Understanding diet and modeling changes in the omega-3 and omega-6 fatty acid composition of U.S....

MILITARY MEDICINE, 179, 11:168, 2014

Understanding Diet and Modeling Changes in the Omega-3and Omega-6 Fatty Acid Composition of U.S. Garrison

Foods for Active Duty Personnel

Bernadette P. Marriott, PhD*†; Karina Yu, BS‡; Sharon Majchrzak-Hong, MS‡;Jeremiah Johnson, RD‡; Joseph R. Hibbeln, MD‡

ABSTRACT Research indicates that dietary omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) are impor-tant in reducing the risk of mental illness. We used the DoD Survey of Health Related Behaviors among Active DutyMilitary Personnel (HRBS) to assess current military dietary patterns and meal locations. We used the Lands Equationto model PUFAs in a sample Garrison diet and the nutritional impact of substitution of foods higher in omega-3 PUFAsand lower in omega-6 PUFAs on tissue composition. The military diet was very poor quality compared to 2010 HealthyPeople Guidelines. A representative Garrison diet does not meet our estimated healthy n-3 HUFA intake at 3.5 g/d,corresponding with a tissue composition of 60% n-3 in HUFA (i.e., 40% n-6 in HUFA). Substitution of n-3 rich eggs,poultry, pork and other food commodities, combined with use on low linoleic acid oils, may contribute significantly toattaining healthier n-6/n-3 proportions in the tissue.

INTRODUCTIONHighly unsaturated omega-3 (n-3) fatty acids (n-3 HUFAs)

have been demonstrated to have health benefits such as car-

diovascular protection, prevention from adverse surgical con-

sequences, and reduction of risk for mental illnesses.1 Several

international organizations have issued recommendations for

dietary intakes of n-3 HUFAs. However, neither the most

recent Dietary Guidelines for Americans nor the national

Dietary Reference Intakes from the Institute of Medicine

provide recommendations for omega-3 fatty acids.2,3 The

U.S. military develops nutrient intake guidance based on the

IOM civilian recommendations called the Military Dietary

Reference Intakes (MDRIs). At present, the MRDIs do not

address omega-3 or omega-6 fatty acids.

Dietary deficiencies of nutrients critical for optimal brain

function, such as n-3 HUFAS, may be a significant risk factor

for adverse psychiatric outcomes such as depression and sui-

cide.4 Meta-analyses of clinical treatment trials of n-3

HUFAs with diagnosed depression among adults indicate

efficacy in reduction of depression symptoms, which is com-

parable to that of antidepressant medications.1,5,6 After more

than a decade of war, suicide rates among active duty U.S.

military Personnel are at a record high. According to figures

released by the armed services, the U.S. Military has lost

more troops to suicide than to combat in Iraq and Afghanistan

during both 2009 and 2010.7 Recently, Lewis et al8 reported

that low n-3 HUFA status increased the risk of deaths in a

comparison of 800 active duty suicides to matched controls.

Several challenges exist in elevating n-3 fatty acid intake

among the U.S. military. First, active duty military Personnel

are not included in the national Centers for Disease Control

and Prevention—based, surveillance programs such as the

National Health and Nutrition Examination Survey and the

National Health Interview Survey from which the United

States obtains most national-level diet, nutrition, and health

outcome information for the U.S. population.9 As a result,

little is known about the diet and food choices among the

U.S. active duty Personnel as a whole. Second, military Person-

nel depending upon location may have variable access to a

diversity of food. However, in all but active combat situations,

they have access to food through military dining facilities, or

military-base canteens, snack bars, and contractor-food pro-

viders. Third, while n-3 HUFA dietary supplements provide a

plausible alternative, compliance is often an issue with die-

tary supplements in capsule form. Finally, there may be

variability in the historically high amounts of omega-6 fats

in the background diets, which necessitate variable levels of

omega-3s to be consumed to achieve optimal tissue levels.

To identify dietary intake and location of meals, we refer-

enced data analyzed by one of us (bpm) as part of the 2005

Department of Defense Survey of Health Related Behaviors

among Active Duty Military Personnel (HRBS) final report.10

The HRBS is a stratified cluster sample of worldwide military

installations including the Army, Air Force, Navy, and

Marines. The HRBS began in 1980 with the overall focus on

substance use with an emphasis on worldwide active duty

Personnel’s self-reported use of alcohol, illicit drugs, tobacco,

related health effects, and demographics of the anonymous

respondents. The 2005 survey included questions on substance

use and also addressed selected Healthy People 2010 objec-

tives11 including diet and physical activity. With the 2005

*Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA 22314.

†Currently: Medical University of South Carolina, 114 Doughty Street,

STB 629A,Charleston, SC 29425.

‡Section of Nutritional Neurosciences, Laboratory of Membrane

Biochemistryand Biophysics, National Institute on Alcohol Abuse and Alco-

holism, LMBB, NIAAA, NIH 5625 Fishers Lane, Rm 3N-07, MSC 9410,

Bethesda, MD 20892.

doi: 10.7205/MILMED-D-14-00199

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HRBS final report, data was available on the dietary patterns

of active duty Personnel worldwide for the first time.

We used this data to understand the basic composition and

location of Personnel eating patterns within the context of

assessing the potential to improve the fatty acid composition

of military diets through menu food item substitution. In

general, dietary patterns of active duty Personnel were very

poor compared with the 2010 Healthy People Guidelines

(HPG).12 The HPG recommended 2 or more servings of fruit

per day and 3 or more servings of vegetables per day. Less

than 10% of active duty Personnel reported eating 3 or more

servings of fruits and vegetables per day.11 For whole grains,

the HPG recommended three 1-oz servings per day and

3 cups per day of fat-free or low-fat daily milk or equivalent

products.11 Less than 12% of military Personnel met the

recommendations for the intake of whole grains and low-fat

milk products. Of particular relevance to this study, almost

50% of Personnel reported eating fast food three or more

times per week across all Service branches. Only around

20% of Personnel reported eating lean protein, including fish,

three or more times per week. Therefore, fish as a source of

omega-3 fatty acids is unlikely to be a successful omega-3

delivery vehicle for by active duty Personnel.

Data on the location of breakfast, lunch, and dinner for the

four branches of military Personnel were collected as part of

the 2005 HRBS and included in the final report.10 Forty-three

percent of Personnel reported that they ate breakfast at home

or brought breakfast from home and another 42% said that

they typically skipped breakfast altogether. Thirty percent

said they ate dinner from take-out restaurants, whereas

63% ate dinner at home or meals from home. Twenty-seven

percent of military Personnel indicated that they ate lunch in

military dining facilities or took lunch out from military

dining facilities. Location of lunch varied little across the

Services with approximately 43% saying they brought lunch

from home and 29% reporting obtaining lunch in restaurants

or takeout. These data provided the context for our modeling

study showing that the sources of n-3 HUFAs appeared to be

low in military diets and that the most opportune military

meal setting to make potential meal item substitutions in

garrison settings would be at lunch.

The purpose of our study was to evaluate the feasibility of

using the military-base dining facilities to improve intake and

increase blood levels of n-3 HUFAs through direct substitu-

tion of existing menu items with the same items with higher

omega-3 and lower omega-6 fatty acid content. If substitution

of foods enriched in n-3 and low in n-6 into the current diet

can elevate tissue composition of n-3 HUFAs, potential exists

for improving the overall health status of military populations

without the need for use of dietary supplements. Among such

foods, n-3-enriched eggs are already available commercially,

while other enriched commodities such as pork and chicken

are not yet available to consumers, but are currently being

tested in pilot studies. Key to such a substitution experiment

would be the knowledge of when and where military Person-

nel collectively eat so that food substitution efforts would

have maximal effect.

Our specific goals were to estimate the linoleic acid (LA),

alpha-linolenic acid (ALA), n-6 HUFA, and n-3 HUFA con-

tent and the resulting tissue compositions comparing a regu-

lar diet to a diet with improved fatty acid ingredient

compositions, to determine if such a substitution would be

feasible and meaningful in a military Garrison setting.

MATERIALS AND METHODS

Sample Garrison Menus and Swapping Modeling

We partnered with the U.S. Garrison at Okinawa to obtain

information about menu items that we could use in our theo-

retical model of fatty acid item swapping. A typical U.S.

Garrison diet is divided into three primary food lines: a main-

line menu, a fast-food line, and a line for specialty bars. Only

the mainline and fast-food line menus were analyzed in this

study. In our Okinawa sample, the mainline menu consisted

of 28 daily recipes repeated 1 cycle per month and provided

cafeteria-style meals with hot and cold sides. The fast-food

menu consisted of 1 daily menu repeated 28 cycles per month

and provided typical fast-food-style offerings and grab-and-

go foods, including condiments and drinks. A summary of

these example Garrison food offerings is given in Table I.

Recipes for the above food offerings and forecast servings

data were provided by Lt. Col. Carlos Sanabria, Department

of Defense Food Service and Sustenance Programs.

Estimation of Fatty Acid Composition of Foods inGarrison Menu Lines

An overview of the analysis data path is shown in Figure 1.

The ingredient composition of 507 recipes were entered into

TABLE I. Summary of Garrison Total Offerings for Okinawa for 1 Month (February 2009)

Food Source Calories/Cycle Servings/Cycle Cycles/Month Calories/Month Servings/Month

Mainline 15,774,387 90,611 1 15,774,387 90,611

Fast foods 1,111,309 7,843 28 31,116,652 219,604

(Food Items)

Fast foods 1,258,336 7,843 28 35,233,413 219,604

(Including Fry Oil)

Specialty Bars 792,180 3,485 4 3,168,720 13,940

MILITARY MEDICINE, Vol. 179, November Supplement 2014 169

Military Diet and Modeling Fatty Acid Substitution



the Keep It Managed (KIM) II12 U.S. Department of Agricul-

ture (USDA) food composition database (Fig. 2), which links

to and references the USDA National Nutrient Database for

Standard Reference.13 The total food energy content (kcal per

serving) and fatty acid content (mg per serving) of the following

4 categories of essential fatty acids was obtained from the KIM

II output: (1) 18-carbon n-3 polyunsaturated fatty acid (PUFA)

(ALA), (2) 18-carbon n-6 PUFA (LA), (3) 20- and 22-carbon

n-3 HUFAs (eicosapentaenoic acid [EPA], docosapentaenoic

acid [DPA] n-3, docosahexaenoic acid [DHA]), and (4) 20-

and 22-carbon n-6 HUFAs (AA and DPA n-6).

Forecast correction adjusts for the different distribution of

foods expected to be consumed in a location, for example,

based on the survey data and information from Okinawa,

more cheese burgers than fish sandwiches were forecast to

be consumed. Forecast correction was performed for total

fatty acid intake and total calories consumed by a garrison

population over the 28-day sampling period. The fatty acid

output (mg per serving) and food energy content (kcal per

serving) per recipe serving were entered into a productions

worksheet (C. Sanabria, personal communication), which

details the quantity of each menu offering produced each

day. The quantity of each food item produced daily is deter-

mined by previous consumption patterns in the example gar-

rison. Thus, the productions worksheet was used to obtain a

“forecasted” menu that estimated the quantity of each menu

item that would actually be consumed by the garrison over

the sampling period. This method of estimating total garri-

son consumption involves an inherent limitation in that not

all food that is produced may be consumed, with some food

being discarded as waste and with individuals selecting only

subsets of available foods. Forecast correction was per-

formed by multiplying both the fatty acid output (mg per

serving) and the food energy content (kcal per serving) of

each recipe by the number of servings forecasted for con-

sumption during the sampling period, giving (1) total ALA,

LA, n-3 HUFAs, and n-6 HUFAs intake (g per garrison per

28 days) and (2) total calorie intake (kcal per garrison per

28 days). Forecast correction was performed separately for

each respective food line.

The forecast-corrected fatty acid and food energy content

of 507 recipes were then summed. A detailed description of

the number and types of food items is beyond the scope of

this article. On the basis of 9 kcal per g fat, the percentage

contribution of fatty acids to total energy intake (en%) was

then calculated for ALA, LA, n-3 HUFAs, and n-6 HUFAs.

The fatty acid contents of the experimental foods were pro-

vided by the manufacturers. All calculations were performed

with Microsoft Office Excel (Windows XP; Microsoft).

Estimation of Changes in Tissue CompositionResulting From Hypothetical Food Substitution

The percentage of n-6 in HUFA was determined using an

empirical equation developed by Lands et al,14,15 (see Fig. 3.

Lands Equation), which estimates the relative proportions of

n-6 and n-3 HUFA in the membrane phospholipids resulting

from dietary intake of essential fatty acids. The equation uses

the dietary content of the four categories of essential fatty

acids (i.e., LA, ALA, n-6 HUFAs, and n-3 HUFAS) expressed

as en% to calculate expected %n-6 in HUFA. This empirical

formula accounts for metabolic interactions between the four

main types of essential fatty acids that determine the composi-

tion of n-3 and n-6 in tissues. It should be noted that the %n-6

in HUFA value estimated in the present study reflects the

tissue composition that would result if a single individual were

to consume all foods offered during the month sampled. Thus,

this is not a random sampling of diet selections, so variance in

possible tissue outcomes was not modeled.

Hypothetical Substitution of High n-3 and Low n-6

FoodsSubstitution of foods with elevated n-3 and diminished

FIGURE 1. Study overview and outline of data path from provided recipe to tissue composition predictions.





n-6 content was performed for a sample (n = 8 representative

days) of the mainline menu and for the fast-food menu. In

addition, the predicted impact of fish oil supplements provid-

ing 1 g per day n-3 HUFA (EPA plus DHA) was also assessed

for both the mainline menu and the fast-food menu. Ingredi-

ents that were swapped and their respective fatty acid compo-

sitions are given in Table II. Swapped food commodities

included meat products such as pork, chicken, beef, and tur-

key, as well as shell eggs and shortening. In addition, LA-rich

soy oil comprising all visible and cooking oils was swapped

out in favor of a “high oleic” low-LA soy variant. For the fast-

food line, the predicted impact of swapping only the frying oil

while maintaining the remainder of ingredients the same was

evaluated. The procedure described above was used to calcu-

late en% in forecast-corrected servings for each of the four

categories of essential fatty acids. The Lands tissue prediction

model was then used to estimate %n-6 in HUFA from LA,

ALA, n-6 HUFA, and n-3 HUFA intake expressed as en%.

FIGURE 3. The Lands Equation accounts for metabolic interactions between the types of fatty acid consumed in the diet expressed as en% as inputvariables: 18-carbon n-6 PUFA (P6; 18:2n-6 and 18:3n-6), 18-carbon n-3 PUFA (P3; 18:3n-3 and 18:4n-3), 20-and 22-carbon n-6 HUFAs (H6; 20:3 + 20:4 +22:4 + 22:5), and 20- and 22-carbon n-3 HUFAs (H3; 20:5 + 22:5 + 22:6).The output variable of %n-6 in HUFA expressed the relative amount of n-6 HUFAsin the bioactive pool of n-3 and n-6 HUFAs. Constants are included below the equation. An electronic version is available at www.efaeducation.org.

FIGURE 2. Sausage, egg, and cheese croissant. (A) Input of ingredient composition of recipe into KIM II database. (B) Output of KIM II displayingessential fatty acid content per serving of recipe.





RESULTS

Theoretical Menu-Item Substitution

On the basis of the reported meal consumption patterns of

active duty Personnel from the HRBS, we characterized the

fatty acid composition (LA, ALA, n-6 HUFA, and n-3

HUFA) of a representative 28-day Garrison mainline menu.

The mainline menu consisted of a total Garrison sum offering

of 15,774,387 cal over 28 days, or equivalently, a daily fore-

casted average of (5.63 + 105) ± (3.60 + 104) kcal per day(Fig. 4). The daily average amount of LA, ALA, n-6 HUFA,

and n-3 HUFA consumed in the Garrison mainline diet is also

shown in Figure 4. Thus, in the current Garrison food offer-

ings, the availability of both short-chain and long-chain n-6

fatty acids significantly outweighs that of n-3 fatty acids.

These 4 categories of dietary fatty acids were entered into

the Lands Equation as percentage of total energy (en%) to

obtain a predicted tissue composition of 78% n-6 in HUFA

on the basis of a single person consuming all garrison foods

offered in a month.

Substitutions (Table II) were performed for a representa-

tive sample of 8 days for the mainline menu. Swapping in

n-3-rich foods and substituting LA-rich soy oil with a “high

oleic” low-LA soy variant resulted in an increase in dietary

ALA and n-3 HUFAs accompanied by a decrease in dietary

LA and n-6 HUFAs. The change in the fatty acid composition

(en%) of the diet achieved by these substitutions is shown

in Table III. These changes in the fatty acid composition of

the diet translated to a 19% decrease in the predicted percent-

age n-6 in tissue HUFA value, from 76.4% to 57.1%.

A theoretical modeling addition of 1 g per day n-3 HUFA

(EPA plus DHA) as a salmon oil supplement resulted in a

predicted tissue composition of 53.8% n-6 in HUFA, a 22.6%

decrease relative to current offerings (Table III). However,

background intakes of omega-6 fatty acids may be very high

at baseline necessitating more than 1 g per day to substan-

tially alter tissue levels. As well, this modeling did not

account for foods from other sources.

Theoretical Fast-Food Line Menu Swapping

The fatty acid composition (en%) of the fast-food-line menu

is given in Table III. The current fast-food line offerings

contribute to a predicted 78.5% n-6 in HUFA. For this

menu, we modeled the change in fatty acid composition and

resulting predicted tissue composition achieved by the fol-

lowing: (1) substitution of only frying oils (i.e., high oleic

oil in place of canola and partially hydrogenated oil) and

(2) substitution of all oils and the food commodities listed

in Table III. A comparison of the fatty acid composition

(en%) of current and swapped menus for the fast-food-line

is given in Table III. We report no significant change in the

predicted %n-6 in HUFA from current fast-food-line offer-

ings compared to offerings with only frying oil swapped.

However, a 15.5% decrease in n-6 in HUFA was observed

TABLEII.

Fatty

AcidCompositionofSwapped

FoodIngredients

Oil

Egg

Chicken

Pork

(Loin)

Pork

(BackFat)

Beef

Turkey

Shortening

Fatty

Acid(g/100g)

Canola

Partially

Hydrogenated

HighOleic

Swapped

USDA

Swapped

USDA

Swapped

USDA

Swapped

USDA

Swapped

USDA

Swapped

USDA

Swapped

USDA

Swapped

TotalSaturated

15.25

24.75

12.25

3.1

34.31

1.85

1.18

0.79

32.21

16.02

5.87

5.34

1.21

1.85

30.42

16.14

TotalMonounsaturated

22.73

61.25

81.63

3.81

46.24

2.52

1.36

0.93

41.95

18.39

6.56

4.8

1.52

2.52

50.97

26.75

TotalPolyunsaturated

57.33

9.3

6.12

1.36

33.23

3.4

0.56

0.38

10.35

15.72

0.43

0.53

1.06

3.4

14.2

8.8

18:2n-6

50.3

8.59

5.1

1.15

1.19

2.88

1.55

0.48

0.2

9.5

7.45

0.34

0.43

0.92

1.55

13.6

10.66

18:3n-3

7.03

0.21

1.02

0.03

1.12

0.01

1.64

0.02

0.09

0.74

6.82

0.05

0.07

0.06

1.64

0.6

1.46

20:4n-6

00

00.14

0.06

0.08

0.03

0.05

0.02

0.11

00.04

0.01

0.06

0.03

00

20:5n-3

00

00

0.03

0.01

0.04

00.02

00

00

00.04

00

22:5n-3

00

00

0.05

0.01

0.05

00.01

00

00.02

0.01

0.05

00

22:6n-3

00

00.04

0.18

0.03

0.06

00

00

00

0.01

0.06

00





when both oils and additional food commodities were

swapped (Table III).

DISCUSSIONOn the basis of our modeling, current Garrison food offer-

ings are likely to result in low, and therefore unhealthy,

tissue membrane proportions of n-3 HUFAs relative to n-6

HUFAs. The fatty acid composition of the current Garrison

diet results in a predicted %n-6 in HUFA value of 78%, a

figure similar to the 83% predicted n-6 in HUFA from con-

suming the typical American diet.15 It should be noted that

the percentage of n-6 in HUFA has been found to be

a biomarker for omega-6 status in tissues16,17 and has fur-

thermore been strongly associated with coronary heart dis-

ease mortality.16,17

By comparison to the fatty acid status of worldwide popu-

lations, the modeled estimated %n-6 in tissue HUFA from

FIGURE 4. Summary of current mainline menu offerings. (A) Average total calorie forecasted = (5.63 + 105) ± (3.60 + 104) kcal. (B,C) Summary oftotal fatty acid amounts offered in current menu mainline foods on a daily average basis. (B) Short chain PUFA in kilograms. (C) Long-chain PUFA in grams.

TABLE III. Predicted % n-6 in HUFA Calculated From en% 18:3n-3, en% 18:2n-6, en% n-3 HUFA, and en% n-6 HUFA for Mainlineand Fast-food Menus in Both Current and Swapped Conditions

Average Daily Dietary Intakes

(ML, n = 8 Representative Days; FF, n = 1 Day) ML FF Oil Only FF Oil + Foods

Current Supplemented Swapped Current Swapped Current Swapped

en% 18:3n-3 0.58 0.54 1.23 0.50 0.47 0.50 1.08

en% 18:2 n-6 4.30 3.93 2.90 5.37 5.01 5.37 3.89

en% n-3 HUFA 0.05 0.38 0.13 0.02 0.02 0.02 0.08

en% n-6 HUFA 0.09 0.09 0.08 0.06 0.06 0.06 0.04

Plasma PL: Predicted HUFA Proportions

20:5n-3 + 22:5n-3 (as % of HUFA in PL) 10.1 16.4 25.1 6.9 7.0 6.9 18.4

Other HUFA (as % of HUFA in PL) 22:6n-3; 20:3n9 13.4 29.7 17.7 14.6 14.9 14.6 18.6

% n-6 in HUFA (20:3n-6+20:4n-6 as % of HUFA in PL) 76.4 53.8 57.1 78.5 78.1 78.5 63.0

%n-3 in HUFA 23.6 46.1 42.9 21.5 21.9 21.5 37.0

Omega-3 Index 3.0 7.0 6.5 2.6 2.7 2.6 5.4

FF, fast food; ML, mainline; PL, plasma.





consuming the entire garrison diet is strikingly high. In a

survey of serum fatty acid profiles of four different popula-

tions (i.e., rural Japanese, urban Japanese, Japanese Ameri-

cans, and Caucasian Americans), Iso et al18 found that %n-6

in tissue HUFA varied over a range of 44.9%, from 36.3%

n-6 in HUFA in a rural Japanese population to 81.2% n-6 in

HUFA in a Caucasian American population. Similarly, the

mean %n-6 in HUFA was found to be 65.6% for a sample of

women in a Mediterranean population,19 which is signifi-

cantly lower than the value resulting from consuming a typi-

cal garrison diet. We caution that these estimates reflect the

composition of all foods in the garrison diet, and not indica-

tive of what any one individual will consume when eating

selected items.

The current Garrison diet can be said to be deficient in n-3

fatty acids, based on our modeling. Use of omega-3 supple-

ments is one, but not the only alternative to elevate this

situation. Hibbeln et al20 estimated that 3.5 g per day of n-3

HUFA would be necessary in typical American diet to achieve

a tissue composition approximating 60% n-3 HUFA.20 This

2006 study by Hibbeln et al20 defined deficiency as attributable

risk from 13 major n-3-related morbidity and mortality out-

comes, such as cardiovascular disease and bipolar disorder.

Hibbeln et al20 estimated that 1 g per day would substantially

reduce risk of these illnesses. The representative U.S. Garri-

son diet, like the typical diet of the general U.S. population,

does not currently succeed in meeting the requirement of

this definition.

Substitution of n-3 rich eggs, poultry, pork, and other

food commodities, combined with use of low-LA oils, may

contribute significantly to attaining healthier n-6/n-3 propor-

tions in the tissue. It should be noted that when only dietary

LA was lowered by substituting frying oil in the fast-food-

line, the observed change in %n-6 in HUFA was negligible.

Yet, %n-6 in HUFA was decreased significantly when other

food commodities were substituted with n-3 and low omega-

6-rich variants, in addition to swapping out high-LA oil.

This suggests that lowering dietary n-6 in combination with

elevating n-3 acts more potently than either method alone to

lower tissue composition of n-6. Supplementation of the

mainline food offerings with the use of capsules achieves a

similar effect but may entail problems with compliance as

previously noted.

This current modeling study has several limitations. The

HRBS dietary survey information was limited to only two

questions and the response options were categorical in nature

rather than based on portion sizes of specific food items. In

addition, we used an empirical model and the accuracy of this

model prediction has not been demonstrated in a clinical trial

to date. However, now that this model is in place, clinical

trials can be conducted to determine the efficacy of dietary

changes in effecting more favorable tissue compositions of

fatty acids. In addition, only a small representative sample of

28 days out of a 365-day cycle offering was experimentally

manipulated in this model and it is known that serving sizes

are not strictly enforced in some serving environments and

thus may result in additional variation in the fatty acid com-

position of foods served and resulting tissue compositions

from consuming these diets. Lastly, this modeling does not

reflect actual consumption of the garrison diet or its individ-

ual components. Uncertainties resulting from these aspects of

the study should be taken into account when evaluating the

robustness of these model predictions.

A linear regression analysis comparing %n-6 in HUFA

predicted by the Lands Equation, and %n-6 in HUFA deter-

mined by blood fraction analysis resulted in a correlation

coefficient of 0.73 (P = 0.000000) (n = 92).21 This anal-

ysis was based on a literature search of 34 clinical trials that

reported (1) dietary intake of at least LA (18:2n-6) and ALA

(18:3n-3) and (2) the amounts of at least AA (20:4n-6), EPA

(20:5n-3), and DHA (22:6n-3) in phospholipids or total

lipids of plasma, serum, or red blood cell. Therefore, we

can expect the predicted changes in tissue composition

modeled here to be a reasonable estimation of actual propor-

tions of n-6 and n-3 HUFAs resulting from consuming the

garrison diet.

The tissue compositions of n-3 HUFAs predicted by this

modeling are consistent with measures reported in a recent

study of active duty U.S. military personnel. In a case–control

study, Lewis et al8 reported that %n-6 HUFAs averaged

78% (range 59–89) in a sample population of 800 apparently

healthy active duty personnel. Lewis et al8 assessed whether

deficiencies of n-3 HUFAs, particularly DHA, were associ-

ated with increased risk of suicide among a large random

sample of active duty U.S. military. In a sample population

(n = 800) of health controls in active duty U.S. military,

%n-6 in HUFA was determined to be 78%. The similarity

of this figure to the 76.4% n-6 in HUFA predicted from

consuming the current mainline diet in this model suggests

that the fatty acid composition, and therefore also resulting

tissue compositions, of this sample menu are representative

of actual food intake.

Food substitutions like those described herein raise ques-

tions regarding commodity availability and economic feasi-

bility. To begin to answer the question of whether the

substitutions modeled here are economically acceptable at

the garrison level, we determined the economic impact of

changing the source of chicken shell eggs for egg-based

dishes in the mainline menu. At today’s market prices, regu-

lar eggs versus high omega-3 eggs for 500 garrison Personnel

eating 1 egg per day cost an estimated $1,120.00 per month

regular versus $1,423.33 per mo. However, his price differ-

ential may be reduced by purchasing in bulk and should be

weighed against the possible potential health benefit of incor-

porating high omega-3 eggs into the garrison diet.

CONCLUSIONThe diet offered in the U.S. Garrison menu can be character-

ized as having inadequate n-3 fatty acid and an oversupply of





n-6 fatty acids, resulting in a high predicted tissue composi-

tion of n-6 HUFA. The tissue composition of n-6 in HUFA

can be lowered significantly by substitution of n-3 rich eggs,

poultry, pork, and other food commodities into existing rec-

ipes, combined with use on low LA visible oils and cooking

oils. Dietary supplements such as fish oil pills can improve

n-3:n-6 status, but success is dependent on voluntary compli-

ance. The modeling effort reported in this article suggests

that substitution of food items such as eggs, chicken meat,

pork, and salad dressings with like products, but with lowered

n-6 and elevated n-3 levels will produce marked improve-

ments in n-3:n-6 HUFA status, and may be a viable way to

decrease pathogenesis of diseases consequent to imbalances

in tissue n-3:n-6 HUFA.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the assistance of Viviane Enslein and

Samantha Wise for their work in formatting and editing various versions of

this article. The Intramural program of the National Institute on Alcohol

Abuse and Alcoholism provided support for this work.

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