Draft 1 Soldier use of dietary supplements , including protein and body building supplements , in a 2 combat zone is different than use in garrison 3 4

Complete List of Authors: Austin, Krista; US Army Research Institute of Environmental Medicine , Military Nutrition Division; Oak Ridge Institute for Science and Education, McLellan, Tom; TM McLellan Research Inc., ; Oak Ridge Institute for Science and Education, Farina, Emily; US Army Research Institute of Environmental Medicine , Military Nutrition Division; Oak Ridge Institute for Science and Education, McGraw, Susan; US Army Research Institute of Environmental Medicine, Military Nutrition Division Lieberman, Harris; US Army Research Institute of Environmental Medicine, Military Nutrition Division

) and global consumer demand for DS was estimated to exceed $30 billion in 2011(Anonymous 2012)).
Healthy civilian adults who consume DSs are typically more active, better educated and nonsmokers (Lyle et al. 1998;Radimer et al. 2004).Surveys of active duty Army personnel in garrison who are not deployed to combat theater reveal a greater prevalence of DS use and increased use of performance enhancing DSs, such as protein and amino acid supplements, compared to the U.S. civilian population (Radimer et al. 2004;Lieberman et al. 2010;Knapik et al. 2014).The most frequent reasons cited for DS use by active duty soldiers include promoting general health, increasing energy levels, enhancing performance and promoting gains in strength (Lieberman et al. 2010;Knapik et al. 2014).
Active duty military personnel, due in part to the unique occupational demands of their profession, use greater amounts of certain DSs compared to the general population (Lieberman et al. 2010).Soldiers deployed to combat theater are often exposed to physical and cognitive stressors such as ascent to altitude, heavy load carriage, long periods of reduced sleep and exposure to high ambient temperatures (Lieberman et al. 2005;Nindl et al. 2013).During deployment, soldiers also sometimes reduce their aerobic training but increase frequency of strength training to maintain lean body mass (Sharp et al. 2008;Lester et al. 2010).In addition, the nature and availability of food differs in combat theaters compared to more permanent facilities.Together, these factors may increase the extent of soldiers using DSs when deployed.
Recent findings from a survey of British soldiers deployed in Iraq revealed that 32% of responders (325 of 1017 soldiers) were current users of specific DSs, such as creatine, protein and amino acids, and of these DS users, almost two-thirds initiated their use during deployment D r a f t (Boos et al. 2010).However, this survey may have underestimated DS use since use of multivitamins, which are frequently used by UK soldiers during training, was not assessed in the survey (Casey et al. 2014).A subsequent report assessing DS use of British soldiers deployed in Afghanistan found that over 40% used DSs (Boos et al. 2011).More than two-thirds of the British soldiers surveyed in Iraq and Afghanistan who used DSs reported using protein and amino acid supplements to increase strength and aid in training and recovery.These findings are consistent with a 49% DS use rate by a small number of U.S. soldiers deployed in Iraq in 2006-2007(Lieberman et al. 2010)).Although the prevalence of DS use among these deployed soldiers was not significantly different from a larger cohort of soldiers stationed in the U.S., it appeared that fewer deployed soldiers used multivitamins and there was a tendency for increased use of protein and amino acid supplements.Separately, a larger cohort of deployed U.S. military personnel had higher prevalence of bodybuilding, energy and weight-loss supplement use compared to soldiers who had never deployed (Jacobson et al. 2012).A more recent survey of deployed U.S. Marines in Afghanistan reported that 70% of respondents used DSs and that almost 30% of supplement users began consuming supplements during deployment (Cassler et al. 2013).Protein supplements were the most common supplement used.Collectively, these studies suggest the prevalence and/or pattern of DS use is altered by deployment to a combat theater.However, it should be noted that none of these previous investigations directly compared garrison and deployed personnel with the same survey instrument to determine the influence of deployment on patterns of DS use.Supplement use among garrison soldiers is associated with demographic and lifestyle factors such as age, rank, education, body mass index, aerobic exercise and participation in strength training (Lieberman et al. 2010).However, it is not known whether similar and/or D r a f t additional factors affect patterns and types of DS consumed during deployment.Therefore, the present study examined, using the same survey instrument, factors that influenced DS use by garrison and deployed personnel.incentives were offered to participants, and they completed the survey after an explanation that all information obtained would remain confidential, participation was voluntary and they were free to withdraw from the study.

Survey Administration
Prior to administering the anonymous survey, participants were briefed regarding its contents and provided instructions for completing all questions.Garrison participants completed the

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Dietary Supplement Survey of US Army Active Duty Personnel (Lieberman et al. 2010;Lieberman et al. 2012) and deployed participants completed a version of the survey customized for use in a combat theater, the Dietary Supplement Survey for Deployed Military Personnel.
The latter survey included minor modifications such as specific questions about their current deployment and whether participants were in a Special Forces unit.Other than these modifications, the surveys were identical.To recruit volunteers, a time and place was arranged to distribute the survey through a unit commander or class leader.The local healthcare provider administering the survey delivered a standardized study briefing to potential volunteers describing the purpose and contents of the survey and its confidential and voluntary nature, as well as describing procedures for completing multipart questions.
Both surveys consisted of 43 identical questions assessing type, frequency and reasons for DS use, money spent on DSs, as well as demographic and lifestyle information.The survey included questions for each supplement regarding frequency and reasons for use, including performance enhancement, general health, promoting energy, weight loss, increasing endurance, improving muscle strength, and "other."Individual supplements listed on the survey included 55 generic supplements such as multivitamins, combination antioxidants and individual vitamins and minerals, as well as 37 brand-name supplements.Participants were also instructed to write in supplements they used that were not listed on the survey.Specific brand-name DSs were chosen for inclusion in the survey based on patterns of DS purchases from the Army Air Force Exchange System and General Nutrition Center stores located on or in close proximity to Army bases.
Demographic and lifestyle information collected with the survey included sex, age, military assignment (combat arms, combat support or combat service support) and rank, D r a f t education, marital status, tobacco use, weight management practice and aerobic and strength training exercise performed by soldiers with their unit and individually.In addition, self-reported height and weight were collected and used to calculate body mass index.Self-reported assessments of health, eating habits, fitness and confidence in DS efficacy and safety were also included in the survey.Survey questions assessing participants' health behavior beliefs were as follows: "How do you consider your general health?","How do you consider your overall eating habits?" and "How do you consider your overall fitness level?".For each question, participants selected between four response options: "Excellent", "Good", "Fair" or "Poor".
After preliminary data analyses were conducted, response options were collapsed into the categories of "Excellent/Good" and "Fair/Poor" due to low cell counts in some response options.Participants' beliefs regarding the efficacy and safety of DS were assessed as follows: "How confident are you that your dietary supplements will do as they claim?"and "How confident are you that your dietary supplements are safe for consumption?".Participants selected between four response options: "Extremely confident", "Very confident", "Somewhat confident" or "Not at all confident".

Data Analyses
Surveys were scanned using ScanTools Plus with ScanFlex (version 6.301; Scantron Corporation, Eagan, MN, U.S.A.) and imported to SPSS for all analyses (version 15.0; SPSS Inc., Chicago, IL, U.S.A.).Prior to data analyses, supplements were grouped into the following categories: multivitamins and multiminerals, protein and amino acids, individual vitamins and minerals, combination products, or purported steroid analogues.Those DSs that could not be placed in one of these categories were termed 'other'.Supplements were categorized based on the definitions provided in Table 1.A standardized taxonomy, similar to what is used in national D r a f t surveys such as the National Health and Nutrition and Examination Survey, was used to categorize DSs (Lieberman et al. 2010).Responders were classified as DS users if they reported consuming a DS at least once/week during the 6 months before the survey; all others were classified as non-users.Sport drinks, bars, gels or meal replacement beverages were not included as DSs as they are not classified as DSs by U.S. law.

Insert Table 1 about here.
Logistic regression models were used to examine the likelihood of DS use by deployed and garrison personnel as a function of sex, age, rank, education, assignment, BMI, tobacco use, marital status, weight control, eating habits, ratings of fitness, participation in aerobic exercise and frequency of strength training.Given the significant relationship between the predictor variables (education, assignment, and self-perceived ratings of fitness and health) and supplement use (Table 2), we adjusted our models for these covariates in all other analyses that examined differences in patterns and types of DS use between the populations.Results of logistic regression models are expressed as odds ratios and 95% confidence intervals and tests of interactions between demographic factors and deployed status (deployed vs. garrison) were included.Logistic regression examined the interaction of demographic factors as a function of deployed versus garrison status and use of specific DS class.Results were stratified by deployed status for significant interaction terms in which model integrity could be confirmed.
Wald chi-square analyses were used to assess differences in reasons for DS use between deployed and garrison responders.Analysis of variance was used to compare the total amount of weekly aerobic exercise or strength training sessions respondents conducted within their unit or individually.When a significant F-ratio for the interaction term was observed, a Newman-Keuls D r a f t 9 post-hoc analysis was performed to isolate differences among treatment means.Statistical significance was defined as p < 0.05.

DS Use Associations by Garrison Personnel
The extent of overall use of any DSs by garrison respondents was not significantly associated with sex, age, education, health rating, marital status, tobacco use or eating habits (Table 2).
However, use of any DS was more likely in garrison respondents who were assigned to combat arms when compared to combat service support personnel, had a BMI of 25-29.9kg/m 2 when compared to those with a BMI less than 25, were officers rather than those in the junior enlisted ranks or were desiring to gain weight versus those wanting to maintain body weight.In addition, garrison personnel with excellent or high personal ratings of their fitness and who were extremely or very confident in the efficacy and safety of DSs were more likely to use supplements compared to those who perceived their fitness as fair or poor.Participating in more aerobic exercise and strength training were also significantly associated with DS use by garrison personnel.

DS Use Associations by Deployed Personnel
Like garrison personnel, the overall use of DS by deployed respondents was not significantly associated with sex, age, marital status, or eating habits (Table 2).Also like garrison personnel, deployed soldiers who were officers rather than in the junior enlisted ranks, provided excellent or good ratings of their fitness, were extremely or very confident in the efficacy and safety of DS use, and engaged in more weekly aerobic exercise and strength training, were more likely to use DSs.However there were several differences in predictors of DS use between deployed and garrison personnel.For example, the use of DSs by deployed personnel was not associated with D r a f t 10 assignment, body mass index or weight control but was significantly associated with education, self-perceived health and tobacco use.

Prevalence and Cost of DS Use
A majority of garrison and deployed soldiers used DS, and prevalence of overall use was not significantly different between garrison (63%) and deployed (73%) groups (Table 3).There were also no differences between garrison and deployed personnel in the likelihood of use of multivitamins or multiminerals, single vitamins or minerals, herbals, steroid analogues or 'other' supplements.After controlling for significant predictors of DS use education, assignment, and self-perceived ratings of fitness and health, logistic regression analysis showed deployed personnel were significantly more likely than garrison personnel to use protein supplements and combination products.Amount of money spent during the last 3 months on DSs by deployed personnel ($62.45 ± $7.30 as mean ± SD) was not different than garrison personnel ($63.55 ± $3.10).However, 17% of deployed responders spent more than $50/month, a significantly higher proportion than the 10% of garrison personnel who spent more than $50.

Reasons for DS Use
A significantly greater proportion of deployed (50%) than garrison (41%) personnel reported use of DSs to promote general health, as well as to increase muscle strength (deployed: 30% vs. garrison: 20%), and provide more energy (deployed: 25% vs. garrison: 20%).Use of a multivitamin and mineral to improve health was more prevalent among deployed (38%) than garrison (29%) and similarly the use of single vitamins and minerals to improve strength was D r a f t 11 more prevalent in deployed personnel than non-deployed respondents (2% vs. 0.5%).A significantly greater proportion of deployed soldiers also reported the use of protein and amino acid supplements (24% vs. 16%) and combination products (15% vs. 7%) to improve muscle strength.Use of combination products to increase energy was also more prevalent (12% vs. 6%) among deployed personnel when compared to garrison respondents.The prevalence of DS use for promoting weight loss was significantly less among deployed (12%) compared to garrison (16%) personnel.However, use of weight loss DS to improve weight loss was more prevalent among garrison (3%) than deployed (0.5%) soldiers.A significantly greater proportion (3% vs. 0.5%) of those deployed also reported the use of herbals for weight loss when compared to those in garrison.

Association between Demographics, Deployment Status, and DS Class
All models were adjusted for the demographic characteristics of education, assignment, and selfperceived ratings of fitness and health.Deployment status, gender, eating habits and use of protein supplements were found to be significant interactions.Deployed male personnel were more likely (OR: 1.79; 95% CI: 1.29, 2.48) to use protein supplements, as were female deployed (OR: 6.35; 95% CI 2.57, 15.71) when compared to non-deployed respondents.Deployed personnel reporting excellent/good eating habits were also more likely than garrison soldiers to use protein supplements (OR: 3.08; 95% CI: 1.71, 5.56) and supplements classified as 'other' (OR: 2.09; 95% CI: 1.09,4.02).

Aerobic Exercise and Strength Training Frequency of Garrison and Deployed Personnel
The total number of weekly aerobic exercise and strength training sessions reported by deployed and garrison personnel with their unit and on their own time is presented in Figure 1.Total aerobic exercise time was significantly greater for garrison personnel, and both male and female D r a f t garrison personnel performed a significantly greater amount of aerobic exercise with their unit than deployed personnel.Deployed males had significantly less total aerobic exercise time but a greater number of strength training sessions compared with male garrison respondents.In contrast, female deployed personnel had similar weekly aerobic exercise time and number of total strength training sessions compared with female garrison respondents but conducted more exercise on their own.Both garrison and deployed males reported performing more strength training than did female respondents, but females still engaged in substantial strength training.
Insert Figure 1  Our observation of greater DS use in theater is in agreement with several previous studies of DS use.Deployed male British soldiers reported high levels of protein supplements and body building products in combat theater (Boos et al. 2010;Boos et al. 2011).Also, a large cohort study reported greater use of body building and weight loss supplements in both males and D r a f t 13 females with a history of deployment to a combat theater (Jacobson et al. 2012).Another study found greater DS use by U.S. Marines who were deployed to Afghanistan (Cassler et al. 2013).
The prevalence of overall DS use we observed among deployed personnel was much higher than the 35-40% levels reported in the recent studies of British soldiers deployed in Afghanistan or Iraq, but this may reflect differences in the questionnaires used in each study (Boos et al. 2010;Boos et al. 2011) or general differences between British and American DS use.In the U.S. compared to the U.K. a much wider variety of DSs are available.Interestingly, our findings of DS use among deployed personnel are remarkably similar to DS use by U.S. Marines deployed to the same region of conflict (Cassler et al. 2013).Previous reports of DS use for deployed soldiers (Boos et al. 2010;2011;Cassler et al. 2013;Jacobson et al. 2012) did not directly compare deployed and garrison personnel using the same survey instrument as was done in the current investigation.Therefore, this report is the first we are aware of that definitively demonstrates that patterns of DS use change during deployment.
In comparison to data we collected 4 years earlier (2006)(2007) using the same survey procedures (Lieberman et al. 2010), we observed that in 2010-2011 greater use of DSs in deployed personnel was due to increased consumption of multiple DS classes, including multivitamin and multiminerals, individual vitamins and minerals, protein supplements, combination products and herbals.In comparison, the increased prevalence of DS use by garrison responders was attributable to use of only two types of DSs, protein supplements and combination products.Consistent with widespread DS use we observed in both deployed and garrison personnel, soldiers spent significant sums of money on DS.Although average monthly spending of $20 may seem reasonable, 17% of deployed and 10% of garrison personnel spent more than $50/month on DSs.Ensuring that military personnel receive accurate information D r a f t 14 about the purported efficacy and potential risk of DS consumption could potentially reduce unnecessary spending.Education about proper dietary choices, such as the ingestion of chocolate milk to promote gains in muscle strength resulting from resistance training rather purchasing and using protein supplements and combination products (Hartman et al. 2007;Josse et al. 2010), may be one strategy to emphasize in dining facilities.However, limitations in the availability and quality of perishable food items (such as some dairy products and other protein sources) in a combat theater may prevent such recommendations from being implemented.Therefore, education regarding use of safe and effective dietary supplements may also be warranted.
Occupational assignment has not previously been found to be associated with soldiers' use of DSs (Lieberman et al. 2010); however, in this study we found increased use of DSs in garrison personnel serving in the combat arms, the individuals most likely to engage in actual combat.Occupational assignment was not associated with DS use by deployed personnel in the current study but this could reflect the small numbers of combat arms personnel recruited.However, our findings of greater use of DSs by deployed personnel to garrison personnel are consistent with those of Jacobson et al. (Jacobson et al. 2012) who reported a higher prevalence of DS use in U.S. military personnel who had a history of combat deployment.Thus, the growing popularity of DSs among active duty soldiers may reflect the increased number of deployments to a combat theater.For many deployed British soldiers, DS use was initiated while in a combat theater (Boos et al. 2010).The data presented by Jacobson et al. (Jacobson et al. 2012) and the current findings, especially for combat arms personnel in garrison, suggest that soldiers continue DS use initiated in a combat theater upon returning to their home bases.
The prevalence of protein supplement use by soldiers appears to have increased.Lieberman et al. (Lieberman et al. 2010) previously reported that during 2006-2007 D r a f t approximately 15-20% of active duty U.S. soldiers stationed in non-combat bases and 25% of soldiers deployed in Iraq had consumed protein supplements.A systematic review and metaanalysis of data collected prior to 2008 also reported that use of protein supplements to be about 20% in non-deployed elite military groups (Knapik et al. 2014).The present study using survey data collected in [2010][2011] indicates that protein supplement use has increased to approximately 28% in garrison personnel and 42% in deployed personnel.Greater protein supplement use by both deployed and garrison personnel appears to be consistent with the growing popularity of protein supplements by recreationally active civilian adults (Young and Stephens 2009;Goston and Correia 2010;Tsitsimpikou et al. 2011).In contrast, less than one percent of the general civilian population reports the use of protein supplements (Radimer et al. 2004;Bailey et al. 2013).Recently, an expert panel convened by the DoD Center Alliance of Dietary Supplements Research and the U.S. Army Medical Research and Materiel Command examined the safety and efficacy of protein supplements for Armed Forces personnel and concluded that during periods of high metabolic demand, such as deployment, 1.5 -2.0 g kg -1 of protein be consumed (Pasiakos et al. 2013).High-quality protein foods were the recommended source of protein, but supplements, notwithstanding the additional costs involved, were considered to be an acceptable alternative (Pasiakos et al. 2013).
Consistent with previous reports from civilian and active duty soldier populations, DS use was highest in those respondents who engaged in greater amounts of aerobic and strength training exercise and rated their fitness and health as excellent or good, and significantly less in respondents engaged in unhealthy behaviors such as tobacco use (Lyle et al. 1998;Radimer et al. 2004;Lieberman et al. 2010).Reasons cited for greater DS use among deployed personnel, such as to promote general health, give more energy and for greater muscle strength, are also D r a f t consistent with reasons for supplement use reported by other military surveys (Lieberman et al. 2010;Knapik et al. 2014).These findings suggest military personnel in general and deployed personnel in particular consider the use of these DSs to be important for sustaining the high volume of physical training necessary to maintain the strength and cardiovascular fitness their jobs require.
Although protein supplement use was greater among both male and female deployed personnel who engaged in greater aerobic and strength training exercise, different exercise patterns among female and male deployed personnel, and between garrison and deployed females were observed (see Figure 1).Changes in exercise patterns during deployment have previously been documented for male soldiers (Sharp et al. 2008;Lester et al. 2010) but no data are available for females.The present study confirmed that participation in aerobic training is lower and participation in strength training activity is greater among male deployed soldiers compared to garrison respondents.In males, these differences in exercise patterns during deployment are associated with decreased maximal oxygen consumption while muscle strength is either maintained or increased (Sharp et al. 2008;Lester et al. 2010).Thus, the greater use of protein supplements and greater strength training sessions among male deployed personnel are consistent with the scientific evidence that use of these supplements can result in gains in muscle strength and muscle protein accretion during strength training (Pasiakos et al. 2015).In this study, deployed females engaged in similar volumes of aerobic training as garrison females; however, deployed females engaged in more aerobic training on their own time and they trained less with their unit.Consistent with deployed males, the deployed females also reported more frequent strength training on their own compared with their garrison counterparts, but total weekly strength training sessions remained comparable with female garrison respondents.Whether the change in exercise patterns for deployed females together with their greater use of protein supplements impacted their maximal oxygen consumption and muscle strength during and following deployment is not known.However, given that total aerobic exercise time and strength training sessions were unchanged for deployed females, changes would not be expected in maximal aerobic power and muscle strength post-deployment.

Limitations and Strengths
While the present analyses provide insight into differences in DS use by deployed and garrison populations, the limitations of this study design should be acknowledged.As with all selfreported survey data, report and recall bias cannot be ruled out; however they would be similar for both deployed and garrison respondents.Since it was not possible to weight the sample populations to be representative of U.S. Army deployed and garrison personnel, some sampling bias may have been present as the deployed population consisted of somewhat fewer combat arms soldiers, had attained higher education levels, had higher health and fitness ratings, and used less tobacco.However, all of these predictors were adjusted for in our logistic regression models, which minimize the influence of population sampling differences.Despite these limitations the strengths of the present study, including the use of multivariate analyses to control for demographic differences, assessment of both groups during the same time period and use of the same survey, indicate that the findings from this study should generalize to the larger active duty soldier population.

Conclusion
This study found that prevalence of DS use among deployed personnel was greater compared to their non-deployed counterparts.Higher use of protein supplements during deployment was observed for individuals engaging in more strength and aerobic training and  Herbal Supplements DS that primarily included one or more herbal ingredients; may include other nutrients or supplement ingredients; also includes plant-derived ingredients

Purported Steroid Analogs
Steroidal hormones or herbal substitutes for hormones that were marketed as DS and included the Supplement Facts panel on the label Prevalence is reported as number with percentage in parentheses.Results of logistic regression are presented as odds ratios (OR) with 95% confidence intervals (CIs) in parentheses.Values are presented on the basis of logistic regression modeling with the reference category represented as no supplements being consumed on a weekly basis.

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1 Not included in the analyses due to small participant numbers in that category.Values not sharing a common superscript letter are significantly different.* P < 0.05, ** P < 0.01, *** P < 0.001.

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Soldier use of dietary supplements, including protein and body building supplements, in a combat zone is different than use in garrison Krista G. Austin 1,2 , Tom M. McLellan 1,3 , Emily K. Farina 1,2 , Susan M. McGraw 2 and Harris R. Lieberman 2 1 Oak Ridge Institute for Science and Education, Belcamp, MD 21017 2 Military Nutrition Division, US Army Research Institute of Environmental Medicine (USARIEM), Natick, MA 01760-5007, U.S.A. DS) use is common among adults This was approved by the Human Use Review Committee at the U.S. Army Research Institute of Environmental Medicine.Data were collected from 2010-2011.The sample consisted of 1,218 active duty U.S. Army personnel in garrison from 11 U.S. bases, including 9 U.S. and 2 overseas sites in non-combat regions, and 260 deployed military personnel in Afghanistan.Both users and non-users of DS were included in the sample.Survey sites for garrison personnel were chosen based on the availability of the soldier population and healthcare providers to administer the survey.Personnel who were on temporary or transitional status, including individuals who were absent without leave, incarcerated, or moving between duty stations were excluded.Since DS use is not permitted in Basic Combat Training or Advanced Individual Training, soldiers enrolled in these courses were excluded from the survey.Sites for enrolling deployed personnel were chosen based on the availability and distribution of soldiers and included individuals stationed in forward operating bases, including those located in austere environments.No about here.DiscussionThis study documents various associations between use of specific DSs and current deployment status among male and female U.S. military personnel.Demographic and lifestyle factors, including education, rank, tobacco use, ratings of fitness and health and amount of strength and aerobic training influenced choice of DS use during deployment.We observed significantly greater use of protein and combination supplements in deployed compared to garrison personnel.Compared to data collected four years earlier using the same survey(Lieberman et al. 2010), a greater proportion of both garrison and deployed soldiers used DSs.Supplement use increased from 53% to 63% for soldiers stationed in garrison at non-combat bases and from 49% for soldiers deployed in Iraq in 2006-2007 to 73% for respondents deployed to Afghanistan in2010-2011.
perceived physical fitness.In addition, use of DSs among military personnel appears to have increased over the 4-year period of2006-2007 to 2010-2011,     especially the use of protein supplements and combination products.Further research should be conducted to understand the association between the increased prevalence of protein supplement use and strength training, as well as whether these patterns of DS use and physical activity are of benefit for maintaining or improving the musculoskeletal integrity of deployed soldiers,

Figure 1
Figure Legend

Table 1
Dietary supplement categories as defined for study analyses.

Table 2
Association of dietary supplement (DS) use > 1 time/week over the past 6 months for military personnel deployed to combat theater or garrison personnel in non-combat bases in United States or overseas with selected demographic and lifestyle characteristics. https://mc06.manuscriptcentral.com/apnm-pubs

Table 3
Number and percentage of personnel deployed to combat theater or garrison personnel in non-combat bases in United States or overseas using various dietary supplement (DS) categories minus products categorized as sport drinks, gels, bars or meal replacement beverages.Odds ratios (OR) and confidence intervals (CI) compare deployed to garrison personnel with covariates education, assignment, and self-perceived ratings of fitness and health.Prevalence is reported as number with percentage in parentheses.Results of logistic regression are presented as odds ratios with 95% CIs in parentheses.* P < 0.05, ** P < 0.01, *** P < 0.001.