Public Health Nutrition: 20(17), 3156–3165 doi:10.1017/S1368980017001975 Current dietary supplement use of Australian military veterans of Middle East operations Jolieke C van der Pols1,2,*, Jeeva Kanesarajah1, Alison Bell3 and Chi-Wai Lui1 1The University of Queensland, School of Public Health, Herston, QLD 4006, Australia: 2Queensland University of Technology, School of Exercise and Nutrition Sciences, Kelvin Grove, QLD, Australia: 3Recover Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, Herston, QLD, Australia Submitted 18 July 2016: Final revision received 26 May 2017: Accepted 19 June 2017: First published online 15 August 2017 Abstract Objective: To assess patterns and levels of dietary supplement use among Australian Defence Forces, previously deployed to the Middle East Area of Operations. Design: A cross-sectional study. Participants of a large survey self-completed questions about dietary supplement use, health status, personal and job-related characteristics, and lifestyle factors. Frequency of current use of supplements was assessed in three categories (bodybuilding, energy and weight loss). Setting: Middle East Area of Operations post-deployment health survey. Subjects: Current and ex-serving Australian Defence Force personnel (n 14 032) who deployed to the Middle East between 2001 and 2009. Results: Bodybuilding supplements were used by 17·5 % of participants, energy supplements by 24·5 % and weight-loss supplements by 7·6 %. Overall, 32·3% of participants used any of these supplements. Bodybuilding and energy supple- ments were more often used by men, younger persons and those in the Army, while weight-loss supplements were more commonly used by women and Navy personnel. Supplements in all three categories were more commonly used by Keywords persons in lower ranks, active service and combat roles. Users of bodybuilding Dietary supplements supplements had healthier lifestyles and better health status, while users of energy Military personnel and weight-loss supplements had less healthy lifestyles and poorer mental and Australia · physical health status. Overall, 11 7 % of participants used supplements containing Creatine caffeine and 3·6 % used a creatine-containing product. Caffeine Conclusions: Use of dietary supplements among Australian Defence Force Weight loss personnel is common, and patterned by lifestyle factors and health status. Mental health Use of dietary supplements is common in many Western However, many of the available supplements offer no countries including Australia, where national data indicate health benefits(9) and some may cause harm when multi- that almost a third of adults use these products(1). ple supplements are used, when intake exceeds the However, the efficacy and safety of dietary supplements recommended dose(10) or when their use causes a have long been debated(2). Carbohydrate and/or protein person’s total intake to exceed recommended levels. For drinks can offer benefits during an extended period of example, caffeine and creatine supplements can have intensive exercise(3,4), or iron and calcium supplements ergogenic and performance-enhancing effects(11,12), but can be beneficial for persons with low dietary intakes of caffeine-containing supplements add to the caffeine intake these nutrients(5). Due to the high physical demands from drinks and caffeine intake levels in US military per- commonly experienced by military personnel, they sonnel have been reported to be high(13). Some studies choose to use dietary supplements to improve energy have shown possible risks associated with high caffeine levels, performance, muscle strength and endurance, and intake, including a negative effect on sleep patterns(14), to promote general health(6). Overweight and obesity are although the effects of high caffeine intake on sleep also increasingly affecting military populations(7,8), which quality in a combat environment have not been may lead to use of supplements marketed for weight loss established definitively(15). Certain weight-loss related in this population group, to help them to meet the fitness supplements have been associated with gastrointestinal standards required for employment in military services. distress and nervousness(16,17). *Corresponding author: Email [email protected] © The Authors 2017 Downloaded from https://www.cambridge.org/core. 01 Oct 2021 at 07:05:26, subject to the Cambridge Core terms of use. Supplement use of Australian military personnel 3157 Current evidence indicates that use of dietary supple- following questions in relation to their supplement use: ments by military personnel is higher than that in the ‘How often do you currently take any of the following general population in Western countries. More than 50 % supplements? Body building supplements (such as amino of US soldiers(6) and almost 40 % of British soldiers in acids, weight gain products, creatine etc.); Energy supple- training(18) reported use of dietary supplements, with ments (such as energy drinks, pills, or energy enhancing many using multiple products; and use is higher in army herbs); Weight loss supplements?’, with response options of personnel serving in conflict zones(19,20). Products target- ‘never’, ‘less than once a month’, ‘monthly’, ‘weekly’ and ing muscle strength, muscle mass and endurance are ‘daily or almost daily’. The respondent was then asked to – favoured by British and US military personnel(6,19,21 23), record the name (generic or brand name) of the supple- and weight-loss supplements are also commonly used by ment they used, for each of the three categories. US military personnel(24). The supplement brand name and type listed by the Most of the evidence on use of dietary supplements by participant were entered into an Internet search engine to military personnel comes from data collected on US and verify the product was a dietary supplement and to obtain British military personnel, but evidence for Australian product information. Products in each of the three military personnel, who can take typical multivitamin supplement categories (bodybuilding, energy and weight preparations approved by the Australian Therapeutic loss) were coded into sub-categories based on the most Goods Administration at recommended doses without prominent type of ingredients, including protein and amino prior approval, is lacking. We therefore investigated levels acids, multivitamins and herbs, carbohydrates and sugars, and patterns of use of dietary supplements by Australian stimulants, and creatine monohydrate. We further identified military personnel, particularly those who have experi- which products contained either creatine or caffeine in enced deployment to conflict zones. We studied the each sub-category, given the concern about possible side- characteristics of dietary supplement users by assessing effects associated with these ingredients. Manual coding of general demographic factors, service and lifestyle factors, the data was undertaken by one author and incongruities and mental and physical health status. were resolved through discussion with all authors. Lifetime smoking history was self-reported in three categories (current smoker; ex-smoker; never smoker) and Methods caffeine use was ascertained as the reported average daily consumption of caffeine-containing beverages (250–375 ml) Study design and participants groupedintofourcategories(none;1–2perday;3–5 We analysed data from a large cross-sectional survey of per day; 6 or more per day). Participants were asked to current and ex-serving Australian Defence Force (ADF) report whether they experienced selected health symptoms members who deployed to the Middle East Area of (e.g. sleeping difficulties, headaches, vomiting) in the past Operations (MEAO) between 1 October 2001 and 31 month. The Short Form-12 Survey (SF-12)(26) was com- December 2009(25). This survey included MEAO veterans pleted as part of the study questionnaire, and summary deployed to Iraq or areas supporting operations in Iraq component scores for physical and mental health calculated (including ships in the Persian Gulf), those deployed to using standardised methodology. Major depressive syn- Afghanistan or areas supporting operations in Afghanistan, drome was derived using the Patient Health Questionnaire and those attached to foreign militaries or the UN in the (PHQ-9) Depression module, which evaluates the fre- above areas. A small proportion (6 %) of participants had quency of nine DSM-IV (the Diagnostic and Statistical left the ADF since serving in the Middle East. These ex- Manual of Mental Disorders, 4th edition) criteria for major serving personnel were included in the present study to depression syndrome in the last two weeks(27).Major capture current supplement use of all persons who had depression was considered present if five or more of the served in the Middle East previously and improve repre- nine depressive symptoms were reported more than half sentation of all those who served. the time in the past two weeks, and if one of the symptoms reported was depressed mood or anhedonia. Data collection Ethical approval for the present study was obtained Data were collected in 2010 and 2011 through online from the Australian Department of Defence (protocol surveys or hard copy questionnaires that were sent to all number LREP 14-010) and The University of Queensland eligible current and former ADF members for completion. (protocol number 2009001441) ethics committees. Parti- Participation was voluntary and