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Eat well, live well

From left, Air Force Capt. Abigail Schutz, 39th Medical Operations Squadron health promotions element chief, Staff Sgt. Jennifer Mancini, 39th MDOS health promotions technician, and Tech. Sgt. Brian Phillips, 39th MDOS health promotions flight NCO in charge, pose for a photo at Incirlik Air Base, Turkey. Learning about proper nutrition can help service members stay healthy and ensure they’re in optimal warfighting shape. (U.S. Air Force photo by Staff Sgt. Matthew Wisher) From left, Air Force Capt. Abigail Schutz, 39th Medical Operations Squadron health promotions element chief, Staff Sgt. Jennifer Mancini, 39th MDOS health promotions technician, and Tech. Sgt. Brian Phillips, 39th MDOS health promotions flight NCO in charge, pose for a photo at Incirlik Air Base, Turkey. Learning about proper nutrition can help service members stay healthy and ensure they’re in optimal warfighting shape. (U.S. Air Force photo by Staff Sgt. Matthew Wisher)

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Health Readiness | Nutrition

Who doesn’t have a friend or family member trying out the latest paleo, keto or other diet that eliminates processed foods including grains and sugar? Perhaps you are the one following a strict eating regimen because you want to improve your health. But have you wondered if it’s your best option?

“Many of the fad diets that we see today are just recycled old ones with new names,” explained Air Force Lt. Col. Saunya Bright, chief, health promotion nutrition, Air Force Medical Support Agency, Falls Church, Virginia. Bright described the Paleolithic or “paleo” diet as one including foods that can be hunted or gathered, such as meat, fish, chicken, eggs, vegetables, fruits and berries. The ketogenic or “keto” diet is a low-carbohydrate, high-protein and high-fat eating pattern meant to burn fat rather than carbohydrates for fuel.

While some of these diets emphasize eating more fruits and vegetables and less processed food, “some also cut out complete food groups, such as whole grains and dairy,” said Bright. She cautioned that such diets are difficult to sustain over long periods. “Eliminating food groups or types of foods increases the risk of some nutrient deficiency or disordered eating.”

Army 1st Lt. Vladi Ivanova, chief, outpatient and community nutrition at Madigan Army Medical Center, agreed. “Following a keto diet, for example, means eliminating a full food group. When we restrict certain foods, our bodies notice and may not respond in the way we want.”

Options and choices about what to eat, from diets to trendy snacks and drinks, are plentiful. The result is confusion, according to Ivanova: “My patients are asking a lot of questions, whether a diet is good or bad, or if eating certain foods will help them lose weight. They are overwhelmed by all of the information available.”

According to Bright, a return to the basics is what’s needed. “The most important suggestions for good nutrition are captured in the 2015-2020 Dietary Guidelines for Americans,” she said.

These guidelines, developed jointly by the U.S. Departments of Health and Human Services and Agriculture, provide evidence-based tools and resources that enable everyone to follow a healthy eating pattern for life.

Ivanova likes to use “MyPlate,” a tool developed by the U.S. Department of Agriculture, as a visual aid with her patients. “It shows how to fill a healthy plate of food: one-half should include fruits and vegetables, one quarter whole grains, and one quarter lean protein,” she said.

Using the guidelines, both experts agreed that a healthy eating pattern includes a variety of vegetables; whole fruits; fat-free or low-fat dairy, including milk, yogurt and cheese; and a variety of proteins, including seafood, lean meats and poultry, eggs, beans, nuts and seeds.

Bright said to avoid excess sugar, sodium, and saturated and trans fat as part of establishing a healthy eating pattern. “With all the new and trending foods, it's important to consider how substituting a certain type of food with another can impact your nutritional intake,” she said. “There are instances where foods that are advertised as ‘lower fat’ or ‘no fat’ contain increased sodium or sugar, so being aware of trade-offs is important.”

Ivanova said good nutrition is key to service members’ ability to carry out their mission as well – responding to their needs for quick, healthier meals on-the-go, and also ensuring their families are making good choices. “Often when speaking with my patients, I end up talking to them about their children’s nutrition, too. Any service member who is a parent has to model the diet that they want their kids to eat,” said Ivanova, who advocates a mindful approach to healthy eating.

“My patients have told me that after eating a fast food meal, they feel awful,” she said. “Mindfulness about how and what we eat is critical. You have to make eating healthy a priority in your life. This means taking time to understand healthy options and planning your meals in advance – perhaps for the week – so that you think through what you are putting into your body.”

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Since 1999, the Medical Surveillance Monthly Report (MSMR) has published periodic updates on the incidence of malaria among U.S. service members. Malaria infection remains an important health threat to U.S. service members, who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. This update for 2017 describes the epidemiologic patterns of malaria incidence in active and reserve component service members of the U.S. Armed Forces. Findings •	A total of 32 service members were diagnosed with or reported to have malaria, which is the lowest number of cases in any given year during the 10-year surveillance period. •	Health records documented the performance of laboratory tests for malaria for 22 of the cases. The tests for 17 of the 22 were positive for malaria ( stick figure graphic visually depicts this information). •	In 2017, 75.0% (24 of 32) of malaria cases among U.S. service members were diagnosed during May – October (calendar graphic showing the months visually). •	Of the 32 malaria cases in 2017, more than 1/3 of the infections were considered to have been acquired in Africa. Two bar charts display the following information: •	Bar chart 1: Numbers of malaria cases by Plasmodium species and calendar year of diagnosis/report, active and reserve components, U.S. Armed Forces, 2008 – 2017  •	Bar chart 2: Annual numbers of cases of malaria associated with specific locations of acquisition, active and reserve components, U.S. Armed Forces, 2008 – 2017  The majority of U.S. military members diagnosed with malaria in 2017 were: •	Male (96.9%) •	Active component (81.3%) •	In the Army (75.0%) •	In their 20’s (56.3%) Access the full report in the February 2018 MSMR (Vol. 25 No. 2). Go to www.Health.mil/MSMR  Picture of a mosquito displays on the graphic.

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On 29 July 2016, the U.S. Coast Guard Training Center Cape May (TCCM), NJ, identified an increase in febrile respiratory illness (FRI) among recruits who were unvaccinated against seasonal influenza as a result of the annual vaccine’s expiration. This report characterizes the outbreak and containment measures implemented at TCCM during the outbreak period. In 2016, respiratory infections affected more than 250,000 U.S. service members and comprised approximately 22% of medical encounters among military recruit populations – who are highly susceptible to respiratory infections. Seasonal influenza and rhinovirus are two of the leading respiratory pathogens. During the Surveillance Period: 115 recruits reported respiratory infection symptoms. Pie chart 1 shows the following data: •	41 (35.7%) suspected cases •	74 (64.3%) confirmed cases Among confirmed cases, lab specimens tested positive for: •	Influenza A 34 (45.9%) •	Rhinovirus 28 (37.8%) •	Influenza A and rhinovirus co-infection 11 (14.9%) •	Rhinovirus and adenovirus co-infection 1 (1.4%) Data above depicted in pie chart 2. •	24 July – 6 August, Influenza predominated •	7 August – 20 August, Rhinovirus predominated Although the outbreak significantly affected operations at TCCM, a timely and comprehensive response resulted in containment of the outbreak within 5 weeks. Key Factor for Outbreak Control •	Rapid detection through FRI sentinel surveillance •	Quick decision-making •	Streamlined response by using a single chain of command •	Rapid implementation of both nonpharmaceutical and pharmaceutical interventions Access the full report in the January 2018 MSMR (Vol. 25, No. 1). Go to: www.Health.mil/MSMR

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Insomnia is the most common sleep disorder in adults and its incidence in the U.S. Armed Forces is increasing. A potential consequence of inadequate sleep is increased risk of motor vehicle accidents (MVAs). MVAs are the leading cause of peacetime deaths and a major cause of non-fatal injuries in the U.S. military members. To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia. After adjustment for multiple covariates, during 2007 – 2016, active component service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia. Findings:  •	Line graph shows the annual rates of motor vehicle accident-related injuries, active component service members with and without diagnoses of insomnia, U.S. Armed Forces, 2007 – 2016  •	Annual rates of MVA-related injuries were highest in the insomnia cohort in 2007 and 2008, and lowest in 2016 •	There were 5,587 cases of MVA-related injuries in the two cohorts during the surveillance period. •	Pie chart displays the following data: 1,738 (31.1%) in the unexposed cohort and 3,849 (68.9%) in the insomnia cohort The highest overall crude rates of MVA-related injuries were seen in service members who were: •	Less than 25 years old •	Junior enlisted rank/grade •	Armor/transport occupation •	 •	With a history of mental health diagnosis •	With a history of alcohol-related disorders Access the full report in the December 2017 (Vol. 24, No. 12). Go to www.Health.mil/MSMR Image displays a motor vehicle accident.

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