How Healthy Are the Diets of Cancer Survivors? Characteristics of Those Most at Risk and Opportunities for Improvement

Abstract

Background: Diet quality and adherence to dietary guidelines are strong predictors of positive cancer outcomes among survivors.

Methods: A cross-sectional analysis was conducted using 2-day dietary recalls from a nationwide sample of 818 survivors of 9 obesity-related cancers with ≥70% 5-year survival who expressed interest in a web-based diet and exercise trial. Total diet quality scores and component subscores were generated using the Health Eating Index-2020 (HEI-2020). Subgroup analyses examined differences by cancer diagnosis and treatment, body weight status, and sociodemographic factors.

Results: The mean [SD] HEI-2020 score among survivors was 51.6 [12.05] out of 100-approximately 10 points below norms for comparably aged Americans in the general population. Clinically meaningful deficits were observed for intakes of fruits, vegetables, dairy products, and protein (especially from plant and seafood sources). Survivors' intakes also included excessive amounts of refined grains. Compared with the general population, however, survivors' intakes more closely aligned with guidelines in terms of higher whole grain intake and lower consumption of sodium, saturated fat, and sugar (including sugar-sweetened beverages). Overall diet quality and/or component scores were significantly lower among younger survivors (age <65 years) and those within 5 years of diagnosis, with obesity (body mass index ≥30 kg/m2), of lower education (high school diploma or less), and residing in areas of higher socioeconomic deprivation (Area Deprivation Index ≥50th percentile) (all P<.05). No significant subgroup differences were detected by cancer type or treatment.

Conclusions: Diet quality among survivors of obesity-related cancers is notably suboptimal. Clinicians should leverage survivors' interest in diet and exercise interventions to provide support and referrals targeting identified areas of need, particularly for those at highest risk, such as individuals with obesity, within 5 years of diagnosis, aged <65 years, with a high school diploma or less, and residing in areas of higher socioeconomic deprivation.