Provision of Nutrition Support Therapies in the Recent Iraq and Afghanistan Conflicts

Abstract

This article describes the experience of nutrition support practitioners, specifically dietitians, providing care to combat casualties. It provides a brief overview of dietitians' induction into armed service but focuses primarily on their role in providing nutrition support during the most recent conflicts in Iraq and Afghanistan. The current system of combat casualty care is discussed with specific emphasis on providing early and adequate nutrition support to U.S. combat casualties from injury, care in theater combat support hospitals (CSHs)/expeditionary medical support (EMEDs), and en route care during critical care air transport (CCAT) up to arrival at treatment facilities in the United States. The article also examines practices and challenges faced in the CSHs/EMEDs providing nutrition support to non-U.S. or coalition patients. Over the past decade in armed conflicts, dietitians, physicians, nurses, and other medical professionals have risen to challenges, have implemented systems, and continue working to optimize treatment across the spectrum of combat casualty care.

Effects of Ferulic Acid and γ-Oryzanol on High-Fat and High-Fructose Diet-Induced Metabolic Syndrome in Rats

“…7 ). This could probably be due to their metabolites difference as OZ consists of FA esters with phytosterols, such as campesterol, stigmasterol, or β-stigmasterol [ 11 ]. The ester bond of OZ is broken down during digestion followed by phytosterols release [ 49 ], with subsequent beneficial effects on metabolic dysregulation.…”

“…Ferulic acid (FA), a well-known natural antioxidant present in common fruits and vegetables, has been shown to improve glucose tolerance and lipid metabolism [ 9 , 10 ]. Similarly, γ-oryzanol (OZ), the FA esters with phytosterols, mainly present in rice bran, exhibits numerous nutritive effects, such as free radical scavenging activity, anti-ulcer and neuromodulation [ 11 , 12 ]. Both FA and OZ demonstrated similar effects in preventing alcohol-induced liver injury and regulating glucose and lipid metabolism [ 13 – 15 ].…”

Nutrition Considerations for Burn Patients: Optimizing Recovery and Healing

“…In past conflicts such as Operation Iraqi Freedom and Operation Enduring Freedom, the United States maintained control of the airspace and, with that, casualties were evacuated out of the theater and to a level 5 facility in the United States within 2-3 days of the point of injury [62,63]. Due to this, the average length of stay at a combat support hospital (CSH) was only about 17.4 h, which includes any required surgery and preparation for evacuation, leaving little time for a nutrition evaluation by a dietitian [63]. As a result, there are limited published data on providing nutrition support in an austere environment or warzone.…”

“…Food stuffs may need to be procured via the local economy, and, depending on the region, dietary and cultural restrictions may further dictate the available food products [64]. Stankorb et al discussed a rudimentary concoction made from milk, honey, and eggs due to lack of available commercially prepared options that was used for tube feeding by an Iraqi hospital [63]. Time and temperature controls also need to be considered for both the storing of ingredients and the holding of prepared mixtures.…”