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ABSTRACT: Yanovich, R, Merkel, D, Israeli, E, Evans, RK, Erlich, T, and Moran, DS. Anemia, iron deficiency, and stress fractures in female combatants during 16 months. J Strength Cond Res 25(12): 3412-3421, 2011-The purpose of this study is to evaluate the hematological profile of military recruits in different settings and training programs and to investigate the link between anemia and iron deficiency with stress fracture (SF) occurrence. We surveyed 3 groups of recruits for 16 months: 221 women (F) and 78 men (M) from 3 different platoons of a gender-integrated combat battalion and a control group (CF) of 121 female soldiers from a noncombat unit. Data were fully collected upon induction and at 4 and 16 months from 48F, 21M, and 31CF. Blood tests, anthropometry, physical aerobic fitness, and SF occurrence were evaluated. On induction day, 18.0 and 19.0% of F and CF were found to be anemic, and 61.4 and 50.9%, respectively, were found to have iron deficiency, whereas 7.7% of M were found to be anemic and 10.2% iron deficient. During the 4 months of army basic training (ABT), anemia and iron deficiency prevalence did not change significantly in any group. After 16-months, anemia prevalence decreased by 8% among F and CF and abated in M. Iron deficiency was prevalent in 50.0, 59.4, and 18.8% of F, CF, and M, respectively. Stress fractures were diagnosed in 14 F during ABT, and they had a significantly higher prevalence (p < 0.05) of anemia and iron deficiency anemia compared to F without SFs. The observed link between anemia and iron deficiency on recruitment day and SFs suggests the importance of screening female combat recruits for these deficiencies. To minimize the health impact of army service on female soldiers, preventative measures related to anemia and iron deficiency should be administered. Further research is needed for evaluating the influence of low iron in kosher meat as a possible explanation for the high prevalence of iron deficiency among young Israeli recruits.
The Journal of Strength and Conditioning Research 11/2011; 25(12):3412-21. · 1.83 Impact Factor
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Haematologica 08/2010; 95(8):1433-4. · 6.42 Impact Factor
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ABSTRACT: Combat soldiers have a higher prevalence of anemia than age- and gender-matched civilians. This may be caused by hemodilution, which is typical among athletes, or by reduced body iron stores. The aim of this study was to investigate the incidence of iron-deficiency anemia in recruits to the Israel Defense Force after 6 months of training.
Blood was collected from recruits before training. After 6 months of follow-up, 153 paired blood samples were collected from the initial cohort. Total blood count and serum iron, transferrin, and ferritin were measured at both time points. Soluble transferrin receptor (sTfR) was measured in 119 of the paired samples and the sTfR/log ferritin ratio was calculated.
At recruitment, mean hemoglobin concentration was 14.7 +/- .9 g/dl. Iron-transferrin saturation was 34.1% +/- 13.6%, and mean ferritin concentration was 53.6 +/- 33.2 ng/ml. Anemia prevalence (Hb <14 g/dl) was 17.6%, and 14.9% of participants were iron-deficient (ferritin <22 mg/dl). At 6 months, 50.3% of the cohort was anemic, and 27.3% demonstrated iron-store depletion. Paired analysis showed an average reduction of .83 g/dl in hemoglobin (p < .001), and of 9.8 mg/dl in ferritin (p < .001). sTfR increased from 1.9 to 2.1 mg/dl (p < .003) among recruits who became anemic. Half of the recruits experienced mild anemia after 6 months of training. Iron store depletion was observed among 24.5% of the cohort after training, as opposed to 15% at recruitment. Overall, these changes were not accompanied by a significant increase in sTfR, but among the subset of anemic subjects, there was a slight increase in index value.
In half of the cases, new-onset anemia was attributable to iron deficiency, and in the remainder, to hemodilution.
Journal of Adolescent Health 09/2009; 45(3):286-91. · 3.33 Impact Factor
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ABSTRACT: To evaluate gender differences in physical fitness before and after a 4-month gender-integrated basic training (BT) course and to determine whether this program effectively narrowed the differences between male and female soldiers in physical fitness parameters.
One hundred and thirty-seven soldiers (109 females and 28 males) successfully completed a 4-month BT course in the Israeli Defense Forces (IDF). The subject's physical fitness was evaluated pre- and post-BT by three laboratory tests [the maximal aerobic capacity (VO2max), the Leonardo Ground Reaction Force Plate, and the Wingate Anaerobic Test (WAnT)] and by the IDF physical fitness test (IDF-PT).
Females significantly improved their scores in the IDF-PT and laboratory aerobic tests, whereas males significantly improved only in the IDF-PT. After BT, gender differences narrowed by approximately 4% in all tests except upper body strength. Although fitness improvement after BT was marginally higher in females than males, resulting in a slight narrowing of the gender differences, a significant gender gap in physical fitness still exists after BT.
There was only a small overlap in physical abilities at the beginning of BT, which indicated vast differences in physical fitness between the genders. As expected, integrated combat BT improved physical fitness. Although females demonstrated marginally higher improvement in aerobic capacity, basic physiological gender differences were still evident at the end of the training regimen.
Medicine and science in sports and exercise 11/2008; 40(11 Suppl):S654-9. · 3.71 Impact Factor
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Daniel S Moran,
Eran Israeli,
Rachel K Evans,
Ran Yanovich,
Naama Constantini,
Nogah Shabshin, Drorit Merkel,
Orit Luria,
Tomer Erlich,
Arie Laor,
Aharon Finestone
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ABSTRACT: To develop a new prediction model for stress fractures (SF) in female recruits during basic training (BT) to identify risk factors and to try to prevent orthopedic injuries.
Measurements and data collection were taken from three companies of gender-integrated recruited units before the BT program (a total of 227 females and 83 males). Measurements included anthropometric variables, blood samples for hematology profile and markers for bone metabolism, fitness tests, bone quality (peripheral quantitative computed tomography), nutritional and activity habits, psychological assessment, and medical evaluation. SF were diagnosed during BT by bone scintigraphy and/or magnetic resonance imaging.
All collected measurements were used to construct a new prediction model for the 27 and 192 female soldiers found with and without stress fracture, respectively. There were no SF in the male soldiers. The model successfully predicts 76.5% of the female soldiers with and without stress fractures (SF) as follows:PSF = -13.98 + 0.079 Ht - 0.014 Fe + 0.464 BUR - 0.105 BMI + 0.035 Ferritin,where PSF is the SF prediction according to the log odds(SF); odds(SF) is the ratio between probability of SF existence and nonexistence; Ht is the height (cm); BUR is a subjective assessment of burnout on a scale of 1 to 7; Fe is the iron blood level (microg x dL); ferritin is the iron storage level (ng x mL); and BMI is the body mass index (kg x m).
A young female recruited to an integrated light combat unit is at risk for stress fracture if she is tall, lean, feels "burnout," has iron deficiency, and is at the high end of the normal ferritin range. However, further evaluation is required in different populations, conditions, and training programs to evaluate these results.
Medicine and science in sports and exercise 11/2008; 40(11 Suppl):S636-44. · 3.71 Impact Factor
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ABSTRACT: With the growing number of females accepted for combat-related military duties in the Israeli Defense Forces, their special needs should be addressed. Previous studies on females in combat training have found a high prevalence of iron deficiency at recruitment as well as an increased rate of stress fractures (SF) and overuse injuries during training when compared with males. The aim of this study was to assess the correlation between hematological and inflammatory variables and SF occurrence among military recruits during basic training.
Three gender-integrated light infantry units were followed prospectively. Female recruits inducted for medic and dental assistants' courses were followed for comparison. Hemoglobin, iron, transferrin, ferritin, C-reactive protein, and interleukin-6 levels were measured for all participants at recruitment and at 2 and 4 months of training. SF were diagnosed radiographically or scintigraphically according to the Israeli Defense Forces protocol.
A total of 438 subjects were recruited (female combatants = 227, male combatants = 83, noncombatant females = 128). At induction, 18% of female combatants had anemia compared with 8% of males and 19% of noncombatants. Iron deficiency was noted in 40%, 6%, and 38%, respectively. There were no clinically significant changes during training. Twelve percent of female combatants developed SF, whereas none occurred among male combatants or noncombatants. Subjects sustaining an SF had significantly lower levels of serum iron and iron saturation.
A high incidence of anemia as well as iron deficiency was found in this young asymptomatic cohort, with no significant change during training. The lower level of iron in female combatants sustaining SF warrants further investigation.
Medicine and science in sports and exercise 11/2008; 40(11 Suppl):S691-7. · 3.71 Impact Factor
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ABSTRACT: The impact of iron deficiency is considerable when enhanced physical fitness is required. Female military recruits represent a unique population faced with intense physical and cognitive demands.
To examine the prevalence of iron deficiency and the impact of dietary habits among female recruits in the Israel Defense Forces.
Three hundred and forty-eight recruits completed the study (188 female combatants, 58 male combatants, and 92 noncombat females). Dietary intake was assessed using a Food Frequency Questionnaire. Blood samples were collected for complete blood cell count, iron indices, and vitamin B12. The common definitions for anemia and iron store deficiency were used as follows: hemoglobin <12 g x dL for females and <14 g x dL for males; serum ferritin <12 mg x dL.
The prevalence of iron deficiency and iron deficiency anemia was 29.8% and 12.8%, respectively, among female combatants. Similar data were found among noncombat females (27.2% and 17.4%, respectively) as compared with 5.2% and 0% among males. No significant difference in iron or total calorie intake was detected between subjects with iron deficiency (with or without anemia) when compared with subjects with normal iron status in the same study group. Plant sources constituted 85% of dietary iron source for females, in comparison to 73% for males. The contribution of red meat to the daily iron intake was 2% for females and 20% for males.
A high prevalence of iron deficiency was found among female recruits. Coupled with the iron loss during menstruation, inadequate iron intake may have a permissive role for iron deficiency in female recruits and is an important issue facing females in the military.
Medicine and science in sports and exercise 10/2008; 40(11 Suppl):S685-90. · 3.71 Impact Factor
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The Israel Medical Association journal: IMAJ 06/2008; 10(5):374-6. · 1.02 Impact Factor
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ABSTRACT: Iron deficiency and lead poisoning are common and are often associated. This association has been suggested previously, mainly by retrospective cross-sectional studies.
To assess the impact of short-term lead exposure at indoor firing ranges, and its relationship to iron, ferritin, lead, zinc protoporphyrin, and hemoglobin concentrations in young adults.
We conducted a clinical study in 30 young healthy soldiers serving in the Israel Defense Forces. Blood samples were drawn for lead, zinc protoporphyrin, iron, hemoglobin and ferritin prior to and after a 6 week period of intensive target practice in indoor firing ranges.
After a 6 week period of exposure to lead dust, a mean blood lead level increase (P < 0.0001) and a mean iron (P < 0.0005) and mean ferritin (P < 0.0625) decrease occurred simultaneously. We found a trend for inverse correlation between pre-exposure low ferritin levels and post-exposure high blood lead levels.
The decrease in iron and ferritin levels after short-term lead exposure can be attributed to competition between iron and lead absorption via divalent metal transport-1, suggesting that lead poisoning can cause iron depletion and that iron depletion can aggravate lead poisoning. This synergistic effect should come readily to every physician's mind when treating patients with a potential risk for each problem separately.
The Israel Medical Association journal: IMAJ 04/2008; 10(4):292-5. · 1.02 Impact Factor
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ABSTRACT: There is limited information regarding the optimal hemoglobin level for physical activity and most studies followed relatively few participants. The object of this study was to assess iron storage levels in a population of healthy young males and their impact on physical fitness. Blood samples were drawn from 358 consenting infantry recruits for hemoglobin, iron, ferritin, transferrin, folic acid, and B(12) levels. A detailed medical and nutritional history was noted. Recruits performed a field fitness test including a 2,000-m run. Mean hemoglobin was 13.8 +/- 1.0 g/dl. Level of hemoglobin lower than 14 and 12 g/dl were found in 53.6% and 4.5% of the recruits, respectively. Mean ferritin was 57 +/- 34 ng/ml, with 15% of the recruits under 25 ng/ml. On multivariate analysis, after adjusting for pre-induction sports activity (P < 0.001), intermediate pre-induction hemoglobin level (12-14 g/dl) was associated with significantly faster 2,000-m running time (530 +/- 69 s, n = 176) than both the lower hemoglobin group (570 +/- 77 s, n = 16) and the higher hemoglobin group (552 +/- 86 s, n = 166, P < 0.05). The subjects in this study were non-athletic healthy young men. The high rate of abnormally low hemoglobin and ferritin values probably indicates a nutritional deficit in this population. The slower running results in the group with hemoglobin below 12 g/dl are in line with previous work, indicating the need for iron supplementation. The decrease in running ability with increased hemoglobin above 14 g/dl is surprising and will need further evaluation.
American Journal of Hematology 02/2007; 82(2):128-33. · 4.67 Impact Factor
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ABSTRACT: There is a lack of awareness among physicians, dieticians, and public health planners as to the prevalence of iron deficiency and anemia among adolescents undergoing strenuous physical training. The aim of this study was to estimate the prevalence of iron deficiency and anemia among male adolescents undergoing such activity.
We studied 292 male adolescents on the day of entry into a volunteer military unit. Hemoglobin (Hb), mean corpuscular volume, ferritin, iron, iron-transferrin saturation, and soluble transferrin receptor (TfR) were measured, and TfR-F index was calculated.
The mean Hb level (+/-SD) in the study population was 14.7 +/- .9 g/dL (range, 10.8-16.8 g/dL), mean ferritin level was 50.6 +/- 32.6 ng/mL (range, 5.4-162.5 ng/mL), and mean iron level was 97.1 +/- 39.9 microg/dL (range, 24-267 microg/dL). The prevalence of anemia (Hb <14 g/dL) was 18.5%, and 3.4% had Hb concentrations less than 13 g/dL. Iron deficiency (ferritin <22 ng/mL) was present in 18% of the subjects, and 11.3% had ferritin levels less than 17 ng/mL. The mean soluble transferrin receptor concentration was 1.9 +/- .8 mg/L, and the mean TfR-F index was 1.21 +/- .57.
Nearly 19% of the study subjects had mild anemia at recruitment, and depletion of iron stores was observed among 18%. Overall, these changes were not accompanied by a significant increase in soluble TfR. This high prevalence is most likely the result of "sports anemia" due to the intense physical training regimen adopted prior to their recruitment.
Journal of Adolescent Health 09/2005; 37(3):220-3. · 3.33 Impact Factor
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ABSTRACT: Pim-1 and Pim-2 are murine proto-oncogenes implicated in lymphomagenesis. The aim of this study was to investigate whether the human Pim-2 (hPim-2) expression is altered in chronic lymphocytic leukemia (B-CLL) and non-Hodgkin's lymphomas (NHL). We analyzed hPim-2 expression in 48 patients with NHL and CLL by quantitative in-situ hybridization, quantitative RT-PCR and FACS analysis. In-situ hybridization revealed a 5.5 +/- 2.2 times higher expression of hPim-2 in NHL over normal lymphocytes (P < 0.001). Similarly, with quantitative RT-PCR, expression in NHL was 1.5 to 2.6 times higher in involved splenic foci compared to nearby uninvolved regions (n = 3). hPim-2 mRNA was increased 3-folds in B-CLL over normal B-cells (P < 0.006). The increased hPim-2 levels correlated with lymphocyte doubling time (DT), in that mRNA levels were two times greater in patients with rapid DT (P < 0.006). Moreover, a significant correlation was found between hPim-2 expression and the Binet staging system of CLL (P < 0.022). The hPIM-2-protein expression was also upregulated in CLL, as assessed by FACS analysis. Therefore, this report provides direct evidence for a linkage of hPim-2 upregulation to NHL and CLL in man. This relationship between hPim-2 and NHL and CLL raises a number of novel mechanistic options for the genesis and/or progression of some types of human lymphomas.
Leukemia and Lymphoma 06/2004; 45(5):951-5. · 2.58 Impact Factor
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ABSTRACT: Employee absenteeism as a result of illness, as well as the need to enhance worker efficiency, are areas of increasing concern to employers. Given that preemployment medical assessments are expensive, the authors believe it is prudent to evaluate the cost-effectiveness of such procedures. Medical literature was reviewed, and relevant studies on preemployment assessments were analyzed in terms of yield and methodology. The authors found no clear guidelines for preemployment medical evaluations for white-collar applicants, who typically work in low-risk environments; however, they did conclude that laboratory testing and imaging methods are likely overused. Clear criteria should exist for medical assessment of job applicants, with an emphasis on cost-effectiveness. On the basis of recommendations contained in the literature, the authors suggest use of a self-administered questionnaire, with evaluation by an occupational health staff member when necessary, as the method(s) of choice for preemployment assessment of white-collar workers.
Archives of Environmental Health An International Journal 12/2003; 58(11):723-7.
