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

Objective: 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). Methods: WTC 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. Results: 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 −0.68 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. Conclusion: 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.