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Aus dietary calcium& iron review
1. Dietary Calcium Review
• Osteoporosis is a major public health issue in Australia
• Calcium intakes of female officers-in-training have
improved over the last decade
• 10% of Army recruits (male) and 20% of female officers-
in-training do not eat sufficient dietary calcium
Publications: Carins J. Nutritional determinants of bone health: A survey of ADF
trainees DSTO TR-1754, 2005.
Booth CK, Carins J. Nutritional Determinants of Bone Health: Implications for the
Australian Defence Force. Aust Mil Med 2006;15:9-13.
2. Dietary Calcium Review
Recommendations:
• An holistic approach to nutrition education
• Increase range of dairy foods provided within Defence
messes to include low-fat varieties
• Supplements should be considered for ADF personnel
engaged in strenuous physical activity in hot climates
where combat ration packs (CRP) are the major source
of nutrition
• On-going monitoring of dietary intake
3. Bone Health
• What is the prevalence of preventable risk factors
among the Australian Defence Force?
• How to identify high risk groups? (simple screening)
• Are groups at particular risk?
– Clearance divers
– Submariners
– Infantry
– Special Forces
What are the best interventions for the ADF?
4. ADF Bone Health Survey
Determine prevalence of key risk factors across ADF
– Diet and lifestyle factors
– Calf-muscle endurance, muscle size, foot type
– Tibia and calcaneal densitometry
– 25 (OH) Vitamin D, serum bone markers (6% mild vit D
deficiency)
→Design screening and prevention programs
5. Iron Status & Performance
Iron status & fitness
-5.0 -2.5 0.0 2.5 5.0 7.5 10.0
-60
-40
-20
0
20
Change in aerobic fitness
Changeinironstatus
(%)
6. Iron Status & Performance
Iron status & alcohol
1 2 3 4 5 6 7 8 9 10 11
-70
-50
-30
-10
10
Alcoholic drinks per day
Changeinironstatus
(%)
7. Iron Status & Performance
Female officers-in-training
Baseline 7 weeks 13 weeks
20
25
30
35
Low-dose iron supplement
Placebo supplement
Ironstatus
8. Iron Status & Performance
Iron status over the ACRT
0 10 20 30 40 50
60
90
120
150
Haemoglobin-M (g/L)
Ferritin-M (mg/L)
Day
Ironstatus
9. Gender Issues: Iron Status
Use of low-dose COTS iron supplements is not an
effective preventive strategy for iron deficiency
Publication: Carins J, Booth C, Coad R. A Low Dose Ferrous Gluconate
Supplement Fails to Alter the Iron Status of Female Officers-in-Training.
ARM 01/067, DSTO-RR-0297, 2005.
Recommendations:
• Nutrition education
• Iron status monitoring program for females
• Supplemental iron (slow-release, 30–100 mg Fe) be
administered under medical supervision for
treatment of diagnosed iron deficiency
10. Iron Status and Performance
• Do the observed decreases in iron status have
adverse training outcomes?
• Does iron intake above the recommended levels
have beneficial effects on physical or cognitive
performance?
• What is the best strategy to prevent iron deficiency?
Editor's Notes
The importance of dietary calcium in the prevention of poor bone health and osteoporosis in later life is well recognised and two National Diet Surveys have highlighted the problem of many Australian women eating insufficient calcium. Surveys of ADF trainees revealed 10 % of Army recruits (mostly male) and 20 % of female officers-in-training at risk of not meeting their calcium requirements – mostly due to not eating enough dairy foods. Although the eating habits of female officers-in-training appear to have improved over the last 10 years, many of the women still fall short of meeting their calcium requirements. Furthermore, female recruits are more at risk of bone-related injury than males.This paper discusses the nutritional determinants of bone health of most relevance to the ADF, describes some current US and Australian military research and makes some recommendations for prevention of poor bone health among ADF personnel.
Poor diet has been identified as a modifiable risk factor for stress fractures and other bone-related injuries, particularly among female military personnel. Other personnel (such as submariners) living for periods in closed environments and away from sunlight may have reduced plasma levels of 25-(OH) vitamin D and special challenges in calcium metabolism, which may compromise bone health.
ADF personnel have been involved in a study designed to determine the prevalence of known risk factors for poor bone health and bone-related injury, including dietary calcium intake, vitamin D status, serum markers of bone turnover, bone mineral density, life-style factors, calf-muscle strength and foot type. ADF personnel at particular risk of poor bone health and bone-related injury will be identified. This will be achieved by correlation of known risk factors with actual injuries.
Note: The prospective injury study has been abandoned, because we were unable to access Army recruits. The data analysis will now make use of previous injury history. Data analysis will begin in the next few months (2207)
B-CTX (resorption), P1NP (formation)
These data show the plasma ferritin results for a group of British sappers engaged in Adventure training (2000). Aerobic fitness was estimated by use of the standard Shuttle run test combined with heart rate monitors. Results were recorded at the beginning and on the final day of the 23 day adventure training.
Publication: Booth CK, Coad RA, Roberts W. The Nutritional, Physiological and Psychological Status of a Group of British Sappers after 23 Days of Adventure Training in the Hot Wet Tropics. ARM 01/067; DSTO-RR-0243, 2002.
From the same study as shown in the previous slide, change in iron status (plasma ferritin) is associated with the amount of alcohol consumed. A standard drink contains about 10g of alcohol. (Only one group of soldiers had access to alcohol during the training exercise). Alcohol intake is the average per day over 23 days for each soldier.
Iron status as measured by plasma ferritin at 3 testing points over one semester of university coursework. There was no evidence for a difference between the control and treatment groups, for any of the measures of iron status used in this study. However, the changes at each time point were significant.
Publication: Carins J, Booth C, Coad R. A Low Dose Ferrous Gluconate Supplement Fails to Alter the Iron Status of Female Officers-in-Training. ARM 01/067, DSTO-RR-0297, 2005.
These data are from a study involving Army recruits undertaking basic training (the Army Common Recruit Training). The data for males, only, is presented. Changes at the testing points were significant.
Publication: Booth CK, Probert B, Forbes-Ewan CF, Coad RA. Australian Army Recruits in Training Display Symptoms of Overtraining. Mil Med 2006;171:1059-1064.
