Prevalence of food insecurity among military households with children 5 years of age and younger.

OBJECTIVE: Food insecurity increases risk of health conditions that may decrease military readiness. The aim of the present study was to define the prevalence of food insecurity among households with young children utilizing military installation childcare facilities and to describe household characteristics associated with food insecurity among this population. DESIGN: Cross-sectional survey including demographic questions and the US Department of Agriculture Food Security Survey Module six-item short form given to households (n 248) enrolled in Joint Base San Antonio Child Development Centers (JBSA-CDC) during the spring of 2015. SUBJECTS: Department of Defense families with at least one child less than 6 years old enrolled in a JBSA-CDC. Settings Joint Base San Antonio, TX, USA. RESULTS: Nearly one in seven families reported food insecurity. Households were more likely to be food-insecure if the head of household's highest level of education was high school or equivalent (P=0·003) and if the head of household was unmarried/unpartnered (P=0·001). Among food-insecure households headed by military service members, all were junior enlisted or non-commissioned officers (E1-E9). Food-insecure households were less likely to live off-post in owned or rented homes compared with those who were food-secure (P=0·016). Other characteristics associated with food insecurity included at least one family member enrolled in the Exceptional Family Member Program (P=0·020) and more children in the household (P=0·029). Few families reported enrolment in government supplemental food programmes. CONCLUSIONS: Food insecurity is prevalent in military families. Targeted interventions and policies can be developed using the demographic risk factors identified in the present study.

Microbial contamination of enteral feeding products in thermoneutral and hyperthermal ICU environments.

BACKGROUND: Temperature is known to affect bacterial growth, but current safety recommendations for enteral formula are based on studies conducted in thermoneutral environments, which are not representative of select burn intensive care units (ICUs) that are kept therapeutically hyperthermal. This project evaluated microbial growth in 3 enteral feeding systems: closed, open, and open with modular additives (modular tube feeding [MTF]) exposed to 2 different environments. PROCEDURES: Product for each of the 3 systems was prepared and hung in both a thermoneutral (23.3°C) and a hyperthermal (32.5°C) ICU room. At baseline, 4 hours, and 8 hours, samples were plated and incubated overnight and the number of colony-forming units (CFUs) counted. FINDINGS: In the thermoneutral and hyperthermal environments, there was no evidence of microbial growth in the open or closed feeding systems at any time point. The MTF exhibited baseline contamination with a median of 10 CFUs (95% CI, 8-16) and significant growth over time to 54 CFUs (95% CI, 20-230) by 8 hours in the thermoneutral setting. In the hyperthermal environment, the MTF showed baseline contamination of 390 CFUs (95% CI, 40-1600) and significant growth over time, with 30% of samples exhibiting contamination levels exceeding Food and Drug Administration standards by 4 hours and CFUs being too numerous to count by 8 hours. CONCLUSION: CFUs in enteral formula did not differ between open and closed feeding systems in either environment for up to 8 hours; however, the addition of modulars to open systems may result in an unacceptable risk of contamination in hyperthermal environments.

Gastric vs Small Bowel Feeding in Critically Ill Neurologically Injured Patients: Results of a Multicenter Observational Study.

BACKGROUND: To evaluate gastric compared with small bowel feeding on nutrition and clinical outcomes in critically ill, neurologically injured patients. MATERIALS AND METHODS: International, prospective observational studies involving 353 intensive care units (ICUs) were included. Eligible patients were critically ill, mechanically ventilated with neurological diagnoses who remained in the ICU and received enteral nutrition (EN) exclusively for at least 3 days. Sites provided data, including patient characteristics, nutrition practices, and 60-day outcomes. Patients receiving gastric or small bowel feeding were compared. Covariates including age, sex, body mass index, and Acute Physiology and Chronic Health Evaluation II score were used in the adjusted analyses. RESULTS: Of the 1691 patients who met our inclusion criteria, 1407 (94.1%) received gastric feeding and 88 (5.9%) received small bowel feeding. Adequacy of calories from EN was highest in the gastric group (60.2% and 52.3%, respectively, unadjusted analysis; P = .001), but this was not significant in the adjusted model (P = .428). The likelihood of EN interruptions due to gastrointestinal (GI) complications was higher for the gastric group (19.6% vs 4.7%, unadjusted model; P = .015). There were no significant differences in the rate of discontinuation of mechanical ventilation (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.66-1.12; P = .270) or the rate of being discharged alive from the ICU (HR, 0.94; 95% CI, 0.72-1.23; P = .641) and hospital (HR, 1.16; 95% CI, 0.87-1.55; P = .307) after adjusting for confounders. CONCLUSIONS: Despite a higher likelihood of EN interruptions due to GI complications, gastric feeding may be associated with better nutrition adequacy, but neither route is associated with better clinical outcomes.

Attitudes, beliefs, and behaviors of active duty soldiers attending the ArmyMOVE! weight management program.

INTRODUCTION: The objective of this study was to assess the attitudes, beliefs, and behaviors of Active Duty Soldiers attending the ArmyMOVE! (AM!) weight management program at three locations in Texas. METHODS: A 40-question survey on weight-loss attitudes, beliefs, and behaviors was administered to participants before receiving the AM! education. RESULTS: The response rate was 82.8% (n = 312). The sample was predominantly obese (64.3%), male (81.7%), and enlisted (95.3%). Only 30% were able to correctly identify their weight status using body mass index. The majority felt that weight standards were achievable (47%) and were confident in their ability to make diet (88.8%) and exercise (87.5%) changes; though most felt the tape test was not an accurate measure of body composition (71.5%). Soldiers reported using suboptimal weight-loss behaviors including diet pills (48.7%), sweat suits/saunas (44.9%), fasting (45.3%), and herbal supplements (31.1%), whereas the majority were not achieving proven recommendations for weight loss including adequate fruit (57%) and vegetable (93%) intake and adequate sleep duration (80%). CONCLUSION: This survey demonstrated AM! participants are using suboptimal methods of weight loss, few are following the Army Surgeon General's guidelines for nutrition and sleep, and an increased intensity of the AM! program is desired by the participants.

Provision of nutrition support therapies in the recent Iraq and Afghanistan conflicts.

This article describes the experience of nutrition support practitioners, specifically dietitians, providing care to combat casualties. It provides a brief overview of dietitians' induction into armed service but focuses primarily on their role in providing nutrition support during the most recent conflicts in Iraq and Afghanistan. The current system of combat casualty care is discussed with specific emphasis on providing early and adequate nutrition support to U.S. combat casualties from injury, care in theater combat support hospitals (CSHs)/expeditionary medical support (EMEDs), and en route care during critical care air transport (CCAT) up to arrival at treatment facilities in the United States. The article also examines practices and challenges faced in the CSHs/EMEDs providing nutrition support to non-U.S. or coalition patients. Over the past decade in armed conflicts, dietitians, physicians, nurses, and other medical professionals have risen to challenges, have implemented systems, and continue working to optimize treatment across the spectrum of combat casualty care.

The effects of different IV fat emulsions on clinical outcomes in critically ill patients.

OBJECTIVE: To examine the effects of different IV fat emulsions on clinical outcomes in critically ill patients. DESIGN: Secondary analysis of data from a prospective multicenter study. SETTING: An international sample of ICUs. PATIENTS: Adult patients who were admitted to the ICU for more than 72 hours, were mechanically ventilated within 48 hours, received exclusive parenteral nutrition for more than or equal to 5 days, and did not change IV fat emulsion type during the data collection period. INTERVENTIONS: Demographic and clinical data were collected for up to 12 days, until death, or discharge from the ICU, whichever came first. Clinical outcomes were recorded at 60 days following ICU admission. MEASUREMENTS: Lipid-free, soybean, medium-chain triglyceride, olive, and fish oils in parenteral nutrition were compared using an adjusted Cox proportional hazard model to examine time to termination of mechanical ventilation alive, time to ICU discharge alive, and time to hospital discharge alive. MAIN RESULTS: A total of 451 patients were included in this study: 70 (15.5%) in the lipid-free group, 223 (49.5%) in the soybean oil group, 65 (14.4%) in the medium-chain triglyceride group, 74 (16.4%) in the olive oil group, and 19 (4.9%) in the fish oil group. When compared with lipid-free parenteral nutrition, patients who received fish oil had a faster time to ICU discharge alive (hazard ratio, 1.84; 95% CI, 1.01-3.34; p = 0.05). When compared with soybean oil, patients who received olive oil or fish oil had a shorter time to termination of mechanical ventilation alive (hazard ratio, 1.43; 95% CI, 1.06-1.93; p = 0.02 and hazard ratio, 1.67; 95% CI, 1.00-2.81; p = 0.05, respectively) and a shorter time to ICU discharge alive (hazard ratio, 1.76; 95% CI, 1.30-2.39; p < 0.001 and hazard ratio, 2.40; 95% CI, 1.43-4.03; p = 0.001, respectively). CONCLUSIONS: Use of alternative IV fat emulsions in parenteral nutrition, particularly olive and fish oil, was associated with improved clinical outcomes.

Energy expenditure in acute posttraumatic amputation: comparison of four methods for assessment.

BACKGROUND: Adequate energy intake is a component of successful recovery after injury, yet little is known about the energy requirements in the acute period following traumatic amputation. The purpose of this study was to compare the clinical applicability of resting energy expenditure (REE) measured by a handheld calorimeter and estimated by 3 different predictive equations to that measured by the gold standard, indirect calorimetry using a metabolic cart, during the acute postamputation period of inpatient hospitalization. MATERIALS AND METHODS: Indirect calorimetry measured using both a metabolic cart and handheld calorimeter and predicted by 3 equations were used to assess energy needs of eligible subjects admitted to Brooke Army Medical Center with traumatic amputation(s). REE measured by the handheld calorimeter and estimated using 3 predictive equations (Mifflin St. Jeor, Ireton-Jones 1992, and the American College of Chest Physicians [ACCP]) were compared to the gold standard metabolic cart. Each measure was assessed for significant differences and level of clinical acceptability defined as ± 10% REE by metabolic cart. RESULTS: Thirteen male service members with traumatic amputation(s) were included. The majority of subject's measurements using the handheld calorimeter (n = 9, 69%) and 3 predictive equations (Mifflin St. Jeor [n = 7, 54%], Ireton-Jones 1992 [n = 8, 62%], ACCP [n = 7, 54%]) fell outside of the ± 10% range of clinical acceptability. CONCLUSION: Use of the metabolic cart for measuring energy needs remains optimal in this population.

Enteral feeding practices for U.S. service members in a deployed combat support hospital.

Evidenced based practice guidelines for nutrition support recommend implementation of early enteral nutrition (EEN) in certain patient populations, including trauma and critical illness. Early enteral nutrition has been associated with immune benefits, improved healing, reduced length of stay, and a trend towards a reduction in mortality. Rapid evacuation of combat casualties across the continuum of care presents challenges to implementing EEN during wartime operations. This is the first study to examine enteral feeding practices for combat casualties during Operation Iraqi Freedom. The study method was a prospective records review of all U.S. military combat casualties evacuated from a Combat Support Hospital (CSH) in Iraq, from 1 November to 31 December 2006. The results of this study suggest that casualties who meet the criteria for EEN are not receiving it at the CSH in theater. Further research is needed to explore the impact of delayed enteral nutrition in the combat casualty.