Moffatt, S. (Steven)
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- Association of the modified mediterranean diet score (mMDS) with anthropometric and biochemical indices in US career firefighters(MDPI, 2020) Tripsianis, G. (Grigorios); Kales, S.N. (Stefanos N.); Christophi, C. (Costas); Romanidou, M. (Maria); Sotos-Prieto, M. (Mercedes); Moffatt, S. (Steven); Hershey-de-la-Cruz, M.S. (María Soledad); Constantinidis, T.C. (Theodoros C.)The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of career firefighters. The participants were from Indiana Fire Departments, taking part in the “Feeding America’s Bravest” study, a cluster-randomized controlled trial that aimed to assess the efficacy of a Mediterranean diet intervention. We measured Mediterranean diet adherence using the mMDS. Anthropometric, blood pressure, and biochemical measurements were also collected. Univariate and multivariate linear regression models were used. In unadjusted analyses, many expected favorable associations between the mMDS and cardiovascular disease risk factors were found among the 460 firefighters. After adjustment for age, gender, ethnicity, physical activity, and smoking, a unitary increase in the mMDS remained associated with a decrease of the total cholesterol/HDL ratio (β-coefficient −0.028, p = 0.002) and an increase of HDL-cholesterol (β-coefficient 0.254, p = 0.004). In conclusion, greater adherence to the Mediterranean diet was associated with markers of decreased cardiometabolic risk. The mMDS score is a valid instrument for measuring adherence to the Mediterranean diet and may have additional utility in research and clinical practice.
- Anthocyanin Intake and physical activity: associations with the lipid profile of a US working population(MDPI, 2020) Martinez-Gonzalez, M.A. (Miguel Ángel); Kales, S.N. (Stefanos N.); Ruiz-Canela, M. (Miguel); Cassidy, A. (A.); Sotos-Prieto, M. (Mercedes); Moffatt, S. (Steven); Hershey-de-la-Cruz, M.S. (María Soledad)While growing evidence exists on the independent associations between anthocyanins and physical activity on cardiovascular disease (CVD) risk determinants, the possible interaction between these exposures has not yet been studied. We aimed to study the potential synergism between anthocyanin intake and physical activity on lipid profile measures. This cross-sectional study was conducted among 249 US career firefighters participating in the Feeding America's Bravest trial. Anthocyanin intake was calculated using a validated food frequency questionnaire (FFQ) and physical activity level by a validated questionnaire. Multivariable linear regression models determined the extent to which anthocyanin intake and physical activity predicted lipid parameters. Generalized linear models were used for joint effect and interaction analyses on the multiplicative and additive scales. Both anthocyanins and physical activity were independently inversely associated with total cholesterol:high density lipoprotein (HDL) cholesterol. Only physical activity was inversely associated with triglycerides, low density lipoprotein (LDL) cholesterol:HDL, and triglycerides (TG):HDL. Although the combined exposure of low anthocyanin intake and low physical activity was associated with lower (RR is 2.83; 95/100 CI: 1.42 to 5.67) HDL cholesterol 40 mg/dL, neither multiplicative (p is 0.72) nor additive interactions were detected (relative excess risk due to interaction (RERI): 0.02; 95/100 CI: -1.63 to 1.66; p is 0.98). Our findings provide insight on the potential synergism between anthocyanin intake and physical activity on the lipid profile.
- 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.