Day-to-day reliability of basal heart rate and short-term and ultra short-term heart rate variability assessment by the Equivital eq02+ LifeMonitor in US Army soldiers.

INTRODUCTION: The present study determined the (1) day-to-day reliability of basal heart rate (HR) and HR variability (HRV) measured by the Equivital eq02+ LifeMonitor and (2) agreement of ultra short-term HRV compared with short-term HRV. METHODS: Twenty-three active-duty US Army Soldiers (5 females, 18 males) completed two experimental visits separated by >48 hours with restrictions consistent with basal monitoring (eg, exercise, dietary), with measurements after supine rest at minutes 20-21 (ultra short-term) and minutes 20-25 (short-term). HRV was assessed as the SD of R-R intervals (SDNN) and the square root of the mean squared differences between consecutive R-R intervals (RMSSD). RESULTS: The day-to-day reliability (intraclass correlation coefficient (ICC)) using linear-mixed model approach was good for HR (0.849, 95% CI: 0.689 to 0.933) and RMSSD (ICC: 0.823, 95% CI: 0.623 to 0.920). SDNN had moderate day-to-day reliability with greater variation (ICC: 0.689, 95% CI: 0.428 to 0.858). The reliability of RMSSD was slightly improved when considering the effect of respiration (ICC: 0.821, 95% CI: 0.672 to 0.944). There was no bias for HR measured for 1 min versus 5 min (p=0.511). For 1 min measurements versus 5 min, there was a very modest mean bias of -4 ms for SDNN and -1 ms for RMSSD (p≤0.023). CONCLUSION: When preceded by a 20 min stabilisation period using restrictions consistent with basal monitoring and measuring respiration, military personnel can rely on the eq02+ for basal HR and RMSSD monitoring but should be more cautious using SDNN. These data also support using ultra short-term measurements when following these procedures.

US Army basic combat training alters the relationship between body mass index and per cent body fat.

INTRODUCTION/BACKGROUND: As a proxy for adiposity, body mass index (BMI) provides a practical public health metric to counter obesity-related disease trends. On an individual basis, BMI cannot distinguish fat and lean components of body composition. Further, the relationship between BMI and body composition may be altered in response to physical training. We investigated this dynamic relationship by examining the effect of US Army basic combat training (BCT) on the association between BMI and per cent body fat (%BF). METHODS: BMI and %BF were measured at the beginning (week 1) and end (week 9) of BCT in female (n=504) and male (n=965) trainees. Height and weight were obtained for BMI, and body composition was obtained by dual X-ray absorptiometry. Sensitivity and specificity of BMI-based classification were determined at two BMI thresholds (25 kg/m2 and 27.5 kg/m2). RESULTS: A progressive age-related increase in fat-free mass index (FFMI) was observed, with an inflection point at age 21 years. In soldiers aged 21+, BMI of 25.0 kg/m2 predicted 33% and 29% BF in women and 23% and 20% BF in men and BMI of 27.5 kg/m2 predicted 35% and 31% BF in women and 26% and 22% BF in men, at the start and end of BCT, respectively. Sensitivity and specificity of BMI-based classification of %BF were poor. Soldiers below BMI of 20 kg/m2 had normal instead of markedly reduced %BF, reflecting especially low FFMI. CONCLUSIONS: BCT alters the BMI-%BF relationship, with lower %BF at a given BMI by the end of BCT compared with the beginning, highlighting the unreliability of BMI to try to estimate body composition. The specific BMI threshold of 25.0 kg/m2, defined as 'overweight', is an out-of-date metric for health and performance outcomes. To the extent that %BF reflects physical readiness, these data provide evidence of a fit and capable military force at BMI greater than 25.0 kg/m2.

Body composition of extreme performers in the US Marine Corps.

BACKGROUND: The creation of highly muscled and strong fighters is a recurring theme in human performance enhancement concepts. Physical readiness standards, intended to prevent obesity in the military, produce contradictory objectives, hounding large individuals to lose weight because of confusion between body size and body composition. Through selection, specialised training and policy exceptions the US Marine Corps has successfully developed a unique group of large (body mass index (BMI) >30 kg/m2) and strong individuals, the body bearers (BB) who carry coffins of Marines to their final resting place. METHODS: We examined the relationship between adiposity and body size from nine male BB (age 25.0±2.1, height: 1.84±0.04 (1.80-1.92) m, BMI: 33.0±2.1 (30-37) kg/m2). Body composition was assessed by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance (BIA) and tape measured abdominal circumference (AC)-based equations and from three-dimensional scanning (3DS). RESULTS: Measures were made of fat-free mass (FFM): 90.5±7.0 (82.0-106.7) kg, where FFM included total body water: 62.8±5.0 (55.8-71.8) L, representing 69±2 (67-73) % of FFM, along with calculated FFM index: 26.8±2.4 (24.4-32.9) kg/m2). DXA measures were made for bone mineral content 4.1±0.4 (3.5-4.9) kg, bone mineral density (BMD) 1.56±0.10 (1.37-1.76) g/cm2 and %BF 19.5±6.6 (9.0-27.8). Additional measures of percent body fat (%BF) were made by AC: 20.3±2.9 (15.2-24.6), BIA: 23.7±6.4 (9.8-29.2) and 3DS: 25.5±4.7 (18.9-32.2). AC %BF reasonably matched DXA %BF, with expected overprediction and underprediction at low and high DXA %BF. BIA %BF was affected by deviations from assumed FFM hydration (72%-73%). CONCLUSION: These men are classified as obese by BMI but carried massive amounts of muscle and bone on their large frames, while presenting a range of %BF irrelevant to strength performance. BMI did not predict obesity and adiposity had no association with muscle mass and strength performance.

Evaluation of anthropometric equations to assess body-composition changes in young women.

BACKGROUND: Healthy young women who engage in an exercise program may lose fat that is not reflected in body weight changes because of concurrent gains in fat-free mass (FFM). OBJECTIVE: This study addressed the question of how well anthropometry-based predictive equations can resolve these changes. DESIGN: Several widely used skinfold-thickness- or circumference-based equations were compared by using dual-energy X-ray absorptiometry to study 150 healthy young women before and after 8 wk of Army basic combat training (average energy expenditure: 11.7 MJ/d). RESULTS: Women lost 1.2 +/- 2.6 kg fat (mean +/- SD) and gained 2.0 [corrected] +/- 1.5 kg FFM. Fat loss (r = 0.47), but not FFM gain (r = 0.01), correlated with initial fatness. Thus, for many women who lost fat, body weight did not change or increased. Fat loss was associated with a reduction in abdominal circumference but this alone was not a consistent marker of fat loss. One circumference equation and one skinfold-thickness equation yielded the smallest residual SDs (2.0% and 1.9% body fat, respectively) compared with the other equations in predicting body fat. The sensitivity and specificity of the best equations in predicting changes in percentage body fat were not better than 55% and 66%, respectively. CONCLUSIONS: These data suggest that for women, anthropometry can provide better estimates of fatness than body mass index but it is still relatively insensitive to short-term alterations in body composition. Not surprisingly, the circumference equation that includes the most labile sites of female fat deposition (ie, waist and hips instead of upper arm or thigh) proved to be the most reliable.

Endocrine markers of semistarvation in healthy lean men in a multistressor environment.

We tested the hypothesis that key endocrine responses to semistarvation would be attenuated by changing only the food intake in a multistressor environment that also included sustained workload, inadequate sleep, and thermal strain. Serum hormones were compared within and between two groups of healthy young male volunteers participating in the 8-wk US Army Ranger course, with four repeated cycles of restricted energy intakes and refeeding: group 1 (n = 49) and group 2 (n = 48); energy deficits averaged 1,200 and 1,000 kcal/day, respectively. After 8 wk, most of group 1 achieved a minimum body fat, serum 3,5,3'-triiodothyronine (T(3)) was below normal (78 +/- 20 ng/dl), testosterone (T) approached castrate levels (4.5 +/- 3.9 nmol/l), insulin-like growth factor I (IGF-I) declined by one-half (75 +/- 25 microg/l), and cholesterol rose from 158 +/- 31 to 217 +/- 39 mg/dl. Bioavailable T(3) and T were further reduced by increases in their specific binding proteins in response to declining insulin. Refeeding, even with continuation of the other stressors, produced prompt recovery of T(3), T, and IGF-I. Higher energy intakes in group 2 attenuated the subclinical hypothyroidism and hypercholesterolemia, whereas consistent luteinizing hormone suppression indicated centrally mediated threshold effects on gonadal hormone suppression. We conclude that low T, T(3), and IGF-I remained reliable markers of acute energy deficits in the presence of other stressors; elevated cholesterol and cortisol provided information about chronic status, corresponding to diminishing body fat stores.

Physical performance and metabolic recovery among lean, healthy men following a prolonged energy deficit.

Previous studies have demonstrated that full recovery from weight loss may take months or years. The present investigation examined short-term recovery (5 wks "post") of physical performance (muscular strength, muscular power, vertical jump), body composition, metabolic hormones (testosterone, luteinizing hormone, sex hormone binding globulin, insulin-like growth factor-1, triiodothyronine, thyroxine, thyroid binding globulin, and thyroid-stimulating hormone) and metabolic markers (transferrin, ferritin, prealbumin, glycerol, nonesterified fatty acids, high-density lipoproteins, and lactate) in 10 healthy young men after an 8-week Army course with an energy deficit (1000 kcal/d) and loss of body mass (-12%). Subjects ate ad libitum after the course ended ("post"). Body composition was determined by dual-energy X-ray absorptiometry; strength from a simulated power clean, power from body mass and jump height, and metabolic hormones were measured in morning-fasted blood by radioimmunoassay. With the exception of transferrin and glycerol, all study parameters were significantly (p<.05) altered by the training course. At 5 weeks post fat-free mass along with all physical performance measures returned to initial levels; however, fat mass had significantly (p<.05) increased over initial levels. Also, with the exception of lactate, all measured hormones and markers were close to initial levels and within normal ranges. Reported complications during recovery included sleep irregularities, diarrhea, loss of motivation and feelings of fatigue. While the long range effect of this energy deprivation experience is uncertain, these data do suggest that severe weight loss does not result in lasting alterations of the contractile and metabolic properties of skeletal muscle in young, lean, healthy men.

Validity of percent body fat predicted from circumferences: classification of men for weight control regulations.

Each of the military services classifies individuals in their weight control programs using percent body fat predicted by circumference-based equations. Although derived independently from service-specific samples, each of the male equations relies on waist circumference adjusted by a neck circumference. In this study, the authors examined the performance of the equations in 496 young (< 40 years) male soldiers, compared to percent body fat measured by dual-energy X-ray absorptiometry. The strength of the relationship to percent body fat improved from body mass index (weight/height2), to a waist circumference alone, to the difference between waist and neck circumferences. Overweight men who were misclassified by overestimation of total percent body fat using the equations (2.6% of the total sample) had normal neck circumferences and height but large waistlines, indicating that they were still classified appropriately to the goals of the weight control programs, all of which center on abdominal adiposity. The authors demonstrate that each of the service equations yield substantially similar results and discuss why a single equation could be easily agreed to and used by the Department of Defense for male body fat prediction.

Effects of food restriction in military training on T-lymphocyte responses.

In a stress model which included food restriction, we examined the effects of physically rigorous military training and increased caloric intake on T-lymphocyte responses and lymphocyte subsets. T-lymphocyte proliferation and release of soluble receptor for interleukin-2 (slL-2R) in vitro were measured in two separate training classes of male U.S. Army ranger course (RC) trainees at the start and during the RC. Trainees in group 1 (n = 55) and 2(n = 50), respectively, had mean (+/- SD) energy intakes of 11.8 +/- 7.0 and 13.6 +/- 6.7 MJ/d, averaged total daily energy expenditures of 16.7 and 17.6 MJ/d, and experienced body weight losses of 15.]% and 12.6%. Both groups showed decreases T-lymphocyte responses in vitro: proliferation to phytohemagglutinin (PHA) and tetanus toxoid (TT), and released slL-2R to PHA. Group 2 with an intended 15% increase in energy during the RC over group 1 showed 22% and 26% less severe suppressions of T-lymphocyte proliferation and released slL-2R, respectively, in vitro. Group 2 also showed that short-term (9 days) removal of the food restriction stressor allowed for corrected body weight, total lymphocyte and T-lymphocyte subset counts but not suppressed T-lymphocyte responses in vitro. These results demonstrate that soldiers in physically rigorous military training are at risk of suppressed T-lymphocyte immunocompetence, and this is greater if they also experience inadequate energy intake.

Development and biomedical testing of military operational rations.

This article gives a brief history of military nutrition research in this century and reviews recent advances made through field testing. Although modern rations are nutritionally complete, ration developers are challenged to improve palatability to promote increased intakes in field training and combat settings. The principal goal for military nutritionists is to identify the optimal macronutrient mix and specific ration components that sustain a soldier's performance in the face of operational stressors such as sleep deprivation, intense physical activity, climatic extremes, and hypobaric hypoxia. Energy expenditures during typical field-training exercises average approximately 4000 kcal/day, whereas energy intakes are usually 3000 kcal/day or less when operational rations are consumed. One way to ameliorate the effects of this shortfall is to provide soldiers with a carbohydrate beverage supplement.

Use of bioelectrical impedance analysis measurements as predictors of physical performance.

Through its association with fat-free mass (FFM), bioelectrical impedance analysis (BIA) offers an alternative to physical performance testing. We examined the relations between stature2/resistance (S2/R), FFM, and muscular strength in data from three studies of young military men and women. Resistance was measured at 50 kHz by using the conventional tetrapolar electrode method. FFM was based on skinfold thicknesses, and estimated with the regression equations of Durnin and Womersley. Strength was measured as a one-repetition maximum on an incremental lift test (IL1RM), which is widely used by the military services to predict overall body strength. Although there was an association between IL1RM and S2/R in each of these studies (correlations ranged from 0.35 to 0.53), correlations were strongest between FFM and S2/R (R = 0.53 to 0.85), indicating that BIA and FFM derived from skinfold thicknesses are better correlated with each other than are the relations of either of these with physical performance. Modest increases in FFM and strength in one 8-wk training study correlated with S2/R; however, large decreases in FFM and strength in another study (with weight losses of 10 kg in 8 wk) were not reflected by changes in S2/R. Thus, BIA is not particularly useful for performance prediction despite its moderate relation to FFM. BIA is especially problematic with large changes in body composition, for which there are apparent deviations in hydration status; expedient methods such as skinfold predictions will be more resistant to such effects.

Regional fat placement in physically fit males and changes with weight loss.

The abdomen is the principal site of fat deposition in men, and because abdominal fat is readily mobilized during exercise, the relative proportion of fat in the abdominal site may negatively correlate with the amount of regular physical activity, and even with physical fitness. This study presents data for regional fatness in 165 fit young men (U.S. Army Ranger candidates; initial body fat = 14.7 +/- 4.7%) assessed by dual-energy x-ray absorptiometry (DEXA), and for relative changes occurring following a 13% weight loss produced by a 1000 kcal.d-1 energy deficit over 8 wk. Fat-free mass was constant across quintiles of percent body fat; only fat mass was different (16.2 +/- 2.2 kg and 6.0 +/- 1.4 kg at upper and lower quintiles, respectively). Truncal fat accounted for about 41% of total body fat in all quintiles; only the proportion of fat distributed to the arms was significantly higher in the fattest quintiles of men. Among a group of less intensely trained soldiers with the same average fatness as the highest quintile of Ranger students (20%), relative fat distribution to the trunk approached 50% of the total fat. Following weight loss, Ranger students lost half of the fat in all regions assessed (legs, arms, and trunk). The only significant association between regional losses and initial fatness was a greater proportion of fat lost from the arms in the fattest Rangers. These data suggest a "fit fat" distribution in active young men in which fat remains in the arms and legs until extreme weight loss occurs and the metabolically more active abdominal fat approaches depletion.

Effects of reduced fat intake on serum lipids in healthy young men and women at the U.S. Military Academy.

To assess the benefits of Army nutrition initiatives reducing intakes of fat and cholesterol, the authors studied the dietary intakes of cadets at the U.S. Military Academy and compared these results and related nutritional indicators (body composition, serum lipid status) to data obtained one decade earlier. The regular Cadet Mess menu provided 16.6 MJ/day of energy with 34% derived from fat. Actual intakes, including supplements, averaged 14.9 +/- 2.9 and 9.7 +/- 2.1 MJ/day for 119 male and 86 female cadets, respectively. Most cadets derived < 35% of energy from dietary fat (11% from saturated fatty acids), representing a significant reduction since the previous study, in which nearly one-third of cadets received 40 to 45% of calories from fats; cholesterol intakes were markedly reduced. Serum cholesterol levels were approximately 7% lower, but were less affected than predicted by the reductions in fat and cholesterol intakes; serum low-density lipoprotein-cholesterol was also significantly reduced. Fasting serum insulin correlated with saturated fat intake in female cadets, indicating another health risk factor affected by intakes. The authors conclude that nutrition initiatives reducing energy derived from fats and total cholesterol intake have had a beneficial effect on the nutritional status of this fit young population.

Lower limit of body fat in healthy active men.

We examined body composition changes in 55 normal young men during an 8-wk Army combat leadership training course involving strenuous exercise and low energy intake, with an estimated energy deficit of 5.0 +/- 2.0 MJ/day and a resultant 15.7 +/- 3.1% weight loss. Percent body fat (BF) measured by dual-energy X-ray absorptiometry (DEXA) averaged 14.3% (range 6-26%) and 5.8 +/- 1.8% (range 4-11%) at the beginning and end of the course, respectively. Men who achieved a minimum percent BF (4-6%) by 6 wk demonstrated only small additional total and subcutaneous fat losses in the final 2 wk and sacrificed increasingly larger proportions of fat-free mass. Percent BF estimated from skinfold thicknesses reflected relative changes in fat mass, although actual percent BF was overestimated. Instead of reaching a plateau after fat stores were substantially depleted, abdominal, hip, and thigh girths continued to decline with body weight loss. Final percent BF for the leanest men was similar to that observed after a 25% body weight reduction in the 1950 Minnesota study (5.2% by underwater weighting), and height-corrected final fat mass was the same (1.0 +/- 0.2 vs. 0.9 +/- 0.7 kg fat/m2), suggesting that these values represent a minimal body fat content in healthy men and that weight loss subsequent to achieving this level is contributed from the fat-free mass. Our results suggest that 4-6% BF or approximately 2.5 kg fat represents the lower limit for healthy men, as assessed by DEXA or by underwater weighing.

Loss of muscle mass is poorly reflected in grip strength performance in healthy young men.

Isometric maximal handgrip strength (GSmax) has been used as an expedient test of overall muscle strength and index of fat-free mass (FFM). We tested this relationship in 55 fit young men undergoing high rates of FFM loss in an 8.5-wk military training course involving multiple stressors including nutritionally uncomplicated energy deficit. GSmax was measured by a hand dynamometer interfaced with a computer providing visual feedback; another strength test, measuring dynamic strength of larger muscle groups (Cleansim), was also performed. GSmax did not change (530 +/- 57 vs 529 +/- 63 N) in the face of a 15.6% loss of body weight (12.1 +/- 3.4 (SD) kg), including 6.9% loss of FFM (4.6 +/- 2.6 kg), but Cleansim decremented significantly (77.4 +/- 9.6 to 58.7 +/- 8.9 kg) and changes were significantly correlated with delta FFM for GSmax (r = 0.31) and Cleansim (r = 0.49). We conclude that GSmax is not a good representation of changes in total FFM in healthy young men even though it appears to be useful in more severely catabolic patients with extreme losses of FFM and in pubertal boys making large gains in FFM. Other aspects of physical performance are clearly affected by high rates of weight loss, as demonstrated by decrements in the Cleansim and its stronger relationship to delta FFM.

Maintenance of iron status in healthy men during an extended period of stress and physical activity.

Body weight loss and iron status of 55 male soldiers were measured during 62 d of intense physical activity and sustained stress and sleep deprivation. Body weight declined from (mean +/- SD) 75.9 +/- 9.0 to 63.8 +/- 6.7 kg (P < 0.05). Serum iron fell from 13.7 +/- 5.6 to 8.3 +/- 3.6 mumol/L by 14 d (P < 0.05), but returned to baseline values by 8 wk. Total iron-binding capacity declined from 53.4 +/- 6.8 at baseline to 47.5 +/- 6.3 mumol/L at 8 wk (P < 0.05). During the study, hematocrit, serum hemoglobin, and erythrocyte count did not change, whereas ferritin increased from 116 +/- 84 to 202 +/- 106 micrograms/L (P > 0.05). Adequate dietary iron, initiation of training with adequate body iron stores, and physical activity not in excess of pretraining workloads contributed to the maintenance of iron status during prolonged physical activity and stress. Our results suggest that some acute phase-like disturbances in iron metabolism may be a normal component of adaptation to stress and physical activity in healthy men.

A longitudinal study of infections and injuries of Ranger students.

Causes of medical attrition and their implications for medical support for the U.S. Army Ranger course are considered, based on data collected from 190 students in a summer class. In the second half of the course, an increase in documented infection rates, notably cellulitis of the lower extremities and Streptococcus carriage prevalence, coincided with indications of compromised immune function. The authors suggest that aggressive treatment in the field, including liberal use of antibiotics, and periodic examination of each student by medical personnel are critical factors which will minimize medical attrition and ensure safe participation of soldiers in this and other stressful and sustained field exercises.

Factors associated with stress fracture in young army women: indications for further research.

Several factors which affect bone density and predict risk of osteoporosis (e.g., ethnic origin, amenorrhea) are reportedly associated with a higher incidence of stress fracture in active premenopausal women. The authors surveyed 2,312 active duty Army women for the prevalence of ever having been diagnosed ("told by a doctor") with a stress fracture (16.1% of respondents) and examined the relationship between surveyable risk factors for low bone density and this self-reported stress fracture history (self-reported SF). Current smoking, previous history of amenorrhea (menses absent greater than 6 months), and known family history of osteoporosis were significantly associated with self-reported SF, while black ethnic origin was a protective factor. These data suggest hypotheses of stress fracture pathogenesis in Army women which bear further testing.