Self-reported eating behaviors of military recruits are associated with body mass index at military accession and change during initial military training

Sleep, Activity, and Nutrition Among an Army Sample: Strengths, Deficits, and Demographic Differences

Sleep, activity, and nutrition (SAN) are key components in overall health, and an individual's knowledge about and self-confidence to engage in healthy SAN behaviors can have an impact on their actions. This evaluation examined SAN knowledge, self-confidence, and behaviors among U.S. Army Soldiers prior to participating in a health promotion program. Baseline surveys from participating Soldiers provide evidence in this evaluation. U.S. Army Soldiers (N = 11,485) participating in a health promotion program completed surveys. Participants completed an online survey assessing SAN knowledge, self-confidence, and behaviors (among other constructs). We examined the common patterns of SAN behaviors, the associations between them, and the differences based on gender and rank. Knowledge, self-confidence, and behaviors were correlated within each of the three SAN domains. Men reported more aerobic exercise (d = .48) and more resistance training (d = .34) per week than women. Officers reported greater self-confidence in their ability to consume a post-exercise snack (i.e., refuel; d = .38), greater refueling behaviors (d = .43), greater activity knowledge (d = .33), and greater self-confidence in their ability to achieve activity goals (d ranging from .33 to .39), compared to enlisted Soldiers. Finally, greater confidence in one's ability to achieve healthy sleep correlated with getting more sleep, both during workweek (r = .56, p < .001) and weekend (r = .25, p < .001). These baseline data support the need for health promotion of SAN behaviors among these Soldiers.

Exploring Influences of Eating Behaviors Among Emerging Adults in the Military

OBJECTIVE

Identify factors influencing eating behaviors among emerging adults in the military.

DESIGN

Focused ethnography using interviews, observations, and artifacts for data.

SETTING

Three US Naval installations.

PARTICIPANTS

Thirty-two active-duty Sailors aged 18-25 years.

ANALYSIS

Qualitative data were organized in NVivo and analyzed sequentially to categorize culturally relevant domains and themes using a social ecological model (SEM). Descriptive statistics were used to describe questionnaire data in SPSS (version 27.0, IBM, 2020).

RESULTS

Leaders encouraged healthy eating through policies and messages, but cultural contradictions and environmental barriers undermined Sailors' efforts to eat healthily. Stress and resource constraints (intrapersonal), peer pressure (social), unhealthy food environments and lack of access to food preparation (environmental), and eating on the go because of mission-first norms (cultural) promoted unhealthy eating behaviors. Nutrition and culinary literacy (intrapersonal); peer support and leadership engagement (social); access to healthy, convenient, and low-cost foods (environmental); and indoctrination to healthy eating during recruit training (cultural) positively influenced eating behaviors.

CONCLUSION AND IMPLICATIONS

The eating behaviors of service members are influenced by many modifiable factors. Targeted education, leadership engagement, and policies that make nutritious foods easily accessible, appealing, and preferred are needed.

Changes in eating pathology symptoms during initial military training in men and women and associations with BMI and injury risk

Nutritional fitness, which comprises food choices, meal timing, and dietary intake behaviors, is an important component of military service member health and performance that has garnered recent attention. This study utilized generalized linear mixed effects modeling (GLMM) to investigate changes in eating pathology symptoms in men and women during initial military training (Marine Corps Officer Candidates School (OCS)). Associations among eating pathology, musculoskeletal injury risk and BMI were also assessed. This investigation includes data from the Eating Pathology Symptoms Inventory (EPSI) and BMI at the start of OCS (n = 598: Male n = 469, Female n = 129) and end of the 10-week program (n = 413: Male n = 329, Female n = 84), and injury surveillance throughout. At baseline, female candidates presented with greater body dissatisfaction, binge eating, purging, and restricting, but lower negative attitudes toward obesity compared to male candidates (p < 0.001). Eating symptoms changed during military training indicated by decreased body dissatisfaction in women (p = 0.003), decreased excessive exercise and negative attitudes toward obesity in men (p < 0.001), decreased cognitive restraint (p < 0.001), restricting (p < 0.001), purging (p = 0.013), and muscle building (p < 0.001) and increased binge eating (p < 0.001) in both sexes. Changes in restricting were significantly related to changes in BMI during training (p < 0.05). The likelihood of future injury was 108 % higher in female candidates than males and decreased by 5 % for each unit increase in excessive exercise. Eating attitudes and behaviors change during military training environments and are associated with military health and readiness outcomes including BMI and injury risk.

Weight management behaviours mediate the relationship between weight cycling, BMI and diet quality among US Army Soldiers

Weight cycling is prevalent in sports/professions with body composition standards, and has been associated with weight management behaviours that may contribute to suboptimal diet quality and weight gain. US Army Soldiers may be at increased risk of weight cycling relative to civilians due to mandated body composition standards. However, the relationship between weight cycling, weight management behaviours, BMI and diet quality among Soldiers is unknown. In this cross-sectional study, 575 Soldiers (89 % enlisted, 90 % male, 23 ± 4 years) at Army installations at Joint Base Elmendorf-Richardson, AK, Joint-Base Lewis McChord, WA, and Fort Campbell, KY completed questionnaires on food frequency, health-related behaviours and history of weight cycling (≥ 3 weight fluctuations ≥ 5 % body weight). Weight cycling was reported by 33 % of Soldiers. Those who reported weight cycling reported higher BMI (27 ± 4 v. 25 ± 3 kg/m², P < 0·001) and higher prevalence of engaging in weight management behaviours prior to body weight screening but did not report lower dietary quality (Healthy Eating Index-2015 (HEI) scores 59 ± 10 v 59 ± 11, P = 0·46) relative to those who did not report weight cycling. Results of mediation analyses suggested that weight cycling may affect BMI both directly (c' = 1·19, 95 % CI: 0·62, 1·75) and indirectly (ab = 0·45, 95 % CI: 0·19, 0·75), and HEI scores indirectly (ab = 0·69, 95 % CI: 0·20, 1·35) through the adoption of weight management behaviours. Weight cycling is common in Soldiers and is associated with higher BMI and higher prevalence of engaging in weight management behaviours that mediate associations between weight cycling, BMI and diet quality.

Body Composition of Female Air Force Personnel: A Comparative Study of Aircrew, Airplane, and Helicopter Pilots

This research aimed to analyze the body composition (BC) of different groups of women aircrew units in the Spanish Air Forces for a better understanding and improvement of their operability. Specifically, 184 female aircrew members were analyzed and classified into specialties (38 airplane pilots, age: 32.8 ± 10.8; 26 helicopter pilots, age: 32.0 ± 9.18; and 120 transport aircrew, age: 36.9 ± 8.18). The women’s BC was analyzed with an InBody720 bioimpedance device previously used in the military population. There were differences in the BC among specialties, although there were similarities between airplane and helicopter pilots. Airplane (24.0% ± 10.4%) and helicopter pilots (22.6 ± 6.32%) had a smaller percentage of body fat mass than transport aircrew (26.3 ± 7.51%), but there was uniformity among groups in skeletal muscle mass and soft lean mass. We found no differences in body water among specialties. Differences in BCs were previously reported for men in the air force, and these results in women showed similarities for different job entry requirements, different training needs, and different occupational behaviors among units in the Air Force. These results help to deepen the previous knowledge of women’s BC standards in military units. Although pilots are primarily responsible for the aircraft, healthy habits should be encouraged to keep fit and improve the performance of all aircrew members both in flight and when they are deployed.

Healthy Eating Score-7 as a Measure of Diet Quality in a Military Population

OBJECTIVE

Identify potential revisions to the Healthy Eating Score (HES-5) that improve associations with the Healthy Eating Index (HEI) -2015 total and component scores.

METHODS

Pearson r correlations were determined from soldiers' (n = 433) survey data, including the HES, proposed additional questions, and the Block Food Frequency Questionnaire.

RESULTS

Adding sugar-sweetened beverages and energy drink questions (HES-7) strengthened the HES and HEI-2015 correlation (HES-5; r = 0.42, n = 433, r² = 0.18, P < 0.001) (HES-7; r = 0.52, r² = 0.27, P < 0.001). The HES components and Block Food Frequency Questionnaire consumption correlations were as follows: quantity of fruit (r = 0.37, r² = 0.14, P < 0.001), vegetables (r = 0.41, r² = 0.17, P < 0.001), whole grains (r = 0.35, r² = 0.12 P < 0.001), dairy (r = 0.34, r² = 0.12, P < 0.001), fish (r = 0.31, r² = 0.10, P < 0.001), and energy drink (r = 0.59, r² = 0.35, P < 0.001).

CONCLUSIONS AND IMPLICATIONS

HES-7 had the strongest correlation with HEI-2015. Future studies can explore if including consumption quantity in the HES improves its representation of diet quality.

Development and Validation of the Military Eating Behavior Survey

OBJECTIVE

To describe the Military Eating Behavior Survey (MEBS), developed, and validated for use in military populations.

DESIGN

Questionnaire development using a 6-phase approach that included item generation, subject matter expert review, cognitive interviewing, factor analysis, test-retest reliability testing, and parallel forms testing.

SETTING

US Army soldiers were surveyed at 8 military bases from 2016 to 2019 (n = 1,561).

MAIN OUTCOME MEASURE

Content, face, and construct validity and reliability of the MEBS.

ANALYSIS

Item variability, internal consistency, and exploratory factor analysis using principal coordinates analysis, orthogonal varimax rotation, and scree test (correlation coefficient and Cronbach alpha), as well as consistency and agreement (intraclass correlation coefficient) of test-retest reliability and parallel forms reliability.

RESULTS

Over 6 phases of testing, a comprehensive tool to examine military eating habits and mediators of eating behavior was developed. Questionnaire length was reduced from 277 items to 133 items (43 eating habits; 90 mediating behaviors). Factor analysis identified 14 eating habit scales (hunger, satiety, food craving, meal pattern, restraint, diet rigidity, emotional eating, fast/slow eating rate, environmental triggers, situational eating, supplement use, and food choice) and 8 mediating factor scales (body composition strategy, perceived stress, food access, sleep habits, military fitness, physical activity, military body image, and nutrition knowledge).

CONCLUSIONS AND IMPLICATIONS

The MEBS provides a new approach for assessing eating behavior in military personnel and may be used to inform and evaluate health promotion interventions related to weight management, performance optimization, and military readiness and resiliency.

Military nutrition research: Contemporary issues, state of the science and future directions

The importance of diet and nutrition to military readiness and performance has been recognized for centuries as dietary nutrients sustain health, protect against illness, and promote resilience, performance and recovery. Contemporary military nutrition research is increasingly inter-disciplinary with emphasis often placed on the broad topics of (1) determining operational nutrition requirements in all environments, (2) characterizing nutritional practices of military personnel relative to the required (role/environment) standards, and (3) developing strategies for improving nutrient delivery and individual choices. This review discusses contemporary issues shared internationally by military nutrition research programmes, and highlights emerging topics likely to influence future military nutrition research and policy. Contemporary issues include improving the diet quality of military personnel, optimizing operational rations, and increasing understanding of biological factors influencing nutrient requirements. Emerging areas include the burgeoning field of precision nutrition and its technological enablers.

Eating Behaviors Are Associated With Physical Fitness and Body Composition Among US Army Soldiers

OBJECTIVE

Examine associations between soldiers' eating behaviors, compliance with body composition and fitness standards, and physical performance.

DESIGN

Cross-sectional study.

SETTING

Eight Army installations.

PARTICIPANTS

US Army Soldiers (n = 1,591; 84% male).

MAIN OUTCOME MEASURES

Characteristics, eating behaviors, compliance with body composition and physical fitness standards, and fitness level were assessed via questionnaire.

ANALYSIS

Bivariate and multivariable logistic regression.

RESULTS

Eating mostly at a dining facility was associated with lower odds of body composition failure (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.26-0.73); whereas, eating at a fast rate (OR, 1.51; 95% CI, 1.05-2.17) or often/always ignoring satiety cues (OR, 2.12; 95% CI, 1.06-4.27) was associated with higher odds of body composition failure. Eating mostly fast-food/convenience meals (OR, 1.75; 95% CI, 1.19-2.59) and eating at a fast rate (OR, 1.42; 95% CI, 1.04-1.93) was associated with higher odds of physical fitness failure. Skipping breakfast was associated with lower odds of high physical performance (OR, 0.41; 95% CI, 0.23-0.74); whereas, nutrition education was associated with higher odds of high physical performance (OR, 1.02; 95% CI, 1.01-1.04).

CONCLUSIONS AND IMPLICATIONS

As eating behaviors are modifiable, findings suggest opportunities for improving the specificity of Army health promotion and education programs.

Dietary Intake and Elevated C-Reactive Protein Levels in US Military Veterans

Elevated inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), have been associated with the pathogenesis of cardiovascular disease (CVD)-related diseases. However, limited studies have evaluated the potential association between dietary consumption and hs-CRP levels in a large, nationally representative sample, and fewer have investigated their role in ethnic and racial minority military populations. The goal of this study is to explore the relationship between dietary intake, health behaviors, and hs-CRP in individuals with prior military status and whether these associations differ by race/ethnicity. A complex, multistage, probability sample design was used from the National Health and Nutrition Examination (NHANES) 2015-2018 waves. Our results indicate that previously deployed military service members had a higher prevalence of clinically elevated hs-CRP levels than civilians. Differences in hs-CRP among deployed veterans and civilians remained even after multivariable adjustment. Individuals classified as overweight and obese demonstrated clinically elevated hs-CRP levels compared with those with a normal body mass index (BMI). Dietary factors did not attenuate the association between changes in hs-CRP levels and veteran status. These findings suggest the need for further investigation into how military-specific stressors contribute to unfavorable health outcomes for the military population.

Healthy Eating Index and Nutrition Biomarkers among Army Soldiers and Civilian Control Group Indicate an Intervention Is Necessary to Raise Omega-3 Index and Vitamin D and Improve Diet Quality

Diet quality and nutrition status are important for optimal health and military performance. Few studies have simultaneously evaluated diet quality and biochemical markers of nutritional status of military service members. The Healthy Eating Index (HEI) can be used to assess dietary quality and adherence to federal nutrition guidelines. The aim of this study was to assess soldiers' diet quality and nutritional status and compare results to a civilian control group.

METHODS

A cross-sectional study was conducted with 531 soldiers. A food frequency questionnaire was used to calculate HEI scores. A blood sample was collected for analysis of select nutrition biochemical markers. Non-parametric analyses were conducted to compare the diet quality and nutritional status of soldiers and controls. Differences in non-normally distributed variables were determined by using the Wilcoxon signed-rank test.

RESULTS

Soldiers had an HEI score of 59.9 out of 100, marginally higher than the control group (55.4). Biochemical markers of interest were within normal reference values for soldiers, except for the omega-3 index and vitamin D.

CONCLUSIONS

This study identified dietary components that need improvement and deficits in biochemical markers among soldiers. Improving diet quality and nutritional status should lead to better health, performance, and readiness of the force.

Comparison of Energy and Nutrient Intake vs. Estimated Needs in Warfighters: an Update

Active members of the military must perform optimally under conditions of thermal stress and/or energy deficiency. Military dietary reference intakes (MDRIs) provide guidelines for energy and nutrient intakes but is based studies largely conducted in Army. Needs may vary by service branch and/or position. New protein recommendations have emerged, which are not reflected in MDRIs. PURPOSE OF REVIEW: Compare reported dietary intake in active duty members to MDRIs and 2016 American College of Sports Medicine (ACSM) sports nutrition guidelines. RECENT FINDINGS: Active duty members are not meeting their energy and carbohydrate needs with low-to-adequate protein intake and adequate-to-high fat intake. Other nutrients of concern are vitamin D, calcium, iron, B-vitamins, and fiber. Thermal stress increases energy needs and suppresses appetite and thus increase risk for energy and nutrition deficiencies. Energy and nutrients needs can vary by branch of armed service, job responsibility, and external stressors.