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)是应急人员最常见的心理健康状况 2001年9月11日世界贸易中心(WTC)灾难。创伤后应激障碍患者的创伤后应激障碍水平 包括心血管疾病、肥胖症、抑郁症、认知功能减退和死亡率在内的并存疾病。 全身性炎症是包括心血管在内的许多慢性疾病的特征致病机制 疾病、肥胖和代谢综合征(METS)在患有糖尿病的人中也非常普遍 创伤后应激障碍。医学干预受到了众多心理和生理因素的挑战 症状，因此，生活方式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措施，包括饮食和体力活动(PA)是很好的 饮食因素在预防全身性炎症、慢性病和 与创伤后应激障碍相关的蛋氨酸标志物。因此，扩大我们的治疗选择是当务之急。 通过提供一种生活方式医学方法以及出色的临床护理，老年WTC响应者。那里 大量科学证据表明，坚持地中海饮食模式(MedDiet)与 慢性代谢性疾病的风险和死亡率较低，这是因为它强调高抗- 心脏健康食品，如水果、蔬菜、橄榄油、豆类、坚果、 豆类、草药、香料和全谷物。尽管创伤后应激障碍和相关慢性病的发病率很高 在WTC响应者中，生活方式干预，特别强调以体力活动为主的MedDiet 组件尚未实现。世界贸易中心健康项目(WTC-HP)在龙 Island提供了独特的机会，通过随机试点来测试MedDiet干预的可行性 在超重和肥胖的创伤后应激障碍患者中进行对照试验(RCT)。利用几个 以前测试过的干预方式，包括个人营养咨询、小组会议和 通过智能手机进行教育，我们将：1)测试为期8周的高剂量和可接受性 使用PA组件的高保真营养干预，共有60名应答者(30名MedDiet和30名 照常治疗)；2)评估组内和组间饮食摄入量、MedDiet评分和PA的变化； 以及3)评估组内和组间体重、炎性生物标志物和 Met，并探索Met、体重或MedDiet的变化对 全身性炎症生物标志物。这种生活方式干预的结果将为WTC-HP广泛的 研究和临床努力有可能提供一个极好的预防护理模式，以减少 患有创伤后应激障碍的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.