What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Adult survivors of childhood cancer (n=3516). Intervention: Adherence to healthy diet (HEI-2015, DASH, aMED) vs. Lower adherence to healthy diet. Primary outcome: Cardiovascular disease (CVD) (OR 0.88, 95% CI 0.75-1.03).

July 3, 2023Open Access

Adherence to healthy diet and risk of cardiovascular disease in adult survivors of childhood cancer in the St. Jude Lifetime Cohort: a cross-sectional study

Key Result

Greater adherence to the Healthy Eating Index-2015 was associated with a non-significantly lower risk of cardiovascular disease in female adult survivors of childhood cancer (OR 0.88 per 10-score increment).

Study Design

Type

Cross-Sectional (n=3,516)

Multicenter

Structured PICO

Does adherence to healthy dietary patterns reduce the risk of cardiovascular disease in adult survivors of childhood cancer?

Population

3,525 adult survivors of childhood cancer (18-65 years old, 1,882 men and 1,634 women) in the St. Jude Lifetime Cohort (SJLIFE), mean age ~30 years, average 21.7 years since cancer diagnosis. Excluded: no dietary assessment, extreme energy intake, pregnant women, inconsistent gender records, chronic kidney disease, or pancreatitis.

Intervention

High adherence to healthy dietary patterns (Healthy Eating Index [HEI]-2015, Dietary Approaches to Stop Hypertension [DASH], and alternate Mediterranean diet [aMED]) assessed via 2005 Block Food Frequency Questionnaire.

Comparator

Low adherence to healthy dietary patterns (lowest quintile or tertile of HEI-2015, DASH, or aMED scores).

Outcome

Prevalent cardiovascular disease (CVD), defined as at least one grade 2 or higher CVD-related diagnosis at baseline (including myocardial infarction, cardiomyopathy, cerebrovascular disease, vascular disease, aortic root aneurysm, stroke, cardiac dysrhythmia, conduction abnormality, right heart failure, heart valve disorder, and right ventricular systolic dysfunction).composite

Greater adherence to healthy dietary patterns is associated with a lower prevalence of cardiovascular disease in adult survivors of childhood cancer, particularly among women.

Main Result

Effect estimate: OR 0.88 (95% CI 0.75-1.03)

Limitations

Cross-sectional design cannot establish temporal relationship between dietary patterns and CVD
Potential for reverse causation if survivors with prevalent CVD changed their diet to a healthier one
Insufficient power in analyses using diet score categories
Possibility of residual confounding due to inadequate adjustment of contextual socioeconomic factors
Measurement errors in self-reported diet using a food frequency questionnaire

Abstract

Abstract Background Whether diet has beneficial effects on cardiovascular disease (CVD) in childhood cancer survivors as in the general population is unknown. Therefore, we examined associations between dietary patterns and risk of CVD in adult survivors of childhood cancer. Methods Childhood cancer survivors, 18–65 years old in the St Jude Lifetime Cohort (1882 men and 1634 women) were included in the analysis. Dietary patterns were defined by the adherence to the Healthy Eating Index (HEI)–2015, Dietary Approaches to Stop Hypertension (DASH), and alternate Mediterranean diet (aMED) based on a food frequency questionnaire at study entry. CVD cases (323 in men and 213 in women) were defined as participants with at least one grade 2 or higher CVD-related diagnosis at baseline. Multivariable logistic regression adjusted for confounders was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of CVD. Results Greater adherence to HEI-2015 (OR=0.88, 95% CI: 0.75–1.03, per 10 score increment), DASH (OR=0.85, 95% CI: 0.71–1.01, per 10 score increment), and aMED (OR=0.92, 95% CI: 0.84–1.00, each score increment) were, albeit trending towards significance, associated with a lower risk of CVD in women. HEI-2015 was associated with a non-significantly lower risk of CVD in men (OR Q5 vs. Q1 =0.80, 95% CI: 0.50–1.28). These dietary patterns were also associated with a lower risk of CVD in survivors with high underlying CVD risk. Conclusions As recommended to the general population, a diet rich in plant foods and moderate in animal foods needs to be a part of CVD management and prevention in childhood cancer survivors.

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