A Food-Based Intervention in a Military Dining Facility Improves Blood Fatty Acid Profile.

Enhancing dietary omega-3 highly unsaturated fatty acids (n-3 HUFA) intake may confer neuroprotection, brain resiliency, improve wound healing and promote cardiovascular health. This study determined the efficacy of substituting a few common foods (chicken meat, chicken sausage, eggs, salad dressings, pasta sauces, cooking oil, mayonnaise, and peanut butter) lower in omega-6 polyunsaturated fatty acids (n-6 PUFA) and higher in n-3 HUFA in a dining facility on blood fatty acid profile. An eight-week prospective, between-subjects (n = 77), repeated measures, parallel-arm trial was conducted. Participants self-selected foods consumed from conventionally produced foods (control), or those lower n-6 PUFA and higher n-3 HUFA versions (intervention). Changes in blood omega-3 index, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), n-6 PUFA, lipid profile, and food satisfaction were main outcomes. Between-group differences over time were assessed using a linear mixed model to measure the effect of diet on blood serum fatty acids and inflammatory markers. The intervention group achieved a higher omega-3 index score (3.66 ± 0.71 vs. 2.95 ± 0.77; p < 0.05), lower total n-6 (10.1 ± 4.6 vs. 15.3 ± 6.7 µg/mL; p < 0.05), and higher serum concentration of EPA (5.0 ± 1.31 vs. 4.05 ± 1.56 µg/mL; p < 0.05) vs. controls. Satisfaction in intervention foods improved or remained consistent. Substitution of commonly eaten dining facility foods with like-items higher in DHA and EPA and lower in n-6 PUFA can favorably impact fatty acid status and the omega-3 index.

Weight management behaviours mediate the relationship between weight cycling, BMI and diet quality among US Army Soldiers.

Weight cycling is prevalent in sports/professions with body composition standards, and has been associated with weight management behaviours that may contribute to suboptimal diet quality and weight gain. US Army Soldiers may be at increased risk of weight cycling relative to civilians due to mandated body composition standards. However, the relationship between weight cycling, weight management behaviours, BMI and diet quality among Soldiers is unknown. In this cross-sectional study, 575 Soldiers (89 % enlisted, 90 % male, 23 ± 4 years) at Army installations at Joint Base Elmendorf-Richardson, AK, Joint-Base Lewis McChord, WA, and Fort Campbell, KY completed questionnaires on food frequency, health-related behaviours and history of weight cycling (≥ 3 weight fluctuations ≥ 5 % body weight). Weight cycling was reported by 33 % of Soldiers. Those who reported weight cycling reported higher BMI (27 ± 4 v. 25 ± 3 kg/m2, P < 0·001) and higher prevalence of engaging in weight management behaviours prior to body weight screening but did not report lower dietary quality (Healthy Eating Index-2015 (HEI) scores 59 ± 10 v 59 ± 11, P = 0·46) relative to those who did not report weight cycling. Results of mediation analyses suggested that weight cycling may affect BMI both directly (c' = 1·19, 95 % CI: 0·62, 1·75) and indirectly (ab = 0·45, 95 % CI: 0·19, 0·75), and HEI scores indirectly (ab = 0·69, 95 % CI: 0·20, 1·35) through the adoption of weight management behaviours. Weight cycling is common in Soldiers and is associated with higher BMI and higher prevalence of engaging in weight management behaviours that mediate associations between weight cycling, BMI and diet quality.

Development and Validation of the Military Eating Behavior Survey.

OBJECTIVE: To describe the Military Eating Behavior Survey (MEBS), developed, and validated for use in military populations. DESIGN: Questionnaire development using a 6-phase approach that included item generation, subject matter expert review, cognitive interviewing, factor analysis, test-retest reliability testing, and parallel forms testing. SETTING: US Army soldiers were surveyed at 8 military bases from 2016 to 2019 (n = 1,561). MAIN OUTCOME MEASURE: Content, face, and construct validity and reliability of the MEBS. ANALYSIS: Item variability, internal consistency, and exploratory factor analysis using principal coordinates analysis, orthogonal varimax rotation, and scree test (correlation coefficient and Cronbach alpha), as well as consistency and agreement (intraclass correlation coefficient) of test-retest reliability and parallel forms reliability. RESULTS: Over 6 phases of testing, a comprehensive tool to examine military eating habits and mediators of eating behavior was developed. Questionnaire length was reduced from 277 items to 133 items (43 eating habits; 90 mediating behaviors). Factor analysis identified 14 eating habit scales (hunger, satiety, food craving, meal pattern, restraint, diet rigidity, emotional eating, fast/slow eating rate, environmental triggers, situational eating, supplement use, and food choice) and 8 mediating factor scales (body composition strategy, perceived stress, food access, sleep habits, military fitness, physical activity, military body image, and nutrition knowledge). CONCLUSIONS AND IMPLICATIONS: The MEBS provides a new approach for assessing eating behavior in military personnel and may be used to inform and evaluate health promotion interventions related to weight management, performance optimization, and military readiness and resiliency.

Eating Behaviors Are Associated With Physical Fitness and Body Composition Among US Army Soldiers.

OBJECTIVE: Examine associations between soldiers' eating behaviors, compliance with body composition and fitness standards, and physical performance. DESIGN: Cross-sectional study. SETTING: Eight Army installations. PARTICIPANTS: US Army Soldiers (n = 1,591; 84% male). MAIN OUTCOME MEASURES: Characteristics, eating behaviors, compliance with body composition and physical fitness standards, and fitness level were assessed via questionnaire. ANALYSIS: Bivariate and multivariable logistic regression. RESULTS: Eating mostly at a dining facility was associated with lower odds of body composition failure (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.26-0.73); whereas, eating at a fast rate (OR, 1.51; 95% CI, 1.05-2.17) or often/always ignoring satiety cues (OR, 2.12; 95% CI, 1.06-4.27) was associated with higher odds of body composition failure. Eating mostly fast-food/convenience meals (OR, 1.75; 95% CI, 1.19-2.59) and eating at a fast rate (OR, 1.42; 95% CI, 1.04-1.93) was associated with higher odds of physical fitness failure. Skipping breakfast was associated with lower odds of high physical performance (OR, 0.41; 95% CI, 0.23-0.74); whereas, nutrition education was associated with higher odds of high physical performance (OR, 1.02; 95% CI, 1.01-1.04). CONCLUSIONS AND IMPLICATIONS: As eating behaviors are modifiable, findings suggest opportunities for improving the specificity of Army health promotion and education programs.

Body weight status, perceived stress, and emotional eating among US Army Soldiers: A mediator model.

BACKGROUND: In civilians, overweight and obesity are associated with emotional eating behaviors such as eating in response to stress, but this association has not been examined in Soldiers, a population with unique stressors. This cross-sectional study examined the relationship between perceived stress (PS), emotional eating (EE), and outcomes of body mass index (BMI), and failing Army body composition (BC) standards among Soldiers. METHODS: Soldiers (N = 1460, 83% male, 23.5 ±â€¯5.2 years old) completed validated surveys on PS, EE, and adherence with military BC standards. Conditional process models and mediation models tested gender as a moderator and EE as a mediator of associations between PS and BMI and PS and BC failure, respectively. RESULTS: Higher PS was associated with more frequent self-reported EE behaviors (p < 0.001), higher BMI (p < 0.001), and BC failure (p < 0.001). BMI significantly increased with frequency of reported EE behaviors (p < 0.001). Gender was not a statistically significant moderator in the relationship between PS, EE, and, BMI (p = 0.83) or BC failure (p = 0.57). PS appears to affect BMI indirectly through EE behaviors (c' = 0.03, 95% CI: 0.02, 0.04). PS may affect BC failure directly (c' = 1.04, 95% CI: 1.01, 1.08) and indirectly (ab = 1.02, 95% CI: 1.01, 1.03) through EE as a mediator. CONCLUSIONS: EE behaviors may mediate the positive association between PS, BMI, and BC failure. Prospective investigation is warranted to better understand the role of EE in health-related outcomes among Soldiers and populations in high stress professions.

Interstitial glucose concentrations and hypoglycemia during 2 days of caloric deficit and sustained exercise: a double-blind, placebo-controlled trial.

Military personnel and some athlete populations endure short-term energy deficits from reduced energy intake and/or increased energy expenditure (EE) that may degrade physical and cognitive performance due to severe hypoglycemia (<3.1 mmol/l). The extent to which energy deficits alter normoglycemia (3.9-7.8 mmol/l) in healthy individuals is not known, since prior studies measured glucose infrequently, not continuously. The purpose of this study was to characterize the glycemic response to acute, severe energy deficit compared with fully fed control condition, using continuous glucose monitoring (CGM). For 2 days during a double-blind, placebo-controlled, crossover study, 23 volunteers (17 men/6 women; age: 21.3 ± 3.0 yr; body mass index: 25 ± 3 kg/m) increased habitual daily EE [2,300 ± 450 kcal/day [means ± SD)] by 1,647 ± 345 kcal/day through prescribed exercise (~3 h/day; 40-65% peak O2 consumption), and consumed diets designed to maintain energy balance (FED) or induce 93% energy deficit (DEF). Interstitial glucose concentrations were measured continuously by CGM (Medtronic Minimed). Interstitial glucose concentrations were 1.0 ± 0.9 mmol/l lower during DEF vs. FED (P < 0.0001). The percentage of time spent in mild (3.1-3.8 mmol/l) hypoglycemia was higher during DEF compared with FED [mean difference = 20.5%; 95% confidence interval (CI): 13.1%, 27.9%; P = 0.04], while time spent in severe (<3.1 mmol/l) hypoglycemia was not different between interventions (mean difference = 4.6%; 95% CI: -0.6%, 9.8%; P = 0.10). Three of 23 participants spontaneously reported symptoms (e.g., nausea) potentially related to hypoglycemia during DEF, and an additional participant reported symptoms during both interventions. These findings suggest that severe hypoglycemia rarely occurs in healthy individuals enduring severe, short-term energy deficit secondary to heavy exercise and inadequate energy intake.

Altered Appetite-Mediating Hormone Concentrations Precede Compensatory Overeating After Severe, Short-Term Energy Deprivation in Healthy Adults.

BACKGROUND: Adaptive responses of appetite-mediating hormones to negative energy balance are thought to contribute to a counterregulatory response that drives weight regain, but they have not been studied while controlling for reduced diet volume. OBJECTIVE: In this secondary analysis, we aimed to determine the effects of short-term, severe energy deprivation (ED) on appetite and appetite-mediating hormone concentrations. METHODS: Twenty-one adults with a mean ± SD age of 21 ± 3 y and body mass index of 25 ± 3 kg/m(2) consumed isovolumetric diets provided over separate 48-h periods while increasing habitual energy expenditure by 1683 ± 329 kcal/d through light- and moderate-intensity exercise. Energy intake was matched to energy expenditure to maintain energy balance (EB) (-44 ± 92 kcal/d) or was <10% of energy expenditure to generate a -3696 ± 742-kcal/d energy deficit. Postprandial appetite, glucose, insulin, acyl ghrelin, peptide YY, pancreatic polypeptide (PP), and glucagon-like peptide-1 (GLP-1) responses and ad libitum energy intake were measured as secondary outcomes after both experimental periods. RESULTS: Fasting insulin (-56% ± 42%) and acyl ghrelin (-60% ± 17%) concentrations decreased during ED but not during EB (condition-by-time interaction; P-interaction ≤ 0.01), whereas fasting leptin concentrations decreased more during ED compared with during EB (-47% ± 27% compared with -20% ± 27%; P-interaction = 0.05). Postprandial insulin (57% ± 63%; P < 0.001), GLP-1 (14% ± 28%; P = 0.04), and PP (54% ± 52%; P < 0.001) areas under the curve (AUCs) were higher, whereas the acyl ghrelin AUC was lower (-56% ± 13%; P < 0.001) after ED compared with after EB. After ED, self-rated appetite was greater, and ad libitum energy intake was 811 kcal/36 h (95% CI: 184, 1439 kcal/36 h) higher relative to after EB (P = 0.01). CONCLUSIONS: Short-term, severe ED suppressed acyl ghrelin concentrations and increased postprandial anorexigenic hormone concentrations. These effects preceded compensatory overeating, suggesting that in adults without obesity, altered sensitivity to appetite-mediating hormones may contribute to an adaptive counterregulatory response during the initial stages of negative EB. This trial was registered at clinicaltrials.gov as NCT01603550.