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Impact of Fatty Acid Supplementation on Cognitive Performance among United States (US) Military Officers: The Ranger Resilience and Improved Performance on Phospholipid-Bound Omega-3's (RRIPP-3) Study.
Marriott, BP, Turner, TH, Hibbeln, JR, Newman, JC, Pregulman, M, Malek, AM, Malcolm, RJ, Burbelo, GA, Wismann, JW
Nutrients. 2021;(6)
Abstract
Studies have assessed omega-3 fatty acids and cognitive decline among older adults and cognitive development among children, although less is known about cognitive or neurological effects among young adults. We examined whether omega-3 supplementation from krill oil could improve cognition and resilience among young military officers compared to a control. This double-blind, placebo-controlled trial enrolled 555 officers (mean age 23.4 ± 2.8, 98.6% male) entering the United States (US) Army Infantry Basic Officer Leaders Course (IBOLC) with the intention to complete the US Ranger Course. Volunteer participants consumed eight dietary supplements daily of krill oil containing 2.3 g omega-3 or control (macadamia nut oil) over an approximate 20-week period. Cognitive functioning, resilience, and mood were assessed during a well-rested period at approximately 14 weeks and after a battlefield simulation at 16 weeks. Blood spot samples were collected to monitor compliance and dietary intake was assessed. All hypotheses were tested using both 'Intention to Treat' (ITT) and 'As Per Protocol' (APP) approaches. Of the 555 randomized individuals, 245 (44.1%) completed the study. No statistically significant group-by-time interactions indicating treatment effect were found on any outcomes. Poor compliance was indicated by lower than expected omega-3 elevations in the treatment group, and may have contributed to a failure to detect a response.
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A Prospective Cohort Study of Vitamin D Supplementation in AD Soldiers: Preliminary Findings.
McCarthy, MS, Elshaw, EB, Szekely, BM, Raju, D
Military medicine. 2019;(Suppl 1):498-505
Abstract
PURPOSE To explore response to vitamin D supplementation in active duty (AD) warfighters and translate findings into evidence-based health policy. BACKGROUND Soldiers are at risk for musculoskeletal injuries and metabolic dysfunction that impact physical performance and military readiness; the link with low vitamin D status is unclear. METHODS This prospective trial enrolled 152 soldiers; baseline 25 hydroxyvitamin (OH) D level determined assignment to a no-treatment control (CG) or treatment group (TG) receiving a vitamin D3 supplement for 90 days. Symptoms, diet, sun exposure, and blood biomarkers obtained at baseline (T1) and 3 months (T2). RESULTS Cohort was predominantly white (58%) with a significant difference in racial distribution for vitamin D status. Mean (SD) 25(OH)D levels were 37.8 (5.6) ng/mL, 22.2 (5.0) ng/mL, and 22.9 (4.7) ng/mL for the CG, low dose TG, and high-dose TG at T1, respectively. Following three months of treatment, one-way ANOVA indicated a statistically significant difference between groups (F5,246 = 44.37; p < 0.0001). Vitamin D intake was 44% of Recommended Dietary Allowance throughout the first phase of the trial. Patient-Reported Outcomes Measurement Information System scores improved in TG for fatigue and sleep, p < 0.01. CONCLUSIONS Vitamin D deficiency is widespread in AD soldiers. Clinicians must intervene early in preventable health conditions impacting warfighter performance and readiness and recommend appropriate self-care strategies.
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Impact of cognitive behavioral therapy for insomnia disorder on sleep and comorbid symptoms in military personnel: a randomized clinical trial.
Taylor, DJ, Peterson, AL, Pruiksma, KE, Hale, WJ, Young-McCaughan, S, Wilkerson, A, Nicholson, K, Litz, BT, Dondanville, KA, Roache, JD, et al
Sleep. 2018;(6)
Abstract
STUDY OBJECTIVES To compare the efficacy of cognitive behavioral therapy for insomnia (CBTi) disorder and a Control condition on reducing insomnia and comorbid symptoms in a sample of active duty military personnel. METHODS Randomized clinical trial of 151 active duty US Army personnel at Fort Hood, Texas. RESULTS This study replicated Original (n = 66) findings (CBTi outperformed Control) in a follow-on sample (n = 85) on diary-assessed sleep efficiency (d = 1.04), total sleep time (d = 0.38), sleep latency (d = -0.93), number of awakenings (d = -0.56), wake time after sleep onset (d = -0.91), sleep quality (d = 1.00), and the Insomnia Severity Index (d = -1.36) in active duty soldiers. CBTi also outperformed Control in the combined sample (N = 151) on four of the five subscales of the Multidimensional Fatigue Inventory (d = -0.32 to -0.96) and the mental health subscale on the Veterans RAND 12-Item Health Survey (d = 0.37). Exploratory analyses also showed CBTi outperformed Control on nicotine (d = -0.22) and caffeine (d = -0.47) use reduction. Significant within-group differences were found for both groups on depression, anxiety, and posttraumatic stress disorder symptoms, but there was no group by time interaction for these symptoms or for use of hypnotics or alcohol. CONCLUSIONS CBTi was an effective treatment for insomnia and comorbid symptoms including daytime fatigue, general mental health, nicotine, and caffeine use. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov; Identifier: NCT01549899; "Comparing Internet and In-Person Brief Cognitive Behavioral Therapy of Insomnia".
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Dissemination of the Look AHEAD Intensive Lifestyle Intervention in the United States Military: A Randomized Controlled Trial.
Krukowski, RA, Hare, ME, Talcott, GW, Gladney, LA, Johnson, KC, Richey, PA, Kocak, M, Keller, PL, Hryshko-Mullen, A, Klesges, RC
Obesity (Silver Spring, Md.). 2018;(10):1558-1565
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Abstract
OBJECTIVE The purpose of this study, "Fit Blue," was to compare a translation of the Look AHEAD (Action for Heath in Diabetes) intensive lifestyle intervention with a self-paced version of the same intervention among active duty military personnel. METHODS Active duty military personnel (N = 248; 49% male, 34% racial minority) with overweight or obesity were randomized to 12-month distance-based (i.e., phone and email) parallel programs, counselor-initiated (CI) condition or self-paced (SP) condition, from 2014 to 2016. Trained lay interventionists were retired military personnel or had extensive familiarity with the military. RESULTS The CI condition had greater weight loss at 4 months (CI: mean ± SD = -3.2 ± 3.4 kg; SP: -0.6 ± 2.9 kg; P < 0.0001) and at 12 months (CI: mean ± SD = -1.9 ± 4.1 kg; SP: -0.1 ± 3.8 kg; P < 0.001). Participants in the CI condition also had a greater percent weight loss at both 4 months (CI: 3.5% ± 3.8, SP: 0.6% ± 3.1; P < 0.0001) and 12 months (CI: 2.1% ± 4.7, SP: 0.0% ± 4.0; P < 0.001). In addition, a greater proportion of CI participants lost 5% or more at 4 months (CI: 29.8%, SP: 10.5%; P < 0.001) and at 12 months (CI: 29.5%, SP: 15.6%; P < 0.05). CONCLUSIONS The CI behavioral weight loss intervention translated from Look AHEAD was well received and is a promising approach for managing weight in an active duty military population.
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A Randomized Controlled Trial of Nurse Coaching vs. Herbal Supplementation for Weight Reduction in Soldiers.
McCarthy, MS, Elshaw, EB, Szekely, BM, Hobbs, C
Military medicine. 2017;(S1):274-280
Abstract
UNLABELLED The number of overweight and obese service members has tripled since the beginning of Overseas Contingency Operations.1 Overwhelming evidence suggesting links between obesity and increased risk for conditions such as musculoskeletal injuries, type II diabetes, and cardiovascular disease,2 poses a threat to the strength and performance of our current and future fighting force. OBJECTIVE The purpose of the study was to test nurse health coaching (NHC) and/or herbal supplementation for weight reduction in Soldiers during a 12-week intervention. METHODS Body composition, biomarkers, adherence, and motivation were measured at three time points. The NHC provided a weekly scripted interaction. Change scores were compared across study groups using general linear models. RESULTS Sample demographics (N = 435): mean age 30 ± 8.2 years, 73.4% men, predominantly white (70.1%) and non-Hispanic (80%), 71% married, and 91% enlisted. Results represent the 3 NHC groups compared to control group. Beneficial intervention effects were observed for heel bone mineral density (d = 0.3), 25-Hydroxyvitamin D (d = 0.43), and fasting blood sugar (d = -0.4), but were not significant following application of a 10% false discovery rate. There were no significant findings for any other comparisons. CONCLUSION Weight loss proved difficult for all groups; there was no advantage of NHC over an herbal supplement as adjuncts to Army MOVE! for weight reduction. Highly motivated Soldiers were unable to sustain weight loss or body composition changes.
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Telehealth Coaching: Impact on Dietary and Physical Activity Contributions to Bone Health During a Military Deployment.
Frank, LL, McCarthy, MS
Military medicine. 2016;(5 Suppl):191-8
Abstract
PURPOSE To examine the difference in bone health and body composition via blood biomarkers, bone mineral density, anthropometrics and dietary intake following deployment to Afghanistan among soldiers randomized to receive telehealth coaching promoting nutrition and exercise. METHODS This was a prospective, longitudinal, cluster-randomized, controlled trial with repeated measures in 234 soldiers. Measures included heel bone scan for bone mineral density, blood biomarkers for bone formation, resorption, and turnover, body composition via Futrex, resting metabolic rate via MedGem, physical activity using the Baecke Habitual Physical Activity Questionnaire, and dietary intake obtained from the Block Food Frequency Questionnaire. RESULTS There were significant increases in body fat (p = 0.00035), osteocalcin (0.0152), and sports index (p = 0.0152) for the telehealth group. No other statistically significant differences were observed between groups. Vitamin D intake among soldiers was ≤ 35% of the suggested Dietary Reference Intakes for age. CONCLUSIONS A 9-month deployment to Afghanistan increased body fat, bone turnover, and physical activity among soldiers randomized to receive telehealth strategies to build bone with nutrition and exercise.
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Calcium and vitamin D supplementation maintains parathyroid hormone and improves bone density during initial military training: a randomized, double-blind, placebo controlled trial.
Gaffney-Stomberg, E, Lutz, LJ, Rood, JC, Cable, SJ, Pasiakos, SM, Young, AJ, McClung, JP
Bone. 2014;:46-56
Abstract
Calcium and vitamin D are essential nutrients for bone health. Periods of activity with repetitive mechanical loading, such as military training, may result in increases in parathyroid hormone (PTH), a key regulator of Ca metabolism, and may be linked to the development of stress fractures. Previous studies indicate that consumption of a Ca and vitamin D supplement may reduce stress fracture risk in female military personnel during initial military training, but circulating markers of Ca and bone metabolism and measures of bone density and strength have not been determined. This randomized, double-blind, placebo-controlled trial sought to determine the effects of providing supplemental Ca and vitamin D (Ca+Vit D, 2000mg and 1000IU/d, respectively), delivered as 2 snack bars per day throughout 9weeks of Army initial military training (or basic combat training, BCT) on PTH, vitamin D status, and measures of bone density and strength in personnel undergoing BCT, as well as independent effects of BCT on bone parameters. A total of 156 men and 87 women enrolled in Army BCT (Fort Sill, OK; 34.7°N latitude) volunteered for this study. Anthropometric, biochemical, and dietary intake data were collected pre- and post-BCT. In addition, peripheral quantitative computed tomography was utilized to assess tibia bone density and strength in a subset of volunteers (n=46). Consumption of supplemental Ca+Vit D increased circulating ionized Ca (group-by-time, P=0.022), maintained PTH (group-by-time, P=0.032), and increased the osteoprotegerin:RANKL ratio (group-by-time, P=0.006). Consistent with the biochemical markers, Ca+Vit D improved vBMD (group-by-time, P=0.024) at the 4% site and cortical BMC (group-by-time, P=0.028) and thickness (group-by-time, P=0.013) at the 14% site compared to placebo. These data demonstrate the benefit of supplemental Ca and vitamin D for maintaining bone health during periods of elevated bone turnover, such as initial military training. This trial was registered with ClincialTrials.gov, NCT01617109.
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Group trauma-focused cognitive-behavioural therapy with former child soldiers and other war-affected boys in the DR Congo: a randomised controlled trial.
McMullen, J, O'Callaghan, P, Shannon, C, Black, A, Eakin, J
Journal of child psychology and psychiatry, and allied disciplines. 2013;(11):1231-41
Abstract
BACKGROUND The Democratic Republic of Congo (DRC) has been home to the world's deadliest conflict since World War II and is reported to have the largest number of child soldiers in the world. Despite evidence of the debilitating impact of war, no group-based mental health or psychosocial intervention has been evaluated in a randomised controlled trial for psychologically distressed former child soldiers. METHOD A randomised controlled trial involving 50 boys, aged 13-17, including former child soldiers (n = 39) and other war-affected boys (n = 11). They were randomly assigned to an intervention group, or wait-list control group. The intervention group received a 15-session, group-based, culturally adapted Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) intervention. Assessment interviews were completed at baseline, postintervention and 3-month follow-up (intervention group). RESULTS Analysis of Covariance (ANCOVA) demonstrated that, in comparison to the wait-list control group, the TF-CBT intervention group had highly significant reductions in posttraumatic stress symptoms, overall psychosocial distress, depression or anxiety-like symptoms, conduct problems and a significant increase in prosocial behaviour (p < .001 for all). Effect sizes were higher when former child soldier scores were separated for sub-analysis. Three-month follow-up of the intervention group found that treatment gains were maintained. CONCLUSIONS A culturally modified, group-based TF-CBT intervention was effective in reducing posttraumatic stress and psychosocial distress in former child soldiers and other war-affected boys.
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Effect of carbohydrate administration on recovery from stress-induced deficits in cognitive function: a double-blind, placebo-controlled study of soldiers exposed to survival school stress.
Morgan, CA, Hazlett, G, Southwick, S, Rasmusson, A, Lieberman, HR
Military medicine. 2009;(2):132-8
Abstract
OBJECTIVE The goal of this project was to evaluate the effects of energy supplementation, as liquid carbohydrate (CHO), on facilitating recovery of cognitive function in soldiers who have been exposed to sustained psychological and physical stress during Survival School Training. PROJECT DESIGN A double-blind, placebo-controlled design was used. Healthy, male volunteers attending survival training were recruited for participation in the study. At the conclusion of the mock captivity phase of survival training and before a recovery night of sleep, subjects participated in cognitive testing. After this, subjects were randomly assigned to one of three treatment groups. Subjects received either a 6% CHO (35.1 kJ/kg), 12% CHO (70.2 kJ/kg), or placebo beverage in four isovolemic doses. In the morning of the following day, all subjects participated in a second assessment of cognitive functioning. RESULTS Compared to subjects who received placebo, those who received supplemental CHO beverages exhibited significantly improved performance on a complex cognitive task (i.e., Stroop Test) involving concentration effectiveness associated with selective attention and response inhibition. No differences were observed on a variety of cognitive tasks of lesser complexity. DISCUSSION These data suggest nutritional interventions enhance the rapid recovery of complex cognitive functions impaired by exposure to significant or sustained stressful conditions. In addition to enhancing speed of recovery of function between operational intervals, the current data suggest that dietary supplement strategies may hold promise for enhancing field performance and a capacity to assist in sustaining operations by military personnel over time.
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A group randomized trial of critical incident stress debriefing provided to U.S. peacekeepers.
Adler, AB, Litz, BT, Castro, CA, Suvak, M, Thomas, JL, Burrell, L, McGurk, D, Wright, KM, Bliese, PD
Journal of traumatic stress. 2008;(3):253-63
Abstract
In a group randomized trial of critical incident stress debriefing (CISD) with platoons of 952 peacekeepers, CISD was compared with a stress management class (SMC) and survey-only (SO) condition. Multilevel growth curve modeling found that CISD did not differentially hasten recovery compared to the other two conditions. For those soldiers reporting the highest degree of exposure to mission stressors, CISD was minimally associated with lower reports of posttraumatic stress and aggression (vs. SMC), higher perceived organizational support (vs. SO), and more alcohol problems than SMC and SO. Soldiers reported that they liked CISD more than the SMC, and CISD did not cause undue distress.