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Hershey MS, Chang CR, Sotos-Prieto M, Fernandez-Montero A, Cash SB, Christophi CA, Folta SC, Muegge C, Kleinschmidt V, Moffatt S, Mozaffarian D, Kales SN. Effect of a Nutrition Intervention on Mediterranean Diet Adherence Among Firefighters: A Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2329147. [PMID: 37589978 PMCID: PMC10436136 DOI: 10.1001/jamanetworkopen.2023.29147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/09/2023] [Indexed: 08/18/2023] Open
Abstract
Importance US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet. Objective To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individual participant level. Design, Setting, and Participants This 12-month cluster randomized clinical trial included US career firefighters from fire stations and homes within 2 Indiana fire departments. Participants were randomized by fire station to either Mediterranean diet or control (usual care). The study was conducted from October 2016 to December 2019, and data were analyzed in November 2022. Intervention For the first 12 months of the study, firefighters located at fire stations randomized to the intervention group were provided with access to supermarket discounts and free samples of Mediterranean diet foods, online nutrition education platforms, email announcements and reminders, family and peer education and support, and chef demonstrations. Firefighters in fire stations allocated to the control group received no intervention and were instructed to follow their usual diet. Main Outcomes and Measures Change in dietary habits at 12 months as measured by a modified Mediterranean diet score (range, 0 to 51 points) at baseline and 6-month and 12-month follow-up. Cardiometabolic parameters were secondary outcomes. Results Of 485 included firefighters, 458 (94.4%) were male, and the mean (SD) age was 47 (7.5) years. A total of 241 firefighters (27 fire stations) were randomized to the Mediterranean nutrition intervention, and 244 (25 fire stations) were randomized to usual diet. Outcomes were analyzed using generalized linear mixed models for modified Mediterranean diet score at 6 months (n = 336) and 12 months (n = 260), adjusting for baseline age, sex, race and ethnicity, fire department, physical activity, and waist circumference. In the intervention group compared with the control group, the modified Mediterranean diet score significantly increased by 2.01 points (95% CI, 0.62-3.40; P = .005) at 6 months and by 2.67 points (95% CI, 1.14-4.20; P = .001) at 12 months. Among secondary outcomes, changes in cardiometabolic risk factors were not statistically significant at 1 year. Results from analyses with multilevel multiple imputation for missingness were similar. Conclusions and Relevance In this Mediterranean nutrition intervention of multicomponent behavioral/environmental changes, career firefighters had increased adherence to a Mediterranean diet. Trial Registration ClinicalTrials.gov Identifier: NCT02941757.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chia-Rui Chang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- Campus of International Excellence (CEI) Universidad Autónoma de Madrid (UAM), Spanish National Research Council (CSIC), Madrid, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Costas A. Christophi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Lemesos, Cyprus
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Carolyn Muegge
- National Institute for Public Safety Health, Indianapolis, Indiana
| | | | - Steven Moffatt
- National Institute for Public Safety Health, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Occupational Medicine, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts
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Dansinger ML, Breton GL, Joly JE, Rhee LQ, Katz DL. Rapid, Digital Dietary Assessment in Association with Cardiometabolic Biomarkers. Am J Health Promot 2023:8901171231156513. [PMID: 36772929 DOI: 10.1177/08901171231156513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
PURPOSE To examine the associations between dietary intake as assessed by a rapid, image-based digital tool and biomarkers of cardiometabolic health. DESIGN Retrospective analysis of adults with blood biomarkers performed by Boston Heart Diagnostics (BHD) between December 2020 and March 2022. SETTING Outpatient centers serviced by BHD. SUBJECTS 546 adults, excluding those taking relevant medications and/or supplements known to affect blood test results. MEASURES Laboratory assays of blood specimens were performed by Boston Heart Diagnostics. Nutrient intake and diet quality data were obtained using Diet Quality Photo Navigation (DQPN®; US Patent #11,328,810 B2) technique via Diet ID™ tool. ANALYSIS Pearson correlation coefficients (for continuous variables) and Spearman coefficients (for ordinal variables) were used to evaluate associations between nutrient intake data and laboratory data for the full study sample. Two-sided P-values < .05 were considered statistically significant. RESULTS Both continuous and ordinal measures of diet quality correlated significantly with HDL-C and triglycerides (n = 485; P < .0 01); with hs-CRP (n = 441; P < .001); with HgbA1c (n = 345; P < .01); with fasting insulin (n = 372; P < .001); and with HOMA-IR (n = 319; P < .001). CONCLUSION Findings affirm that rapid, digital diet quality and composition assessment by pattern recognition rather than recall tracks significantly with key biomarkers of cardiometabolic health.
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Jaskulski S, Nuszbaum C, Michels KB. Components, prospects and challenges of personalized prevention. Front Public Health 2023; 11:1075076. [PMID: 36875367 PMCID: PMC9978387 DOI: 10.3389/fpubh.2023.1075076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
Effective preventive strategies are urgently needed to address the rising burden of non-communicable diseases such as cardiovascular disease and cancer. To date, most prevention efforts to reduce disease incidence have primarily targeted populations using "one size fits all" public health recommendations and strategies. However, the risk for complex heterogeneous diseases is based on a multitude of clinical, genetic, and environmental factors, which translate into individual sets of component causes for every person. Recent advances in genetics and multi-omics enable the use of new technologies to stratify disease risks at an individual level fostering personalized prevention. In this article, we review the main components of personalized prevention, provide examples, and discuss both emerging opportunities and remaining challenges for its implementation. We encourage physicians, health policy makers, and public health professionals to consider and apply the key elements and examples of personalized prevention laid out in this article while overcoming challenges and potential barriers to their implementation.
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Affiliation(s)
- Stefanie Jaskulski
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Competence Network Preventive Medicine Baden-Württemberg, Competence Area of Personalized Prevention, Freiburg, Germany
| | - Cosima Nuszbaum
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Competence Network Preventive Medicine Baden-Württemberg, Competence Area of Personalized Prevention, Freiburg, Germany
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Competence Network Preventive Medicine Baden-Württemberg, Competence Area of Personalized Prevention, Freiburg, Germany.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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Joe MJ, Hatsu IE, Tefft A, Mok S, Adetona O. Dietary Behavior and Diet Interventions among Structural Firefighters: A Narrative Review. Nutrients 2022; 14:nu14214662. [PMID: 36364927 PMCID: PMC9653630 DOI: 10.3390/nu14214662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Structural firefighters (SFFs) are exposed to multiple occupational hazards that affect dietary behavior and can contribute to increased risks of cancer and cardiovascular disease compared to the United States’ general population. Dietary behavior is a feasible modification for positive health outcomes. The objectives of this narrative review are to summarize the diet behavior of SFFs, review findings of diet interventions that positively modify diet behavior, identify research gaps, and suggest recommendations for addressing those gaps. PubMed, MEDLINE, Scopus, and CABI Web of Science were searched between February 2020 and June 2022 for peer-reviewed articles. The inclusion criteria were as follows: (1) study population must include SFFs; (2) investigate diet or diet intervention among SFFs; (3) report results specific to SFFs; and (4) be published in the English language. Thirty-four studies were included. Results indicate that SFFs recognize the importance of a healthy dietary pattern, but do not follow one, and that food choices are often influenced by colleagues. Diet interventions, such as the Mediterranean diet, were observed to have positive health improvements, such as improved lipid levels and lower CVD risk. Team counseling was found to be more effective for adopting healthier diets compared to one-on-one counseling; and general counseling was more effective than no counseling. A gap identified by this review is the lack of information concerning differences in dietary intake, diet quality, and dietary behaviors while on- and off-shift, and throughout the career. Diet is an important risk factor for occupational disease development; therefore, effective, consistent dietary interventions are necessary.
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Affiliation(s)
- Margaux J. Joe
- Department of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Irene E. Hatsu
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
- OSU Extension, The Ohio State University, Columbus, OH 43210, USA
| | - Ally Tefft
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Sarah Mok
- Department of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Olorunfemi Adetona
- Department of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
- Correspondence:
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Choo J, Yang HM, Park S, Park M, Park YM, Lim DS. Appointment Adherence to a City-Wide Cardiovascular Disease Prevention Program: Its Predictors and Outcomes. Asia Pac J Public Health 2021; 33:555-563. [PMID: 34041933 DOI: 10.1177/10105395211012912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study identified predictors of appointment adherence and examined its impacts on improvements in metabolic risk factors in a free city-wide cardiovascular disease prevention program in Seoul, South Korea. Data of 8251 citizens with metabolic syndrome were used. Appointment adherers were defined as having 70% or higher adherence rates, that is, 3 or more visits. Of the 8251 citizens, 17.6% were appointment adherers. Appointment adherers were significantly more likely to be older, low-income earners, nonsmokers, and nonobese than appointment nonadherers. Moreover, appointment adherers, compared with nonadherers, showed significant improvements in waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol, but not in fasting glucose and triglycerides. Designing strategies for increasing appointment adherence to a free city-wide cardiovascular disease prevention program is essential to improve health outcomes, especially targeting population groups with young age, high-income, current smoking, or obesity.
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Affiliation(s)
- Jina Choo
- College of Nursing, Korea University, Seoul, South Korea.,Transdisciplinary Major in Learning Health Systems, Graduate School, Korea University, Seoul, South Korea
| | - Hwa-Mi Yang
- College of Nursing, Korea University, Seoul, South Korea
| | - Sooyeon Park
- College of Nursing, Korea University, Seoul, South Korea
| | - MiSuk Park
- Metabolic Syndrome Management Center of Seoul Metropolitan Government, Seoul, South Korea
| | - Yoo Mi Park
- Citizens' Health Bureau, Seoul Metropolitan Government, Seoul, South Korea
| | - Do-Sun Lim
- Metabolic Syndrome Management Center of Seoul Metropolitan Government, Seoul, South Korea.,Department of Cardiology, School of Medicine, Korea University, Seoul, South Korea
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O'Connor EA, Evans CV, Rushkin MC, Redmond N, Lin JS. Behavioral Counseling to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 324:2076-2094. [PMID: 33231669 DOI: 10.1001/jama.2020.17108] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Cardiovascular disease is the leading cause of death in the US, and poor diet and lack of physical activity are major factors contributing to cardiovascular morbidity and mortality. OBJECTIVE To review the benefits and harms of behavioral counseling interventions to improve diet and physical activity in adults with cardiovascular risk factors. DATA SOURCES MEDLINE, PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through September 2019; literature surveillance through July 24, 2020. STUDY SELECTION English-language randomized clinical trials (RCTs) of behavioral counseling interventions to help people with elevated blood pressure or lipid levels improve their diet and increase physical activity. DATA EXTRACTION AND SYNTHESIS Data were extracted from studies by one reviewer and checked by a second. Random-effects meta-analysis and qualitative synthesis were used. MAIN OUTCOMES AND MEASURES Cardiovascular events, mortality, subjective well-being, cardiovascular risk factors, diet and physical activity measures (eg, minutes of physical activity, meeting physical activity recommendations), and harms. Interventions were categorized according to estimated contact time as low (≤30 minutes), medium (31-360 minutes), and high (>360 minutes). RESULTS Ninety-four RCTs were included (N = 52 174). Behavioral counseling interventions involved a median of 6 contact hours and 12 sessions over the course of 12 months and varied in format and dietary recommendations; only 5% addressed physical activity alone. Interventions were associated with a lower risk of cardiovascular events (pooled relative risk, 0.80 [95% CI, 0.73-0.87]; 9 RCTs [n = 12 551]; I2 = 0%). Event rates were variable; in the largest trial (Prevención con Dieta Mediterránea [PREDIMED]), 3.6% in the intervention groups experienced a cardiovascular event, compared with 4.4% in the control group. Behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol levels, fasting glucose levels, and adiposity at 12 to 24 months' follow-up. Measurement of diet and physical activity was heterogeneous, and evidence suggested small improvements in diet consistent with the intervention recommendation targets but mixed findings and a more limited evidence base for physical activity. Adverse events were rare, with generally no group differences in serious adverse events, any adverse events, hospitalizations, musculoskeletal injuries, or withdrawals due to adverse events. CONCLUSIONS AND RELEVANCE Medium- and high-contact multisession behavioral counseling interventions to improve diet and increase physical activity for people with elevated blood pressure and lipid levels were effective in reducing cardiovascular events, blood pressure, low-density lipoproteins, and adiposity-related outcomes, with little to no risk of serious harm.
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Affiliation(s)
- Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan C Rushkin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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