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. 2026 Jan 1;132(1):e70246.
doi: 10.1002/cncr.70246.

Adherence to healthy dietary patterns and risk of premature aging in adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study

Tuo Lan  1 , Mei Wang  1 , AnnaLynn M Williams  2 , Matthew J Ehrhardt  3   4 , Jennifer Q Lanctot  5 , Zhaoming Wang  4   5   6 , Shu Jiang  1 , Kevin R Krull  7 , Gregory T Armstrong  4   5 , Melissa M Hudson  3   4 , Graham A Colditz  1 , Leslie L Robison  4   5 , Kirsten K Ness  3 , Yikyung Park  1
Affiliations

Adherence to healthy dietary patterns and risk of premature aging in adult survivors of childhood cancer in the St. Jude Lifetime Cohort Study

Tuo Lan et al. Cancer. .

Abstract

Background: Adult survivors of childhood cancer are at higher risk of premature aging compared to their cancer-free peers due to the cancer and its treatments. However, little is known about the effect of adherence to healthy dietary patterns on aging in childhood cancer survivors.

Methods: A cross-sectional analysis was conducted of 3322 participants (mean age, 30.5 years; standard deviation [SD], 8.4) from the St. Jude Lifetime Cohort Study. Diet was measured by a food frequency questionnaire and used to assess the Healthy Eating Index (HEI)-2015 and alternate Mediterranean diet (aMED) scores. Premature aging was assessed by the deficit accumulation index and categorized into low, medium, and high risk. Multinomial logistic regressions adjusting for confounders were used to estimate odds ratios (ORs) with 95% confidence intervlas (CIs).

Results: The mean (SD) HEI-2015 score was 60.0 (10.9) of 100, and the aMED score was 4.2 (2.0) of 9. Twenty percent and 8% of survivors were in the medium and high deficit accumulation index categories, respectively. Higher adherence to HEI-2015 (ORhigh vs. low = 0.80; 95% CI, 0.69-0.93 per 10-point increment) and aMED (ORhigh vs. low = 0.91; 95% CI, 0.84-0.98 per 1-point increment) were associated with a lower risk of premature aging. The associations remained consistent among survivors who received radiation or chemotherapy.

Conclusion: Adherence to a healthy diet may contribute to reducing the premature aging risk in adult survivors of childhood cancer. Interventions that support healthy eating in this population could potentially have benefits for long-term health outcomes.

Keywords: Healthy Eating Index; Mediterranean diet; aging; childhood cancer survivor; dietary patterns; premature aging.

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Conflict of interest statement

Competing interests: The authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
Plot of multivariable-adjusted associations between dietary pattern scores and deficit accumulation index (DAI). A. Health Eating Index (HEI)-2015. B. Alternate Mediterranean Diet (aMED). Models were adjusted for age; sex (in the men and women combined model), race (White, and others); education (less than high school, high school graduation, training after high school, and college or post-grad); smoking (never, former, and current); multivitamin use (yes and no); single supplement use (yes and no); and cancer treatment received: platinum based chemotherapy (yes and no); other chemotherapy (yes and no), chest radiation (yes and no), cranial radiation (yes and no), and other radiation (yes and no), intakes of total energy, and ADI (<43, 43 - <63, 63 - <82, and ≥82). Deficit Accumulation Index (DAI) was assessed based on 44 aging-related health conditions and grouped into low (<0.2), medium (0.2 - <0.35), and high (≥ 0.35) deficit accumulation categories.
Figure 2.
Figure 2.
Multivariable-adjuted odds ratios and 95% confidence intervals of high vs low deficit accumulation index (DAI) category for (A) HEI-2015 and (B) aMED scores in subgroups in the St. Jude Lifetime Cohort Study. Models were adjusted for age; sex (in the men and women combined model), race (White, and others); education (less than high school, high school graduation, training after high school, and college or post-grad); smoking (never, former, and current); multivitamin use (yes and no); single supplement use (yes and no); and cancer treatment received: platinum based chemotherapy (yes and no); other chemotherapy (yes and no), chest radiation (yes and no), cranial radiation (yes and no), and other radiation (yes and no), intakes of total energy, and ADI (<43, 43 - <63, 63 - <82, and ≥82). Deficit Accumulation Index (DAI) was assessed based on 44 aging-related health conditions and grouped into low (<0.2), medium (0.2 - <0.35), and high (≥ 0.35) deficit accumulation categories.
Figure 2.
Figure 2.
Multivariable-adjuted odds ratios and 95% confidence intervals of high vs low deficit accumulation index (DAI) category for (A) HEI-2015 and (B) aMED scores in subgroups in the St. Jude Lifetime Cohort Study. Models were adjusted for age; sex (in the men and women combined model), race (White, and others); education (less than high school, high school graduation, training after high school, and college or post-grad); smoking (never, former, and current); multivitamin use (yes and no); single supplement use (yes and no); and cancer treatment received: platinum based chemotherapy (yes and no); other chemotherapy (yes and no), chest radiation (yes and no), cranial radiation (yes and no), and other radiation (yes and no), intakes of total energy, and ADI (<43, 43 - <63, 63 - <82, and ≥82). Deficit Accumulation Index (DAI) was assessed based on 44 aging-related health conditions and grouped into low (<0.2), medium (0.2 - <0.35), and high (≥ 0.35) deficit accumulation categories.
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