nutritional fitness for military personnel scott j. montain, ph.d. u.s. army research institute of...
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Nutritional Fitness for Military Personnel
Scott J. Montain, Ph.D.U.S. Army Research Institute of Environmental Medicine
CAPT Mark B. Stephens, M.D.Uniformed Services University of the Health Sciences
Defining Total Fitness for the 21st Century , Bethesda MD, 6-9 Dec 2009
Consequences of Poor Nutrition
• Mission Degradation– Reduced physical and cognitive performance– Impaired immune function– Increased injury susceptibility
• Increased Health Care Costs– Disability– Cancer– Heart Disease– Diabetes
Nutrition is FHP
Enabler
The Nutritional Fitness Domain
Nutritional Fitness
Dietary Quality
Specific Nutritional
Requirements
HealthyChoices
Dietary Quality
• Nutritional value– Raw ingredients– Impact of food preparation
• Acceptability• Variety• Physical Factors
– Dining hall hours– Necessity for utensils or food preparation
Providing the “right” stuff
Specific Nutrient RequirementsEnsure individual needs are met
• Dietary needs are not one-size-fits-all– Nutrient requirements BM dependent– Gender-specific nutritional requirements– Energy and fluid needs vary
• Available food must be sufficient to meet these individual requirements
Healthy Choicespicking the “right” stuff
Current Dietary Practices are Suboptimal
• Overconsumption of energy• Reliance on processed foods • Inadequate fruits and vegetables• Inadequate whole grain and dairy• Over reliance on Dietary Supplements ?
Nutritional Knowledge is Poor
Table 1. General Nutrition Knowledge of Special Operations Soldiers. Data are percent
correct responses
Subtopics Minimum Maximum Mean ± SD
Fluid and Hydration (8) 0 100 61 ± 21
General Nutrition Information (25) 8 84 50 ±17
Special Dietary Concerns (11) 0 91 46 ±19
Nutrient Supplementation (4) 0 100 42 ±24
Prior Event Meal (6) 0 83 34 ±20
N=57. (number of questions per topic). Source: Bovill, Tharion and Lieberman, Mil Med
12: 997, 2003
UGR–B: Canned & Dehydrated FoodsUGR-H&S: Heat and serve rationUGR-A: Heat & Serve+ Fresh, Perishable foods
Meal, Ready to EatMeal, Cold Weather/LRP
Public / Private Dining
Garrison Dining
Operational RationsGroup Rations Individual
Rations
Unconstrained Constrained
Challenge #1
• Nutrient Factors
– Macronutrients
– Micronutrients
– Bioactive Components
• Non-Nutrient Factors
– Food associated
– Individual associated
– Environmental
Nutritional Value
Food Preferences&
Consumption
NutritionalAdequacy
Meiselman & MacFie, 1996
“It’s not nutrition until it’s eaten” - COL Dave Schnakenberg
Health Is not often the chief motive for young men to change eating behavior –(vigor, appearance, performance)
Challenge #2
Assessing Nutritional Fitness
• Tools– Survey and Diary– Direct Observation– Assessment of Physiological Markers
• Standards– Military Recommended Dietary Intake (MRDI)– Food Group Recommendations (e.g., Healthy
People 2010)
Measuring Success: Metrics
• Healthy People 2010– Eat at least 2 servings of fruit per day. Target: 75%
– “ “ 3 servings of vegetables per day. Target: 50%
– 3 servings of whole grain products/day. Target: 50%
– Consume less than 30% of calories from fat. Target: 75%
– Increase # worksites that offer nutrition or wt. mgmt. classes or counseling. Target: 85%
Nutrient Content Manipulation of ad lib diet– Jayhawk Observed Eating Trial (Donnelly et al., Obesity.
2008)• 305 sedentary normal & overweight men &
women, reduced fat diets – Only effective in weight loss when energy intake was
reduced
Ad lib food choice can be manipulated– Harvard SPH Cafeteria Study (Michels, et al., J Am Coll
Nutr. 2008)• Educational displays• Price subsidies for “healthy” selections
Why are french fries & hotdogs cheaper than salad?
Promoting Healthy Eating Behavior -Civilian Cafeteria Research
Promoting Healthy Eating Behavior -Civilian Cafeteria Research
NIH-funded Cafeteria Study (Lowe, et. al., unpublished ongoing project)
• Detailed food labeling
• Greater number “healthy” selections
• Price subsidies for reduced energy density items
Yale NSLP Study (Schwartz, Int. J. Behav. Nutr. Phys. Act. 2007)
• Verbal prompts by servers encourage fruit selection
”Sargent Choice” at Boston University • Logo label “healthy” food choices throughout DFACs
Promoting Healthy Eating Behavior -Fort Bragg DFAC Intervention (on-going)
• Intervention– Dietary Guidelines for Americans 2005– Presentation, placement, nutrition labeling, education
• Measurements– Ad lib food selections & intake, demographics &
satisfaction ratings
– Digital photography to assess quantity/quality of food selected.
– Outcomes• Primary - % kilocalories intake from fat
• Secondary - % carbohydrate and protein intake, food selection, fruit & vegetable servings, total kilocalories food intake.
To Achieve Nutritional Fitness:
• Ensure High quality foods are available for consumption
– Healthy cooking oils
• Meet nutritional requirements of diverse military work force
– IOM DRIs, FSR
• Identify strategies for healthy eating
– Education, Incentives, Dietetic Consultants