Effectiveness of nutrition interventions on improving diet quality and nutrition knowledge in military populations: a systematic review.

CONTEXT: Optimizing nutrition in military groups through improved diet quality and nutrition knowledge is key in supporting the high physical and cognitive demands. OBJECTIVE: The objective of this investigation was to systematically review the effectiveness of nutrition interventions among military personnel in improving diet quality and/or nutrition knowledge. DATA SOURCES: Medline, Embase, CINAHL, and Scopus were searched from the earliest records to May 2020. DATA EXTRACTION: Data were extracted by 2 reviewers. The primary outcomes were diet quality and/or nutrition knowledge. DATA ANALYSIS: Twenty studies were included. The main intervention approaches identified were nutrition education of individuals (i.e., education-based studies; EB) (n = 12), and manipulation of the food service environment (i.e., dining facility studies; DFACs) (n = 8). The most common strategies were face-to-face lectures (n = 8) for EB, and healthier menus (n = 7) and education of catering staff (n = 6) for DFAC interventions. Most studies (18/20) demonstrated favorable within-group effects; however, dietary changes were inconsistent. Five of 10 studies using a comparator group demonstrated positive between-group differences. CONCLUSION: Although potential exists for improving diet quality and nutrition knowledge in military populations, the heterogeneity of the studies to date limits conclusions on the most efficacious strategies.

Dietary Supplement Use in Australian Army Personnel.

INTRODUCTION: Military personnel are reported to use more dietary supplements (DS) than the general population. However, a comprehensive investigation of DS use in Australian Army personnel has not been conducted. This study investigated the prevalence and types of DS used by Australian Army personnel and examined the underpinning reasons and demographic factors influencing this use. MATERIALS AND METHODS: A Convenience sample of Australian Army personnel from both Headquarter (desk-based) and Brigade (field-based) environments completed a researcher-designed DS questionnaire. The questionnaire examined 19 types of DS (including sports foods) and reasons for use. Logistic regression, adjusting for age, sex, education, physical activity, BMI, and occupational group were performed. RESULTS: A total of 667 personnel completed the questionnaire. Overall, 74.5% of personnel reported using ≥1 DS/day, with ~26% reporting use of ≥5 types of DS at least once/week. The most common DS used daily were caffeine (48.4%), vitamin and mineral supplements (34.8%), protein powders (27.9%), creatine (13.3%), and amino acids (13.2%). Reasons for use in descending order were "to provide energy," "performance," "general health," "I like it," "muscle gain," "hydration," "endurance," "convenience," and "weight loss." Using ≥5 DS/week was associated with a higher level of education (p = 0.034), physical activity >10 h/week (p < 0.0005) and having an occupation as a physical training instructor (p = 0.040). CONCLUSION: If military personnel choose to utilize DS, it is important they are used in a safe, legal and effective manner. Education and up to date guidance on the rapidly evolving range of DS available are therefore necessary.

Relationship between general nutrition knowledge and diet quality in Australian military personnel.

A balanced diet informed by sound nutrition knowledge is key for operational readiness and the health of military personnel. Unfortunately, research suggests that military personnel have inadequate dietary intakes. This study assessed general nutrition knowledge, diet quality and their association in Australian military personnel. A convenience sample of male military personnel (n 211) including Army soldiers and officers completed a validated general nutrition knowledge questionnaire (GNKQ) and FFQ. The GNKQ assessed knowledge of dietary guidelines (Section A), sources of nutrients (Section B), choosing everyday foods (Section C) and diet-disease relationships (Section D). The Australian Recommended Food Score (ARFS) was used to assess diet quality from FFQ data. Statistical analyses included the χ 2 test, Spearman's correlation test, t test, median test, ANCOVA and ordinal logistic regression. The mean total GNKQ score was 52·7 %. Participants performed best on Section A (58·5 %) followed by Sections B (57·3 %) and C (57·0 %) and worst on Section D (31·0 %). Overall, officers scored significantly higher than soldiers (58·7 v. 51·9 %, P=0·001). Age was weakly but positively correlated with GNKQ total scores (r 0·307; P<0·0005), with no significant effects seen for level of education (P=0·463) or living arrangement (P=0·167). Overall ARFS was 37·6 (sd 7·7) (50·8 %) with officers scoring significantly higher than soldiers (54·7 v. 50·3 %, P=0·040). No demographic variables influenced total ARFS. The total GNKQ score had a significant, positive but weak relationship with total ARFS (r 0·179; P=0·009). Given the importance of nutrition to personnel health and operational readiness, initiatives to improve nutrition knowledge and diet quality are recommended in this population, especially in soldiers.

Evaluation of General Nutrition Knowledge in Australian Military Personnel.

BACKGROUND: Sound nutrition knowledge and a balanced diet are essential for operational readiness and optimal health of military personnel. Few studies have examined nutrition knowledge in this population. OBJECTIVE: To assess the level of general nutrition knowledge across military occupations (ie, officers [OFFRs], physical training instructors [PTIs], cooks [CKs], and soldiers [SOLs]) compared with a civilian, community (C) sample. DESIGN: Cross-sectional study. PARTICIPANTS/SETTING: Convenience sample of Australian military (M) and C participants. MAIN OUTCOME MEASURES: General nutrition knowledge measured using the validated General Nutrition Knowledge Questionnaire (GNKQ). Knowledge scores and the influence of demographic characteristics (eg, age, sex, level of education, and living arrangement) within and between M and C groups were evaluated. STATISTICAL ANALYSES: Analysis of variance, general linear models, independent-samples median test, t tests, χ(2) test, and Spearman's correlation. RESULTS: A sample of 1,295 participants were recruited with 622 (48%) from C. The M sample (n=673) consisted of SOLs 62.1%, OFFRs 9.1%, PTIs 12.8%, and CKs 16.0%. Mean age was higher for C than M (35.5±14 y vs 29.7±9.2 y; P<0.001). However, SOLs were younger and OFFRs older than other groups (P<0.001). The M sample had more men (91.1% vs 39.4%; P<0.001). The OFFRs, PTIs, and C members had similar total GNKQ scores (62.8%, 61.9%, and 64.7%, respectively) with these groups higher (P<0.001) than CKs and SOLs (56.4% and 50.6%, respectively). Across all participants, there was a positive relationship between total GNKQ score and age, female sex, and tertiary education (all P values <0.001). Significant differences identified in total GNKQ score between groups remained after adjusting for demographic factors. Young men (M or C) without tertiary education had the lowest GNKQ scores. CONCLUSIONS: Because low general nutrition knowledge may be detrimental to dietary intake, health, and operational readiness in military personnel, nutrition education programs particularly targeted at SOLs and CKs seem warranted.

Relationship between nutrition knowledge and dietary intake.

The present systematic review examined the relationship between nutrition knowledge and dietary intake in adults (mean age ≥ 18 years). Relevant databases were searched from the earliest record until November 2012. Search terms included: nutrition; diet or food knowledge and energy intake; feeding behaviour; diet; eating; nutrient or food intake or consumption. Included studies were original research articles that used instruments providing quantitative assessment of both nutrition knowledge and dietary intake and their statistical association. The initial search netted 1,193,393 potentially relevant articles, of which twenty-nine were eligible for inclusion. Most of them were conducted in community populations (n 22) with fewer (n 7) in athletic populations. Due to the heterogeneity of methods used to assess nutrition knowledge and dietary intake, a meta-analysis was not possible. The majority of the studies (65·5%: community 63·6%; athletic 71·4%) reported significant, positive, but weak (r< 0·5) associations between higher nutrition knowledge and dietary intake, most often a higher intake of fruit and vegetables. However, study quality ranged widely and participant representation from lower socio-economic status was limited, with most participants being tertiary educated and female. Well-designed studies using validated methodologies are needed to clarify the relationship between nutrition knowledge and dietary intake. Diet quality scores or indices that aim to evaluate compliance to dietary guidelines may be particularly valuable for assessing the relationship between nutrition knowledge and dietary intake. Nutrition knowledge is an integral component of health literacy and as low health literacy is associated with poor health outcomes, contemporary, high-quality research is needed to inform community nutrition education and public health policy.