Open Access Open Badges Research article

Dietary intake and stress fractures among elite male combat recruits

Daniel S Moran12*, Yuval Heled1, Yael Arbel1, Eran Israeli3, Aharon S Finestone14, Rachel K Evans5 and Ran Yanovich1

Author Affiliations

1 Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, ISRAEL

2 Ariel University Center of Samaria, Ariel, ISRAEL

3 Division of Medicine, Department of Gastroenterology, Hebrew University-Hadassah Medical Center, Jerusalem, ISRAEL

4 The, Orthopaedic Department, Assaf Harofeh Medical Center, Zerifin and The Sackler School of Medicine, Tel Aviv University, Zerifin, Tel Aviv, ISRAEL

5 Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA

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Journal of the International Society of Sports Nutrition 2012, 9:6  doi:10.1186/1550-2783-9-6

Published: 13 March 2012



Appropriate and sufficient dietary intake is one of the main requirements for maintaining fitness and health. Inadequate energy intake may have a negative impact on physical performance which may result in injuries among physically active populations. The purpose of this research was to evaluate a possible relationship between dietary intake and stress fracture occurrence among combat recruits during basic training (BT).


Data was collected from 74 combat recruits (18.2 ± 0.6 yrs) in the Israeli Defense Forces. Data analyses included changes in anthropometric measures, dietary intake, blood iron and calcium levels. Measurements were taken on entry to 4-month BT and at the end of BT. The occurrence of stress reaction injury was followed prospectively during the entire 6-month training period.


Twelve recruits were diagnosed with stress fracture in the tibia or femur (SF group). Sixty two recruits completed BT without stress fractures (NSF). Calcium and vitamin D intakes reported on induction day were lower in the SF group compared to the NSF group-38.9% for calcium (589 ± 92 and 964 ± 373 mg·d-1, respectively, p < 0.001), and-25.1% for vitamin D (117.9 ± 34.3 and 157.4 ± 93.3 IU·d-1, respectively, p < 0.001). During BT calcium and vitamin D intake continued to be at the same low values for the SF group but decreased for the NSF group and no significant differences were found between these two groups.


The development of stress fractures in young recruits during combat BT was associated with dietary deficiency before induction and during BT of mainly vitamin D and calcium. For the purpose of intervention, the fact that the main deficiency is before induction will need special consideration.

Basic training; Bone; Calcium; Vitamin D; Nutrition