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Original research
Impact of the occupational environment of a submerged submarine on cardiometabolic health of Royal Navy submariners
  1. Frances Gunner1,
  2. Michael Lindsay2,
  3. Pieter Brown1,
  4. Anneliese Shaw1,
  5. Trish Davey1,
  6. Susan Lanham-New3,
  7. Bruce Griffin3,
  8. Joanne Fallowfield1
  1. 1 Environmental and Medicine Sciences, Institute of Naval Medicine, Gosport, UK
  2. 2 Underwater Medicine Division, Institute of Naval Medicine, Gosport, UK
  3. 3 Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, Surrey, UK
  1. Correspondence to Dr Frances Gunner, Environmental and Medicine Sciences, Institute of Naval Medicine, Gosport PO12 2DL, UK; frances.gunner100{at}


Objective To determine the effect of prolonged exposure to a submarine environment on biomarkers of cardiometabolic risk in Royal Navy (RN) submariners.

Methods Serum lipids (cholesterol (C), triglyceride (TG), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL-C), glucose, insulin and anthropometrics were compared within three RN submarine crews before and after submerged patrols of 12 or 6 weeks, and with a crew that remained ashore (SUB-HOME). Dietary intake and activity patterns were self-reported during each patrol. Differences were assessed in crew characteristics using one-way analysis of variance and in serum lipids using paired t-tests.

Results Postpatrol, the mean body weight of submerged crews decreased (−1.4±4.2 kg, p=0.0001), but increased in SUB-HOME (1.9±1.8 kg, p=0.0001). Modest improvements in serum lipids (mean individual change (mmol/L); C=−0.3±0.7, p=0.0001; TG=−0.3±0.7, p=0.0001; HDL-C=−0.1±0.3, p=0.0001; non-HDL-C=−0.2±0.6, p=0.012), glucose (−0.2±0.5, p=0.0001) and insulin (−1.5±4.6 mU/L, p=0.001) were observed in submerged crews. Changes in serum lipids were positively associated with changes in body weight within crews combined. Energy intake was maintained during submerged patrols but was lower compared with non-submerged (11 139±2792 vs. 9617±2466 kJ, p=0.001; 11 062±2775 vs. 9632±2682 kJ, p=0.003).

Conclusions The environment of a submerged submarine produced no adverse effects on serum biomarkers of cardiometabolic risk in crew. Conversely, modest improvements in these biomarkers were associated with a decrease in body weight.

  • health surveillance
  • defence force personnel
  • environment
  • occupational health practice

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  • Contributors FG and JF designed and planned the study. FG, ML, PB, JF and AS conducted the subject recruitment and data collection. TD performed the dietary analysis. BG and SL-N provided sample analysis and data interpretation. FG performed the data analysis. FG, JF and BG wrote and submitted the manuscript.

  • Funding This study was funded by the UK Ministry of Defence.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Ministry of Defence Ethics Committee (protocol 0903/228).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data from this study are Crown copyright.