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Nutritional Fitness for Military Personnel

Defining Total Fitness for the 21 st Century , Bethesda MD, 6-9 Dec 2009. 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.

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Nutritional Fitness for Military Personnel

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  1. Defining Total Fitness for the 21st Century , Bethesda MD, 6-9 Dec 2009 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

  2. 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

  3. The Nutritional Fitness Domain Nutritional Fitness Specific Nutritional Requirements Dietary Quality Healthy Choices

  4. Dietary Quality Providing the “right” stuff • Nutritional value • Raw ingredients • Impact of food preparation • Acceptability • Variety • Physical Factors • Dining hall hours • Necessity for utensils or food preparation

  5. 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

  6. Healthy Choicespicking the “right” stuff

  7. 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 ?

  8. Nutritional Knowledge is Poor

  9. Challenge #1 Operational Rations Public / Private Dining Group Rations Individual Rations Garrison Dining Unconstrained Constrained Meal, Ready to Eat Meal, Cold Weather/LRP UGR–B: Canned & Dehydrated Foods UGR-H&S: Heat and serve ration UGR-A: Heat & Serve+ Fresh, Perishable foods

  10. “It’s not nutrition until it’s eaten” - COL Dave Schnakenberg Challenge #2 • Nutrient Factors • Macronutrients • Micronutrients • Bioactive Components • Non-Nutrient Factors • Food associated • Individual associated • Environmental Nutritional Value Nutritional Adequacy Food Preferences & Consumption Health Is not often the chief motive for young men to change eating behavior – (vigor, appearance, performance) Meiselman & MacFie, 1996

  11. 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)

  12. 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%

  13. Promoting Healthy Eating Behavior -Civilian Cafeteria Research 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 CollNutr. 2008) • Educational displays • Price subsidies for “healthy” selections Why are french fries & hotdogs cheaper than salad?

  14. 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

  15. 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.

  16. 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

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