Mediterranean diet intervention among World Trade Center responders with post‐traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial

Abstract

ObjectiveResponders of the World Trade Center (WTC) disaster suffer from co‐morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post‐traumatic stress disorder (PTSD).MethodsWTC Health Program members (N = 62), 45–65 years, males 87%, body mass index (BMI) 27–45 kg/m2 randomized to MedDiet (n = 31) or usual nutrition counseling (n = 31). The 10‐week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in‐person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post‐intervention, and 3‐months (follow‐up). The primary outcome was intervention feasibility and secondary outcomes were within‐ and between‐group changes of all measures at post‐intervention and follow‐up. Nonparametric Wilcoxon rank sum tests for between‐group comparisons and Wilcoxon signed rank tests for pre‐post within‐group comparisons.ResultsA total of 58(94%) and 46(74%) participants completed the post‐intervention and follow‐up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low‐density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66–135.17) kg, BMI 33.20 (27.50–41.75) kg/m2, and Waist circumference (WC) 109.22 (90.17–150.62) cm. Median % weight loss at post‐intervention was MedDiet: −3% (−11%–7%), p = 0.0002; Control: −1% (−13%–4%), p = 0.008 and at follow‐up MedDiet: −2% (−14%–12%), p = 0.07; Control: −2% (−20%–3%), p = 0.006. The overall BMI was reduced by −0.68 kg/m2 (−4.61–2.09) kg/m2 p < 0.0001 at post‐intervention and by −0.60 kg/m2 (−6.91–3.39) kg/m2, p < 0.0009 at follow‐up. Overall, median WC was reduced (p < 0.0001); post‐intervention −3.81 cm (−33.00–3.30)cm and follow‐up −4.45(−38.10–4.57)cm. There were group differences in HbA1c (p = 0.019) and serum ω6/ω3 (p = 0.029) at post‐intervention.ConclusionOnline intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.