Iron b vit def dec 06

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BCT

Nutritional

DeficienciesDEC 06

vNOV06

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BLUF1. Military studies show BCT females’ iron indicators

significantly worsen in BCT. Few male studies, so male status is unknown.

2. Iron is important to PT performance, cognitive, and immune functions.

3. There are multiple hypotheses for iron decreases:a. Intensity and duration of exercise.

b. Iron losses in sweat, feces, menses, and urine.

c. Inadequate dietary intake (low intake or non-bioavailable iron sources).

4. Athletic adolescents need more nutrients than the general population.

5. Analyst conclusions/recommendations:a. Intervention studies show beef consumption counters

exercise-related iron losses effectively (21, 26, 27, 28)(see pages 12-13).

b. Continue Fort Jackson nutrition study.

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McClung et al, Prevalence of Iron Deficiency and Iron Deficiency Anemia among Three Populations of Female Military Personnel in the US Army, Journal of the American College of Nutrition, Vol 25, No. 1, 2006

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Iron Deficient 13.4 32.8 9.6Iron Anemia 5.8 20.9 4.8

BCT entry AIT entry Perm Party

1. Iron deficiency and anemia affects physical, cognitive, and immune function2. Rates are distributed by race (see next slide).3. The implication is that hard training and the BCT diet affects iron status.

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Caucasion Deficient 8.9 24.8 7.9

Caucasion Anemic 2.2 10.5 2

Hispanic Deficient 7.1 43.8 6.8

Hispanic Anemic 0 21.9 0

AA Deficient 16.7 32.5 8.7

AA Anemic 8.3 22.9 5.6

BCT entry AIT entry Perm Party

McClung et al, Prevalence of Iron Deficiency and Iron Deficiency Anemia among Three Populations of Female Military Personnel in the US Army, Journal of the American College of Nutrition, Vol 25, No. 1, 2006

Generally, Hispanic and African-American iron deficiency and anemia rates increased significantly more than Caucasion rates

increased.

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USARIEM BCT Study• 1993 study of 174 women in an all-female 8-week BCT company at Fort

Jackson, SC (158 graduated).• Serum ferritin (body iron stores) were low pre-BCT (56% females at less

than 20 ng/ml iron) and decreased further by graduation (84%)(pg.109). • Anemia was correlated with poor PT performance (pg. 111) • Serum folate levels were low normal pre-BCT and “decreased significantly

over BCT.” (pg. 2)• Maternal low folate intake and blood levels have been "associated with

(fetal) neural tube defects“ (pg. 39) (note: neural tube defects can be fatal for the fetus).

• Menu was adequate in energy, but inadequate in B6, folic acid, calcium, magnesium, iron, and zinc.

• Source: “Health, Performance, and Nutritional Status of U.S. Army Women during Basic Combat Training,” (1995)(ADA302042)

• NOTE: Study BCT menu governed by the 1985 AR 40-25

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Institute of Medicine (IOM) Review• Separate review of multiple studies.• 17% of women were iron deficient (<12 ng/ml) and 8% were anemic at BCT entry.

• 35% were deficient and 26% were anemic at AIT entry.• Source: National Academy of Science’s Institute of Medicine (IOM) Committee on Military Nutrition Research (CMNR) 1995 “Review of Issues Related to Iron Status in Women During U.S. Army Basic Combat Training”

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General Population• General Population: 9-11% of adolescent and child-bearing age women are iron deficient and 2-5% are anemic.

• Source: The National Health and Nutrition Examination Survey (NHANES)(1988-1994)(TAB D) conducted by the Center for Disease Control (CDC)

• NOTE: The NHANES uses a more conservative iron deficiency definition than the USARIEM study.

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1985 AR 40-25• AR 40-25, “Nutrition Allowances, Standards, and Education” (BUMEDINST

10110.6; AFI 44-141) • Establishes the dietary allowances for all soldiers 17-50 y/o with

moderate activity levels. • 1985 AR 40-25:

• “The dietary allowance for females and 17- to 18-year old males is 18 milligrams (mg)/day …” (page 3, Chapter 2-5, e)

• "Moderately active female personnel consuming an average of 2,400 calories per day may require supplemental iron to meet the recommended 18 mg/day“ (page 3, Chapter 2-5, e)

• “The computed iron density represents an interpolation between the male and female MRDA for iron. … This iron density (6 mg/1,000 calories) may be inadequate for women." (page 3, Chapter 3-1).

• MRDA for men was 10-18 mg/day and 18 mg/day for females.• AR 40-25 was updated in 2001.

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2001 AR 40-25

• Established iron MRDI at 10 mg/day for men and 15 mg/day for women.

• Added notes that the MRDIs for iron, calcium, phosphorous, and magnesium are low for 17-18 year-olds and menus should be adjusted if the dining facility has a large <19 y/o population. (page 6, Table 2-1, Notes 9-12)

NOTE 1: Current IOM standards for menstruating women on a regular diet are 18 mg/day of iron (27 mg/day for vegetarians) while men only need 12 mg/day. Excess iron is not desirable.

NOTE 2: Federal dietary policy shifted between 1985 and 2001. The 1985 policy was the ‘minimum needed to avoid disease’ while today’s policy is to ‘optimize health.’

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Deficiency Common CausesDiet

• Too little dietary iron• Iron absorption factors:

• plant-based iron is less bio-available than red meat-based iron

• vitamin C-rich foods increase iron absorption• Tea/coffee binds iron in food

Red Blood Cell loss • Menses• Gastro Intestinal bleeding• Ulcers• Exercise

NOTE: Anemia should be evaluated by a physician.

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Deficiency Common ImpactsIron Deficiency/Anemia• Decreased PT/work performance• Fatigue/weakness• Psychological (e.g. Irritability, etc.)• Shortness of breath• Mild decreased cognitive ability

Folate Deficiency Anemia• Birth defects• Fatigue• Anorexia nervosa • Pale skin • Paranoia • Rapid heart beat • Sore, inflamed tongue • Weakness • Weight loss.

• Bruises or tires easily • Feels ill for more than five days • Feels weak or out of breath • Looks pale or jaundiced.

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References1.) The American Dietetic Association and The Canadian Dietetic Association. Position of The American Dietetic Association and The Canadian Dietetic Association: Nutrition for physical fitness and athletic performance for adults. J. Am. Diet. Assoc. 93: 691-696;1993.2.) McArdle, W.D. ; Katch, F.T.; Katch, V.L. Sports & Exercise Nutrition. Philadelphia, PA: Lippincott Williams & Wilkins; 1999.3.) Berning, J.R.; Steen, S.N. Nutrition for Sports and Exercise.Second Edition. Gaithersburg, MD: Aspen Publ. Inc.; 1998.4.) Konig, D.; Weinstock, C.; Keul, J.; Northoff, H.; Berg, A. Zinc, iron, and magnesium status in athletes – influence on the regulation ofexercise-induced stress and immune function. Exerc. Immunol. Rev. 4: 2-21; 1998.5.) Ekblom, B. Micronutrients: effects of variation in [Hb] and iron deficiency on physical performance. In: Nutrition and Fitness: Metabolic and Behavioral Aspects in Health and Disease. World Rev. Nutr. Diet. 82: 122-130; 1997.6.) Weaver, C.M.; Rajaram, S. Exercise and iron status. J. Nutr. 122: 782-787; 1992.7.) Selby, G.B.; Eichner, E.R. Hematocrit and performance: the effect of endurance training on blood volume. Semin. Hematol. 31: 122-127; 1994.8.) Lukaski, H.C.; Bolonchuk, W.W.; Siders, W.A.; Milne, D.B. Chromium supplementation and resistance training: effects on bodycomposition, strength, and trace element status of men. Am. J. Clin. Nutr. 63: 954-965; 1996.9.) Campbell, W.W.; Beard, J.L.; Joseph, L.J.; Davey, S.L.; Evans, W.J. Chromium picolinate supplementation and resistive training by oldermen: effects on iron status and hematologic indexes. Am. J. Clin. Nutr. 66: 944-949; 1997.10.) National Cattlemen’s Beef Association. Iron in Human Nutrition. 2nd ed. Chicago, IL: National Cattlemen’s Beef Association; 1998.11.) Zhu, Y.I.; Haas, J.D. Iron depletion without anemia and physical performance in young women. Am. J. Clin. Nutr. 66: 334-341; 1997.12.) Brun, J.F.; Dieu-Cambrezy, C.; Charpiat, A.; Fons, C.; Fedou, C.; Micallef, J.P.; Fussellier, M.; Bardet, L.; Orsetti, A. Serum zinc inhighly trained adolescent gymnasts. Biol. Trace Elem. Res. 47: 273- 278; 1995.13.) Khaled, S.; Brun, J.F.; Micallef, J.P.; Bardet, L.; Cassanas, G.; Monnier, J.F.; Orsetti, A. Serum zinc and blood rheology in sportsmen(football players). Clin. Hemorheology & Microcirculation 17: 47-58; 1997.14.) Cordova, A.; Navas, F.J. Effect of training on zinc metabolism: changes in serum and sweat zinc concentrations in sportsmen. Ann.Nutr. Metabol. 42: 274-282; 1998.15.) Dolev, E.; Burstein, R.; Lubin, F.; Wishnizer, R.; Chetrit, A.; Shefi, M.; Deuster, P.A. Interpretation of zinc status indicators in a strenuouslyexercising population. J. Am. Diet. Assoc. 95: 482-484; 1995.16.) Singh, A.; Deuster, P.A.; Moser, P.B. Zinc and copper status in women by physical activity and menstrual status. J. Sports Med. Phys.Fit. 30: 29-36; 1990.

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17.) Lemon, P.W.R. Effects of exercise on dietary protein requirements. Int. J. Sport. Nutr. 8: 426-447; 1998.18.) National Research Council. Recommended Dietary Allowance, 10th ed. Washington, DC: National Academy Press; 1989.19.) Biolo, G.; Tipton, K.D.; Klein, S.; Wolfe, R.R. An abundant supply of amino acids enhances the metabolic effect of exercise on muscle protein. Am. J. Physiol. 273: E122-E129; 1997.20.) Singh, M.A.F. Combined exercise and dietary intervention to optimize body composition in aging. Ann. N.Y. Acad. Sci. 854: 378-393; 1998.21.) Campbell, W.C.; Barton, Jr., M.L.; Cyr-Campbell, D.; Davey, S.L.; Beard, J.L.; Parise, G.; Evans, W.J. Effects of an omnivorous dietcompared with a lactoovovegetarian diet on resistance-traininginduced changes in body composition and skeletal muscle in older men. Am. J. Clin. Nutr. 70: 1032 -1039; 1999.22.) Campbell, W.W.; Crim, M.C.; Young, V.R.; Evans, W.J. Increased energy requirements and changes in body composition with resistancetraining in older adults. Am. J. Clin. Nutr. 60: 167-175; 1994.23.) Campbell, W.W.; Crim, M.C.; Young, V.R.; Joseph, I.J.; Evans, W.J. Effect of resistance training and dietary protein intake on proteinmetabolism in older adults. Am. J. Physiol. 268: E1143-E1153; 1995.24.) Pannemans, D.L.E.; Wagenmakers, A.J.M.; Westerterp, K.R.; Schaafsma, G.; Halliday. D. Effect of protein source and quantity onprotein metabolism in elderly women. Am. J. Clin. Nutr. 68: 1228- 1235; 1998.25.) Nieman, D.C. Physical fitness and vegetarian diets: is there a relation? Am. J. Clin. Nutr. 70 (suppl): 570s-575s; 1999.26.) Lyle, R.M.; Weaver, C.M.; Sedlock, D.A.; Rajaram, S.; Martin, B.; Melby, C.L. Iron status in exercising women: the effect of oral irontherapy vs increased consumption of muscle foods. Am. J. Clin. Nutr. 56: 1049-1055; 1992.27.) Pahnke, T.; Lyle, R.M.; Martin, B.; Weaver, C.M.; Corrigan, D. Effect of increased lean beef consumption on iron status and serum zinc in female adolescent runners. FASEB J. 13(4), Part 1, abst. # 217.16, A 246; 1999.28.) Pahnke, T.; Lyle, R.M.; Martin, B.; Weaver, C.M.; Corrigan, D. Effect of increased lean beef consumption on iron status andperformance of adolescent female runners. Med. Sci. Sports Exerc. 31 (suppl 5): 162s; 1999.29.) United States Department of Agriculture. The Food Guide Pyramid. Home and Garden Bulletin No. 252. August 1992.30.) National Cattlemen’s Beef Association. Zinc in Human Nutrition. 2nd ed. Chicago, IL: National Cattlemen’s Beef Association; 1997.

Health & Medicine

Iron b vit def dec 06