Food Intake REstriction for Health OUtcome Support and Education (FIREHOUSE) Trial

Investigators propose to measure metabolites on this expanded cohort with serum sampled before and after 6-month intervention with calorie restricted Mediterranean diet to: 1) determine the effects of a technology assisted calorie restricted diet on metabolic risk and lung function; 2) determine differences between usual care and intervention group using genomics and metabolomics that may be targetable markers for further evaluation; 3) quantify the metabolome and evaluate pre/post changes in BMI, FEV1, FeNo, vascular stiffness, and overall quality of life; and 4) explore dietary modification as treatment of WTC-LI. The biomarker profile of the cohort control will be useful for discovering biomarker associations with other disease manifestations such as: bronchial wall thickening on CT, obstruction on FEV1 /FVC ratio, bronchodilator response, methacholine reactivity, and other definitions of loss of FEV 1 . This cohort control will be an asset to future studies.

Inclusion criteria

• Age 21-90.
• Born male sex and currently identify as genetic male
• FDNY rescue and recovery worker.
• Documented WTC exposure.
• Enrolled in the FDNY WTC Health Program
• Subjects are willing and able to consent for themselves to study enrollment
• Subjects are willing and able to participate in study procedures
• Are able to perform their activities of daily living independently
• Are either light duty or retired FDNY Firefighters
• Have an FEV1 less than the LLN of predicted for age/sex/weight documented at any time after 9/11/2001.
• Have a BMI>27 kg/m2 and <50kg/m2
• Willing and able to modify their diet and activity level.
• Subjects who have a spirometry available within the last 36 months, and at their post-9/11 visits at the FDNY
• Demonstrate minimal proficiency using a smart phone
• Have means to accommodate transportation to/from in-person visits

Exclusion criteria

• Have pre-existing and documented conditions or concurrent diagnoses, including (and not necessarily limited to) active cancer, severe heart disease, significant cognitive impairment, eating disorders, significant psychiatric illness, end-stage COPD, severe pulmonary hypertension, or organ transplant.
• Concomitant use of interfering medication(s) or devices currently or within the month prior to enrollment, including anti-retrovirals, human monoclonal antibodies, supplemental daytime oxygen, and insulin pumps.
• Severe gastrointestinal issues or illnesses that would prevent adherence to the proposed diets.
• Severe kidney disease requiring dialysis
• Severe liver disease requiring frequent medical intervention
• Participating in other diet modification studies.
• High dose steroid (>20mg prednisone or equivalent) or other hormonal treatments/chemotherapy use in the last month, including testosterone supplementation.
• Life-expectancy < 6 months
• BMI ≥50 kg/m2 or ≤27 kg/m2
• Recent significant intentional or unintentional weight loss, defined as over 5% reduction in total body weight over the last month. (Blackburn Criteria).
• Significant or severe alcohol abuse disorder