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Evaluation of Diet Quality Among American Adult Cancer Survivors: Results From 2005-2016 National Health and Nutrition Examination Survey

Published:November 03, 2020DOI:https://doi.org/10.1016/j.jand.2020.08.086

      Abstract

      Background

      Diet quality among adult cancer survivors is low, and there is minimal information on the Healthy Eating Index (HEI)-2015 score, a measure of diet quality and adherence to the 2015-2020 Dietary Guidelines for Americans, in this population.

      Objective

      This study aimed to examine HEI-2015 total and component scores and associated factors among adult cancer survivors. Also, this study examined which dietary components needed the most change to improve diet quality in this population.

      Design

      The National Health and Nutrition Examination Survey (NHANES) is an ongoing nationally representative population-based cross-sectional study that is conducted annually.

      Participants/setting

      In all, 1971 adults with a self-reported cancer diagnosis in their lifetime (both individuals with cancer currently and those that are cancer-free) from NHANES 2005-2016 were included in this study.

      Main outcome measures

      HEI-2015 total and 13 component scores were calculated using the simple scoring algorithm method from the average of 2 24-hour recalls.

      Statistical analyses

      The associations of the HEI-2015 total score with sociodemographic, lifestyle, and health-related factors were analyzed using the least square means comparisons. A multivariable survey regression model was used to identify associations with the HEI-2015 total score after adjustment for potential confounders. The 13 component scores were also compared by participant characteristics to identify target food groups for subgroup-specific nutrition intervention.

      Results

      The average HEI-2015 total score was 55.6 (95% confidence interval = 54.8-56.4). Factors associated with the HEI-2015 total score included age, race/ethnicity, education, smoking status, body mass index, and oral health status. Overall, poor adherence to the 2015-2020 Dietary Guidelines for Americans was found for most HEI-2015 components, with Whole Grains, Greens and Beans, Sodium, and Fatty Acids components having less than 50% of the maximum possible scores.

      Conclusions

      Results indicate poor diet quality among American adult cancer survivors, with significant disparities observed across sociodemographic and lifestyle factors, particularly education levels, body mass index, and smoking status. Nutrition interventions for cancer survivors should consider focusing on improving diet quality by increasing intakes of whole grains and greens and beans, lowering sodium consumption, and achieving a healthy balance of fatty acids (ie, a favorable ratio of unsaturated fats to saturated fats).

      Keywords

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      Biography

      E. Lee is an assistant professor, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando.

      Biography

      J. Zhu is an research assistant, Department of Statistics and Data Science, University of Central Florida College of Sciences, Orlando.

      Biography

      J. Velazquez was an undergraduate researcher, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando, FL.

      Biography

      R. Bernardo was an undergraduate researcher, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando.

      Biography

      J. Garcia is an assistant professor, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando.

      Biography

      M. Rovito is an associate professor, Department of Health Sciences, University of Central Florida College of Health Professions and Sciences, Orlando.

      Biography

      R. B. Hines is an associate professor, Department of Population Health Sciences, University of Central Florida College of Medicine, Orlando.