Abstract Background Diet is a modifiable determinant of metabolic health and may contribute to respiratory disease risk among World Trade Center (WTC)-exposed populations, but nutritional services are not covered by the federal WTC Health Program. Previous studies in the WTC firefighters’ cohort linked dietary quality with development of WTC-obstructive airways disease. Building on that work, we aim to characterize dietary habits in the more diverse WTC General Responder Cohort (WTC-GRC) and evaluate associations between dietary quality and lung function outcomes, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and longitudinal FEV1 trajectories. Methods Dietary habits were assessed on volunteer WTC-GRC participants using the Rapid Eating and Activity Assessment for Participants-Short Version (REAP-S) questionnaire, with the scores categorized into low/moderate (13-29) and high (30-39). Standardized differences (StD) were used for bivariate analyses of demographic and clinical characteristics (age, sex, BMI, ethnicity/race), WTC exposure intensity (arrival within 48 hours), lung function and selected laboratory values (neutrophil counts, HDL and LDL). Multivariable regression models were used to examine associations between dietary quality (continuous REAP-S scores or categorical groupings) and spirometry outcomes (FVC%predicted, FEV1%predicted, longitudinal FEV1slope), adjusting for age, sex, and ethnicity/race. Results Among 90 WTC-GRC participants, 45 were classified as having low/moderate and 45 as having high dietary quality by REAP-S scores, which differed substantially between the groups (25.5 vs. 30.9, respectively; StD = -2.25). Groups were broadly similar in age, height, sex, and WTC exposure intensity. The low/moderate group had higher BMI, lower LDL levels, higher neutrophil counts, lower FVC%predicted and slightly lower FEV1%predicted. Longitudinal FEV1 trajectory distributions suggested more “improvers” (FEV1slope0/year) in the low/moderate dietary quality group and more “intermediate decliners” (0FEV1slope-62.5 ml/year) in the high dietary quality group. In a multivariable linear regression model, each unit increase in the REAPS-score was associated with a 1.01% increase in FVC%predicted (p = 0.0142). Conclusions In this preliminary analysis of WTC-GRC responders, dietary quality was associated with BMI, lipid measures, and lung function outcomes. The relationship between dietary and longitudinal lung function trajectory is likely more complex. While the cross-sectional findings are exploratory and based on a limited sample, they support prior evidence linking dietary quality (as well as obesity and longitudinal weight gain) to respiratory health in WTC-exposed occupational populations. Further modeling will clarify independent associations and inform whether dietary interventions may represent a modifiable target for improving lung health in this cohort. This abstract is funded by: U01 OH011300
Hadeli et al. (Fri,) studied this question.