Lifestyle Intervention to Reduce Body Weight and Systemic Inflammation Among World Trade Center Responders with PTSD: Pilot Randomized Control Trial

Details

• Personal Author:
  Arcan C
• Description:
  Background: Responders who worked on the rescue and recovery efforts of the World Trade Center (WTC) disaster on September 11, 2001 (9/11) suffer from multiple morbidities. While post-traumatic stress disorder (PTSD) is the most common mental health condition, obesity and metabolic disorders are also prevalent posing a challenge to medical interventions alone. There is also evidence for poor dietary intake, inactivity and disturbed sleep patterns. Healthful lifestyle interventions including diet and physical activity (PA) hold promise for the prevention/development of chronic diseases such as diabetes, cardiovascular, cancer and dementia. It was, therefore, imperative that we enriched the therapeutic choices for the aging WTC responders by providing a lifestyle medicine approach along with the excellent clinical care. Therefore, a pilot randomized-controlled trial (RCT) was implemented to test the feasibility and preliminary efficacy of a Mediterranean Diet (MedDiet) intervention with a physical activity component among WTC responders with overweight, obesity, and PTSD. Methods: Sixty-two members (males: 87%; age 45-65 years) from the WTC Health Program (WTC-HP) at Stony Brook University's two clinics were randomized to MedDiet intervention (n=31) or control (usual nutrition counseling) (n=31) conditions. The MedDiet group received 10-weeks online nutrition and physical activity program delivered through a study website, weekly reminder and motivational mobile text messages, and goal setting; both groups had three in-person counseling sessions. Baseline, post-intervention and 3-month follow-up (FU) data collected (blood biomarkers, anthropometrics, psychosocial surveys, MedDiet questionnaire, dietary intake, and PTSD checklist score). Descriptive statistics (frequencies/percent) of demographics at baseline and study feasibility (participant recruitment, retention and satisfaction) were calculated (Aim 1). Statistical comparisons of MedDiet score by condition at three measurement times were calculated (Aim 2) and within and between group changes in body weight, inflammatory biomarkers, prevalence of MetS, and PTSD were assessed (Exploratory aim); for continuous outcomes, nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons were conducted. Results: A total of 58 (94%) participants completed the post-intervention and 46 (74%) completed all follow-up measurements. Among MedDiet participants, more than 85% watched the weekly videos and responded to teach back questions, 83% (20/24) reported being satisfied and very satisfied with the program, 96% (23/24) would participate again, and 100% (24/24) would recommend it to other WTC-HP members. Both groups experienced an increase in the MedDiet score by 4 points at post intervention and by 3 points at follow-up (baseline was 6 points out of 14 points maximum). Compared to control, the MedDiet group had significant reductions in HbA1c, w6/w3, and hsCRP. Both groups experienced significant reduction in waist circumference (WC), but the MedDiet group had larger reduction at both times. Both groups experienced a significant reduction in PCL scores and in oxidized LDL (oxLDL) and total cholesterol. Conclusion: In both groups, nutrition intervention has contributed to a significant decrease in anthropometrics, MedDiet score, oxLDL, total cholesterol and PTSD symptoms; the MedDiet group had higher reductions in metabolic and inflammatory markers. Larger RCTs are needed to confirm the findings and elucidate mechanism of action. [Description provided by NIOSH]
• Subjects:
  Body Weight Diet Emergency Responders Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  Activity Levels Body Weight Chronic Inflammation First Responders Metabolic Disorders Obesity Physical Exercise Post-traumatic Stress Disorder PTSD World Trade Center WTC

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• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; New York City Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-39
• NIOSHTIC Number:
  nn:20070834
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-012057, 2025 Mar; :1-39
• Email:
  hrisanti.arcan@vcuhealth.org
• Federal Fiscal Year:
  2025
• Performing Organization:
  State University New York Stony Brook
• Peer Reviewed:
  False
• Start Date:
  20201201
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20210630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6e38d1922a5f9d2e515d5288135f72cbec6ce2c7069b6c24a600e3a21d9f68f2de495fbfcca434a7a4707e488d6ccbf27d0c8359d7c992e705d678476fed5949
• Download URL:
  https://stacks.cdc.gov/view/cdc/219286/cdc_219286_DS1.pdf
• File Type:
  [PDF - 3.86 MB ]