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