title: Prevalence and Impact of Anemia on Basic Trainees in the US Air Force.
abstract: BACKGROUND
  Anemia has been implicated in adverse health outcomes of athletes and military trainees, ranging from overuse injuries to degraded physical and cognitive performance. The purpose of this study was to investigate prevalence of anemia among US Air Force (USAF) basic trainees, to compare physical performance and discharge rates between anemic and non-anemic trainees, and to determine the risks and relative risks of being discharged for anemic versus non-anemic women and men.
  
  
  METHODS
  All USAF basic trainees were screened for anemia between July 2013 and January 2014, during an 8-week basic training course at Joint Base San Antonio-Lackland, TX. Age, sex, screening hemoglobin, anthropometric measurements, initial/final physical fitness assessment scores, and discharge data were collected from trainees. Those identified as anemic (hemoglobin <13.5 g/dL for males and <12.0 g/dL for females) received additional labwork, nutritional counseling, and oral iron-replacement, if indicated. Mean percent improvement was calculated for all performance parameters from beginning to end of training. Anemic trainees were compared to non-anemic trainees byttest with Welch modification. Results were stratified by sex and anemia severity with post-hoc Bonferroni correction.
  
  
  RESULTS
  Prevalence of anemia was 12.6 % (N= 18,827). Respective prevalence of borderline, moderate, and severe anemia was 12.6, 10.9, and 1.9 % for females and 4.8, 3.8, and 0.3 % for males. Mean 1.5-mile run-time, push-up and sit-up counts improved from beginning to end of training for both anemic and non-anemic trainees (p< 0.001 both). Non-anemic trainees had slightly greater run-time improvements than borderline and moderate anemics (female: 17.7 vs. 15.2, and 15.1 % improvement,p< 0.05 both; male: 14.9 vs. 13.2, and 13.5 % improvement,p< 0.05 both). One-way ANOVA demonstrated statistically significant differences between initial and final fitness data for all measures and both genders (p< 0.001) with the exception of final sit-up counts for male trainees (p= 0.082). Discharge rate for anemic trainees was 9.0 % (20 % for severely anemic trainees) as compared to 5.7 % for non-anemics.
  
  
  CONCLUSIONS
  Anemia was prevalent among USAF basic trainees. Identification and treatment of anemia may optimize physical performance and decrease the rate of medical discharge.
authors.affiliation: Joint Base San Antonio, Adolescent and Young Adult Medicine Service, Fort Sam Houston, San Antonio, TX USA ; University of Texas School of Public Health, San Antonio, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Myhre
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Bryant J
authors.initials: BJ
authors.lastname: Webber
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Cropper
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Juste N
authors.initials: JN
authors.lastname: Tchandja
authors.affiliation: Joint Base San Antonio, Adolescent and Young Adult Medicine Service, Fort Sam Houston, San Antonio, TX USA.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Ahrendt
authors.affiliation: Joint Base San Antonio, Adolescent and Young Adult Medicine Service, Fort Sam Houston, San Antonio, TX USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Dillon
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Haas
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Guy
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Pawlak
authors.affiliation: Joint Base San Antonio, Lackland, San Antonio, TX USA.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Federinko