Comparison of childhood cancer survivors' nutritional intake with US dietary guidelines

Abstract

Background Despite improved survival, childhood cancer survivors experience significantly elevated risk of premature mortality and serious morbidity due to chronic health conditions. Poor diet quality can exacerbate chronic health conditions in the survivors but their nutritional intake has not been adequately studied. Procedure We assessed the Healthy Eating Index 2010 (HEI-2010) in 22 survivors of pediatric acute lymphoblastic leukemia and lymphoma (median age = 11.7 years) and compared survivors' dietary intake to the 2010 Dietary Guidelines for Americans. Dietary data were collected using repeated 24-hour dietary recalls over a one-year period, which were averaged to estimate habitual intake. Results The mean HEI-2010 in childhood cancer survivors was 52.7, about 50 percent of the maximum score. Long-term survivors (time from diagnosis ≥10 years) had a significantly lower HEI-2010 than recent survivors (time from diagnosis <5 years) (β = -11.5, 95% CI: -22.1, -0.9, p=0.047). For individual food groups and nutrients, survivors had a particularly poor adherence to green vegetables and beans, total vegetables, and whole fruits. None of the survivors met the guidelines for dietary fiber and potassium intake. Only 4%, 19%, 24%, and 29% met the guidelines for vitamin D, sodium, calcium, and saturated fat intake. The average intake in relative to the recommended intake was 32% for vitamin D, 50% for potassium, 63% for fiber, and 85% for calcium, but was 115% for saturated fat and 143% for sodium. Conclusions Childhood cancer survivors, in particular long-term survivors, have a poor adherence to the US dietary guidelines.

Adult Survivors of Childhood Cancer Have Poor Adherence to Dietary Guidelines

“…The mean HEI-2010 score identified in this large cohort of childhood cancer survivors is consistent with findings from previous studies in smaller cohorts of survivors that reported diet quality scores ranging from 33% to 56% of the maximum score (5)(6)(7)(8)24). Although dietary assessment methods or indexes to measure diet quality varied between studies, the collective evidence consistently points to poor diet quality in childhood cancer survivors.…”

Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions

“…The current study focused on exercise and healthy eating because of the documented poor adherence of childhood cancer survivors and AYAs to these health behaviors, the relevance of these health behaviors to multidisciplinary teams serving survivors that include dietitians and physical therapists, and that evidence-based interventions addressing these behaviors share common components and often address diet and exercise concurrently. 17,[50][51][52][53] However, there are other health behaviors, such as limiting smoking and drinking alcohol and implementing sun protection, which should also be examined in future studies.…”

Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods

“…Such a large gap is unlikely to be reversed by exercise alone. Our prior study [12] and those of others [15-17] have also shown that childhood cancer survivors have poor adherence to existing dietary guidelines. Their intake patterns are particularly low in fiber and whole grains and high in sodium and empty calories (calories from solid fats and added sugars), all of which are established risk factors for obesity and CVD-related morbidities.…”

“…Although malnutrition due to cancer-related anorexia and cachexia still represents an important concern in cancer care [33], overconsumption of calories through poor eating habits [12,15-17] and a high prevalence of obesity are increasingly recognized in childhood ALL survivors [2,34]. Weight management programs for childhood cancer survivors should respond to the growing need to curb early onset of obesity and CVD risk factors by reducing overconsumption of calories to achieve energy balance.…”

“…We conducted preliminary studies that identified intake patterns and levels of total energy expenditure in young survivors of pediatric ALL and lymphoma [11,12]. These intake and activity patterns were originally thought to be adaptive responses to cancer treatment but tend to last beyond treatment completion and are particularly difficult to reverse in long-term survivors.…”