Effects of a healthy food supply intervention in a military setting: positive changes in cereal, fat and sugar containing foods

International Journal of Behavioral Nutrition and Physical Activity

Pilvikki Absetz²  Piia Jallinoja⁴  Marja Kinnunen²  Pauli Puukka¹  Marjaana Lahti-Koski³  Clarissa ML Bingham² 

[1] Department of Chronic Disease Prevention, National Institute for Health and Welfare, Peltolantie 3, FI-20720, Turku, Finland;Health Behavior and Health Promotion Unit, Department of Lifestyle and Participation, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland;Finnish Heart Association, Oltermannintie 8, P.O. Box 50, 00621, Helsinki, Finland;National Consumer Research Center, P.O. Box 5, (Kaikukatu 3), 00531, Helsinki, Finland

关键词: Soldiers;    Military;    Health promotion;    Intervention;    Food intake;    Food habits;   

Others  :  824663
DOI  :  10.1186/1479-5868-9-91

 received in 2011-12-13, accepted in 2012-07-05,  发布年份 2012

【 摘 要 】

Background

In Finland, all men are liable to military service and a clear majority completes service. The increasing prevalence of obesity also among soldiers concerns conscripts’ food choices. Conscripts are served nutritionally planned regular main meals but individual choices take place in free-time eating. This study assesses the effects in conscripts’ eating habits in an intervention targeting the supply of healthy foods available in the military setting.

Methods

Participants were 604 18-21-year old male conscripts of whom 242 belonged to Control Group and 362 to Intervention Group. Participants of Control Group were historical controls performing military service one year before Intervention Group. The intervention targeted selection, placement, and attractiveness of healthy foods in garrison refectories and soldier’s home cafeterias, the two main food providers in the military. Dietary intake data was collected by self-administered questionnaire at three time points: before/beginning of military service (T0), 8 weeks (T1) and 6 months (T2) of military service. Outcome measures were food consumption frequencies and four dietary indexes (Cereal Index, Fruit and Vegetable Index, Fat Index and Sugar Index) developed to characterize the diet. Changes between study groups in outcome variables and in time were analysed by repeated-measures analysis of covariance.

Results

Significant (p < 0.05) intervention effects and time-intervention interactions mostly in favor of Intervention Group were found. In Intervention Group, Cereal Index was significantly higher at T2 and the overall level of porridges and cereals was higher during follow-up when comparing to Control Group. Also, the overall levels of Fat Index, potato chips, soft drinks and desserts as well as sweet pastries at T1 were significantly lower in Intervention Group. At the same time, Fruit and Vegetable Index and the level of fruit and berries were lower in Intervention Group during follow-up.

Conclusions

In the military setting, healthier food choices can be promoted by intervening on the main food environments by improving the supply of healthy foods. However, impacting on conscripts’ individual selection as fruit and vegetable consumption is more challenging.

【 授权许可】

   
2012 Bingham et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]McLaughlin R, Wittert G: The obesity epidemic: implications for recruitment and retention of defence force personnel. Obes Rev 2009, 10:693-699.
• [2]Sanderson PW, Clemes SA, Biddle SJ: The correlates and treatment of obesity in military populations: a systematic review. Obes Facts 2011, 4:229-237.
• [3]Palvelukseen astuvien miesten kehonpaino ja -pituus vuosina 1993–2009 (In Finnish). In English: Weight and height of conscripts entering service in 1993–2009. [http://www.puolustusvoimat.fi/wcm/4e27990041190b9eb6a1ffe364705c96/palvelukseen_astuvien_nuorten_miesten_fyysinen_kunto_tilastot_1975_2009.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=4e27990041190b9eb6a1ffe364705c96 webcite]
• [4]Santtila M, Kyröläinen H, Vasankari T, Tiainen S, Palvalin K, Häkkinen A, Häkkinen K: Physical fitness profiles in young Finnish men during the years 1975–2004. Med Sci Sports Exerc 2006, 38:1990-1994.
• [5]Bingham-Teissala C, Koponen P, Suihko J, Ohrankämmen O, Sahi T: Varusmiesten ravitsemus, terveyden riskitekijät ja terveystaju (In Finnish, with English summary) In English: Conscripts' nutrition, health risk factors and health sense. In Terveyden riskitekijät (Health Risk Factors). Edited by Jallinoja P, Sahi T, Uutela A. Helsinki: National Public Health Institute; 2008:28-33.
• [6]Mousavinasab F, Tähtinen T, Jokelainen J, Koskela P, Vanhala M, Oikarinen J, Keinänen-Kiukaanniemi S: Lack of increase of serum adiponectin concentrations with a moderate weight loss during six months on a high-caloric diet in military service among a young male Finnish population. Endocrine 2005, 26:65-69.
• [7]Tanskanen M, Uusitalo AL, Häkkinen K, Nissilä J, Santtila M, Westerterp KR, Kyröläinen H: Aerobic fitness, energy balance, and body mass index are associated with training load assessed by activity energy expenditure. Scand J Med Sci Sports 2009, 19:871-878.
• [8]Yamane GK: Obesity in civilian adults: potential impact on eligibility for U.S. military enlistment. Mil Med 2007, 172:1160-1165.
• [9]Department of Defense: 2008 Department of Defense survey of health related behaviors among active duty military personnel. Military Health System. North Carolina, USA: Research Triangle Institute; 2009. http://www.tricare.mil/2008HealthBehaviors.pdf webcite
• [10]Sundin J, Fear NT, Wessely S, Rona RJ: Obesity in the UK Armed Forces: risk factors. Mil Med 2011, 176:507-512.
• [11]Bingham CM, Ovaskainen ML, Tapanainen H, Lahti-Koski M, Sahi T, Paturi M: Nutrient intake and food use of Finnish conscripts in garrison, on leave, and in encampment conditions. Mil Med 2009, 174:678-684.
• [12]Bingham CM, Jallinoja P, Lahti-Koski M, Absetz P, Paturi M, Pihlajamäki H, Sahi T, Uutela A: Quality of diet and food choices of Finnish young men: a sociodemographic and health behaviour approach. Public Health Nutr 2010, 13:980-986.
• [13]Bingham CM, Lahti-Koski M, Absetz P, Puukka P, Kinnunen M, Pihlajamaki H, Sahi T, Uutela A, Jallinoja P: Food choices and health during military service: increases in sugar- and fibre-containing foods and changes in anthropometric and clinical risk factors. Public Health Nutr 2012, 15:1-8.
• [14]Jallinoja P, Tuorila H, Ojajarvi A, Bingham C, Uutela A, Absetz P: Conscripts' attitudes towards health and eating. Changes during the military service and associations with eating. Appetite 2011, 57:718-721.
• [15]Tähtinen T, Vanhala M, Oikarinen J, Keinänen-Kiukaanniemi S: Changes in insulin resistance-associated cardiovascular risk factors of Finnish men during military service are due to changes in eating habits. Ann Med Milit Fenn 2001, 76:239-246.
• [16]Public Information Division of the Defence Staff: Facts about the Finnish Defence Forces. Helsinki: Finnish Defence Forces; 2005.
• [17]Multimäki P, Parkkola K, Sourander A, Haavisto A, Nikolakaros G, Helenius H: Military fitness class of Finnish 18-year-old men–prediction of military fitness class at call-up with the YASR and sociodemographic factors. Soc Psychiatry Psychiatr Epidemiol 2005, 40:57-63.
• [18]Bowles SV, Picano J, Epperly T, Myer S: The LIFE program: a wellness approach to weight loss. Mil Med 2006, 171:1089-1094.
• [19]Davis MK: A comprehensive weight-loss program for soldiers. Mil Med 1996, 161:84-88.
• [20]Earles JE, Kerr B, James LC, Folen RA: Clinical effectiveness of the LE3AN program: a military healthy lifestyle program. J Clin Psychol Med Sett 2007, 14:51-57.
• [21]James LC, Folen RA, Garland FN, Edwards C, Noce M, Gohdes D, Williams D, Bowles S, Kellar MA, Supplee E: The Tripler Army Medical Center LEAN Program: a healthy lifestyle model for the treatment of obesity. Mil Med 1997, 162:328-332.
• [22]James LC, Folen RA, Page H, Noce M, Brown J, Britton C: The Tripler LE3AN Program: a two-year follow-up report. Mil Med 1999, 164:389-395.
• [23]Dennis KE, Pane KW, Adams BK, Qi BB: The impact of a shipboard weight control program. Obes Res 1999, 7:60-67.
• [24]Gambera PJ, Schneeman BO, Davis PA: Use of the Food Guide Pyramid and US Dietary Guidelines to improve dietary intake and reduce cardiovascular risk in active-duty Air Force members. J Am Diet Assoc 1995, 95:1268-1273.
• [25]James LC, Folen RA, Davis MK: A new frontier for clinical health psychologists: our leadership role in the development of an inpatient weight management program. Prof Psychol Res Pract 1997, 28:146-152.
• [26]Trent LK, Stevens LT: Evaluation of the Navy's obesity treatment program. Mil Med 1995, 160:326-330.
• [27]Sproul AD, Canter DD, Schmidt JB: Does point-of-purchase nutrition labeling influence meal selections? A test in an Army cafeteria. Mil Med 2003, 168:556-560.
• [28]Thorsen AV, Lassen AD, Tetens I, Hels O, Mikkelsen BE: Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables. Public Health Nutr 2010, 13:1647-1652.
• [29]Absetz P, Valve R, Oldenburg B, Heinonen H, Nissinen A, Fogelholm M, Ilvesmaki V, Talja M, Uutela A: Type 2 diabetes prevention in the "real world": one-year results of the GOAL Implementation Trial. Diabetes Care 2007, 30:2465-2470.
• [30]Hoppu U, Lehtisalo J, Kujala J, Keso T, Garam S, Tapanainen H, Uutela A, Laatikainen T, Rauramo U, Pietinen P: The diet of adolescents can be improved by school intervention. Public Health Nutr 2010, 13:973-979.
• [31]Lindstrom J, Absetz P, Hemio K, Peltomaki P, Peltonen M: Reducing the risk of type 2 diabetes with nutrition and physical activity - efficacy and implementation of lifestyle interventions in Finland. Public Health Nutr 2010, 13:993-999.
• [32]Pietinen P, Lahti-Koski M, Vartiainen E, Puska P: Nutrition and cardiovascular disease in Finland since the early 1970s: a success story. J Nutr Health Aging 2001, 5:150-154.
• [33]Jallinoja P, Sahi T, Uutela A: Varusmiesten ravitsemus, terveyden riskitekijät ja terveystaju (in Finnish with English summary). In English: Conscripts' nutrition, health risk factors and health sense. Helsinki: National Public Health Institute; 2008.
• [34]Aromaa A, Koskinen S: Terveys ja toimintakyky Suomessa. Terveys 2000 -tutkimuksen perustulokset. Helsinki: Kansanterveyslaitos. National Institute of Public Health; 2002:148.
• [35]Helakorpi S, Pajunen T, Jallinoja P, Virtanen S, Uutela A: Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys, kevät 2010. Health Behaviour and Health among the Finnish Adult Population, Spring 2010. Helsinki: National Institute for Health and Welfare; 2011.
• [36]Paalanen L, Mannisto S, Virtanen MJ, Knekt P, Rasanen L, Montonen J, Pietinen P: Validity of a food frequency questionnaire varied by age and body mass index. J Clin Epidemiol 2006, 59:994-1001.
• [37]Peltonen M, Harald K, Männistö S, Saarikoski L, Peltomäki P, Lund L, Sundvall J, Juolevi A, Laatikainen T, Aldén-Nieminen H, et al.: National FINRISKI 2007 health study. (In Finnish, with English summary). Helsinki: National Public Health Institute; 2008.
• [38]Committee for Proprietary Medicinal Products: Committee for Proprietary Medicinal Products (CPMP): points to consider on adjustment for baseline covariates. Stat Med 2004, 23:701-709.
• [39]Uglem S, Frolich W, Stea TH, Wandel M: Correlates of vegetable consumption among young men in the Norwegian National Guard. Appetite 2007, 48:46-53.
• [40]Uglem S, Frolich W, Stea TH, Wandel M: Preferences and perceptions of personal vegetable consumption: a study among young men in the Norwegian National Guard. Int J Food Sci Nutr 2008, 59:279-290.
• [41]Champagne CM, Hunt AE, Cline AD, Patrick K, Ryan DH: Incorporating new recipes into the Armed Forces Recipe File: determination of acceptability. Mil Med 2001, 166:184-190.
• [42]Engbers LH, van Poppel MN, Chin APMJ, van Mechelen W: Worksite health promotion programs with environmental changes: a systematic review. Am J Prev Med 2005, 29:61-70.
• [43]Pérez-Rodrigo C, Aranceta J: School-based nutrition education: lessons learned and new perspectives. Public Health Nutr 2001, 4:131-139.
• [44]Hunter CM, Peterson AL, Alvarez LM, Poston WC, Brundige AR, Haddock CK, Van Brunt DL, Foreyt JP: Weight management using the internet a randomized controlled trial. Am J Prev Med 2008, 34:119-126.
• [45]Wu ML, Whittemore AS, Jung DL: Errors in reported dietary intakes. I. Short-term recall. Am J Epidemiol 1986, 124:826-835.
• [46]Prasad M, Lumia M, Erkkola M, Tapanainen H, Kronberg-Kippila C, Tuokkola J, Uusitalo U, Simell O, Veijola R, Knip M, et al.: Diet composition of pregnant Finnish women: changes over time and across seasons. Public Health Nutr 2010, 13:939-946.
• [47]Uusitalo U, Arkkola T, Ovaskainen ML, Kronberg-Kippila C, Kenward MG, Veijola R, Simell O, Knip M, Virtanen SM: Unhealthy dietary patterns are associated with weight gain during pregnancy among Finnish women. Public Health Nutr 2009, 12:2392-2399.