Nutrition and Food Security among Veterans: Operationalizing 'Nutritional Functioning'

Diana P Brostow; Alexandra A Smith; Nazanin H Bahraini; Karen Besterman-Dahan; Jeri E Forster; Lisa A Brenner

doi:10.1016/j.apmr.2024.04.006

Nutrition and Food Security among Veterans: Operationalizing 'Nutritional Functioning'

Arch Phys Med Rehabil. 2024 Apr 20:S0003-9993(24)00948-1. doi: 10.1016/j.apmr.2024.04.006. Online ahead of print.

Authors

Diana P Brostow¹, Alexandra A Smith², Nazanin H Bahraini³, Karen Besterman-Dahan⁴, Jeri E Forster⁵, Lisa A Brenner⁶

Affiliations

¹ VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Electronic address: diana.brostow@va.gov.
² VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA.
³ VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ VA VISN 5 Mental Illness Research Education and Clinical Center (MIRECC); Department of Nutrition and Dietetics, College of Public Health, University of South Florida, Tampa, FL, USA.
⁵ VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA.
⁶ VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, CO, USA; Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA; Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

PMID: 38649010
DOI: 10.1016/j.apmr.2024.04.006

Abstract

Objective: To assess injured military veterans' experiences, beliefs and daily physical and psychosocial functioning in relation to food and nutrition.

Design: We used a convergent mixed-methods study design, and the International Classification of Functioning, Disability and Health to operationalize the core constructs and influencing factors related to physical and psychosocial functioning, and food and nutrition.

Setting: Three Veterans Affairs Polytrauma Rehabilitation Centers.

Participants: Veterans who served in the United States military on or after September 11^th, 2001, and whose medical diagnoses met the criteria for polytrauma; at least one mild traumatic brain injury, and at least one associated comorbidity (e.g., post-traumatic stress disorder, chronic musculoskeletal pain, vestibular disturbances).

Intervention: None MAIN OUTCOME MEASURES: Themes from survey responses and semi-structured interview data were pooled into core constructs, and influencing factors.

Results: 37 veterans completed all surveys and participated in recorded interviews. Based on qualitative and quantitative data, veterans' relation to food and nutrition (i.e., nutritional functioning) was found to be characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning was found to be shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relationships, and current beliefs and behaviors.

Conclusions: Nutritional functioning (food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces) among injured veterans is complex, and shaped by multiple physical, psychosocial, economic, and cultural factors.