Lifestyle Intervention to Reduce Body Weight and Systemic Inflammation Among World Trade Center Responders

Eksperimentell: Mediterranean Diet & Physical Activity

Nutrition with a Physical Activity component. 10-week intervention implementing the Mediterranean Diet.

Atferdsmessig: Mediterranean Diet & Physical Activity

At the beginning of each week (1-10), members were sent a text message introducing the week and providing the link to the week's website. This website includes downloadable material for this group with recipes and other important nutrition information, as well as the weekly topic information and informative video. After receiving the link to the website, members received a Qualtrics survey with a teach-back question related to the video and a goal-setting question related to the topics of the week. At the end of each week, members received another Qualtrics survey with a question regarding the goal of the past week.

• Visit 1: discuss Mediterranean diet score results from baseline and ways to improve
• Visit 2: discuss anti-inflammatory diet scorecard and ways to improve
• Discuss optimal dietary pattern (Med Diet pyramid handout)
• Personal dietary and exercise goals, reviewed baseline intake form, social support, self-efficacy, challenges, or barriers to achieving goals

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Aktiv komparator: Usual Care

Usual care involves one-on-one monthly nutrition counseling

Atferdsmessig: Usual Care

As part of usual care, members attended one-on-one monthly counseling sessions with the assigned dietitian and reviewed their current eating habits and physical activity, as well as other environmental factors that may be affecting their weight such as work, home environment, sleeping issues, and medications. After reviewing current practices, the RD provided medical nutrition therapy (MNT), a specific application of the Nutrition Care Process in clinical settings that focuses on the management of diseases (e.g. diabetes, heart disease, etc.). Specific dietary recommendations are based on the Bull's Eye Food Guide, used by Stony Brook University Hospital for outpatient nutrition counseling. Individuals in the standard care received more individualized calorie recommendations (usual care) than the Mediterranean diet group.

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Mediterranean diet score

Participant's Mediterranean diet score is measured with a 14-item Mediterranean diet scale; possible score range 0-14.

The Mediterranean Diet questionnaire will be given at each participant visit with the dietitians and at baseline, post, and at 3-month follow up

Physical activity

Daily step count is measured with Fitbit that was worn over seven days. Physical activity are measured at baseline, post-intervention, and 3-month follow up.

Body mass index (BMI)

Body mass index (weight/height square) will be objectively measured at baseline, post intervention and at 3-month follow up.

Body mass index: weight in kilograms/square of height in meters

Waist Circumference

Waist circumference is measured at baseline, post-intervention, and 3-month follow up.

Waist circumference cut off (Women>88cm; Men>102 cm)

Total cholesterol

Total cholesterol is measured at baseline, post-intervention, and at 3-months follow-up; reference range: 125 to 200mg/dL

oxidized LDL

Serum oxLDL is measured at baseline, post-intervention, and at 3-months follow-up; reference range: 10-170 ng/mL

HDL cholesterol

Serum HDL cholesterol was measured at baseline, post-intervention, and at 3-months follow-up;

At risk Men: Less than 40 mg/dL (1.0 mmol/L) Women: Less than 50 mg/dL (1.0 mmol/L)

Omega 3 fatty acid

Serum or plasma Free (Nonester) Fatty Acids Measured at baseline, post-intervention, and at 3-months follow-up. reference range:

Optimal >3.2 % Moderate 2.2-3.2 % High <2.2 %

Omega 6 to omega 3 ratio

Omega 6 is measured at baseline, post-intervention, and at 3-months follow-up;

Omega 6/omega 3 ratio:

Reference range: 5.7-21.3 (the lower the better)

HA1c

Serum Hemoglobin A1C (hA1C) is measured at baseline, post-intervention, and 3-month follow up.

hA1C: Normal: <5.7%

Cytokines

The following cytokines will be measured:

FNɣ, IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-22 and TNFα, high-sensitivity C-reactive protein (hs-CRP) at >3mg/L.

The cytokines will be measured at two time points at baseline and post-intervention.

Psychosocial questionnaire

A total of 40 questions will be used to assess sedentary behaviors, home food availability, social support, self-efficacy, perceived barriers to adhering to lifestyle behaviors reflecting the behavioral strategies that will be addressed in the proposed intervention. The survey will be completed online at baseline, post-intervention and at 3-month follow up.

PCL score

Post Traumatic Stress Disorder symptoms will be tested with a PCL score. PCL is a 20-item self-report measure of current (past month) PTSD symptoms based on the DSM-V criteria. PCL will be measured at baseline, post intervention and at 3-month follow up