Examining the association between diet quality scores, inflammation and treatment outcomes in pediatric acute lymphoblastic leukemia: an exploratory observational study

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. Diet quality may influence inflammation and treatment response. This study investigated the association between diet quality, pre-treatment inflammatory markers, and post-induction clinical outcomes. This cross-sectional study was conducted over one year using convenience sampling among newly diagnosed pediatric ALL patients at the induction therapy stage. Dietary intake was assessed via a Food Frequency Questionnaire, with healthy eating index (HEI-2015) and dietary diversity score (DDS) used to evaluate diet quality. Associations between dietary scores and clinical outcomes (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), hospitalization, febrile neutropenia) were examined using simple and multiple linear regression, adjusted for age, sex, and BMI. Subgroup analyses were performed by sex and age. A total of 54 patients were enrolled. Significant associations emerged between specific dietary components and inflammatory or treatment-related outcomes. Higher DDS was associated with increased PNI among females (β = 3.90, 95% CI = 0.94, 6.58). Among HEI-2015 components, higher dairy intake was associated with elevated MLR (β = 0.02, 95% CI = 0.003, 0.05), whereas higher total fruit intake was associated with reduced MLR (β = − 0.05, 95% CI = -0.1, -0.04). Higher fatty-acid scores were associated with lower MLR (β = − 0.03, 95% CI = -0.06, -0.004) and lower PLR (β = − 19.53, 95% CI = -35.75, -3.31). Additionally, increased whole-grain intake was associated with longer hospitalization duration (β = 1.17, 95% CI = 0.28, 2.07). Diet quality may play a supportive role in modulating inflammation and treatment outcomes during ALL induction therapy. A varied diet with more fruits and healthy fats showed favorable associations, while higher dairy and whole grain intake were linked to adverse outcomes. These findings highlight the potential value of tailored dietary strategies in managing pediatric leukemia. The study protocol was approved by the ethics committee of Tabriz University of Medical Sciences (ethic number: IR.TBZMED.REC.1401.1080).