Mozaffarian, D. (Dariush)

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    Effect of a nutrition intervention on Mediterranean diet adherence among firefighters a cluster randomized clinical trial
    (2023) Chang, C.R. (Chia-Rui); Kales, S.N. (Stefanos N.); Folta, S. (Sara); Christophi, C. (Costas); Fernandez-Montero, A. (Alejandro); Cash, S.B. (Sean B.); Mozaffarian, D. (Dariush); Muegge, C. (Carolyn); Sotos-Prieto, M. (Mercedes); Kleinschmidt, V. (Vanessa); Moffatt, S. (Steven); Hershey-de-la-Cruz, M.S. (María Soledad)
    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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    Definitions and potential health benefits of the mediterranean diet: views from experts around the world
    (BMC Medicine, 2014) Martinez-Gonzalez, M.A. (Miguel Ángel); Khandelwal, S. (Shweta); Prabhakaran, D. (Dorairaj); Tong, T.Y.N. (Tammy Y.N.); Trichopoulou, A. (Antonia); Forouhi, N.G. (Nita G.); Mozaffarian, D. (Dariush); Lorgeril, M. (Michel) de
    The Mediterranean diet has been linked to a number of health benefits, including reduced mortality risk and lower incidence of cardiovascular disease. Definitions of the Mediterranean diet vary across some settings, and scores are increasingly being employed to define Mediterranean diet adherence in epidemiological studies. Some components of the Mediterranean diet overlap with other healthy dietary patterns, whereas other aspects are unique to the Mediterranean diet. In this forum article, we asked clinicians and researchers with an interest in the effect of diet on health to describe what constitutes a Mediterranean diet in different geographical settings, and how we can study the health benefits of this dietary pattern.