Disclaimer Disclaimer: The opinions or assertions contained herein - PDF document

3/1/2019 Disclaimer Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of The Army Eating Environment: the Army or the Department of Defense. Any citations of commercial organizations and trade names in this report do not constitute an official Current Nutritional and Behavioral Concerns Department of the Army endorsement of approval of the products or services of these organizations UNCLASSIFIED Adrienne Hatch, MS, RD, CSSD MAJ Julianna Jayne, PhD, RDN, CHES U.S. Army Research Institute of Environmental Medicine Military Nutrition Division The opinions or assertions contained herein are the private views of the author(s) and are not to be construed 2 1 as official or as reflecting the views of the Army or the Department of Defense. Outline Army Demographics Race Black or African • The Army as a population American • Dietary guidelines for military personnel 16.8% • Military feeding today and current challenges White 69.7% • Body weight concerns • Military‐specific eating behaviors • Eating behavior research efforts and findings • Conclusion Data taken from the 2017 DoD Demographics Report 3 4 Army Demographics Soldiers Eat in Many Places Occupational Specialty 70 60.7 % of Army Population 60 45.7 50 39.3 37.6 40 30 16.7 20 10 0 0 Men Women Men Women Men Women Combat Arms Combat Support Combat Service Support 5 6 Data taken from Stanford Military Data Repository, 2011-2014 1

3/1/2019 Dietary Guidelines for Military Personnel Military Dietary Reference Intakes (MDRI’s) • Energy Requirements Take • Nutrient requirements Nutrition Standards for Military Feeding to into Consideration: listed include: Support Human Performance Optimization – Carbohydrate • – MDRI calculation Defines nutritional responsibilities of the Army, Navy, Air force – Protein – Body size • Includes recommended nutrient standards = Military – Fat – Physical activity Dietary Reference Intakes (MDRI’s) – Fiber – Environmental factors • Implements DoD menu standards – Iron • Nutritional standards for rations – Clothing and equipment • Water, sodium, & CHO • Energy expenditure under various environmental – Terrain electrolyte beverages conditions (cold, hot, high altitude) – Metabolic adjustments • Establishes basic nutrition education standards for – Fluid requirements for various Army Regulation 40-25 initial military training programs across Services work intensities, temperatures, altitudes, clothing worn – Guidance on sodium requirements 7 Under‐consumption with Field Feeding: Past US Military Field Feeding Recommendations vs Reality • Eating behavior WW2 – expanded catalog of 23 different combat rations INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES − Consumer preferences, menu fatigue • Individual • Group – special purpose Committee on Military Nutrition Research − C Ration – 1 day (3 meals, ~ 3,800 Kcal/d ) − Mountain & Jungle Rations − Limited time & unappealing places to eat − D Ration – 600 Kcal survival bar − 10 in 1 & 5 in 1, Squad/Crew • Food availability constraints − K Ration – 1 meal ( ~ 2,800 Kcal/d) , compact, − Air Crew Lunch − Remote operations & austere logistics/resupply easy-to-carry, for paratroopers − Lifeboat − Size & Weight limit amount of rations carried Ration, Type K Ration, Type C Ration, Type D 1 MRE ~ 1 lb 6 days for 10 Soldiers 3 MRE / day •3900 Kcal R&D Innovations 1995 •Carb: 507 g • Packaging – shelf stability, safety •Protein: 137 g • Weight/Cube reduced •Fat: 147 g • Situationally specific rations • Nutrient requirements as per 1941 RDAs 10 Expedient solution: field stripping MREs Hard to Match Energy Intake to High Physiological Analysis of Marines During Warfighter TDEEs Mountain Warfare Training Purpose: To better understand the physiological impact of Marines training in summer and winter mountain operations by measuring: – Calorie expenditure and intake • Doubly labeled water, combat ration intake logs, dietary recalls – Body weight and muscle mass Warfighters in high-intensity • Bioelectrical impedance combat operations unlikely to – Anabolic hormones, inflammation, and nutrition-health status consume > 3 MRE/day • Blood draws – Physical performance testing 3 MREs (3,900 kcal) • Beep test, sprint test, vertical jump Military Dietary Reference Intake Standard Energy Allowance (3400 Kcal/d) Data collected before (PRE), during (MID), after (POST) 30 day training in summer and winter Tharion et al. Appetite 2005 12 2

3/1/2019 Current Field Feeding Options Current Field Feeding Options Long Range First Strike ~1540 kcals/day Patrol Ration ~2900 kcals/day Special Cold Purpose MORE Meal, Ready Weather Pack to Eat ~4620 kcals/day Rations Unitized Carbo Group Ration‐ Pack Express ~1050 kcals/pack ~1300 kcals/meal ~1300 kcals/meal ~380 kcals/pack, 75 g CHO 13 14 Influencing Nutritious Behaviors in Garrison feeding the Garrison Environment • Approximately 74% of non-deployed military personnel consume at least 1 meal/day in military dining facilities (DFAC) 1 • Labelling “healthy” entrees in an Army DFAC did not effectively increase sales of those items, but taste and food quality did 2 • Soldier intake is less than ideal with low fruit, vegetable, nutrient-rich food consumption in an ad lib environment 1,3 • Modest menu enhancements in a DFAC intervention showed reductions in energy intake, total fat, % energy from fat and saturated fat 4 Particular challenge in feeding Special Operations Forces that expended 140% energy expended by typical garrison soldiers 5 1 Bray et al. 2008 DoD Survey of Health Related Behaviors Among Active Duty Military Personnel; 2009 2 Sproul et al. Military Medicine; 2003 3 Smith et al. J. Acad Nutr Diet; 2013 4 Crombie et al. J Acad Nutr Diet; 2013 5 Tharion et al. Appetite 2005 15 Cole et al., J Nutr Educ Behav; 2018 16 Implementing a Performance‐Based Menu Weight for Height Table Improved Diet Quality Healthy Eating Index Score Based upon energy density at 1000 kcal 100 Higher Score is Better * Male weight in pounds, by age Female weight in pounds, by age >80 pts = a good diet 90 51‐80 pts = needs improvement 40+ 17-20 21-27 28-39 40+ 17-20 21-27 28-39 <50 pts = a poor diet 80 60.1 56.7 National Average ranges from 48‐57 pts 70 49.1 60 • No change in the control DFAC U.S. Points over time 50 adults 40 • HEI score for intervention DFAC ~3 points over time 30 which was significant 20 10 • in whole fruits, total protein, seafood and plant protein 0 Control (0 ‐ 12 Mo) Intervention (0 Mo) Intervention (4‐12 Mo) • in total vegetables, dairy, fatty * p = .002 pre- post intervention acids Cole et al., J Nutr Educ Behav; 2018 17 18 Army Regulation 600-9; 2013 3