Study highlights need for dietary interventions in cancer survivors

While most cancer survivors in the United States are motivated to seek information about food choices and dietary changes to improve their health, a new study comparing their dietary patterns to federal guidelines indicates that they often fall short. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the findings point to the need for dietary interventions in this vulnerable population.

Cancer survivors have significantly elevated risks of a variety of health problems, and nutrition is among the few modifiable behaviors that can prevent or delay their onset. To see how well cancer survivors adhere to existing dietary guidelines, a research team led by Fang Fang Zhang, MD, PhD, of the Friedman School of Nutrition Science and Policy at Tufts University, analyzed the diets of 1533 adults participating in the National Health and Nutrition Examination Survey from 1999 to 2010. The investigators looked at how the diets aligned with advice from the 2010 Dietary Guidelines for Americans, which was jointly issued by the Department of Agriculture and the Department of Health and Human Services.

Among the major findings:

• Cancer survivors had poor adherence to the guidelines, with a total Healthy Eating Index score of 47.2 out of 100 compared with a score of 48.3 in adults without a history of cancer. Their adherence was especially poor concerning recommended intake for green vegetables and whole grains.
• Compared with individuals with no history of cancer, cancer survivors consumed less fiber and more empty calories, such as those from solid fats or added sugars.

  Cancer survivors had low dietary intakes of vitamin D (31 percent of the recommended intake), vitamin E (47 percent), potassium (55 percent), and calcium (73 percent), but high intakes of saturated fat (112 percent) and sodium (133 percent).

• Diet quality in cancer survivors increased linearly with age: the older the age, the better the diet quality.

• Survivors with lower education (high school or less) had significantly worse diet quality than those with higher education.

• Survivors who were current smokers had significantly worse diet quality than non-smokers or former smokers.

• For the four major cancer types in the United States (breast, prostate, lung, and colon and rectal), breast cancer survivors had the best diet quality whereas lung cancer survivors had the worst diet quality.

Knowing how well cancer survivors adhere to federal dietary guidelines can help inform evidence-based priorities for improving nutritional intake in cancer survivors in the United States. "Dietary changes that include more fiber, fruit, and vegetables in the diet and less fat, sodium, and added sugar would be important for cancer survivors," said Dr. Zhang. "Oncology care providers can play critical roles in reinforcing the importance of a healthful diet, and can refer patients to registered dietitians who are experts in oncology care or to other reputable sources in order to improve survivors' overall health."