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Session: Dietary Patterns and Components in Cancer Risk and Survivorship (Poster Theater Flash Session 6)

(PTFS06-02-24) Diet Quality Among Cancer Survivors and Its Association With Mortality Risks: Results From NHANES 1999-2018

Sunday, June 30, 2024
12:04 PM – 12:08 PM CT
Location:  W185A-C

    Presenting Author(s)

  • ZL

    Zhongyao Li, MS, RD

    PhD Candidate
    Tufts University
    Newton, Massachusetts, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • HE

    Heather A. Eliassen, ScD

    Harvard University, United States

  • Dariush Mozaffarian, MD, DrPH

    Dean
    Friedman School of Nutrition Science and Policy at Tufts University
    Boston, Massachusetts, United States

  • Fang Fang Zhang, MD, PhD

    Associate Professor
    Friedman School of Nutrition Science and Policy at Tufts University
    Tufts University
    Boston, Massachusetts, United States

Objectives: The study is to evaluate the prospective association between diet quality and mortality risks among a representative sample of cancer survivors in the United States (US) in NHANES 1999-2018.

Methods: Adults aged 20+ years who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and reported a history of cancer diagnosis were identified as cancer survivors (N=3,388). Diet quality, measured by Healthy Eating Index (HEI)-2020, was assessed using dietary intake data collected from 24-hour diet recalls. Mortality outcomes including all-cause, cancer- and cardiovascular disease (CVD)-specific mortality were ascertained via linkage of the National Death Index through December 31, 2019. The Cox proportional hazard model was used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) associated with diet quality and mortality risks with adjustments of demographics, lifestyle factors, and comorbid conditions. All analyses were adjusted for survey weights to account for complex survey design.

Results: The mean HEI-2020 total score among cancer survivors was 54.4 out of 100, with particularly low component scores for greens and beans (1.74 out of 5), whole grains (3.02 out of 10), and sodium (4.32 out of 10). Cancer survivors in the highest quartile of HEI-2020 were older, had higher education and income attainment, had a healthy weight, were physically active, were more likely to be non-smokers, and were diagnosed at an older age than those in the lowest quartile. Each 5-unit increase in HEI-2020 total score was associated with a 6% lower risk of all-cause mortality (HR=0.94, 95% CI: 0.91-0.96) and an 8% lower risk of cancer-specific mortality (HR=0.92, 95% CI: 0.87-0.96) adjusting for age. No association was found between HEI-2020 and CVD-specific mortality among cancer survivors. Adjustments for demographics, lifestyle factors (physical activity, smoking, alcohol drinking, and BMI) and comorbid conditions weakened the association.

Conclusions: There is no association between diet quality and all-cause mortality among cancer survivors adjusting for demographic and lifestyle factors, though there is a suggestion of inverse association for cancer-specific mortality.

Funding Sources: Li is supported by the Friedman Fellowship at Tufts University.