habits and supplement use. Nutritional Supplement Use Supplementation with certain nutrients may be of value for sustaining host defense mechanisms (including those conferred by the immune system)
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Research Methodology · The CMNR recommends that research be conducted to determine the appropriate field measures (see Table S-2) for monitoring nutritionally induced immune responses, particularly for determining the presence of acute-phase reactions and changes in immune function of the type and degree that are likely to occur as a result of the nutritional insults suffered by soldiers in typical deployment situations.
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required Assay of ·ELISA allows batch ·Need initial 1-2 circulating processing preparation step for cytokines and Urine is a possible blood sample; samples soluble receptors sample source must be stored appropriately ·Special handling *
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Such a determination should be made before urinary IL-6 measurements are used in field studies, where 24-h urinary collections are virtually impossible to obtain. · The CMNR recommends the development and field testing of appropriate cytokine markers in urine and blood that are reflective of ongoing acute-phase reactions and of changes in immune status in
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· The CMNR recommends that if research is conducted on the ability of nutrients to influence immune status, priority should be placed on the antioxidant nutrients ,B-carotene and vitamins C and E The committee acknowledges that insufficient data are available to identify any specific nutrient or combination of nutrients as having adequately demonstrated the ability to enhance immune Unction under the military operational conditions investigated.
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Marriott, ed. A report of the Committee on Military Nutrition Research, Food and Nutrition Board.
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