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

摘要 创伤后应激障碍（PTSD）是最常见的心理健康状况的反应者， 2001年9月11日，世界贸易中心（WTC）灾难。患有PTSD的人 合并症包括心血管疾病、肥胖、抑郁、认知能力下降和死亡率。 全身炎症是包括心血管疾病在内的许多慢性疾病的特征性发病机制 疾病、肥胖和代谢综合征（MetS）在患有以下疾病的人中也是高度流行的： 创伤后应激障碍医疗干预措施受到了众多心理和生理问题的挑战。 症状，因此生活方式方法对于减少这种多因素精神疾病的公共卫生负担至关重要。 健康状况。健康的生活方式干预，包括饮食和体育活动（PA）是很好的 饮食因素在预防全身性炎症、慢性疾病和 与PTSD相关的MetS标记物。因此，必须扩大我们的治疗选择， 通过提供一种生活方式医学方法沿着出色的临床护理，那里 有相当多的科学证据表明，坚持地中海饮食模式（MedDiet）与 降低慢性代谢性疾病的风险和死亡率，因为它强调高抗 炎症和高抗氧化剂含量的心脏健康食品，如水果，蔬菜，橄榄油，豆类，坚果， 豆类、香草、香料和全谷物。尽管创伤后应激障碍和相关慢性疾病的发病率很高， 在世贸中心响应者中，生活方式干预，特别是强调MedDiet与身体活动 该部分尚未实施。世界贸易中心健康计划（WTC-HP） 岛提供了独特的机会，通过试点随机测试MedDiet干预的可行性 在超重和肥胖的WTC创伤后应激障碍响应者中进行对照试验（RCT）。利用若干 以前测试过的干预方式，包括个人营养咨询，小组会议， 通过智能手机教育，我们将：1）测试8周高剂量的可行性和可接受性， 高保真营养干预与PA成分，共60名应答者（30名MedDiet和30名 2）评估组内和组间饮食摄入、MedDiet评分和PA的变化; 和3）评估组内和组间体重、炎性生物标志物和炎症的患病率的变化。 MetS，并探索MetS，体重或MedDiet的变化对MetS变化的潜在调节作用。 全身炎症生物标志物。这种生活方式干预的结果将为WTC-HP的广泛研究提供信息。 研究和临床努力，有可能提供一个很好的预防护理模式，以减少 创伤后应激障碍的WTC应答者的炎症和体重。

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.