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Institute of Medicine (US) Committee on Dietary Supplement Use by Military Personnel; Greenwood MRC, Oria M, editors. Use of Dietary Supplements by Military Personnel. Washington (DC): National Academies Press (US); 2008.

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Use of Dietary Supplements by Military Personnel.

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Preface

This report, titled Use of Dietary Supplements by Military Personnel, is the product of the work of an ad hoc committee under the auspices of the Standing Committee on Military Nutrition Research (CMNR). The CMNR, a standing committee of the Food and Nutrition Board (FNB), was established in 1982 to advise the U.S. Department of Defense (DoD) on the need for and conduct of nutrition research and related issues. This report was produced in response to a request by the Military Nutrition Division of the U.S. Army Research Institute of Environmental Medicine (USARIEM) to the Institute of Medicine (IOM) to convene a committee to review the use of dietary supplements by military personnel and recommend an approach to determine which dietary supplements need active management. Initial sponsors of the study were USARIEM, the U.S. Army Medical Research and Materiel Command, the Samueli Institute, and the National Institutes of Health Office of Dietary Supplements. Their representatives helped with the formulation of the specific questions in consultation with the CMNR. As the project was initiated, the U.S. Food and Drug Administration’s (FDA’s) Center for Food Safety and Applied Nutrition became a sponsor of the study.

A 12-member committee was formed that had expertise in micronutrients, protein, energy balance and sports nutrition, gastroenterology, clinical medicine, food processing and technology, eating behavior and intake regulation, clinical nutrition, dietetics, and psychology. Dietary supplements are widely available through a rapidly expanding market of products that are commonly advertised as being beneficial for health, performance enhancement, and disease prevention. These claims may influence the use of dietary supplements by military personnel, given the importance and frequent evaluation of physical performance and health as criteria to join and remain in the military. The increase in use of these products has raised some concern regarding their overall and long-term efficacy and safety. The evaluation of such products is especially difficult since many contain multiple ingredients, have a changing composition over time, or are used intermittently at doses difficult to measure. Because of these difficulties, it may take a long time for the current system of voluntary adverse event reporting to detect problems. Although the vast majority of military personnel are assumed to be at the same general risk as the overall U.S. population, the specific requirements of some military personnel require that additional due diligence be exercised both with respect to possible benefits and to the possible risks when these products are used by military personnel in particular job classifications and/or environments. For special military subpopulations, relatively minor adverse effects could seriously affect the unit’s ability to perform its mission. It is clear then that these subpopulations within the military are different from the general civilian population, and guidance on managing their use of dietary supplements needs to be tailored to address their specific needs.

This expert committee analyzed the patterns of dietary supplement use among military personnel, and by examining published reviews of the scientific evidence, the committee identified those dietary supplements that are beneficial and/or warrant concern due to risks to health or performance. The committee also developed a system to monitor adverse health effects and recommended a framework to identify the need for active management of dietary supplement use by military personnel. Specifically, the committee did the following:

  1. It reviewed survey data and findings made available to the committee related to supplement use by military personnel to identify (a) which dietary supplements are of most prevalent use, with consideration of differences according to demographic factors such as age, rank, sex, deployment status, military occupational specialty, organization, and unit; and (b) expectations of benefits and reasons for use of dietary supplements by military personnel.
  2. It identified information gaps regarding dietary supplement use by military personnel and recommended processes and designs by which current and future usage of supplements (including dosages, quality, and forms of supplement) should be monitored, surveyed, analyzed, reported, and the resultant data shared.
  3. It selected a limited number of dietary supplements from those identified as commonly used. On the basis of already published reports that review the available scientific evidence, the committee identified those supplements that may be of benefit and/or pose serious hazards to the health and/or physical and cognitive performance capability of military personnel and determined whether further examination and integrative evaluation or research on each is warranted. The committee considered potential effects of supplement withdrawal and interactions.
  4. It considered existing military policies for managing dietary supplements, and assessed the applicability to a military setting of the framework outlined in the 2005 IOM report Dietary Supplements: A Framework for Evaluating Safety and determined how it could be modified to determine which supplements need active management by the military.
  5. It proposed an approach that could be followed to monitor military personnel for adverse health effects that might indicate a concern associated with consumption of dietary supplements.

The DoD has provided many policies and regulations on nutrition for military personnel in many different settings; however, there is currently no systematic approach by which the risks and benefits of the use of dietary supplements by the military are evaluated and whereby parallel servicewide policies address their management. In the absence of those policies, the DoD relies on the monitoring of dietary supplement safety through the FDA. This approach might be adequate for the general public and for those in the military service that perform tasks similar to those of civilians; however, a different approach is needed for specific military subpopulations so that risks that might compromise the success of military operations are not overlooked, and potential benefits in performance or health from use of dietary supplements by military personnel are realized.

The committee carried out its work over 18 months and held three meetings and numerous teleconferences. The first meeting of the committee was held in conjunction with a 2-day workshop. Speakers addressed the issues related to dietary supplement use in the military and included original data on recent military survey instruments. These presentations were useful for the committee’s deliberations and recommendations and are included in this report as individually authored papers in Appendix B.

The committee expresses its appreciation to Andrew Young, Chief of the Military Nutrition Division and representative from the DoD for this task, for generously giving his time and help and for being available to clarify the task of the committee. Special thanks are extended to Rebecca Costello of the Office of Dietary Supplements; Wayne B. Jonas, Joan Walter, Christine Choate, and Deborah Ader from the Samueli Institute; and Patricia Deuster from the Uniformed Services University of the Health Sciences who helped delineate the task, and to Jean Louis Belard from the Telemedicine and Advanced Technology Research Center (TATRC) for his invaluable input during the first committee meeting. In addition, the committee thanks COL Karl Friedl, Director of TATRC, who continues to support the work of the CMNR and was readily available to provide the appropriate contacts needed to gather information for the committee.

On behalf of the committee, I sincerely thank the workshop participants and speakers for addressing topics critical to the completion of the committee’s work. These presentations were important reference sources for the committee. Each speaker provided an excellent presentation, prepared a manuscript of the presentation (see Appendix B), and worked with IOM staff throughout the revision process. Presenters of military surveys on dietary supplements deserve special thanks for going the extra mile in answering questions and analyzing data throughout the study at the committee’s request.

Further, the committee wants to express its deepest gratitude to David Dinges for his effort and committed participation as a consultant to the committee who helped with drafts of the report and provided valuable comments. The quality of the report was significantly improved by the comments of external reviewers, and the diligent oversight of the National Research Council monitor, John Bailar and the coordinator, Robert Cousins. The committee expresses its gratitude to them as well.

The committee owes a strong debt of gratitude to the FNB staff for their professionalism and effectiveness in ensuring that our committee adhered to its task statement, for providing discipline and experience in helping to assemble the report and effectively respond to reviewers, and for providing background research support and organizing our meetings. In particular, we thank Senior Program Officer Maria Oria, who worked on numerous drafts and revisions. Ably assisting Dr. Oria in her efforts were Program Associate Sandra Amamoo-Kakra and Research Associates Shannon Wisham and Alice Vorosmarti. The committee also wants to acknowledge the excellent work of Hilary Ray who edited numerous versions of the report. The committee is also grateful to the overall guidance and continuous support of Linda Meyers, FNB Director.

And finally I want to thank the members of this committee for their diligent and collegial work. I have worked with many committees over the years, and the members of this committee will always have my deepest respect and admiration for their individual accomplishments and their ability to work as a group on these important issues. I hope our readers will find this report informative and useful.

M.R.C. Greenwood, Chair

Committee on Dietary Supplement Use by Military Personnel

Copyright © 2008, National Academy of Sciences.
Bookshelf ID: NBK3968

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