1. 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 21 st Century, Bethesda MD, 6-9 Dec 2009

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 Dietary Quality Specific Nutritional Requirements Healthy Choices

4. 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

5. 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

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

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

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. 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

14. 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