Researchers from the U.S. Army Research Institute of Environmental Medicine have teamed up with the Trainee Health Surveillance Flight 559th Medical Group’s Basic Military Training Team at Joint Base San Antonio-Lackland, Texas, to make a decision whether increased vitamin D and calcium intake can improve bone health in military personnel.
Stress fractures and musculoskeletal injuries are among the many leading causes of medical holdovers during basic military training, and sometimes bring about attrition of military personnel early of their careers. As many as five percent of males and 20 percent of females may develop some kind of stress fracture during military training because of the novice warriors’ inability to resist unaccustomed, repeated stress to their bodies, reminiscent of marching with body armor.
“Optimizing bone health of military personnel is very important, especially during Basic Military Training and other military training activities,” explained Dr. James McClung, a nutritional biochemist with USARIEM’s Military Nutrition Division. “These injuries are costly to warfighters and to the army, as a good portion of people who are suffering from stress fracture leave military service and stress fracture leads to substantial health care costs related to treatment and rehabilitation.”
Recent studies have linked vitamin D and calcium to bone health and the prevention of stress fractures. In a 2008 study conducted by Creighton University, along with the Navy, greater than 5,000 female recruits underwent an ordeal during which they consumed either a supplement containing vitamin D and calcium or a placebo over the eight weeks of Navy boot camp.
During the process that study, 270 stress fractures were observed within the placebo group, but only 226 stress fractures were observed inside the group receiving the vitamin D and calcium supplement. Advanced analysis showed that vitamin D and calcium supplementation could have reduced the danger of stress fracture by as much as 20 percent.
“We say ‘may have reduced the risk’ because missing from that study were biochemical indicators of nutritional health or functional indicators of bone health,” McClung said. “There were just not enough data to make use of this study because the sole basis for implementing policy changes affecting vitamin D and calcium levels within the warfighter diet.”
So, McClung and his team of researchers, managed by Dr. Erin Gaffney-Stomberg, a research fellow in the division, got down to explore the biochemical and functional basis for these findings, with the goal of providing Army and Air Force personnel with levels of vitamin D and calcium according to the Navy study. After conducting an initial study with the military in 2012, McClung partnered with the team at JBSA-Lackland in October 2013, for more research.
Air Force recruits, both female and male, participated in an ordeal equivalent to the Navy study, but this time they got a snack bar either fortified with vitamin D and calcium that was developed in collaboration with scientists from the dep. of Defense Combat Feeding Directorate on the Natick Soldier Research, Development and Engineering Center, in Natick, Mass., or a placebo snack bar.
McClung’s team of researchers collected physiological data from Airmen twice during their training, on day three in their reception phase of educating and again immediately in advance of graduation. Techniques included body composition assessment (using military standards), blood collection, a bone scan using a tool called a peripheral quantitative computed tomography, and paper surveys. This round of collected data was sent to USARIEM’s headquarters in Natick, Mass., to boot Pennington Biomedical Research Institute, Baton Rouge, La., for assessment.
According to McClung, they’d with reference to a 90 percent rate of compliance from Airmen on this study.
“We have had great support from everyone at Lackland for this study, from the leadership to the recruits,” McClung said. “This is essential because we now have extended the scope of our knowledge beyond the military, and we have now the root to increase nutrition recommendations to the Air Force based upon data collected directly from their personnel.”
The leadership at Lackland agrees that this collaboration is efficacious and will not had been conducted in partnership with some other organization.
“As I reviewed the army literature on stress fractures and prevention, it was clear that Doctor McClung and the USARIEM team were the simplest assets in DOD who had published on nutrition and impacts on military training,” said Thomas Leo Cropper, director of Trainee Health Surveillance Flight 559th Medical Group at Lackland. “We consulted them to realize access to the most recent military science knowledge on nutrition and armed forces performance to enhance military training outcomes.”
According to Cropper, stress fractures are costly because they could require multiple doctor visits and medical tests comparable to X-rays or MRIs, plus physical therapy, that may cost the Air Force greater than $6,000 per case. Added to that, trainees miss weeks to months of costly military training while they wait to heal in medical hold after which exercise to regain fitness to satisfy military physical training standards required to graduate.
“Many trainees get demoralized after a stress fracture and give up,” Cropper said. “If we will be able to prevent stress fractures or other injuries, it’s far better for all concerned.”
McClung and his team plan to come to Lackland in spring 2014, to continue testing within the hopes of forestalling future injuries. On the completion of the study, scientists from USARIEM will share those data with senior leaders from the DOD’s medical and coaching commands on the way to determine whether providing vitamin D and calcium beyond the present recommended daily allowance can be beneficial for the optimization of bone health during military training.
“Military personnel represent a novel population faced with sometimes intense physical demands,” McClung said. “Our goal is that findings from these studies will provide the data essential to determine the optimal vitamin D and calcium requirement of military personnel for the upkeep of bone health and prevention of stress fractures to maintain warfighters mission ready for the long haul.”
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