Abstract
Military personnel experience energy deficit (total energy expenditure higher than energy intake), particularly during combat training and field exercises where exercising energy expenditures are high and energy intake is reduced. Low energy availability (energy intake minus exercising energy expenditure expressed relative to fat free mass) impairs endocrine function and bone health, as recognized in female athletes as the Female Athlete Triad syndrome. More recently, the Relative Energy Deficiency in Sport (RED-S) syndrome encompasses broader health outcomes, physical and cognitive performance, non-athletes, and men. This review summarizes the evidence for the effect of low energy availability and energy deficiency in military training and operations on health and performance outcomes. Energy availability is difficult to measure in free-living individuals but doubly labeled water studies demonstrate high total energy expenditures during military training; studies that have concurrently measured energy intake, or measured body composition changes with DXA, suggest severe and/or prolonged energy deficits. Military training in energy deficit disturbs endocrine and metabolic function, menstrual function, bone health, immune function, gastrointestinal health, iron status, mood, and physical and cognitive performance. There are more data for men than women, and little evidence on the chronic effects of repeated exposures to energy deficit. Military training impairs indices of health and performance, indicative of the Triad and RED-S, but the multi-stressor environment makes it difficult to isolate the independent effects of energy deficiency. Studies supplementing with energy to attenuate the energy deficit suggest an independent effect of energy deficiency in the disturbances to metabolic, endocrine and immune function, and physical performance, but randomized controlled trials are lacking.
Highlights
Military personnel experience episodes of energy deficit throughout their career
The Female Athlete Triad (Triad) [11] and Relative Energy Deficiency in Sport (RED-S) [9, 10] syndromes describe the effects of chronic low energy availability [12] on health and performance outcomes
The Triad reflects the effect of low energy availability on menstrual disturbances and low bone mineral density (BMD) [11]; RED-S describes the effects of low energy availability on a range of wider health and performance outcomes in “at risk” sporting and some non-sporting civilian populations [9, 10]
Summary
Military personnel experience episodes of energy deficit (total energy expenditure higher than energy intake) throughout their career. Energy Deficiency in Soldiers and performance [9,10,11] and potentially impair military effectiveness. The Female Athlete Triad (Triad) [11] and Relative Energy Deficiency in Sport (RED-S) [9, 10] syndromes describe the effects of chronic low energy availability (energy intake minus exercise energy expenditure expressed relative to fat free mass) [12] on health and performance outcomes. The Triad reflects the effect of low energy availability on menstrual disturbances and low bone mineral density (BMD) [11]; RED-S describes the effects of low energy availability on a range of wider health and performance outcomes in “at risk” sporting and some non-sporting (e.g., dancers) civilian populations [9, 10]. The relevance of the Triad and RED-S in a military context has not been comprehensively reviewed
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