Dining Facility Research Articles

Food Choice and Waste in University Dining Commons—A Menus of Change University Research Collaborative Study

The purpose of this multi-campus research was to investigate the relationships of food type and personal factors with food choice, consumption, and waste behaviors of college students at all-you-care-to-eat dining facilities. The amount of food taken and wasted was indirectly measured in units relative to the plate size using before and after photos taken by the diners themselves. Animal protein and mixed dishes (e.g., stir fry, sandwich) took up more of diners’ plate space and these items were correlated to both greater hedonic appeal as well as a higher likelihood of the item being pre-plated. Greater confidence in liking an item before choosing it was correlated to a larger portion being taken. Finally, increased satisfaction with the meal and frequency of visiting the dining commons was correlated to less food waste. Understanding these potential food choice drivers can help dining facilities better target healthier meals to diners while reducing food waste.

Eating Behaviors Are Associated With Physical Fitness and Body Composition Among US Army Soldiers

ObjectiveExamine associations between soldiers’ eating behaviors, compliance with body composition and fitness standards, and physical performance. DesignCross-sectional study. SettingEight Army installations. ParticipantsUS Army Soldiers (n = 1,591; 84% male). Main Outcome MeasuresCharacteristics, eating behaviors, compliance with body composition and physical fitness standards, and fitness level were assessed via questionnaire. AnalysisBivariate and multivariable logistic regression. ResultsEating mostly at a dining facility was associated with lower odds of body composition failure (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.26–0.73); whereas, eating at a fast rate (OR, 1.51; 95% CI, 1.05–2.17) or often/always ignoring satiety cues (OR, 2.12; 95% CI, 1.06–4.27) was associated with higher odds of body composition failure. Eating mostly fast-food/convenience meals (OR, 1.75; 95% CI, 1.19–2.59) and eating at a fast rate (OR, 1.42; 95% CI, 1.04–1.93) was associated with higher odds of physical fitness failure. Skipping breakfast was associated with lower odds of high physical performance (OR, 0.41; 95% CI, 0.23–0.74); whereas, nutrition education was associated with higher odds of high physical performance (OR, 1.02; 95% CI, 1.01–1.04). Conclusions and ImplicationsAs eating behaviors are modifiable, findings suggest opportunities for improving the specificity of Army health promotion and education programs.

Evaluation of Find Your Fuel: A Point-of-Service Labelling Campaign in a Military Dining Facility.

Nutrition plays a critical role in health and job performance in physically demanding roles. Studies have shown Australian military personnel do not consume diets suited to their roles. A range of foods are provided in military dining facilities; however, personnel still need to make appropriate choices for healthier eating and to optimise performance. This study explored the effect of a labelling scheme based on military-specific nutrition guidance, over a one-month period. Food choices were evaluated in a pre-post design using plate photography (pre n = 190; post n = 159 plates); with satisfaction and behavioural influences assessed through a survey (pre n = 79; post n = 67). The results indicate the scheme had a small effect on food choice—potato and hot vegetable choices increased post-campaign for the dinner meal. On average, choices were heathier at lunch post-campaign, and less healthy at dinner. Satisfaction with the meal experience was higher after the campaign, and no difference was observed in behavioural influences (e.g., self-efficacy and other perceptions). These results are in alignment with other point-of-service labelling studies showing the limited capacity labelling schemes have on guiding consumer choices. Rather than using point-of-service labelling in isolation, additional individual and/or environmental strategies may be needed to more effectively encourage nutritious food choices by personnel.

College students’ attitude toward menu labeling differs by sex, BMI, weight management status, and athletic type

Objective Determine students’ attitude toward menu labeling before and after menu labeling implementation at university dining facility. Participants: College students aged 18 years and older eating at campus dining facility. Methods: Survey on attitude toward menu labeling, weight management status, and athletic classification (NCAA, recreational, or non-athlete) was completed 30 days pre- and post-menu labeling implementation. Results: Females showed stronger positive attitude toward menu labeling. Students trying to lose or gain weight had stronger positive attitudes toward menu labeling than students maintaining weight, as did overweight students compared to normal weight students. NCAA athletes had lower attitude mean scores toward menu labeling than other athletic classifications. Conclusion: Attitude toward menu labeling varies by students’ gender, body mass index (BMI), and weight management focus, with NCAA athletes having the least positive attitude. Focus future research on effective ways to inform students on menu labeling in university dining facilities in order to nutritionally engage young adults.

Young College Students’ Perception of DINESERV: A Study of On-Campus Dining in the USA

Purpose – The purpose of this research is to better understand why college students in the USA eat on-campus. Also, this research aims to compare highly satisfied and low satisfied groups in terms of their on-campus dining experiences and behaviors and to understand what values college students are currently satisfied with and what they expect from their on-campus dining. Design – A survey design was implemented in this study. The sample for this research study is any college students who have eaten at on-campus dining facilities within the last 3 months. Methodology – Cluster analysis, correlation, and t-test were utilized for data analysis. The twostep clusters method was used to cluster groups based on the mean values of DINESERV. Approach – The validity of DINESERV for on-campus dining settings was examined, as well as examining the behavior and perception of Generation Y and Z on on-campus dining. Findings – In both clusters, Assurance was the factor with the highest correlation coefficient value, while Tangible ranked last among the five DINESERV factors. The other dimensions of DINESERV were also very important to the young college students, as indicated by the high correlation coefficients. Originality of the research – This research examines the validity of DINESERV in on-campus dining settings in the United States. The uniqueness of this study lies in the sample: young college students, Generation Y and Z.

Barriers to Nutrition Interventions in Army Dining Facilities: A Qualitative Study.

Interventions that encourage good nutrition-related behaviors in the dining environment can potentially influence the health of large numbers of military personnel. Thus, the Army has studied the effectiveness of implementing nutrition education and dining facility (DFAC) changes that included healthier recipes, revised menus, and population-specific point-of-choice labeling, but successful intervention implementation largely depends on the foodservice employees' understanding, knowledge, and desire to sustain changes. This phenomenological, qualitative study aimed to better understand common barriers to the implementation and sustainment of DFAC-based nutrition interventions at two U.S. Army DFACs. Focus group sessions (n = 168 participants) ranging from 60 to 90 minutes in length were conducted at two large DFACs on three separate occasions every 4 months from May 2015 to January 2016 among the foodservice staff during intervention implementation. Focus group transcripts were analyzed using NVivo 11 software. Researchers conducted multiple rounds of coding following an iterative process until four principal themes emerged. Principal themes related to the foodservice employees' experience during the nutrition intervention revealed barriers to a successful implementation related to (1) nutrition knowledge deficits, (2) inadequate culinary training, (3) poor management practices, and (4) low staff morale. A lack of foodservice staff training and education is a significant contributor to implementation barriers. Future interventions should increase engagement with foodservice employees during intervention planning and implementation phases with a structured and tailored nutrition education and culinary skill training program. Addressing these barriers may enhance staff morale and promote intervention adherence.

Abstract 14055: Impact of a Boxed Meal Facilitated Plant-based Diet on Cardiometabolic Endpoints: A Clinical Trial

Background: Plant-based diets (PBD) are increasingly recommended to reduce the risk of cardiovascular disease. Boxed meal-delivery services are a growing market facilitating consumer convenience; however, their effects on health require further study. We compared cardiometabolic changes between a boxed meal facilitated PBD (f-PBD) and Standard Omnivorous Diet (f-SOD). Methods: A prospective, controlled, parallel-designed trial assessing the impact of a f-PBD (n=16) to a f-SOD (n=16) on cardiometabolic endpoints was conducted in military beneficiaries. Participants with a BMI >25 kg/m 2 consuming a standard omnivorous diet volunteered to adopt a f-PBD or f-SOD for a 4-week period. Participants had the option to consume breakfast and lunch according to their adopted diet at the military dining facility. Dinner was facilitated by shipping a commercially available plant-based or standard omnivorous boxed meal kit to participants as appropriate. Lipid parameters were monitored at baseline and at 4 weeks. Weight, blood pressure (BP) and other clinical endpoints were assessed weekly. The primary endpoints were change from baseline at 4 weeks in calculated low-density lipoproteins (LDL-c) and weight. A student’s t-test was performed to assess differences between groups using the intention-to-treat methodology. Results: A total of 32 participants were enrolled in the f-PBD and f-SOD groups. Average age of participants was 33.3±7.8 years, BMI was 29.6±3.5 kg/m 2 and 50% were male. Change in LDL-c from baseline in the f-PBD and f-SOD groups were -9.41±21.7 mg/dl and +5.63±15.9 mg/dl, respectively (p=0.033). The change in weight from baseline in the f-PBD and f-SOD groups were -3.82±4.4 pounds and +0.87±2.7 pounds, respectively (p=0.001). Systolic BP decreased non-significantly in the f-PBD group (-4.88±5.4 mmHg vs -0.38±9.2 mmHg for f-PBD and f-SOD, respectively, p=0.103). Conclusion: Incorporating a meal-delivery f-PBD significantly reduced LDL-c and weight over a 4-week period. Plant-based meal kits could serve as a novel dietary intervention in the optimization of cardiovascular disease burden.

Nutrition Interventions in Military Dining Facilities Can Enhance Diet Quality and Meal Satisfaction

Nutrition Interventions in Military Dining Facilities Can Enhance Diet Quality and Meal Satisfaction

Challenges and Solutions of Providing Healthier Foods in Military Dining Facilities

Challenges and Solutions of Providing Healthier Foods in Military Dining Facilities

Wearable Technology to Quantify the Nutritional Intake of Adults: Validation Study.

BackgroundWearable and mobile sensor technologies can be useful tools in precision nutrition research and practice, but few are reliable for obtaining accurate and precise measurements of diet and nutrition.ObjectiveThis study aimed to assess the ability of wearable technology to monitor the nutritional intake of adult participants. This paper describes the development of a reference method to validate the wristband’s estimation of daily nutritional intake of 25 free-living study participants and to evaluate the accuracy (kcal/day) and practical utility of the technology.MethodsParticipants were asked to use a nutrition tracking wristband and an accompanying mobile app consistently for two 14-day test periods. A reference method was developed to validate the estimation of daily nutritional intake of participants by the wristband. The research team collaborated with a university dining facility to prepare and serve calibrated study meals and record the energy and macronutrient intake of each participant. A continuous glucose monitoring system was used to measure adherence with dietary reporting protocols, but these findings are not reported. Bland-Altman tests were used to compare the reference and test method outputs (kcal/day).ResultsA total of 304 input cases were collected of daily dietary intake of participants (kcal/day) measured by both reference and test methods. The Bland-Altman analysis had a mean bias of −105 kcal/day (SD 660), with 95% limits of agreement between −1400 and 1189. The regression equation of the plot was Y=−0.3401X+1963, which was significant (P<.001), indicating a tendency for the wristband to overestimate for lower calorie intake and underestimate for higher intake. Researchers observed transient signal loss from the sensor technology of the wristband to be a major source of error in computing dietary intake among participants.ConclusionsThis study documents high variability in the accuracy and utility of a wristband sensor to track nutritional intake, highlighting the need for reliable, effective measurement tools to facilitate accurate, precision-based technologies for personal dietary guidance and intervention.

Improving campus dining operations using capacity and queue management: A simulation-based case study

With growing consumer demand, dining facilities athigher education institutions have started to provide a wide assortment of food products catering to the needs of every individual. In developed countries like the United States, labor is an expensive asset, and campus dining facilities are struggling to utilize their employees efficiently and achieve service excellence. This research is motivated by a real-life case study of a campus dining service (CDS), which is an all-you-can-eat establishment with an annual influx of 500,000 students. The CDS has eight food stations but experiences long queues only at individual stations that prepare made-to-order (MTO) meals, thereby leading to excessive wait at the facility. Given the characteristics of the CDS, the objective of this paper is to evaluate the impact of capacity reallocation and queue management on customer waiting time. The methodology integrates the six sigma DMAIC (Define, Measure, Analyze, Improve, and Control) framework with a discrete event simulation modeling approach to understand, analyze, and improve the service responsiveness at CDS. Five different alternatives pertaining to capacity reallocation and queue management are proposed. The experimental analyses indicate that reallocating underutilized workers to high demand MTO stations can reduce the average waiting time by 29%. Besides, when adopting a combination of server reallocation and queue management, the CDS can curtail wait times by up to 45%. Finally, the alternatives are evaluated with respect to multiple criteria (cost and ease of implementation, responsiveness, and sustainability) to provide managerial insights to the CDS.

Cool Food Collective Greenhouse Gas Emissions Baseline and 2030 Reduction Target

Cool Food is a global initiative that helps dining facilities commit to a science-based target to reduce their food-related greenhouse gas (GHG) emissions by 25 percent by 2030 relative to 2015. This paper establishes the baseline estimate for Cool Food members’ collective food-related GHG emissions and also reports the group’s 2030 reduction target. In total, members reported more than 129,000 tonnes (t) of food purchased in the base year. If members met the collective 25 percent GHG emissions reduction target, their actions would reduce the group’s annual emissions by more than 1,071,000 t CO2e per year by 2030 relative to the base year—a reduction equivalent to avoiding the annual tailpipe emissions from more than 230,000 passenger vehicles. We will provide a progress update using the group’s 2019 food purchase data once new data are available.

P177 Military Dining Facility Staff Perspectives on the Implementation Barriers and Facilitators of Go for Green 2.0, a Department of Defense Nutrition Initiative

Background In an effort to optimize performance, readiness, and health of military service members, the Department of Defense (DoD) created a performance nutrition initiative, Go for Green (G4G). Challenges led to program revision and development of G4G 2.0, however successful implementation has yet to be accomplished. Objective The purpose of this study was to improve the G4G 2.0 program framework by informing and developing best practices through explication of dining facility (DFAC) staff perspectives. Study Design, Settings, Participants Focus groups were conducted in two phases (May 2017 to February 2018) with supervisors and staff of Wolf DFAC, at Fort Carson, Colorado prior to G4G 2.0 implementation. Participants were recruited by purposive sampling (n = 89). Focus groups were audio recorded to capture all verbal responses, transcribed verbatim, and lasted an average of 31 minutes (range 24 to 58 minutes). Measurable Outcome/Analysis Focus group transcripts of DFAC staff perspectives were reviewed via qualitative content analysis using an exploratory, inductive approach to elucidate emergent themes from the data. Results DFAC staff perspectives of barriers to G4G implementation included lack of, or ineffective training, inconsistent preparation of food items, fidelity issues, staff perceptions of patron preferences, lack of patron familiarity to new G4G food items and lack of buy-in. Implementation facilitators included training, G4G team site visits, and patron exposure to G4G menu items. Staff suggestions for G4G implementation and program improvement included training on preparation methods, having a flexible implementation timeline, up front provision of all G4G materials, for the G4G team to conduct a needs assessment, and G4G and nutrition education and awareness outside the DFAC. Conclusion Results demonstrated that barriers to G4G 2.0 implementation outweighed facilitators, and supported the idea that there may be more viable, less time and work-intensive methods to promote healthier food selection by patrons. Incorporating methods to improve patron selection of healthful items in DFACs could play an instrumental role in improving Service Member health, thereby enhancing readiness to meet mission requirements. Funding United States Army Research Institute of Environmental Medicine.

Military Dining Facility Staff Perspectives on the Implementation Barriers and Facilitators of Go for Green 2.0, a Department of Defense Nutrition Initiative (P04-003-19)

ObjectivesIn an effort to optimize performance, readiness, and health, the Department of Defense (DoD) created a performance nutrition initiative, Go for Green (G4G). Study aims were to determine dining facility staff perspectives on barriers and facilitators to implementation as well as recommendations for program improvement. The purpose of this study was to improve the G4G 2.0 program framework by informing and developing best practices through explication of dining facility (DFAC) staff perspectives. MethodsFocus groups were conducted in two phases (May 2017 to February 2018) with supervisors and staff of Wolf DFAC, at Fort Carson, Colorado prior to G4G 2.0 implementation. Participants were recruited by purposive sampling and were identified as key stakeholders (n = 89) in the G4G initiative. Focus groups were audio recorded to capture all verbal responses, transcribed verbatim and lasted an average of 31 minutes (range 24 to 58 minutes). Transcripts were reviewed via qualitative content analysis using an exploratory, inductive approach to elucidate emergent themes from the data. ResultsDFAC staff perceptions of barriers to G4G implementation included lack of, or ineffective G4G training, inconsistent preparation of food items, G4G fidelity issues, staff perceptions of patron preferences, lack of patron familiarity to new G4G food items and lack of G4G buy-in. Implementation facilitators included training, G4G team site visits, and patron exposure to G4G menu items. Staff suggestions for G4G implementation and program improvement included training on preparation methods, having a flexible implementation timeline, up front provision of all G4G materials, for the G4G team to conduct a needs assessment, and G4G and nutrition education and awareness outside the DFAC. ConclusionsResults demonstrated that barriers to G4G 2.0 implementation outweighed facilitators, and supported the idea that there may be more viable, less time and work-intensive methods (aside from color-coded food cards) to promote healthier food selection by patrons. Incorporating methods to improve patron selection of healthful items in DFACs could play an instrumental role in improving Service Member health, thereby enhancing readiness to meet mission requirements. Funding SourcesUnited States Army Research Institute of Environmental Medicine.

Nutritional Quality of Undergraduate Student Meals in an All-You-Care-to-Eat Campus Dining Facility (P04-156-19)

ObjectivesTo assess the overall nutritional quality of meals chosen by undergraduate students during weekday lunches at campus all-you-care-to-eat dining halls. MethodsA previously validated exit survey was used to collect self-reported data from undergraduate students on foods and beverages they consumed during a single visit to two all-you-care-to-eat dining halls on the George Mason University Fairfax campus, during 4 weeks. (n = 468) Nutritional quality of each meal was evaluated on a 7-point rubric, according to the ‘Wellness Meal’ standards from the Partnership for a Healthier America: ≤700 kilocalories, ≤10% calories from saturated fat, ≤800 mg sodium, ≥2 ounces whole grains, ≥1 cup lowfat dairy, ≥ 1.75 cups fruits and vegetables, and ≥ 2 ounces lean protein. ResultsOf the maximum score of 7 on the meal nutritional quality rubric, 4 participants earned the highest score of 5, whereas 43, 150, 132, 88, and 51 participants had scores of 4, 3, 2, 1, and 0, respectively. The most commonly attained rubric standard was saturated fat, where 60% of participants consumed ≤ 10% calories from saturated fat and average consumption was 9.1% (± 5.4%) of calories. The least achieved rubric category was lowfat dairy, where only 2% of students consumed 1 cup equivalent, followed by only 9% of participants having consumed the 2 ounce equivalent of whole grains. Approximately one-third of students met calorie, lean protein, sodium, and fruit/vegetable standards. ConclusionsDespite a wide variety of food options in the campus all-you-care-to-eat dining halls during the lunch hours, most undergraduate students consumed meals of subpar nutritional quality, with the vast majority meeting fewer than half the categories on the meal nutritional quality rubric. All-you-care-to-eat university dining halls may be a prime location for nutrition education and interventions. Funding SourcesThis research was funded by the George Mason University Provost’s Multidisciplinary Research Award.

Eating Behaviors Are Associated with Body Composition and Physical Fitness Standards Failure Among US Army Soldiers (P21-042-19)

ObjectivesUS Army Soldiers must comply with body composition (BC) and physical fitness (PF) standards as a condition for military entry and retention. Whether eating behaviors are associated with meeting these standards is unknown. This cross-sectional study aimed to determine the specific eating behaviors associated with failing BC and PF standards, and to characterize the eating behaviors and other habits of Soldiers who are high performers as defined by high PF scores and consistently meeting BC standards. MethodsSoldiers (N = 1460, 93% enlisted, 83% male, 23.5 ± 5.2 years of age with 3.5 ± 4.0 years of service) completed a questionnaire to assess their eating behaviors and history of compliance with BC and PF standards. Multivariate adjusted logistic regression models using maximum likelihood estimation were used to examine relationships between Soldiers’ eating behaviors and failing standards. Bivariate analysis was used to test differences between high (HP) and low performers (LP). ResultsEating mostly (>50% of meals in last 7 days) at a dining facility lowered the odds of BC failure by 2.63 times (OR: 0.38, 95% CI: 0.22, 0.64); whereas, eating mostly Meals, Ready-to-Eat (MRE), eating at a fast rate, and ignoring fullness cues raised the odds by 2.23 times (95% CI: 1.15, 4.35), 2.65 times (95% CI: 1.18, 5.94) and 1.90 times (95% CI: 1.16, 3.11), respectively. Eating mostly at restaurants, being distracted while eating, and extreme hunger prior to meals, raised the odds of PF failure by 1.70 times (95% CI: 1.17, 2.48), 1.68 times (95% CI: 1.13, 2.51), and 1.55 times (95% CI: 1.08, 2.24), respectively. HP were significantly less likely than LP to eat mostly at restaurants (25% HP, 39% LP) and were significantly more likely than LP to report longer work hours (33% HP, 28% LP) (P < 0.05). ConclusionsFindings suggest that specific eating behaviors of Soldiers are associated with failing BC and PF standards. As eating behaviors may be modifiable, these findings could identify opportunities for improving the specificity of Army health promotion and education programs aimed at increasing force readiness and performance. Funding SourcesUS Army Medical Research and Materiel Command. DisclaimerAuthors’ views do not reflect official DoD or Army policy.

Single-Meal Nutrient Assessment by a Self-Administered, Electronic Exit Survey Compared with a Multipass Dietary Interview in University Undergraduates in an All-You-Care-to-Eat Campus Dining Hall

BackgroundAssessing nutritional intake in all-you-care-to-eat dining facilities poses unique challenges. New methods that streamline accurate data collection would facilitate better nutrition intervention research in this dining hall environment, which is common on university campuses. ObjectiveTo compare nutrient and food group intake data of university undergraduate students from a single visit to an all-you-care-to-eat campus dining hall, collected by two methods: multiple-pass dietary recall interview and self-administered, electronic survey. Participants/settingUndergraduate students (n=42) ages 18 and older were recruited as they exited the dining hall during lunch service hours during 1 week. DesignUsing a cross-sectional design, participants completed two dietary assessment methods in random order: an electronic tablet-based exit survey listing the available menu items at that service with drop-down menus to report portion size consumed and a multiple-pass structured dietary interview by a single, trained interviewer. Statistical analyses performedAgreement of nutrients and food groups between the two methods was assessed by Pearson and Spearman correlations and paired t tests. Significance was set at P<0.05. ResultsRespondents were primarily underclassmen and women who lived on campus, with 16 of 42 students identifying as white. Students reported an average of 1.1 additional food items via the diet interview method compared with the survey. Average kilocalorie intake by the interview and survey methods was 837±561 and 860±586, respectively. Mean intake of all measured nutrients and all food groups except total and lean protein was not significantly different across the two methods. Spearman correlations between method results ranged across nutrients from r=0.541 to r=0.998 and across food groups from r=0.507 to r=0.948; all were significant at P<0.001. However, mean differences between methods exhibited notable variation. ConclusionsThe electronic survey method performs similar to a multiple-pass dietary interview in assessing mean nutrient intake of ethnically diverse university undergraduates in a single eating occasion at an all-you-care-to-eat dining hall, but the survey may not be as efficient at capturing the total number of food items consumed.

Magnitude, distribution, risk factors and care-seeking behaviour of acute, self-reported gastrointestinal illness among US Army Soldiers: 2015.

Throughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66-20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04-2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7-3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance under-estimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.

678. Outbreak of Shiga Toxin-Producing Escherichia coli Infections at Marine Corps Recruit Depot (MCRD), San Diego and Camp Pendleton, California: October–November, 2017

BackgroundShiga toxin-producing Escherichia coli (STEC) infections are a major cause of foodborne illness and the principal cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC and the US Navy responded to an outbreak of STEC illnesses in military recruits at the Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures.MethodsIn October 2017, medical staff identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were defined as confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), or suspected (bloody diarrhea). We conducted environmental evaluations of dining facilities, training areas, and barracks. A case–control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case–control study.ResultsWe identified 64 confirmed, 105 probable, and 91 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Ages ranged from 17 to 28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was significantly associated with illness (mOR 2.40, CI 1.04–5.72, P = 0.04). We identified a single ground beef supplier for MCRD, but dining facility records did not document the dates on which specific lots of ground beef were used.ConclusionCase–control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits.Disclosures All authors: No reported disclosures.

Serum and Erythrocyte Biomarkers of Nutrient Status Correlate with Short-Term Α-Carotene, Β-Carotene, Folate, and Vegetable Intakes Estimated by Food Frequency Questionnaire in Military Recruits

Objective: Food frequency questionnaires (FFQs) estimate habitual dietary intake and require evaluation in populations of interest in order to determine accuracy. Thus, the purpose of this study was to determine agreement between circulating biomarkers and FFQ estimated dietary intake in a military population consuming all meals in a dining facility over 12 weeks.Methods: 2014 Block FFQs were administered and fasted blood samples were drawn to assess nutritional biomarkers at the end of a 12-week training period in male (n = 141) and female (n = 125) Marine recruits undergoing initial military training. FFQ estimates of alpha- and beta-carotene, folate, and fruit and vegetable intake and circulating concentrations of serum alpha- and beta-carotene and serum and erythrocyte folate were measured. Partial correlations were used in the full model, and weighted kappa coefficients were used to determine agreement between ranking quartiles of dietary intake estimates with corresponding biomarker status quartiles.Results: Serum and dietary intake of alpha-carotene were positively associated in males (p = 0.009) and females (p < 0.001), as was serum and intake of beta-carotene (males, p = 0.002; females, p < 0.001). Alpha-carotene was positively associated with vegetable intake in males (p = 0.02) and beta-carotene with vegetable intake in females (p = 0.003). Serum folate in males (p = 0.002) and erythrocyte folate in females (p = 0.02) were associated with dietary folate intake. In females, the relationships between biomarker and dietary estimates yielded significant kappa coefficients. In males, a significant kappa coefficient was observed for erythrocyte folate and dietary intake of folate only. The kappa coefficient for serum and estimated intake of beta-carotene was not significant in males.Conclusion: Twelve-week habitual intake of alpha-and beta-carotene and folate were correlated with circulating biomarkers in a military training population. The 2014 Block FFQ was able to accurately rank females into quartiles of nutrient status based on intake, while males were ranked less accurately than females.