Dietary Behavior and Diet Interventions among Structural Firefighters: A Narrative Review

Abstract

Structural firefighters (SFFs) are exposed to multiple occupational hazards that affect dietary behavior and can contribute to increased risks of cancer and cardiovascular disease compared to the United States’ general population. Dietary behavior is a feasible modification for positive health outcomes. The objectives of this narrative review are to summarize the diet behavior of SFFs, review findings of diet interventions that positively modify diet behavior, identify research gaps, and suggest recommendations for addressing those gaps. PubMed, MEDLINE, Scopus, and CABI Web of Science were searched between February 2020 and June 2022 for peer-reviewed articles. The inclusion criteria were as follows: (1) study population must include SFFs; (2) investigate diet or diet intervention among SFFs; (3) report results specific to SFFs; and (4) be published in the English language. Thirty-four studies were included. Results indicate that SFFs recognize the importance of a healthy dietary pattern, but do not follow one, and that food choices are often influenced by colleagues. Diet interventions, such as the Mediterranean diet, were observed to have positive health improvements, such as improved lipid levels and lower CVD risk. Team counseling was found to be more effective for adopting healthier diets compared to one-on-one counseling; and general counseling was more effective than no counseling. A gap identified by this review is the lack of information concerning differences in dietary intake, diet quality, and dietary behaviors while on- and off-shift, and throughout the career. Diet is an important risk factor for occupational disease development; therefore, effective, consistent dietary interventions are necessary.

Cancer and Potential Prevention with Lifestyle among Career Firefighters: A Narrative Review

“…Epidemiological studies observed that firefighters have a high consumption of red meat and fast food [74,75]. Similarly, fat, cholesterol, protein, sugar, and sodium were overconsumed, whereas fruits, vegetables, grains, and dietary fibers were below recommended levels [61,76]. Evidence from surveys shows that the Mediterranean diet could be the most appealing healthy diet option accepted by many firefighters [58], and is consistent with revised US government dietary guidelines [58].…”

“…They are often influenced by their colleagues. Hence, counseling and followup were often found to be effective [61]. Moreover, cultural barriers and challenges that might be faced when implementing nutrition intervention programs among firefighters should be carefully evaluated.…”

Effect of a Nutrition Intervention on Mediterranean Diet Adherence Among Firefighters

“…Few nutritional interventions within workplace settings have targeted firefighter populations . A recent randomized clinical trial among 137 San Diego firefighters with 24-hour shifts, the Healthy Heroes Study, demonstrated the feasibility of a Mediterranean diet with a self-selected 10-hour time-restricted eating window for 12 weeks and benefit on very LDL particle size (−1.10 nm; 95% CI, −2.16 to −0.03) compared with a standard of care arm.…”

“…48,49 One strength was engaging the firefighters in both their work and home environments, given that 80% of representative firefighters previously reported their spouse's opinion/support was important for healthy eating, whereas almost one-third of weekly meals were consumed at the firehouse. 19,28 Given the team setting has shown a greater influence on interventions focused on improving firefighter diet and eating together at the firehouse has been positively associated with benefits unique to the workplace, 43,50 the evaluation specifically considered habits both in the firehouse and at home.…”

“…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 4,16,[39][41] Few nutritional interventions within workplace settings have targeted firefighter populations 42,43. A recent randomized clinical trial among 137 San Diego firefighters with 24-hour shifts, the Healthy Heroes Study,44 demonstrated the feasibility of a Mediterranean diet with a selfselected 10-hour time-restricted eating window for 12 weeks and benefit on very LDL particle size (−1.10 nm; 95% CI, −2.16 to −0.03) compared with a standard of care arm.…”