Every aspect of immune function and host defense is dependent upon a proper supply and balance of nutrients. Severe malnutrition can cause significant alteration in immune response, but even subclinical deficits may be associated with an impaired immune response, and an increased risk of infection. Infectious diseases have accounted for more off-duty days during major wars than combat wounds or nonbattle injuries. Combined stressors may reduce the normal ability of soldiers to resist pathogens, increase their susceptibility to biological warfare agents, and reduce the effectiveness of vaccines intended to protect them. There is also a concern with the inappropriate use of dietary supplements.

This book, one of a series, examines the impact of various types of stressors and the role of specific dietary nutrients in maintaining immune function of military personnel in the field. It reviews the impact of compromised nutrition status on immune function; the interaction of health, exercise, and stress (both physical and psychological) in immune function; and the role of nutritional supplements and newer biotechnology methods reported to enhance immune function.

The first part of the book contains the committee's workshop summary and evaluation of ongoing research by Army scientists on immune status in special forces troops, responses to the Army's questions, conclusions, and recommendations. The rest of the book contains papers contributed by workshop speakers, grouped under such broad topics as an introduction to what is known about immune function, the assessment of immune function, the effect of nutrition, and the relation between the many and varied stresses encountered by military personnel and their effect on health.

Contents

• COMMITTEE ON MILITARY NUTRITION RESEARCH
• FOOD AND NUTRITION BOARD
• PREFACE
• EXECUTIVE SUMMARY
  • Committee's Task
  • Overview of Nutritional Status and Immune Function
  • Findings and Conclusions
  • Recommendations
  • Recommendations for Future Research
  • References
• I. COMMITTEE SUMMARY, RESPONSES TO QUESTIONS, CONCLUSIONS, AND RECOMMENDATIONS
  • 1. A Review of the Role of Nutrition in Immune Function
    • The Committee's Task
    • Stage Setting: The Military Situation
    • Introduction to Immune Function
    • Assessment of Immune Function
    • Nutrition
    • Health and Stress
    • Summary
    • References
  • 2. Committee Responses to Questions
    • Responses to Questions Posed by the Army
    • References
  • 3. Committee Conclusions and Recommendations
    • Conclusions
    • Recommendations
    • Recommendations for Future Research
    • References
• II. STAGE SETTING: THE MILITARY SITUATION
  • 4. Why Is the Army Interested in Nutrition and Immune Function?
    • Introduction
    • Background
    • Immune Suppression and Inflammatory Responses to Operational Stressors
    • Military Models to Study Operational Stressors
    • Mechanisms of Increased Infection Susceptibility: Army-USDA Cooperative Research Data
    • Specific Nutritional Fixes and the Promise of Immune Sustainment and Potential Superimmunity
    • Dietary Supplements: Army Researchers as the Honest Brokers
    • Author's Conclusions
    • References
    • Discussion
  • 5. Physiological and Immunological Impact of U.S. Army Special Operations Training A Model for the Assessment of Nutritional Intervention Effects on Temporary Immunosuppression
    • Introduction
    • Research Objectives
    • Results
    • Author's Conclusions and Recommendations
    • References
    • Discussion
  • 6. Immune Function Studies During the Ranger Training Course of the Norwegian Military Academy
    • Introduction
    • Immune Changes During Norwegian Ranger Training
    • Author's Summary and Recommendations
    • References
    • Discussion
• III. INTRODUCTION TO IMMUNE FUNCTION
  • 7. Nutrition and Immune Responses: What Do We Know?
    • Introduction
    • General Concepts
    • Immune Responses in Altered Nutritional Status
    • Other Factors Influencing Immune Responses
    • Nutritional Supplements for Boosting Immunity
    • Concluding Remarks
    • References
    • Discussion
  • 8. Cytokines and Nutritional Status: Possible Correlations and Investigations
    • Introduction
    • References
    • Discussion
• IV. ASSESSMENT
  • 9. Methodological Issues in Assessment of Human Immune Function
    • Introduction
    • Rationale for Immune Assessment
    • The Immune System
    • Selection and Development of the Test System
    • Author's Conclusions
    • References
    • Discussion
  • 10. Application of Whole-Blood Cultures to Field Study Measurements of Cellular Immune Function In Vitro
    • Background
    • Methods and Results
    • Author's Conclusion
    • References
    • Discussion
• V. NUTRITION
  • 11. Glutamine
    • Introduction
    • Physiologic Biochemistry
    • Glutamine and Immune Function
    • Glutamine and the Gastrointestinal Tract
    • Author's Discussion and Conclusions
    • References
    • Discussion
  • 12. Vitamin A and Immune Function
    • Introduction
    • Clinical Manifestations of Vitamin A Deficiency
    • Epidemiology of Vitamin A Deficiency
    • Vitamin A Deficiency in Adults
    • Vitamin A Deficiency As An Immunodeficiency Disorder
    • Considerations for Adult Men and Women
    • Author's Conclusions
    • References
    • Discussion
  • 13. Vitamin E, Vitamin C, and Immune Response: Recent Advances
    • Introduction
    • Aging
    • Cancer
    • Aids
    • Asthma and Lung Function
    • Exercise
    • Authors' Conclusions
    • Acknowledgments
    • References
    • Discussion
  • 14. Fatty Acids and Immune Functions
    • Introduction
    • Amount of Fat Intake and Human Immune Response
    • n-6 Pufa and Human IR
    • n-3 Pufa and Human Immune Response
    • Clinical Trials With n-3 PUFA
    • Mechanisms by Which Dietary Fat Alters Immune Response
    • Author's Conclusions and Recommendations
    • References
    • Discussion
  • 15. Iron Metabolism, Microbial Virulence, and Host Defenses
    • Introduction
    • Iron Metabolism
    • Iron Acquisition by Microbes
    • Effects of Iron Deficiency on Immune Function
    • Effects of Iron Excess on Immune Function
    • Clinical Data in Iron Deficiency and Iron Excess
    • Implications of Iron Deficiency for the Military
    • References
    • Discussion
  • 16. Trace Minerals, Immune Function, and Viral Evolution
    • Introduction
    • Zinc
    • Copper
    • Selenium
    • Author's Summary and Conclusions
    • References
    • Discussion
• VI. HEALTH AND STRESS
  • 17. Exercise, Infection, and Immunity: Practical Applications
    • Introduction
    • Exercise Prescription and the Immune Response to Acute Exercise Bouts
    • Chronic Exercise and Immunity
    • Exercise and Upper Respiratory Tract Infections
    • Infection and Exercise Performance
    • Exercise and HIV Infection
    • Exercise, Aging, and Immunity
    • Practical Guidelines for Military Recruits and Athletes
    • Author's Conclusions and Recommendations
    • References
    • Discussion
  • 18. Neuroendocrine Consequences of Systemic Inflammation
    • Introduction
    • Hypothalamic-Pituitary-Adrenal Activation
    • Syndrome of Inappropriate Antidiuretic Hormone Secretion
    • Pituitary-Thyroid Regulation in Inflammatory Disease
    • Pituitary-Gonadal Regulation
    • Growth Hormone in Sepsis
    • Author's Summary and Conclusions
    • References
    • Discussion
  • 19. Inflammatory Stress and the Immune System
    • Introduction
    • Immune Regulation of the HPAA by Cytokines
    • Immune System Activation of the HPAA Counterregulates Cytokines and Protects Against an Excessive Host Response to Inflammatory, Immune, and Infectious Insults
    • Inflammatory, Immune, and Infectious Stress Induces Peripheral Immunosuppression and Anti-Inflammatory Effects
    • Author's Conclusions and Recommendations
    • Acknowledgments
    • References
    • Discussion
  • 20. Chronobiology of the Immune System
    • Introduction
    • Biologic Rhythms in the Number and Function of Circulating White Blood Cells
    • Biologic Rhythms in Cytokines and Their Inhibitors
    • Biologic Rhythmicity of the Humoral Immune Response
    • Biologic Rhythms in Response to Vaccination
    • Chronobiology in Cell-Mediated Immunity, Including Allograft Rejection
    • Time-Dependent Changes in Cutaneous Allergy and Allergic Asthma
    • The Rhythms of Sleep and Immunity
    • Changes in Immune System-Related Variables During the Menstrual Cycle
    • Seasonal Changes and/or Circannual Variations in Immune Response
    • Modification of Immune-Related Rhythms by Exercise
    • Modification of Immune-Related Rhythms by Time of Food Uptake
    • Biologic Rhythmicity in Neuroendocrine-Immune Interactions
    • Chronopharmacology and Chronotherapeutics
    • Author's Conclusions
    • References
  • 21. Conclusions: Militarily Important Issues Identified in this Report
    • Introduction
    • General Concepts
    • Militarily Useful Methods to Evaluate Immunological Functions
    • Health Status, Stress, and Immune Function
    • New Research Directions
    • Summary
    • References
• APPENDIXES
  • A Overview of the Immune System and Other Host Defense Mechanisms
  • B Glossary of Immunological Terms
  • C Overview of Immune Assessment Tests
  • D Emerging Infections, Nutritional Status, and Immunity
  • E Workshop Agenda
  • F Biographical Sketches
  • G Acronyms and Abbreviations
  • H Nutrition and Immune Function: A Selected Bibliography

This report was produced under grant DAMD17-94-J-4046 between the National Academy of Sciences and the U.S. Army Medical Research and Materiel Command. The views, opinions, and/or findings contained in chapters in Parts II through VI that are authored by U.S. Army personnel are those of the authors and should not be construed as official Department of the Army positions, policies, or decisions, unless so designated by other official documentation. Human subjects who participated in studies described in those chapters gave their free and informed voluntary consent. Investigators adhered to U.S. Army regulation 70-25 and United States Army Medical Research and Materiel Command regulation 70-25 on use of volunteers in research. Citations of commercial organizations and trade names in this report do not constitute an official Department of the Army endorsement or approval of the products or services of these organizations. The chapters are approved for public release; distribution is unlimited.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.