Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

Abstract

Background: Poor nutritional intake can exacerbate the chronic disease burden in childhood cancer survivors, whereas a healthful diet serves a protective function. Few studies have provided detailed evaluations of the diet of childhood cancer survivors.

Objectives: This study aimed to evaluate diet quality and dietary intakes of key food groups and nutrients in a large cohort of childhood cancer survivors and whether cancer and treatment characteristics have an impact on survivors' long-term intake.

Methods: Diet was assessed in 2570 adult survivors of childhood cancer enrolled in the St. Jude Lifetime cohort (mean age = 32.3 y) by using the Block food-frequency questionnaire. The Healthy Eating Index-2010 (HEI-2010) was calculated to quantify diet quality. Cancer diagnosis and treatment exposure were abstracted from medical records. Differences in HEI-2010 by patient characteristics and treatment exposure were examined by using ANCOVA.

Results: The mean ± SD HEI-2010 in childhood cancer survivors was 57.9 ± 12.4 of a maximum score of 100. Referenced to Dietary Reference Intakes, survivors consumed inadequate amounts of vitamin D, vitamin E, potassium, fiber, magnesium, and calcium (27%, 54%, 58%, 59%, 84%, and 90% of the recommended intakes) but excessive amounts of sodium and saturated fat (155% and 115% of the recommended intakes) from foods. Survivors diagnosed when <5 y of age had a lower diet quality than did those diagnosed when ≥5 y of age (mean HEI-2010 score: 56.9 compared with 58.2; P = 0.046). Survivors who received higher radiation doses to the abdomen had a lower diet quality than those who received lower doses (mean HEI-2010 scores = 58.9, 57.2, 56.7, and 56.1 for doses of 0, 1-19.9, 20-29.9, and ≥30 Gy, respectively; P = 0.02).

Conclusions: Long-term childhood cancer survivors have poor adherence to the 2010 Dietary Guidelines for Americans. Findings reinforce the need to incorporate nutrition into cancer care to improve diet quality and to reduce morbidities.

Keywords: cancer survivors; cancer treatment; childhood cancer survivors; diet quality; nutrition.

FIGURE 1

Study flow chart. SJLIFE, St. Jude Lifetime cohort.

FIGURE 2

HEI-2010 mean scores and percentage of mean scores to the maximum scores in adult survivors of childhood cancer. HEI-2010, Healthy Eating Index–2010.

FIGURE 3

Dietary intakes of nutrients from foods compared with recommended intakes or limits in adult survivors of childhood cancer. The length the gray bar for each nutrient corresponds to the percentage of mean intake to the recommended intake level × 100. Recommended intake is estimated on the basis of the age-sex groups of RDAs published by Institute of Medicine (18), weighted by the age and sex distribution of the childhood cancer survivors. For sodium, the limit is estimated on the basis of the Tolerable Upper Intake Level. For the percentage of calories from saturated fat with no quantitative DRI, dietary guidelines recommendations were used (17). Nutritional goals are set at 100 when the mean intake meets the recommended intake or limit.