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

Abstract

Responders 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). WTC Health Program members (N=62), 45-65years, males 87%, body mass index (BMI) 27-45kg/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. A 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 -0.68kg/m2 (-4.61-2.09)kg/m2 p<0.0001 at post-intervention and by -0.60kg/m2 (-6.91-3.39)kg/m2, p<0.0009 at follow-up. Overall, median WC was reduced (p<0.0001); post-intervention -3.81cm (-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. Online 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.