Introduction:
The increased cardiovascular disease risk of childhood cancer survivors should be managed through the promotion of a healthy diet and exercise. However, how a history of childhood cancer affects diet and how diet affects adiposity in survivors are not known.
Methods:
Survivors and healthy siblings from a NCI cohort study in Rochester, NY completed 3-day diet logs, analyzed using the Nutritional Data System for Research dietary software. Caloric intake was expressed as a percentage relative to age-, sex-, and activity level-specific USDA recommendations. Diet quality was expressed using the Healthy Eating Index (HEI) which measures adherence to USDA guidelines using 12 food-group- and nutrient-specific sub-scores that sum to range from 0 (no adherence) to 100 (full adherence). Survivors and siblings were compared using generalized linear mixed models to account for matching and adjust for age and sex. Overweight and obese were defined using BMI (BMI≥85 and ≥95% of CDC growth charts for those <20 yrs old or BMI>25 and ≥30 for those over 20 yrs old). Percent body fat was measured using dual energy X-ray absorptiometry. Associations between diet and adiposity were age- and sex-adjusted.
Results:
Compared to the 91 survivors who were a mean 13 years from cancer diagnosis, the 30 siblings were of younger mean age (20.8 vs 16.6 yrs, P=.03), more likely male (42/91 vs. 18/30, P=.19), of lower mean percent body fat (33.9 vs 23.8%, P<.01) but similarly likely to be overweight (37/91 vs 14/30, P=.56) or obese (18/91 vs 7/30, P=.73). The mean age- and sex-adjusted caloric intake relative to recommended did not differ between survivors and siblings (96 vs 104%, P=.17), nor did the adjusted proportion with a total caloric intake above 110% of recommended (28 vs 38%, P=.30). The mean adjusted HEI did not differ between survivors and siblings (50.5 vs 48.9, P=.30) nor did any of the HEI component scores. Survivors and siblings scored worst for the consumption of dark green and orange vegetables (1.0 / 5) and sodium (2.8 / 10) and best for the consumption of total grains (4.7 and 4.6 / 5, respectively). In survivors, caloric intake relative to recommended was not associated with percent body fat (Beta=-.14, P=.14) or with being overweight (.99 vs .93, P=.37) or obese (1.01 vs .93, P=.32). In survivors, the total HEI score was not associated with percent body fat (Beta=-.15, P=.09) or with being overweight (49.7 vs 50.4, P=.74) or obese (47.5 vs 50.9, P=.17).
Conclusions:
While the relative caloric intake of survivors is consistent with recommendations, survivor’s dietary quality is only somewhat consistent with recommendations, but not different than that of siblings. In survivors, neither relative caloric intake nor diet quality is associated with adiposity. The role of diet in reducing survivor’s cardiovascular disease burden, who may require focused interventions for effective management, is unknown.Funding(This research has received full or partial funding support from the American Heart Association, Greater Southeast Affiliate (Alabama, Florida, Georgia, Louisiana, Mississippi, Puerto Rico&Tennessee))
The Equation Relating Body Density to Percent Body Fat in Boys and Girls.