Transcript Nutritional Fitness Components - Uniformed Services University of

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
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
Healthy
Choices
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
Specific Nutrient Requirements
Ensure 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 Choices
picking 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
Challenge #1
Public /
Private Dining
Unconstrained
Operational Rations
Garrison Dining
Group Rations
Individual
Rations
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
Challenge #2
“It’s not nutrition until it’s eaten”
- COL Dave Schnakenberg
•
Nutrient Factors
– Macronutrients
– Micronutrients
Nutritional Value
– Bioactive Components
•
Nutritional
Adequacy
Non-Nutrient Factors
– Food associated
– Individual associated
Food Preferences
&
Consumption
– Environmental
Meiselman & MacFie, 1996
Health Is not often the chief
motive for young men to change
eating behavior –
(vigor, appearance, performance)
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%
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 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
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