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Assessments of Dietary Intakes of Canadian Armed Forces Consuming Field Rations

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Assessments of Dietary Intakes of Canadian Armed Forces Consuming Field Rations Assessments of Dietary Intakes of Canadian Armed Forces Consuming Field Rations by Mavra Ahmed A thesis submitted in conformity with the requirements for the degree of Doctorate of Philosophy Department of Nutritional Sciences University of Toronto © Copyright by Mavra Ahmed 2017 Assessments of Dietary Intakes of Canadian Armed Forces Consuming Field Rations Mavra Ahmed Doctor of Philosophy Department of Nutritional Sciences University of Toronto 2017 Abstract Military personnel frequently encounter metabolically challenging training or deployment conditions and are known to not eat enough during these field operations. Such conditions also make it challenging to collect accurate dietary intake data using traditional dietary assessment methods. The specific objectives of this thesis were to assess energy and nutrient intakes of a convenience sample of CAF personnel consuming: 1a) home diets and; 1b) ad libitum field rations at home; 2) ad libitum field rations under different temperature conditions with strenuous activities vs. sedentary in a laboratory setting; and 3) field rations during a 5-day winter weather field exercise. Additionally, 4) a mobile tablet application for dietary assessment of military personnel was evaluated. Energy intakes were similar between home diets and from ad libitum consumption of field rations at home but CAF participants’ had less than recommended intakes of some micronutrients. In a temperature and humidity-controlled chamber with simulated military-type tasks, energy intakes were similar between treatments of varying temperatures with strenuous physical activity in comparison with the sedentary treatment. Energy consumption did not ii increase during the rest of the day upon completion of the treatments. During the winter weather field exercise, participants had insufficient energy intakes in relation to their measured energy expenditures, resulting in a significant weight loss. An electronic tablet application was found to be a valid method of assessing dietary intakes from field rations. Overall, this thesis characterized home diets of a sample of CAF personnel and demonstrated that reduced energy intake is not due to ration palatability, time to prepare or eat the food in an acute setting. Using the best available dietary assessment methodologies, this thesis demonstrated that energy intakes did not increase in harsh environmental temperatures with strenuous physical activities even with ample time to eat and food prepared on request and showed that during a winter weather field exercise, participants exhibited ‘voluntary anorexia’ (under-consumption of food) and weight loss, which has implications for potential impairments in performance and health of CAF personnel during longer duration deployments. Additionally, the use of mobile technology enables accurate dietary intake assessments of military personnel. iii Acknowledgements Foremost, my deepest gratitude goes to my supervisor Dr. Mary L’Abbé for believing in me and guiding me with her wisdom, insight and encouragement. Thank you, Mary, for your continuous support of my PhD research, your dedication to my success, for helping me grow my critical thinking and nutritional expertise, and for providing me with numerous opportunities that opened so many doors for me. I have admired and been inspired by your balanced approach to hard work and living life to the fullest. My utmost gratitude goes to Dr. Ira Jacobs, Dr. Len Goodman and Dr. Jonathon Maguire. Dr. Jacobs, thank you for having confidence in my abilities and for challenging my thinking and writing and fostering my intellectual development. I have learned immensely from your mentorship and truly appreciate your dedicated interest in my progress. Dr. Goodman, thank you for providing invaluable feedback every step of the way and for your support and encouragement in helping me achieve my goals. I am grateful for your patient approach in helping me grow academically and professionally. Dr. Jonathon Maguire, I appreciate your commitment to my success and thank you for helping me think critically and beyond my area of focus. An immense thanks to my examiners, Dr. David Jenkins and Dr. Katherine Gray-Donald, for an engaging defense while challenging me and helping me produce a polished product. It has been a rewarding experience and a true privilege to be mentored by them over the course of my PhD. I would like to give special thanks to the Canadian Armed Forces and course coordinators at CFB Meaford for their contribution to this project. I was fortunate to collaborate with staff at Defence Research and Development Canada who enormously contributed to this research with their guidance and support. As well, this project would not have been possible without the enthusiasm of CAF volunteers who kindly gave their time and energy to the experiments. I am very fortunate to have had Iva Mandic as my collaborator. Iva, I am glad to have met you as a colleague but I thank you for being a friend during our long experimental trial days and I am looking forward to cherishing future years with you as a friend. iv I would also like to acknowledge L’Abbe Lab ladies for listening to my endless chatter, trying out new places for lunches, concocting endless coffees in Rm87 and for contributing to a lively and vibrant graduate experience. Special thanks to Jodi Bernstein, Mary Scourboutakos, Alyssa Schermel, and Theresa Poon for the much needed friendship and support along the way, providing me with a listening ear on my toughest days, answering my ceaseless questions, for insight on my research and for helping me succeed on this very important journey. I am also grateful to the staff, professors and graduate students at the Department of Nutritional Sciences for their energy and enthusiasm as well as for providing a productive and an enjoyable learning environment. Dr. JoAnne Arcand, you have my sincerest gratitude. Thank you for believing in me for the last 8 years and being an absolutely inspirational role model and mentor. Your dedication to my perseverance has motivated me to reach this significant milestone. Most importantly, I would like to thank my family for their love and encouragement. A special recognition to my dad, Colonel (Ret.) Javed Ahmed, a retired army officer, and to whom I dedicate this thesis. Thank you to my parents, Javed and Atiya, and my siblings, Myra and Ali, for being supportive of every endeavor I have ever chosen to undertake and for cheering me at every moment during the completion of my thesis. I am especially fortunate for my husband Zohaib’s everlasting love and belief in my pursuit of knowledge. I could not have completed this significant chapter of my life without your love, support and encouragement to succeed. Funding Acknowledgement I have been fortunate to receive several scholarships and research support for my PhD training. The Canadian Institute of Health Research provided funding through the Public Health Policy Fellowship program and Health Research Forum Travel Award. I have also received the Ontario Graduate Scholarship and additional travel awards from The New York Academy of Sciences and University of Toronto School of Graduate Studies. v Table of Contents Acknowledgements......................................................................................................................... iv Table of Contents ............................................................................................................................ vi List of Tables ................................................................................................................................ xiv List of Figures ............................................................................................................................... xvi List of Abbreviations ................................................................................................................. xviii List of Appendices ........................................................................................................................ xix Chapter 1 Assessments of Dietary Intakes of Canadian Armed Forces on Field Rations ............... 1 Introduction ................................................................................................................................. 1 Chapter 2 Background and Literature Review ................................................................................ 4 Part 1: Nutrition in Military Personnel ....................................................................................... 4 2.1 Importance of Habitual Dietary Intakes of Military Personnel ........................................... 5 2.2 Importance of Energy Balance Under Training or Operational Conditions – The Risk of Suboptimal Consumption ................................................................................................ 6 2.2.1 Factors Contributing to Voluntary Anorexia ........................................................... 7 2.2.2 Physiological and Psychological Consequences of Suboptimal Dietary Intakes ...................................................................................................................... 8 2.2.3 Impact of Temperature Extremes on Energy Intake .............................................. 10 2.3 Current Feeding Practices and Nutrition Recommendations of Canadian Armed Forces (CAF) Personnel .................................................................................................... 12 2.3.1 Dietary Reference
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