Discussion
left ventricular abnormalities, obesity-associated cancers
SUDDEN CARDIAC DEATH, ATHEROSCLEROSIS, FIRE
In this 1-year cluster-randomized clinical trial, we found that a multicomponent behavioral/environmental Mediterranean nutrition intervention significantly improved Mediterranean diet adherence, increasing mean mMDS by 2.67 points (95% CI, 1.14-4.20), a more than a 10% increase from baseline, among career firefighters. Additionally, significant improvements were observed for several individual Mediterranean diet components. The results suggest that the workplace intervention strategy used in this trial may be an effective approach for improving nutrition among US career firefighters, who frequently experience atherosclerosis, left ventricular abnormalities, sudden cardiac death, and an excess of obesity-associated cancers.Few nutritional interventions within workplace settings have targeted firefighter populations.Among different components of the Mediterranean diet, most suggested numeric improvements in the intervention vs control group, with statistically significant improvements in the quality of cooking oil and bread/starches consumed at work, increased fish and nut consumption, and fewer alcoholic beverages and fast food. Studying the individual Mediterranean diet components may help target simple dietary substitutions to improve diet quality among the US fire service.The implementation of the current trial across multiple firefighters’ worksite settings and routines yielded pragmatic and methodological advantages.