Military Strategies for Sustainment of Nutrition and Immune Function in the Field -- Copyright -- PREFACE -- HISTORY OF THE COMMITTEE -- COMMITTEE TASKS AND PROCEDURES -- ORGANIZATION OF THE REPORT -- ACKNOWLEDGMENTS -- Contents -- EXECUTIVE SUMMARY -- COMMITTEE'S TASK -- OVERVIEW OF NUTRITIONAL STATUS AND IMMUNE FUNCTION -- Background -- FINDINGS AND CONCLUSIONS -- Nutritional Status -- Nutritional Supplements -- RECOMMENDATIONS -- Optimizing General Health Status -- Optimizing Nutritional Status -- Nutritional Supplement Use -- Research Methodology -- 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 -- The Army's Interest in Nutrition and Immune Function -- U.S. Army Training Courses -- Norwegian Ranger Training -- INTRODUCTION TO IMMUNE FUNCTION -- Current State of Knowledge of the Field -- Emerging Infections, Nutritional Status, and Immunity -- The Cytokine System -- ASSESSMENT OF IMMUNE FUNCTION -- Assessment Techniques -- Considerations in Study Design -- NUTRITION -- Nutrients with Roles Implicated in Immune Function -- Protein and Amino Acids -- Vitamins -- Fatty Acids -- Amount of Fatty Acid Intake -- Amount of n-6 PUFA -- Amount of n-3 PUFA -- Minerals -- Iron -- Zinc -- Copper -- Selenium -- Other Factors -- Alcohol -- HEALTH AND STRESS -- Exercise, Infection, and Immunity -- Hormonal Responses to Stress -- The Stress Response Model -- Neuroendocrine Consequences of Systemic Inflammation -- Hypothalamic-Pituitary-Adrenal System -- Hypothalamic-Pituitary-Thyroid System -- Pituitary-Gonadal System -- Growth Hormone -- Inflammatory Stress and the Immune System -- Biologic Rhythms in the Immune System and Nutrition.

Biologic Rhythms in the Number and Function of White Blood Cells -- Biologic Rhythms in Cytokines and Their Inhibitors -- Biologic Rhythmicity of the Humoral Immune Response -- Potential Clinical Relevance of Biologic Rhythms in Immune Function -- Factors That Interact with Circadian Rhythms in Immune Function -- Chronopharmacology and Chronotherapeutics -- Effects of Other Stressors on Immune Function -- Extremes of Temperature -- Exposure to High Altitude -- Sleep Deprivation -- Emotional Stress -- Smoking and Environmental Pollutants -- Effects of Combined Stressors -- SUMMARY -- References -- 2 Committee Responses to Questions -- RESPONSES TO QUESTIONS POSED BY THE ARMY -- Technical Issues -- Methodologic Issues -- References -- 3 Committee Conclusions and Recommendations -- CONCLUSIONS -- General Health Status -- Nutritional Status -- Nutritional Supplements -- RECOMMENDATIONS -- Optimizing General Health Status -- Optimizing Nutritional Status -- Nutritional Supplement Use -- Research Methodology -- 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 -- INTRODUCTION -- RESEARCH OBJECTIVES -- RESULTS -- Studies Involving Ranger Training -- Studies Involving Special Forces Assessment and Selection Training.

AUTHOR'S CONCLUSIONS AND RECOMMENDATIONS -- References -- DISCUSSION -- 6 Immune Function Studies During the Ranger Training Course of the Norwegian Military Academy -- INTRODUCTION -- The Ranger Training Course of the Norwegian Military Academy -- IMMUNE CHANGES DURING NORWEGIAN RANGER TRAINING -- Changes in Parameters of Immune Function -- Leukocyte Numbers -- Plasma Levels of Immunoglobulins -- Interleukins -- Lymphocyte Mitogenic Response -- Changes in Phagocyte Function -- Granulocyte Functions -- Monocytes -- Effect of Reducing the Calorie Deficiency -- Neuropeptide Effect During Norwegian Ranger Training -- Vasoactive Intestinal Peptide -- Catecholamines -- Adrenoglucocorticoid Regulation of Phagocyte Function in Animal Studies -- 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 -- Nutrient Deficiencies -- Nutrient Excesses -- OTHER FACTORS INFLUENCING IMMUNE RESPONSES -- NUTRITIONAL SUPPLEMENTS FOR BOOSTING IMMUNITY -- CONCLUDING REMARKS -- References -- DISCUSSION -- 8 Cytokines and Nutritional Status: Possible Correlations and Investigations -- INTRODUCTION -- What Are the Cytokines? -- The Nature of the Cytokines -- Biochemistry -- Mode of Action -- Principles of Cytokine Action -- Cytokine Experimentation -- Classification of the Cytokines -- Inflammatory Cytokines -- T- and B-Lymphocyte Growth Factors -- Hematopoietic Growth and Differentiation Factors -- Chemotactic Agents -- Inhibitory/Regulatory Factors -- Cytotoxic/Cytostatic Inducers and Effectors -- Other Growth Factors -- Measurement of Cytokines -- Sample Types and Preparation -- Clinical Use of Cytokines -- Cytokines and Nutrition: Author's Observations and Recommendations -- 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 -- In Vivo Assessment of Immune Response -- In Vitro Assessment of Immune Response -- Proliferative Response -- Development of Effector Cell Response -- Assessment of Cell Types by Flow Cytometry -- 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 -- Blood Donors -- Blood Collection -- Lymphocyte Proliferation in Whole-Blood Cultures -- Amount of Blood per Culture -- Duration of Incubation of Whole-Blood Cultures -- Duration of 3H-Thymidine Label of Whole-Blood Cultures -- Finalized Durations of Cell Culture and 3H-Thymidine Labeling -- Data Presentation of Lymphocyte Proliferation in Whole-Blood Cultures -- Effects of Holding and Shipping Blood on Whole-Blood Lymphocyte Proliferation -- Cytokine Production and Receptor Release In Vitro -- Concentration of Stimulant per Culture -- 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 -- Vitamin E -- Vitamin C -- 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 -- Cu-Zn Interactions -- 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 -- Mechanisms Behind the Acute Immune Response to Exercise -- Practical Applications for Exercise Prescription -- CHRONIC EXERCISE AND IMMUNITY -- NK Cell Activity -- Cross-Sectional Studies -- Prospective Studies -- Neutrophil Function -- T-Cell Function -- Other Measures of Immunity -- Practical Applications for Exercise Prescription -- EXERCISE AND UPPER RESPIRATORY TRACT INFECTIONS -- The J Curve -- Heavy Exertion and Risk of URTI -- Moderate Exercise and Risk of URTI -- Public Health Recommendations -- INFECTION AND EXERCISE PERFORMANCE -- Exercise Recommendations During Infection -- EXERCISE AND HIV INFECTION -- Practical Recommendations -- EXERCISE, AGING, AND IMMUNITY.

PRACTICAL GUIDELINES FOR MILITARY RECRUITS AND ATHLETES.