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Tryon EG, Barringer ND, Lieberman HR, Conkright WR. Energy Deficit and Factors Associated with Energy Balance during a Combat Deployment in U.S. Army Special Operation Forces Soldiers. Nutrients 2024; 16:3072. [PMID: 39339672 PMCID: PMC11434678 DOI: 10.3390/nu16183072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
The purpose of this study was to determine the difference between estimated energy expenditure (EE) and self-reported dietary intake (EI), and factors associated with energy balance in deployed U.S. Army Special Operations Forces (SOF) Soldiers. METHODS Forty-six SOF Soldiers (age: 30.1 ± 3.5 yrs, body mass index: 27.7 ± 4.1 kg/m2) completed surveys on demographic data, mission activity characteristics, gastrointestinal issues, ration consumption, resilience, mood state, and dietary intake using a 127-question food frequency questionnaire at the end of a six-month deployment. EE was estimated using a SOF-specific prediction equation with a physical activity factor of 2.1. A paired t-test compared reported energy intake (EI) with estimated energy expenditure (EE). Pearson correlations identified significant variables associated with energy balance, which were then incorporated into a multiple linear regression model. The regression analysis included Profile of Mood States (POMS) anger and POMS depression as predictor variables to determine their influence on energy balance. RESULTS Reported mean EI was 2512 ± 1059 kcal·d-1, while estimated mean EE was 5272 ± 525 kcal·d-1. The mean energy imbalance was -2854 kcal/d (95% CI: -2655 to -3055, p < 0.001), with all participants in negative energy balance (range: -492 to -3813 kcal/d). POMS depression (r = 0.517, p < 0.01) and POMS anger (r = 0.363, p = 0.020) were associated with energy balance. The regression model was significant (R2 = 0.23, F (2, 38) = 7.02, p < 0.01), with POMS depression significantly predicting energy balance (β = 50.76, p = 0.011). CONCLUSIONS Deployed SOF Soldiers reported high EE and limited EI, which may negatively impact performance. Higher POMS depression scores were associated with lower energy deficits. Future studies should investigate the relationship between mood and energy balance, using direct measures of EI and EE.
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Affiliation(s)
- Evan G. Tryon
- Nutrition Care Division, Madigan Army Medical Center, Joint-Base Lewis McChord, WA 98433, USA;
| | - Nicholas D. Barringer
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA; (N.D.B.); (H.R.L.)
| | - Harris R. Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA; (N.D.B.); (H.R.L.)
| | - William R. Conkright
- Nutrition Care Division, Madigan Army Medical Center, Joint-Base Lewis McChord, WA 98433, USA;
- Office of the Surgeon, U.S. Army Special Operations Command, Fort Bragg, NC 28303, USA
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2
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Howard IM, Sedarsky K, Gallagher M, Miller M, Puffer RC. Combat-related peripheral nerve injuries. Muscle Nerve 2024. [PMID: 38837797 DOI: 10.1002/mus.28168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/09/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Active-duty service members (ADSM) and military Veterans represent a population with increased occupational risk for nerve injuries sustained both during training operations and wartime. Mechanisms of war-related nerve injuries have evolved over time, from the musket ball-related traumas described by S.W. Mitchell to complex blast injuries and toxic exposures sustained during Middle East conflicts in the 21st century. Commonly encountered nerve injury etiologies in this population currently include compression, direct trauma, nutritional deficits, traumatic limb amputation, toxic chemical exposures, or blast-related injuries. Expeditious identification and comprehensive, interdisciplinary treatment of combat-associated neuropathies, as well as prevention of these injuries whenever possible is critical to reduce chronic morbidity and disability for service members and to maintain a well-prepared military. However, diagnosis of a combat-associated nerve injury may be particularly challenging due to comorbid battlefield injuries or delayed presentation of neuropathy from military toxic exposures. Advances in imaging for nerve injury, including MRI and ultrasound, provide useful tools to compliment EMG in establishing a diagnosis of combat-associated nerve injury, particularly in the setting of anatomic disruption or edema. Surgical techniques can improve pain control or restoration of function. In all cases, comprehensive interdisciplinary rehabilitation provides the best framework for optimization of recovery. Further work is needed to prevent combat-associated nerve injuries and promote nerve recovery following injury.
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Affiliation(s)
- Ileana M Howard
- Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Kaye Sedarsky
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Gallagher
- Rehabilitation Care Services, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Matthew Miller
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ross C Puffer
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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3
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Pihlainen K, Santtila M, Nindl BC, Raitanen J, Ojanen T, Vaara JP, Helén J, Nykänen T, Kyröläinen H. Changes in physical performance, body composition and physical training during military operations: systematic review and meta-analysis. Sci Rep 2023; 13:21455. [PMID: 38052976 PMCID: PMC10698179 DOI: 10.1038/s41598-023-48712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Systematic review and meta-analysis applying PRISMA guidelines with a PICOS format was constructed to provide an overview of changes in physical performance, body composition and physical training in soldiers during prolonged (≥ 3 months) military operations. Twenty-four studies out of the screened 4431 records filled the inclusion criteria. A small decrease in endurance performance was the most consistent finding (Hedge's g [g] - 0.21, 95% CI - 0.01 to - 0.41) while small overall increases in maximal strength of the lower (g 0.33, 95% CI 0.16-0.50) and upper body (g 0.33, 95% CI 0.19-0.46) were observed. In addition, small increases in strength endurance (push-up, g 0.34, 95% CI 0.15-0.52; sit-up g 0.26, 95% CI 0.07-0.44) were observed. The overall changes in body composition were trivial. Heterogeneity in the outcome variables varied mainly between low to moderate. Large inter-individual variations were observed in physical training volume, including decrements especially in endurance training frequency and volume. A reduction in total training load was often associated with negative changes in body composition and physical performance according to the principle of training specificity. Individuals with higher initial fitness level were more susceptible to decrements in their physical performance during operation.
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Affiliation(s)
- K Pihlainen
- Human Performance Sector, Training Division, Defence Command, Helsinki, Finland.
| | - M Santtila
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - B C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Raitanen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - T Ojanen
- Human Performance Division, Finnish Defence Research Agency, Tuusula, Finland
| | - J P Vaara
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - J Helén
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - T Nykänen
- Army Academy, Finnish Defence Forces, Lappeenranta, Finland
| | - H Kyröläinen
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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4
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Hatch-McChesney A, Smith TJ. Nutrition, Immune Function, and Infectious Disease in Military Personnel: A Narrative Review. Nutrients 2023; 15:4999. [PMID: 38068857 PMCID: PMC10708187 DOI: 10.3390/nu15234999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Consuming a diet that meets energy demands and provides essential nutrients promotes a healthy immune system, while both under- and over-nutrition have been associated with immune dysfunction. Military personnel comprise a unique population who frequently endure multi-stressor environments, predisposing them to immune decrements. Additionally, 49% and 22% of active duty U.S. military personnel are classified as overweight and obese, respectively. A literature search on PubMed was conducted to identify studies, reports, review papers, and references within those sources relevant to the topic area. Military personnel experiencing either under- or over-nutrition can suffer from degraded health, readiness, and performance. Insufficient intake of nutrients during military operations increases infection risk and negatively impacts infection recovery. Energy, protein, iron, zinc, and vitamins C and D are nutritional areas of concern that may impact immune competence in a multi-stressor environment. Over-nutrition can promote accretion of excess body fat and obesity, which contributes to a chronic inflammatory state that coincides with immune impairments. Prioritizing efforts to optimize nutrient intake is one approach for reducing disease burden and improving readiness. This review discusses nutritional concerns concomitant to multi-stressor environments that impact immune function, and the relevance of obesity to infectious disease risk in the military population.
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Affiliation(s)
| | - Tracey J. Smith
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA 01760, USA;
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5
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Weight management behaviours mediate the relationship between weight cycling, BMI and diet quality among US Army Soldiers. Br J Nutr 2022; 128:569-576. [PMID: 34470676 DOI: 10.1017/s000711452100338x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Gwin JA, Hatch-McChesney A, Pitts KP, O'Brien RP, Karis AJ, Carrigan CT, McClung JP, Karl JP, Margolis LM. Initial military training modulates serum fatty acid and amino acid metabolites. Physiol Rep 2022; 10:e15385. [PMID: 35818300 PMCID: PMC9273871 DOI: 10.14814/phy2.15385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022] Open
Abstract
Initial military training (IMT) results in increased fat-free mass (FFM) and decreased fat mass (FM). The underlying metabolic adaptations facilitating changes in body composition during IMT are unknown. The objective of this study was to assess changes in body composition and the serum metabolome during 22-week US Army IMT. Fifty-four volunteers (mean ± SD; 22 ± 3 year; 24.6 ± 3.7 kg/m2 ) completed this longitudinal study. Body composition measurements (InBody 770) and blood samples were collected under fasting, rested conditions PRE and POST IMT. Global metabolite profiling was performed to identify metabolites involved in energy, carbohydrate, lipid, and protein metabolism (Metabolon, Inc.). There was no change in body mass (POST-PRE; 0.4 ± 5.1 kg, p = 0.59), while FM decreased (-1.7 ± 3.5 kg, p < 0.01), and FFM increased (2.1 ± 2.8 kg, p < 0.01) POST compared to PRE IMT. Of 677 identified metabolites, 340 differed at POST compared to PRE (p < 0.05, Q < 0.10). The majority of these metabolites were related to fatty acid (73%) and amino acid (26%) metabolism. Increases were detected in 41% of branched-chain amino acid metabolites, 53% of histidine metabolites, and 35% of urea cycle metabolites. Decreases were detected in 93% of long-chain fatty acid metabolites, while 58% of primary bile acid metabolites increased. Increases in amino acid metabolites suggest higher rates of protein turnover, while changes in fatty acid metabolites indicate increased fat oxidation, which likely contribute changes in body composition during IMT. Overall, changes in metabolomics profiles provide insight into metabolic adaptions underlying changes in body composition during IMT.
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Affiliation(s)
- Jess A Gwin
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | | | - Kenneth P Pitts
- U.S. Army Research Institute for the Behavioral and Social Sciences, Fort Benning, Georgia, USA
| | - Rory P O'Brien
- U.S. Army Maneuver Center of Excellence, Fort Benning, Georgia, USA
| | - Anthony J Karis
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | | | - James P McClung
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - J Philip Karl
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Lee M Margolis
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Association between Diet, Physical Activity and Nutritional Status of Male Border Guard Officers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095305. [PMID: 35564700 PMCID: PMC9101595 DOI: 10.3390/ijerph19095305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/10/2022]
Abstract
The main factors that determine the effectiveness and reliability of duties and tasks performed by border guard officers, are very good health and maintaining a high level of psychophysical fitness that depend mainly on adequate diet and physical activity and thus, nutritional status. The aim of the study was to verify the correlations between dietary habits, physical activity level and selected nutritional status indicators. One hundred and sixty-nine male border guard officers participated in the study. A 61-item food frequency questionnaire (FFQ) was used to assess dietary habits and a long-form International Physical Activity Questionnaire (IPAQ) was used to assess physical activity. Fat mass was determined by bioelectrical impedance analysis (BIA) and bone calcification was assessed by the dual energy X-ray absorptiometry (DXA). Many correlations between dietary habits, as well as the physical activity of officers and body mass index (BMI), fat mass index (FMI) and visceral fat level (VFL) were found, while bone mineral density (BMD T-score) negatively correlated only with two food groups and 6 out of 61 products but did not correlate with physical activity. The results also confirmed many poor dietary habits and abnormalities in nutritional status. Thus, there is a need for nutritional education and further monitoring of health-related behaviors, as well as monitoring the nutritional status of border guard officers.
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8
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Paśko W, Guła P, Brożyna M, Dziadek B, Zadarko E, Śliż M, Polak K, Przednowek K. Psychomotor abilities of candidates for Polish Special Forces. Sci Rep 2022; 12:5075. [PMID: 35332229 PMCID: PMC8948284 DOI: 10.1038/s41598-022-09138-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Combat tasks involving special units often put a mental and physical strain on the soldiers. During the military operation, soldiers may struggle with multiple difficulties such as extreme physical effort, sleep deprivation, weather conditions, limited access to food and stress. These circumstances require a high level of cognitive ability (including psychomotor abilities) to overcome the physiological stress response and to be able to quickly and efficiently make decisions under stressful situations, especially in combat. The aim of the study was to assess the level of the psychomotor abilities of candidates for the Polish Special Forces. The study comprised 48 candidates for the Polish Special Forces (age: \documentclass[12pt]{minimal}
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\begin{document}$$30.06 \pm 2.87$$\end{document}30.06±2.87), 40 athletes (age: \documentclass[12pt]{minimal}
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\begin{document}$$27.93 \pm 3.91$$\end{document}27.93±3.91) and 40 non-athletes (age: 24). The study was performed using Test2Drive software. Four computer-based tests were used to assess the following psychomotor abilities: simple reaction time, choice reaction time, hand-eye coordination and two-dimensional visuomotor coordination/spatial orientation test (SPANT). The analysis demonstrated statistically significant differences in reaction time and motor time between the study groups. The shortest reaction time in each test was observed in athletes, while the shortest motor time was observed in soldiers. All the psychomotor tests, except for the number of correct answers in SPANT, demonstrated statistically significant differences between the studied groups. It was also found that military training had a positive effect on the motor time in every psychomotor test. As regards the reaction time, it was observed that the athletes were characterised with better reaction times than the special forces candidates. The study has confirmed that military training and sports training have a positive effect on the level of psychomotor abilities, especially motor time.
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Affiliation(s)
- Wojciech Paśko
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland.
| | - Przemysław Guła
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
| | - Maciej Brożyna
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
| | - Bartosz Dziadek
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
| | - Emilian Zadarko
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
| | - Maciej Śliż
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
| | - Klementyna Polak
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
| | - Krzysztof Przednowek
- Institute of Physical Culture Sciences, Medical College of Rzeszów University, Rzeszów University, Rzeszow, Poland
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KHAN MAF, SOHAIB M, IQBAL S, ALI A, CHAUDHRY M. Revision of ration scale for Pakistani servicemen according to geographical deployment and physical activity level. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.37521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | | | - Ahmad ALI
- University of Veterinary and Animal Sciences, Pakistan
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Harris JA, Carins J, Rundle-Thiele S. Can Social Cognitive Theory Influence Breakfast Frequency in an Institutional Context: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111270. [PMID: 34769788 PMCID: PMC8582903 DOI: 10.3390/ijerph182111270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/22/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Abstract
Breakfast is considered an important meal, especially for people who are about to commence a long or demanding workday, and for roles that may involve physical tasks and a requirement to remain alert and vigilant in potentially high-risk situations. This study looks at breakfast consumption influences within two workplace institutional settings, namely military and mining. Semi-structured interviews were conducted with military personnel (n = 12) and mining employees (n = 12) to understand their breakfast consumption behaviour at work and at home, and the associated behavioural influences. The interview questions were framed by social cognitive theory. Overall, cognitive and environmental influences were the most prominent influences on breakfast consumption, less evident were behavioural influences. A negative stereotype of workplace institutional food services emerged as one of the most significant barriers to breakfast consumption for those already at work. Considerations of environmental influences on behaviour may need to be broadened beyond physical barriers and social influences, to include perceptions of the behavioural environment. Programs that aim to increase breakfast consumption must create areas where their employees want to go. Food systems need to ensure nutritious, quality, and appealing food is available. Interventions need to increase participants’ knowledge, improve their attitudes, and create positive expectations for breakfast.
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Knapik JJ, Farina EK, Fulgoni VL, Lieberman HR. Clinically diagnosed iron and iodine deficiencies and disorders in the entire population of US military service members from 1997 to 2015. Public Health Nutr 2021; 24:3187-3195. [PMID: 33541462 PMCID: PMC8314918 DOI: 10.1017/s1368980021000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/24/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Iron and/or iodine deficiencies can have multiple serious adverse health outcomes, but examination of incidence rates of these deficiencies has rarely been conducted in any large population. This study examined incidence rates, temporal trends and demographic factors associated with medically diagnosed iron and iodine deficiencies/disorders in US military service members (SM). DESIGN The Defense Medical Epidemiological Database (DMED) was queried for medical visits of active duty SM to obtain specific International Classification of Diseases, Version 9, codes involving clinically diagnosed iron and iodine deficiencies/disorders. SETTING Analysis of existing database (DMED). PARTICIPANTS Entire population of US military SM from 1997 to 2015 (average n per year = 1 382 266, 15 % women). RESULTS Overall incidence rates for iron and iodine were 104 and 36 cases/100 000 person-years, respectively. Over the 19-year period, rates for iron disorders increased steadily (108 % for men, 177 % for women). Rates for iodine disorders also increased steadily for men (91 %), but, for women, there was an initial rise followed by a later decline. Overall, women's rates were 12 and 10 times higher than men's for iron and iodine, respectively. Compared with whites, blacks and those of other races had higher rates of deficiencies of both minerals. Incidence rates for iodine deficiency increased substantially with age. CONCLUSIONS The overall incidence of clinically diagnosed iron and iodine deficiency among SM was low, but increased over the 19 years examined, and certain demographic groups were at significantly greater risk. Given the unexpected increases in incidence of these mineral disorders, increased surveillance may be appropriate.Clinical Trial Registration No. ISRCTN58987177 (http//:www.isrctn.com/ISRCTN58987177).
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
| | - Victor L Fulgoni
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA01760, USA
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Knapik JJ, Farina EK, Fulgoni VL, Lieberman HR. Clinically-diagnosed vitamin deficiencies and disorders in the entire United States military population, 1997-2015. Nutr J 2021; 20:55. [PMID: 34130698 PMCID: PMC8207601 DOI: 10.1186/s12937-021-00708-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study examined incidence rates, temporal trends, and demographic factors associated with vitamin deficiencies/disorders in all United States military personnel from 1997 to 2015 (mean N = 1,382,266/year). METHODS Employing an ecological study design, the Defense Medical Epidemiological Database and specific International Classification of Diseases codes were used to determine incidence rates for clinically-diagnosed vitamin deficiencies/disorders. Associations with demographic factors were examined. RESULTS The overall incidence rate of vitamin deficiencies/disorders was 92.7 cases/100,000 person-years (p-yr). Highest rates were for vitamin D (53.7 cases/100,000 p-yr), other B-complex vitamins (20.2 cases, 100,000 p-yr), vitamin B12 anemia (7.6 cases/100,000 p-yr), deficiencies of "other vitamins" (5.9 cases/100,000 p-yr), and vitamin A (2.5 cases/100,000 p-yr). Thiamin, riboflavin, niacin, pyridoxine, folate, vitamin C, and vitamin K deficiencies and hypervitaminoses A and D had < 1 case/100,000 p-yr. Rates for vitamin D, other B-complex, "other vitamin", and thiamin deficiencies increased over time, while vitamin A and C deficiencies decreased. Women had higher incidence rates for all examined deficiencies/ disorders except niacin and vitamin C. Incidence rates rose with age in 8 of 15 deficiency/disorder categories and blacks had higher incidence rates in 9 of 15 deficiency/disorder categories. CONCLUSIONS The overall rate of clinically-diagnosed vitamin deficiencies and disorders was low but higher in women and minority subgroups. As for most illnesses, the diagnosed incidence of such disorders may be an underestimate of the actual incidence. These findings can guide clinical decision making with regard to testing for nutritional deficiencies and delivering public health information to at risk populations. CLINICAL TRIAL REGISTRATION (No. ISRCTN58987177 ). Registration date 9 October 2019.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Victor L Fulgoni
- Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, MI, 49014, USA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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Cross S, Kurmas N, Byrne C, Julius M, Burant C, Utech A, Aoun A. Diabetes Self-Management Education Support Healthy Teaching Kitchen Cooking Classes Delivered Using a Telehealth Technology. Sci Diabetes Self Manag Care 2021; 47:199-206. [PMID: 34000912 DOI: 10.1177/26350106211004887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the effectiveness of diabetes self-management education and support (DSMES) among veterans with diabetes using the Healthy Teaching Kitchen (HTK) by means of telehealth communication. METHODS A retrospective chart review collected data from veterans with type 2 diabetes (T2DM) that participated in the DSMES-HTK program at 2 Veterans Affairs Northeast Ohio Healthcare System facilities between February 2013 and December 2018. A factorial design was used to compare A1C data and use of clinical video telehealth from main hub to satellite site. Statistical analyses were performed using SPSS (Version 25). Repeated measures analysis of variance (RMANOVA) were performed to compare mean A1C in veterans that attended HTK at the main site versus a telehealth site. RMANOVA was also used to compare mean A1C in veterans that attended at least 1 hands-on class versus those that attended at least 1 demonstration class. RESULTS A1C values of all groups improved over time and were sustained regardless of DSMES-HTK delivery method or location. CONCLUSIONS Sustained improvement in A1C was observed in patients that participated in both DSMES-HTK in person and via clinical video telehealth classes conducted by hub site facilitator with RDN, CDCES credential. The use of a clinical video telehealth strategy for DSMES-HTK capitalizes on limited, highly skilled, credentialed instructional team members.
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Affiliation(s)
- Samantha Cross
- VA Northeast Ohio Healthcare System, Cleveland, Ohio.,Orangetheory Fitness, Lakewood, Ohio
| | - Neal Kurmas
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Cally Byrne
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Mary Julius
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Christopher Burant
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Anne Utech
- Department of Veterans Affairs, Central Office, Washington, DC.,Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Arianna Aoun
- VA Northeast Ohio Healthcare System, Cleveland, Ohio
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14
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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. Nutrients 2020; 13:nu13010122. [PMID: 33396252 PMCID: PMC7823425 DOI: 10.3390/nu13010122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 02/05/2023] Open
Abstract
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.
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15
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Vyas N, Cialdella-Kam L. Comparison of Energy and Nutrient Intake vs. Estimated Needs in Warfighters: an Update. Curr Nutr Rep 2020; 9:405-413. [PMID: 33118099 DOI: 10.1007/s13668-020-00336-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Neil Vyas
- Department of Nutrition, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Lynn Cialdella-Kam
- Department of Nutrition, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA. .,Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA.
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16
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O'Leary TJ, Wardle SL, Greeves JP. Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military. Front Nutr 2020; 7:142. [PMID: 32984399 PMCID: PMC7477333 DOI: 10.3389/fnut.2020.00142] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
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.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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17
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Farina EK, Thompson LA, Knapik JJ, Pasiakos SM, Lieberman HR, McClung JP. Diet Quality Is Associated with Physical Performance and Special Forces Selection. Med Sci Sports Exerc 2020; 52:178-186. [PMID: 31436735 DOI: 10.1249/mss.0000000000002111] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study determined associations between diet quality measured by the Healthy Eating Index (HEI)-2015, physical performance, and successful selection following a U.S. Army Special Forces Assessment and Selection course characterized by arduous cognitive and physical demands. METHODS The HEI-2015 scores were calculated from usual diet assessed with a Block food frequency questionnaire among 782 soldiers attending Special Forces Assessment and Selection. Differences in HEI-2015 scores according to demographics and physical performance were determined with analysis of variance. Differences in likelihood of selection according to HEI-2015 scores were determined with logistic regression. Models were adjusted for potential confounders: age, education, body mass index (BMI), duration and type of resistance training, and smoking. RESULTS The HEI-2015 total score was higher among older soldiers (≥25 yr), those with more education (≥some college), higher body mass index (≥25), longer duration of resistance training (≥400 min·wk), those that reported use of free weights, suspension training, Olympic lifting, and nonsmokers (P < 0.05). The HEI-2015 total score was higher among those with higher Army Physical Fitness Test (APFT) total scores, APFT sit-up score, APFT run score, and faster loaded road march times (P < 0.05). Those with higher HEI-2015 total scores were 75% (quartile 3 vs quartile 1: odds ratio, 1.75; 95% confidence interval, 1.09-2.81) and 65% (quartile 4 vs quartile 1: odds ratio, 1.65, 95% confidence interval, 1.03-2.65) more likely to be selected. Higher scores for total vegetables, greens and beans, seafood and plant protein, and refined grains, but lower sodium scores (indicating more sodium consumed), were associated with better physical performance (P < 0.05). CONCLUSIONS Dietary patterns that conform to federal dietary guidelines (except sodium) are associated with physical performance and Special Forces selection.
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Affiliation(s)
- Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | - Lauren A Thompson
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | | | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | - James P McClung
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
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18
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Devine JK, Choynowski J, Burke T, Carlsson K, Capaldi VF, McKeon AB, Sowden WJ. Practice parameters for the use of actigraphy in the military operational context: the Walter Reed Army Institute of Research Operational Research Kit-Actigraphy (WORK-A). Mil Med Res 2020; 7:31. [PMID: 32580783 PMCID: PMC7315473 DOI: 10.1186/s40779-020-00255-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Walter Reed Army Institute of Research (WRAIR) Operational Research Kit-Actigraphy (WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States Army Reserve Officers' Training Corps (ROTC) cadets (n = 286) during a month-long capstone pre-commissioning training exercise. METHODS The sleep of ROTC cadets (n = 286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets (n = 140). RESULTS Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep (all P ≤ 0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime (22:21 ± 1:30 vs. 22:13 ± 0:40, P = 0.21) and waketime (04:30 ± 2:17 vs. 04:31 ± 0:47, P = 0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed (TIB) for major sleep intervals (352 ± 29 min) and self-report nightly sleep duration (337 ± 57 min, P = 0.006) than that between the WORK-A major TIB and Actiware TIB (177 ± 42, P ≤ 0.001). CONCLUSIONS Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.
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Affiliation(s)
- Jaime K Devine
- Operational Fatigue and Performance, Institutes for Behavior Resources, Baltimore, MD, 21218, USA
| | - Jake Choynowski
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Tina Burke
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Kajsa Carlsson
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Vincent F Capaldi
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA
| | - Ashlee B McKeon
- Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD, 20910, USA.
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19
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Anyżewska A, Łakomy R, Lepionka T, Szarska E, Maculewicz E, Tomczak A, Bertrandt J. Association Between Diet, Physical Activity and Body Mass Index, Fat Mass Index and Bone Mineral Density of Soldiers of the Polish Air Cavalry Units. Nutrients 2020; 12:nu12010242. [PMID: 31963454 PMCID: PMC7019523 DOI: 10.3390/nu12010242] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 12/27/2022] Open
Abstract
Research from recent years indicates a problem of excessive body weight among soldiers, who, due to the kind of work carried out, should possess good health and fitness levels. The aim of the study was to determine the association between diet and physical activity and the nutritional status of soldiers of the Polish Air Cavalry Units. One hundred and twenty male soldiers (aged 28 ± 5 years) completed a questionnaire (food frequency questionnaire, long-form International Physical Activity Questionnaire). Body composition was determined by bioelectrical impedance analysis, and bone calcification of the forearm was assessed by the DXA (Dual Energy X-ray Absorptiometry) densitometric method. This study confirmed the association between both the diet and physical activity and body mass index (BMI), fat mass index (FMI), and bone mineral density (BMD) expressed as T-score. Significant negative correlations were found between BMI and the frequency of consumption of cereal products, meat products and fish, and nonalcoholic beverages, between FMI and cereal products, and between BMD T-score and meat products and fish, fat, nuts, and grains, sweets and snacks, and nonalcoholic beverages. Physical activity expressed as metabolic equivalent (MET-minutes/week) negatively correlated with FMI (but not BMI) and positively correlated with the BMD T-score. This study confirmed numerous irregularities in eating behavior and in nutritional status indices; therefore, there is a need for nutritional education and further monitoring of both dietary behaviors and nutritional status of soldiers.
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Affiliation(s)
- Anna Anyżewska
- Laboratory of Food and Nutrition Hygiene, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland; (R.Ł.); (T.L.); (J.B.)
- Correspondence: ; Tel.: +48-261-853-145
| | - Roman Łakomy
- Laboratory of Food and Nutrition Hygiene, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland; (R.Ł.); (T.L.); (J.B.)
| | - Tomasz Lepionka
- Laboratory of Food and Nutrition Hygiene, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland; (R.Ł.); (T.L.); (J.B.)
| | - Ewa Szarska
- Laboratory of Physiology, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland; (E.S.); (E.M.)
| | - Ewelina Maculewicz
- Laboratory of Physiology, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland; (E.S.); (E.M.)
| | - Andrzej Tomczak
- Faculty of National Security, Department of Security Education, The War Studies University in Warsaw, Al. gen. Antoniego Chruściela “Montera” 103, 00-910 Warsaw, Poland;
| | - Jerzy Bertrandt
- Laboratory of Food and Nutrition Hygiene, Military Institute of Hygiene and Epidemiology, Kozielska 4, 01-163 Warsaw, Poland; (R.Ł.); (T.L.); (J.B.)
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20
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Ahmed M, Mandic I, Lou W, Goodman L, Jacobs I, L’Abbé MR. Comparison of dietary intakes of Canadian Armed Forces personnel consuming field rations in acute hot, cold, and temperate conditions with standardized infantry activities. Mil Med Res 2019; 6:26. [PMID: 31416472 PMCID: PMC6696676 DOI: 10.1186/s40779-019-0216-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dietary Reference Intakes are used to guide the energy intake of the Canadian Armed Forces (CAF) field rations provided to military personnel deployed for training or operations. However, the high energy expenditures likely to occur under harsh environmental/metabolically challenging deployment conditions may not be adequately considered. This study examined the Ad libitum energy and nutrient intakes of CAF personnel (n = 18) consuming field rations in a resting thermoneutral environment and during a day of standardized strenuous infantry activities at varying environmental temperatures. METHODS Dietary intake was assessed using a measured food intake/food waste method during the experimental treatment and for 6 h after treatment. Four treatments were administered in a randomized counterbalanced design: exercise (as standardized infantry activities) in the heat (30 °C), exercise in the cold (- 10 °C), exercise in temperate thermoneutral (21 °C) air temperatures and a resting (sedentary) trial (21 °C). RESULTS The average Ad libitum consumption of field rations was 70% of the provided total energy (2776 ± 99 kcal/8 h) during all treatments. Even with an acute challenge of increased energy expenditure and temperature stress in the simulated field conditions, participants' energy intakes (1985 ± 747 kcal/8 h) under hot, cold and temperate treatments did not differ from energy intake during the sedentary condition (1920 ± 640 kcal/8 h). Participants' energy intakes (1009 ± 527 kcal/6 h) did not increase during the 6 h posttreatment period when the stresses of the strenuous physical activities and the harsh environmental temperatures had subsided. CONCLUSION These results should be considered when planning the provision of field rations for CAF personnel expected to be engaged in strenuous physical activities with prolonged exposure to temperature extremes.
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Affiliation(s)
- Mavra Ahmed
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Medical Science Building, 1 King’s College Circle, Room 5368, Toronto, Ontario M5S 1A8 Canada
| | - Iva Mandic
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, M5S 2W6 Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, M5T 3M2 Canada
| | - Len Goodman
- Defence Research and Development Canada – Toronto Research Centre, Toronto, M3K 2C9 Canada
| | - Ira Jacobs
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, M5S 2W6 Canada
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Medical Science Building, 1 King’s College Circle, Room 5368, Toronto, Ontario M5S 1A8 Canada
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21
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Folaron I, True MW, Wardian JL, Sauerwein TJ, Sim A, Tate JM, Rittel AG, Zarzabal LA, Graybill SD. Effect of Military Deployment on Diabetes Mellitus in Air Force Personnel. Mil Med 2018; 183:e603-e609. [PMID: 29635533 DOI: 10.1093/milmed/usy050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/07/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Military deployments relocate service members to austere locations with limited medical capabilities, raising uncertainties whether members with diabetes can participate safely. Military regulations require a medical clearance for service members with diabetes prior to deployment, but there is a dearth of data that can guide the provider in this decision. To alleviate the lack of evidence in this area, we analyzed the change in glycated hemoglobin (HbA1c) and body mass index (BMI) before and after a deployment among active duty U.S. Air Force personnel who deployed with diabetes. Materials and Methods A retrospective analysis was conducted using HbA1c and BMI values obtained within 3 mo before and within 3 mo after repatriation from a deployment of at least 90 d between January 1, 2004 through December 31, 2014. The study population consisted of 103 and 195 subjects who had an available pre- and post-deployment HbA1c and BMI values, respectively. Paired t-tests were conducted to determine significant differences in HbA1C and BMI values. Results The majority (73.8%) of members had a HbA1c <7.0% (53 mmol/mol) prior to deployment. For the overall population, HbA1c before and after deployment decreased from 6.7% (50 mmol/mol) to 6.5% (40 mmol/mol) (p = 0.03). Subgroup analysis demonstrated a significant decline in HbA1c among males, those aged 31-40 yr, and those with a pre-deployment HbA1c of >7%. BMI declined for the overall population (28.3 kg/m2 vs. 27.7 kg/m2, p < 0.0001) and for most of the subgroups. Conclusion Air Force service members who deployed with diabetes, including those with a HbA1c > 7%, experienced a statistically significant improvement in HbA1c and BMI upon repatriation. A prospective study design in the future can better reconcile the effect of a military deployment on a more comprehensive array of diabetes parameters.
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Affiliation(s)
- Irene Folaron
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft. Sam Houston, TX
| | - Mark W True
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft. Sam Houston, TX
| | - Jana L Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Bldg 4554 JBSA-Lackland Air Force Base, TX
| | - Tom J Sauerwein
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Bldg 4554 JBSA-Lackland Air Force Base, TX
| | - Alan Sim
- Defense Health Agency, 3515 S General McMullen Suite 200, San Antonio, TX
| | - Joshua M Tate
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft. Sam Houston, TX
| | - Alexander G Rittel
- Defense Health Agency, 3515 S General McMullen Suite 200, San Antonio, TX
| | - Lee Ann Zarzabal
- Defense Health Agency, 3515 S General McMullen Suite 200, San Antonio, TX
| | - Sky D Graybill
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft. Sam Houston, TX
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22
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Kullen C, Prvan T, O’Connor H. Barriers and Enablers Influencing Dietary Practices in Australian Army Personnel. Mil Med 2018; 184:e213-e221. [DOI: 10.1093/milmed/usy249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/29/2018] [Indexed: 01/10/2023] Open
Affiliation(s)
- Charina Kullen
- Australian Regular Army, Randwick Barracks, Sydney, NSW, Australia
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
| | - Tania Prvan
- Department of Statistics, Faculty of Science and Engineering, Macquarie University, Sydney, NSW, Australia
| | - Helen O’Connor
- Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia
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23
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Nykänen T, Pihlainen K, Santtila M, Vasankari T, Fogelholm M, Kyröläinen H. Diet Macronutrient Composition, Physical Activity, and Body Composition in Soldiers During 6 Months Deployment. Mil Med 2018; 184:e231-e237. [PMID: 30215796 DOI: 10.1093/milmed/usy232] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/31/2018] [Indexed: 02/04/2023] Open
Abstract
Abstract
Introduction
Optimal diet together with good physical fitness maintains readiness and military performance during longer deployments. The purpose of this study was to describe changes in dietary macronutrient and energy intake, total physical activity and body composition during a 6-month deployment in South Lebanon. Furthermore, associations of diet macronutrient intake and physical activity on body composition were also studied.
Materials and Methods
Forty male soldiers kept a 3-day food diary and their body composition was measured via bioimpedance and ultrasonography. Total physical activity was evaluated by accelerometers in a subgroup of participants. Measurements were conducted in the PRE-, MID-, and POST-deployment.
Results
Mean carbohydrate intakes were 39.5–42.6 E%, protein intakes 18.7–22.3 E%, and fat intakes 34.9–35.7 E%. Daily energy intake remained stable (10.1–10.3 MJ/D). Total physical activity was decreased during deployment (e.g., step count from 9,835 ± 2,743 to 8,388 ± 2,875 steps/day, p = 0.007). Skeletal muscle mass and subcutaneous fat increased by 1.3% (p = 0.019) and 1.9% (p = 0.006), respectively. Energy and fat intake associated positively with body mass and skeletal muscle mass (r = 0.31–0.48, p < 0.05–0.001).
Conclusions
Carbohydrate intakes and physical activity were low, compared with the general recommendations. Protein intakes were relatively high. Skeletal muscle mass and subcutaneous fat increased. Suboptimal diet together with low level of physical activity may have a negative impact on body composition, physical performance, and cardiometabolic health. Consequently, soldiers should be encouraged to consume more fiber-rich carbohydrates and less saturated fatty acids as well as maintain a high level of physical fitness to sustain military readiness during long-term deployments.
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Affiliation(s)
- Tarja Nykänen
- Finnish Defence Forces, Army Academy, Väinö Valveen katu 4, Lappeenranta, Finland
| | - Kai Pihlainen
- Finnish Defence Forces, Training Division of Defence Command, Helsinki, Finland
| | | | - Tommi Vasankari
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Heikki Kyröläinen
- National Defence University, Helsinki, Finland
- University of Jyväskylä, Faculty of Sport and Health Sciences, (VIV) 40014 University of Jyväskylä, Finland
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