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Peltier MR, Verplaetse TL, Altemus M, Zakiniaeiz Y, Ralevski EA, Mineur YS, Gueorguieva R, Picciotto MR, Cosgrove KP, Petrakis I, McKee SA. The role of neurosteroids in posttraumatic stress disorder and alcohol use disorder: A review of 10 years of clinical literature and treatment implications. Front Neuroendocrinol 2024; 73:101119. [PMID: 38184208 DOI: 10.1016/j.yfrne.2023.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/08/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Rates of alcohol use disorder (AUD) are increasing in men and women and there are high rates of concurrent posttraumatic stress disorder (PTSD) and AUD. AUD and PTSD synergistically increase symptomatology and negatively affect treatment outcomes; however, there are very limited pharmacological treatments for PTSD/AUD. Neurosteroids have been implicated in the underlying neurobiological mechanisms of both PTSD and AUD and may be a target for treatment development. This review details the past ten years of research on pregnenolone, progesterone, allopregnanolone, pregnanolone, estradiol, testosterone and dehydroepiandrosterone/dehydroepiandrosterone-sulfate (DHEA/DHEA-S) in the context of PTSD and AUD, including examination of trauma/alcohol-related variables, such as stress-reactivity. Emerging evidence that exogenous pregnenolone, progesterone, and allopregnanolone may be promising, novel interventions is also discussed. Specific emphasis is placed on examining the application of sex as a biological variable in this body of literature, given that women are more susceptible to both PTSD diagnoses and stress-related alcohol consumption.
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Affiliation(s)
- MacKenzie R Peltier
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA; National Center for PTSD, Clinical Neuroscience Division, West Haven, CT 06516, USA.
| | | | - Margaret Altemus
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA
| | - Yasmin Zakiniaeiz
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
| | - Elizabeth A Ralevski
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA
| | - Yann S Mineur
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
| | - Ralitza Gueorguieva
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Marina R Picciotto
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
| | - Kelly P Cosgrove
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; National Center for PTSD, Clinical Neuroscience Division, West Haven, CT 06516, USA; Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, CT, USA
| | - Ismene Petrakis
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA; National Center for PTSD, Clinical Neuroscience Division, West Haven, CT 06516, USA
| | - Sherry A McKee
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
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Pihlainen K, Santtila M, Nindl BC, Raitanen J, Ojanen T, Vaara JP, Helén J, Nykänen T, Kyröläinen H. Changes in physical performance, body composition and physical training during military operations: systematic review and meta-analysis. Sci Rep 2023; 13:21455. [PMID: 38052976 PMCID: PMC10698179 DOI: 10.1038/s41598-023-48712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
Systematic review and meta-analysis applying PRISMA guidelines with a PICOS format was constructed to provide an overview of changes in physical performance, body composition and physical training in soldiers during prolonged (≥ 3 months) military operations. Twenty-four studies out of the screened 4431 records filled the inclusion criteria. A small decrease in endurance performance was the most consistent finding (Hedge's g [g] - 0.21, 95% CI - 0.01 to - 0.41) while small overall increases in maximal strength of the lower (g 0.33, 95% CI 0.16-0.50) and upper body (g 0.33, 95% CI 0.19-0.46) were observed. In addition, small increases in strength endurance (push-up, g 0.34, 95% CI 0.15-0.52; sit-up g 0.26, 95% CI 0.07-0.44) were observed. The overall changes in body composition were trivial. Heterogeneity in the outcome variables varied mainly between low to moderate. Large inter-individual variations were observed in physical training volume, including decrements especially in endurance training frequency and volume. A reduction in total training load was often associated with negative changes in body composition and physical performance according to the principle of training specificity. Individuals with higher initial fitness level were more susceptible to decrements in their physical performance during operation.
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Affiliation(s)
- K Pihlainen
- Human Performance Sector, Training Division, Defence Command, Helsinki, Finland.
| | - M Santtila
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - B C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Raitanen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
| | - T Ojanen
- Human Performance Division, Finnish Defence Research Agency, Tuusula, Finland
| | - J P Vaara
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - J Helén
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
| | - T Nykänen
- Army Academy, Finnish Defence Forces, Lappeenranta, Finland
| | - H Kyröläinen
- Department of Leadership and Military Pedagogy, National Defence University, Helsinki, Finland
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyvaskyla, Finland
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Farina EK, Thompson LA, Knapik JJ, Pasiakos SM, McClung JP, Lieberman HR. Anthropometrics and Body Composition Predict Physical Performance and Selection to Attend Special Forces Training in United States Army Soldiers. Mil Med 2021; 187:1381-1388. [PMID: 34302352 DOI: 10.1093/milmed/usab315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Anthropometrics and body composition characteristics differentiate many types of athletes and are related to performance on fitness tests and tasks in military personnel. Soldiers competing to enter elite units must demonstrate physical fitness and operational competence across multiple events. Therefore, this study determined whether anthropometrics and body composition predicted physical performance and selection for special forces training among soldiers attending the rigorous Special Forces Assessment and Selection (SFAS) course. MATERIALS AND METHODS Soldiers attending the SFAS course between May 2015 and March 2017 were enrolled in a longitudinal, observational study. Anthropometrics (height, body mass, and body mass index [BMI]; n = 795) and body composition measured by dual-energy X-ray absorptiometry (percentage body fat, fat mass, lean mass, bone mineral content [BMC], and bone mineral density [BMD]; n = 117) were assessed before the course start. Associations with physical performance were determined with correlation coefficients. Associations with selection were determined with analyses of variance and t-tests; effect sizes were calculated as Cohen's d. The U.S. Army Research Institute of Environmental Medicine Institutional Review Board (IRB) initially approved this study, and the U.S. Army Medical Research and Development Command IRB approved the continuing review. RESULTS Lower percentage body fat and fat mass predicted better performance on all assessments: Army Physical Fitness Test (APFT), pull-ups, SFAS run, loaded road march, obstacle course, and land navigation (P ≤ .05). Higher lean mass predicted better performance on the loaded road march (P ≤ .05). Lower body mass and BMI predicted better performance on APFT, pull-ups, run, and obstacle course; higher body mass and BMI predicted better performance on the loaded road march (P ≤ .05). Shorter stature predicted better performance on push-ups (APFT) and pull-ups; taller stature predicted better performance on SFAS run and loaded road march (P ≤ .05). On average, the selected soldiers were taller (179.0 ± 6.6 vs. 176.7 ± 6.7 cm), had higher body mass (85.8 ± 8.8 vs. 82.1 ± 9.6 kg), BMI (26.8 ± 2.2 vs. 26.3 ± 2.6 kg/m2), lean mass (67.2 ± 7.3 vs. 61.9 ± 7.6 kg), BMC (3.47 ± 0.40 vs. 3.29 ± 0.56 kg), and BMD (1.34 ± 0.10 vs. 1.28 ± 0.10 g/cm2), and lower percentage body fat (17.3 ± 3.4 vs. 20.1 ± 4.5%) and fat mass (14.2 ± 3.7 vs. 15.8 ± 4.4 kg) (P ≤ .05). Effect sizes were largest for lean mass (Cohen's d = 0.71) and percentage body fat (d = 0.70), followed by BMD (d = 0.60), body mass (d = 0.40), fat mass (d = 0.39), BMC (d = 0.37), height (d = 0.35), and BMI (d = 0.21). Body mass adjustment attenuated associations between height and selection. CONCLUSIONS Anthropometrics and body composition are predictors of physical performance and SFAS success. Since these measures are modifiable (excluding height), they may be the focus of intervention studies aiming to improve performance in arduous military training courses, sports that require competition in multiple events, and occupations that have varied physical demands, such as firefighting, law enforcement, and construction.
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Affiliation(s)
- Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Lauren A Thompson
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Joseph J Knapik
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - James P McClung
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
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Hernandez D, Kip KE, Long CJ, Redman JL. Accelerated resolution therapy and a thematic approach to military experiences in US Special Operations Veterans. BMJ Mil Health 2021; 168:224-228. [PMID: 33911011 DOI: 10.1136/bmjmilitary-2020-001729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/04/2022]
Abstract
Accelerated Resolution Therapy (ART) is an emerging therapeutic intervention that has demonstrated effectiveness in treating post-traumatic stress, anxiety and depression. The ART protocol aligns with first-line trauma-focused psychotherapies and clinical guides in the USA and UK. This review addresses previous ART research that includes members of US Special Operations Forces. Observations from that research has led to a thematic conceptualisation of trauma through ART interventions. These include three clusters of traumatic memories and several themes relevant to individual distress but not necessarily symptoms that meet diagnostic criteria for PTSD. ART represents a movement in treatment away from the symptoms, to the individuals' story. Not only the story of an event, but how that experience becomes incorporated into one's sense of identity. The themes identified (and treated with ART) appear to have broader application to the entirety of one's military experience, not just PTSD. These themes may be helpful in directing treatment and may help to focus on significant aspects of service not traditionally associated with PTSD. Theoretically, some of these areas may have protective implications in suicide.
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Affiliation(s)
- Diego Hernandez
- Balanced Living Psychology, Tampa, Florida, USA .,College Public Health, University of South Florida, Tampa, Florida, USA
| | - K E Kip
- College Public Health, University of South Florida, Tampa, Florida, USA.,Health Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - C J Long
- College Public Health, University of South Florida, Tampa, Florida, USA
| | - J L Redman
- Division of Counseling and Family Therapy, Regis University, Denver, Colorado, USA
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Spiering BA, Mujika I, Sharp MA, Foulis SA. Maintaining Physical Performance: The Minimal Dose of Exercise Needed to Preserve Endurance and Strength Over Time. J Strength Cond Res 2021; 35:1449-1458. [PMID: 33629972 DOI: 10.1519/jsc.0000000000003964] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Maintaining physical performance: the minimal dose of exercise needed to preserve endurance and strength over time, Spiering, BA, Mujika, I, Sharp, MA, and Foulis, SA. J Strength Cond Res 35(5): 1449-1458, 2021-Nearly every physically active person encounters periods in which the time available for exercise is limited (e.g., personal, family, or business conflicts). During such periods, the goal of physical training may be to simply maintain (rather than improve) physical performance. Similarly, certain special populations may desire to maintain performance for prolonged periods, namely athletes (during the competitive season and off-season) and military personnel (during deployment). The primary purpose of this brief, narrative review is to identify the minimal dose of exercise (i.e., frequency, volume, and intensity) needed to maintain physical performance over time. In general populations, endurance performance can be maintained for up to 15 weeks when training frequency is reduced to as little as 2 sessions per week or when exercise volume is reduced by 33-66% (as low as 13-26 minutes per session), as long as exercise intensity (exercising heart rate) is maintained. Strength and muscle size (at least in younger populations) can be maintained for up to 32 weeks with as little as 1 session of strength training per week and 1 set per exercise, as long as exercise intensity (relative load) is maintained; whereas, in older populations, maintaining muscle size may require up to 2 sessions per week and 2-3 sets per exercise, while maintaining exercise intensity. Insufficient data exists to make specific recommendations for athletes or military personnel. Our primary conclusion is that exercise intensity seems to be the key variable for maintaining physical performance over time, despite relatively large reductions in exercise frequency and volume.
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Affiliation(s)
- Barry A Spiering
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Iñigo Mujika
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Basque Country; and.,Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Marilyn A Sharp
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
| | - Stephen A Foulis
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts
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Conkright WR, O'Leary TJ, Wardle SL, Greeves JP, Beckner ME, Nindl BC. SEX DIFFERENCES IN THE PHYSICAL PERFORMANCE, PHYSIOLOGICAL, AND PSYCHO-COGNITIVE RESPONSES TO MILITARY OPERATIONAL STRESS. Eur J Sport Sci 2021; 22:99-111. [PMID: 33840352 DOI: 10.1080/17461391.2021.1916082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Combat roles are physically demanding and expose service personnel to operational stressors such as high levels of physical activity, restricted nutrient intake, sleep loss, psychological stress, and environmental extremes. Women have recently integrated into combat roles, but our knowledge of the physical, physiological, and psycho-cognitive responses to these operational stressors in women is limited. The aim of this narrative review was to evaluate the evidence for sex-specific physical, physiological, and psycho-cognitive responses to real, and simulated, military operational stress. Studies examining physical and cognitive performance, body composition, metabolism, hypothalamic-pituitary-gonadal axis, and psychological health outcomes were evaluated. These studies report that women expend less energy and lose less body mass and fat-free mass, but not fat mass, than men. Despite having similar physical performance decrements as men during operational stress, women experience greater physiological strain than men completing the same physical tasks, but this may be attributed to differences in fitness. From limited data, military operational stress suppresses hypothalamic-pituitary-gonadal, but not hypothalamic-pituitary-adrenal, axis function in both sexes. Men and women demonstrate different psychological and cognitive responses to operational stress, including disturbances in mood, with women having a higher risk of post-traumatic stress symptoms compared with men. Based on current evidence, separate strategies to maximize selection and combat training are not warranted until further data directly comparing men and women are available. However, targeted exercise training programs may be advisable to offset the physical performance gap between sexes and optimize performance prior to inevitable declines caused by intense military operations.
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Affiliation(s)
- William R Conkright
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory & Warrior Human Performance Research Center, University of Pittsburgh, United States
| | - Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, University College London, London, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Meaghan E Beckner
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory & Warrior Human Performance Research Center, University of Pittsburgh, United States
| | - Bradley C Nindl
- Department of Sports Medicine and Nutrition, Neuromuscular Research Laboratory & Warrior Human Performance Research Center, University of Pittsburgh, United States
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O'Leary TJ, Wardle SL, Greeves JP. Energy Deficiency in Soldiers: The Risk of the Athlete Triad and Relative Energy Deficiency in Sport Syndromes in the Military. Front Nutr 2020; 7:142. [PMID: 32984399 PMCID: PMC7477333 DOI: 10.3389/fnut.2020.00142] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Military personnel experience energy deficit (total energy expenditure higher than energy intake), particularly during combat training and field exercises where exercising energy expenditures are high and energy intake is reduced. Low energy availability (energy intake minus exercising energy expenditure expressed relative to fat free mass) impairs endocrine function and bone health, as recognized in female athletes as the Female Athlete Triad syndrome. More recently, the Relative Energy Deficiency in Sport (RED-S) syndrome encompasses broader health outcomes, physical and cognitive performance, non-athletes, and men. This review summarizes the evidence for the effect of low energy availability and energy deficiency in military training and operations on health and performance outcomes. Energy availability is difficult to measure in free-living individuals but doubly labeled water studies demonstrate high total energy expenditures during military training; studies that have concurrently measured energy intake, or measured body composition changes with DXA, suggest severe and/or prolonged energy deficits. Military training in energy deficit disturbs endocrine and metabolic function, menstrual function, bone health, immune function, gastrointestinal health, iron status, mood, and physical and cognitive performance. There are more data for men than women, and little evidence on the chronic effects of repeated exposures to energy deficit. Military training impairs indices of health and performance, indicative of the Triad and RED-S, but the multi-stressor environment makes it difficult to isolate the independent effects of energy deficiency. Studies supplementing with energy to attenuate the energy deficit suggest an independent effect of energy deficiency in the disturbances to metabolic, endocrine and immune function, and physical performance, but randomized controlled trials are lacking.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, United Kingdom.,Division of Surgery and Interventional Science, UCL, London, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Farina EK, Thompson LA, Knapik JJ, Pasiakos SM, Lieberman HR, McClung JP. Diet Quality Is Associated with Physical Performance and Special Forces Selection. Med Sci Sports Exerc 2020; 52:178-186. [PMID: 31436735 DOI: 10.1249/mss.0000000000002111] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study determined associations between diet quality measured by the Healthy Eating Index (HEI)-2015, physical performance, and successful selection following a U.S. Army Special Forces Assessment and Selection course characterized by arduous cognitive and physical demands. METHODS The HEI-2015 scores were calculated from usual diet assessed with a Block food frequency questionnaire among 782 soldiers attending Special Forces Assessment and Selection. Differences in HEI-2015 scores according to demographics and physical performance were determined with analysis of variance. Differences in likelihood of selection according to HEI-2015 scores were determined with logistic regression. Models were adjusted for potential confounders: age, education, body mass index (BMI), duration and type of resistance training, and smoking. RESULTS The HEI-2015 total score was higher among older soldiers (≥25 yr), those with more education (≥some college), higher body mass index (≥25), longer duration of resistance training (≥400 min·wk), those that reported use of free weights, suspension training, Olympic lifting, and nonsmokers (P < 0.05). The HEI-2015 total score was higher among those with higher Army Physical Fitness Test (APFT) total scores, APFT sit-up score, APFT run score, and faster loaded road march times (P < 0.05). Those with higher HEI-2015 total scores were 75% (quartile 3 vs quartile 1: odds ratio, 1.75; 95% confidence interval, 1.09-2.81) and 65% (quartile 4 vs quartile 1: odds ratio, 1.65, 95% confidence interval, 1.03-2.65) more likely to be selected. Higher scores for total vegetables, greens and beans, seafood and plant protein, and refined grains, but lower sodium scores (indicating more sodium consumed), were associated with better physical performance (P < 0.05). CONCLUSIONS Dietary patterns that conform to federal dietary guidelines (except sodium) are associated with physical performance and Special Forces selection.
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Affiliation(s)
- Emily K Farina
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | - Lauren A Thompson
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | | | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | - Harris R Lieberman
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
| | - James P McClung
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA
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Folaron I, True MW, Kazanis WH, Wardian JL, Tate JM, Graybill SD, Clerc PG, Jenkins CR. Diabetes by Air, Land, and Sea: Effect of Deployments on HbA1c and BMI. Mil Med 2020; 185:486-492. [PMID: 31621859 DOI: 10.1093/milmed/usz311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Service members (SMs) in the United States (U.S.) Armed Forces have diabetes mellitus at a rate of 2-3%. Despite having a chronic medical condition, they have deployed to environments with limited medical support. Given the scarcity of data describing how they fare in these settings, we conducted a retrospective study analyzing the changes in glycated hemoglobin (HbA1c) and body mass index (BMI) before and after deployment. MATERIALS AND METHODS SMs from the U.S. Army, Air Force, Navy, and Marine Corps with diabetes who deployed overseas were identified through the Military Health System (MHS) Management Analysis and Reporting Tool and the Defense Manpower Data Center. Laboratory and pharmaceutical data were obtained from the MHS Composite Health Care System and the Pharmacy Data Transaction Service, respectively. Paired t-tests were conducted to calculate changes in HbA1c and BMI before and after deployment. RESULTS SMs with diabetes completed 11,325 deployments of greater than 90 days from 2005 to 2017. Of these, 474 (4.2%) SMs had both HbA1c and BMI measurements within 90 days prior to departure and within 90 days of return. Most (84.2%) required diabetes medications: metformin in 67.3%, sulfonylureas in 19.0%, dipeptidyl peptidase-4 inhibitors in 13.9%, and insulin in 5.5%. Most SMs deployed with an HbA1c < 7.0% (67.1%), with a mean predeployment HbA1c of 6.8%. Twenty percent deployed with an HbA1c between 7.0 and 7.9%, 7.2% deployed with an HbA1c between 8.0 and 8.9%, and 5.7% deployed with an HbA1c of 9.0% or higher. In the overall population and within each military service, there was no significant change in HbA1c before and after deployment. However, those with predeployment HbA1c < 7.0% experienced a rise in HbA1c from 6.2 to 6.5% (P < 0.001), whereas those with predeployment HbA1c values ≥7.0% experienced a decline from 8.0 to 7.5% (P < 0.001). Those who deployed between 91 and 135 days had a decline in HbA1c from 7.1 to 6.7% (P = 0.010), but no significant changes were demonstrated in those with longer deployment durations. BMI declined from 29.6 to 29.3 kg/m2 (P < 0.001), with other significant changes seen among those in the Army, Navy, and deployment durations up to 315 days. CONCLUSIONS Most SMs had an HbA1c < 7.0%, suggesting that military providers appropriately selected well-managed SMs for deployment. HbA1c did not seem to deteriorate during deployment, but they also did not improve despite a reduction in BMI. Concerning trends included the deployment of some SMs with much higher HbA1c, utilization of medications with adverse safety profiles, and the lack of HbA1c and BMI evaluation proximal to deployment departures and returns. However, for SMs meeting adequate glycemic targets, we demonstrated that HbA1c remained stable, supporting the notion that some SMs may safely deploy with diabetes. Improvement in BMI may compensate for factors promoting hyperglycemia in a deployed setting, such as changes in diet and medication availability. Future research should analyze in a prospective fashion, where a more complete array of diabetes and readiness-related measures to comprehensively evaluate the safety of deploying SMs with diabetes.
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Affiliation(s)
- Irene Folaron
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft, Sam Houston, TX 78234
| | - Mark W True
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft, Sam Houston, TX 78234
| | - William H Kazanis
- Defense Health Agency, 3515 S General McMullen Suite 200, San Antonio, TX 78226
| | - Jana L Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, Bldg 4554 JBSA-Lackland Air Force Base, TX 782363
| | - Joshua M Tate
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft, Sam Houston, TX 78234
| | - Sky D Graybill
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft, Sam Houston, TX 78234
| | - Philip G Clerc
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft, Sam Houston, TX 78234
| | - Craig R Jenkins
- Division of Endocrinology, San Antonio Military Medical Center, MCH-ZDM-E 3551 Roger Brooke Dr. JBSA-Ft, Sam Houston, TX 78234
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Farina EK, Thompson LA, Knapik JJ, Pasiakos SM, McClung JP, Lieberman HR. Physical performance, demographic, psychological, and physiological predictors of success in the U.S. Army Special Forces Assessment and Selection course. Physiol Behav 2019; 210:112647. [DOI: 10.1016/j.physbeh.2019.112647] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022]
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Farina EK, Taylor JC, Means GE, Murphy NE, Pasiakos SM, Lieberman HR, McClung JP. Effects of deployment on diet quality and nutritional status markers of elite U.S. Army special operations forces soldiers. Nutr J 2017; 16:41. [PMID: 28673301 PMCID: PMC5496422 DOI: 10.1186/s12937-017-0262-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/21/2017] [Indexed: 12/03/2022] Open
Abstract
Background Special Operations Forces (SOF) Soldiers deploy frequently and require high levels of physical and cognitive performance. Nutritional status is linked to cognitive and physical performance. Studies evaluating dietary intake and nutritional status in deployed environments are lacking. Therefore, this study assessed the effects of combat deployment on diet quality and serum concentrations of nutritional status markers, including iron, vitamin D, parathyroid hormone (PTH), glucose, and lipids, among elite United States (U.S.) Army SOF Soldiers. Methods Changes from baseline to post-deployment were determined with a repeated measure within-subjects design for Healthy Eating Index-2010 (HEI-2010) scores, intake of foods, food groups, key nutrients, and serum nutritional status markers. Dietary intake was assessed with a Block Food Frequency Questionnaire. The association between post-deployment serum 25-hydroxy vitamin D (25-OH vitamin D) and PTH was determined. Analyses of serum markers were completed on 50 participants and analyses of dietary intake were completed on 33 participants. Results In response to deployment, HEI-2010 scores decreased for total HEI-2010 (70.3 ± 9.1 vs. 62.9 ± 11.1), total fruit (4.4 ± 1.1 vs. 3.7 ± 1.5), whole fruit (4.6 ± 1.0 vs. 4.2 ± 1.4), dairy (6.2 ± 2.7 vs. 4.8 ± 2.4), and empty calories (14.3 ± 3.2 vs. 11.1 ± 4.5) (P ≤ 0.05). Average daily intakes of foods and food groups that decreased included total dairy (P < 0.01), milk (P < 0.01), and non-juice fruit (P = 0.03). Dietary intake of calcium (P = 0.05) and vitamin D (P = 0.03) decreased. PTH increased from baseline (3.4 ± 1.6 vs. 3.8 ± 1.4 pmol/L, P = 0.04), while there was no change in 25-OH vitamin D. Ferritin decreased (385 ± 173 vs. 354 ± 161 pmol/L, P = 0.03) and soluble transferrin receptor increased (16.3 ± 3.7 vs. 17.1 ± 3.5 nmol/L, P = 0.01). There were no changes in glucose or lipids. Post-deployment, serum 25-OH vitamin D was inversely associated with PTH (r = −0.43, P < 0.01). Conclusions HEI-2010 scores and dietary intake of milk, calcium, and vitamin D decreased following deployment. Serum PTH increased and iron stores were degraded. No Soldiers were iron deficient. Personnel that deploy frequently should maintain a high diet quality in the U.S. and while deployed by avoiding empty calories and consuming fruits, vegetables, and adequate sources of calcium, vitamin D, and iron. Improving availability and quality of perishable food during deployment may improve diet quality.
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Affiliation(s)
- Emily K Farina
- Henry Jackson Foundation for the Advancement of Military Medicine, 6720-A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA. .,Oak Ridge Institute for Science and Education, 492 Millennium Drive, Suite 101, Belcamp, MD, 21017, USA. .,U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Avenue, Building 42, Natick, MA, 01760, USA.
| | - Jonathan C Taylor
- Department of Health and Human Sciences, Office of the National Coordinator for Health Information Technology, 330 C Street, NW, Washington, DC, 20201, USA
| | - Gary E Means
- U.S. Army Special Operations Command, 2929 Desert Storm Drive, Fort Bragg, NC, 28303, USA
| | - Nancy E Murphy
- U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Avenue, Building 42, Natick, MA, 01760, USA
| | - Stefan M Pasiakos
- U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Avenue, Building 42, Natick, MA, 01760, USA
| | - Harris R Lieberman
- U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Avenue, Building 42, Natick, MA, 01760, USA
| | - James P McClung
- U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Avenue, Building 42, Natick, MA, 01760, USA
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Milbrandt M, Winter AC, Nevin RL, Pakpahan R, Bradwin G, De Marzo AM, Elliott DJ, Gaydos CA, Isaacs WB, Nelson WG, Rifai N, Sokoll LJ, Zenilman JM, Platz EA, Sutcliffe S. Insight into infection-mediated prostate damage: Contrasting patterns of C-reactive protein and prostate-specific antigen levels during infection. Prostate 2017; 77:1325-1334. [PMID: 28703328 PMCID: PMC5578879 DOI: 10.1002/pros.23392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND To investigate mechanisms underlying our previous observation of a large rise in serum prostate-specific antigen, a marker of prostate pathology, during both sexually transmitted and systemic infections, we measured serum high-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, in our previous case-control study of young, male US military members and compared our findings to those for PSA. METHODS We measured hsCRP before and during infection for 299 chlamydia, 112 gonorrhea, and 59 non-chlamydial, non-gonococcal urethritis (NCNGU) cases; before and after infection for 55 infectious mononucleosis (IM) and 90 other systemic/non-genitourinary cases; and for 220-256 controls. RESULTS Only gonorrhea cases were significantly more likely to have a large hsCRP rise (≥1.40 mg/L or ≥239%) during infection than controls (P < 0.01). However, gonorrhea, IM, and other systemic/non-genitourinary cases were more likely to have a rise of any magnitude up to one year post-diagnosis than controls (p = 0.038-0.077). CONCLUSIONS These findings, which differ from those for PSA, suggest distinct mechanisms of elevation for hsCRP and PSA, and support both direct (eg, prostate infection) and indirect (eg, systemic inflammation-mediated prostate cell damage) mechanisms for PSA elevation. Future studies should explore our PSA findings further for their relevance to both prostate cancer screening and risk.
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Affiliation(s)
- Melissa Milbrandt
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Anke C. Winter
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Remington L. Nevin
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ratna Pakpahan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gary Bradwin
- Department of Laboratory Medicine, Harvard Medical School and Children’s Hospital, Boston, MA
| | - Angelo M. De Marzo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Debra J. Elliott
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charlotte A. Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William B. Isaacs
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William G. Nelson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nader Rifai
- Department of Laboratory Medicine, Harvard Medical School and Children’s Hospital, Boston, MA
| | - Lori J. Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan M. Zenilman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth A. Platz
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO
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