Lifestyle intervention to reduce body weight and systemic inflammation among World Trade Center responders with PTSD: Pilot Randomized Control Trial

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Abstract Post-traumatic stress disorder (PTSD) is the most common mental health condition among responders to the World Trade Center (WTC) disaster on September 11, 2001. Persons with PTSD suffer from increased levels of comorbidities including cardiovascular disease, obesity, depression, cognitive decline and mortality. Systemic inflammation a characteristic pathogenesis of many chronic diseases including cardiovascular disease, obesity and the metabolic syndrome (MetS) is also highly prevalent among those suffering from PTSD. Medical interventions have been challenged by the multitude of psychological and physiological symptoms, thus lifestyle approaches are crucial to reduce the public health burden of this multifactorial mental health condition. Healthful lifestyle interventions including diet and physical activity (PA) are excellent strategies as dietary factors play strong roles in the prevention of systemic inflammation, chronic disease and markers of MetS associated with PTSD. It is therefore imperative to widen the therapeutic choices for our aging WTC responders by providing a lifestyle medicine approach along with the excellent clinical care. There is considerable scientific evidence that adherence to the Mediterranean dietary pattern (MedDiet) is linked to lower risk and incidence of mortality from chronic metabolic diseases due to its emphasis on high anti- inflammatory and high antioxidant content of heart healthy foods like fruits, vegetables, olive oil, beans, nuts, legumes, herbs, spices, and whole grains. Despite the high prevalence of PTSD and related chronic diseases among the WTC responders, lifestyle interventions, especially emphasizing the MedDiet with a physical activity component have not yet been implemented. The World Trade Center Health Program (WTC-HP) In Long Island affords the unique opportunity to test the feasibility of a MedDiet intervention through a pilot randomized control trial (RCT) among WTC responders with PTSD who are overweight and obese. Utilizing several previously tested intervention modalities, including individual nutrition counseling, group meetings, and education through smart phone, we will: 1) test the feasibility and acceptability of an 8-week high dose and high fidelity nutrition intervention with a PA component with a total of 60 responders (30 MedDiet and 30 treatment as usual); 2) assess within and between group changes in dietary intake, MedDiet score and PA; and 3) assess within and between group changes in body weight, inflammatory biomarkers and prevalence of MetS and explore potential moderating effects of changes in MetS, body weight, or MedDiet on changes in systemic inflammatory biomarkers. The findings of this lifestyle intervention will inform the WTC-HP's extensive research and clinical efforts with the potential to provide an excellent preventive care model to reduce inflammation and weight among WTC responders with PTSD.