Healthy diet shown to lower cardiovascular disease risk in adult childhood cancer survivors

By Shanet Susan AlexReviewed by Benedette Cuffari, M.Sc.Jul 6 2023

In a recent study published in BMC Medicine, researchers analyze cardiovascular illness risk across adult childhood cancer survivors following a healthy diet.

Study: 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. Image Credit: nadianb / Shutterstock.com

Background

Childhood cancer survival rates have risen substantially over the past few decades due to advancements in cancer treatments. Nevertheless, numerous organ systems are frequently adversely affected by cancer therapies, thus increasing the risk of persistent chronic health conditions in these individuals.

The long-term consequences of cancer treatment increase the likelihood of cardiovascular disease (CVD) among childhood cancer survivors. CVD is the most prevalent non-cancer cause of mortality and morbidity, with childhood cancer survivors more likely to develop this health condition as they age. 

Diet is a recognized and controllable CVD risk factor. Among non-cancer and high-risk individuals, such as those with hyperlipidemia, diabetes, and hypertension, a diet rich in healthy fatty acids, plant-based foods, moderate sugar, animal-based foods, and salt intake has consistently been linked to a reduced likelihood of CVD.

Although it is known that a healthy diet reduces the risk of CVD among the general population, it is unknown whether this is also applicable to people who have survived childhood cancer. 

About the study

In the present study, researchers investigate the link between dietary patterns and CVD risk among adult childhood cancer survivors. To this end, the researchers evaluated whether adherence to a healthy diet has the same positive impact on CVD in those who have survived childhood cancer as it does in the general population.

A cross-sectional analysis was performed using data from the St. Jude Lifetime Cohort Study (SJLIFE), which comprises adult childhood cancer survivors. The dietary habits of the study participants were assessed using a food frequency questionnaire (FFQ), which subsequently led to their categorization as unhealthy and healthy patterns.

The three most widely examined dietary patterns included the alternate Mediterranean Diet Score (aMED), Healthy Eating Index (HEI)-2015, and Dietary Approaches to Stop Hypertension (DASH) score. These diets were analyzed to thoroughly examine the relationship between a healthy dietary pattern and CVD risk, irrespective of how a dietary pattern is defined operationally. The cardiovascular risk factors of the participants were also determined. 

The study's primary outcome was CVD presence, defined as a self-reported history of stroke, coronary artery disease, heart attack, or evidence of marked coronary artery stenosis upon cardiac imaging. Logistic regression models were used to analyze the association between CVD risk and dietary patterns, as well as account for possible confounding factors like sex, age, cancer diagnosis, and therapy. 

Study findings

A total of 1,882 male and 1,634 female childhood cancer survivors included in the study had an average time following diagnosis of 21.7 years. The CVD prevalence among males and females was 17.2% and 13%, respectively. DASH and HEI-2015 scores were low for both males and females, thus suggesting poor adherence to advised intakes for different food groups. 

Women with CVD had lower dietary nutrient intakes and were older, whereas men with CVD were often non-White, older, more likely to use dietary supplements, and physically inactive. Cancer survivors with elevated HEI-2015 scores were more likely to be older, more educated, non-smokers, physically active, and use single dietary supplements or multivitamins.

High HEI-2015 scores among male subjects were non-linearly linked with a lower risk of CVD, with a threshold impact observed across high scores. However, aMED and DASH were not linked to CVD risk in men.

Comparatively, aMED, HEI-2015 and DASH had a linear relationship with lower CVD risk in females. Although greater adherence to aMED, HEI-2015, and DASH was associated with a lower CVD risk in high-risk females, this was not observed in the low-risk group.

A statistically non-significant association was observed between higher HEI-2015 scores and decreased CVD risk in both males and females across all categories, as well as those without a history of high cholesterol, diabetes, or hypertension.

Conclusions

Although not statistically significant, higher adherence to aMED, HEI-2015, and DASH was linked to a reduced risk of CVD in females. In males, a non-significantly lower CVD risk was associated with HEI-2015.

Among childhood cancer survivors with an increased risk of CVD, these dietary habits were linked to a reduced risk of CVD. Thus, similar to the general population, a diet moderate in animal products and high in plant foods such as vegetables, fruits, lean protein, and whole grains should be a vital element in managing and preventing CVD in pediatric cancer survivors.