Many Cancer Survivors Don't Follow Dietary Guidelines

Fang Fang Zhang, MD, PhD

Fang Fang Zhang, MD, PhD

Despite having significantly elevated risks of long-term health problems, many cancer survivors eat poorer-quality diets than the general population.

The findings, published online in Cancer, showed that cancer survivors had poor adherence to the 2010 Dietary Guidelines for Americans, which was jointly issued by the Departments of Agriculture and Health and Human Services.

In an evaluation of dietary intake of 1533 adult cancer survivors who participated in the National Health and Nutrition Examination Survey from 1999 to 2010, survivors consumed more empty calories and less fiber than individuals with no history of cancer.

Using the 2010 Healthy Eating Index (HEI-2010) to evaluate diet quality, the survivors were matched to 3075 individuals without cancer by age, sex, and race and ethnicity.

Survivors’ HEI-2010 score was 47.2 out of 100 compared with a score of 48.3 in the other individuals.

Compared to those with no cancer history, survivors had a significantly lower score for empty calories (13.6 vs 14.4; P = .001), which corresponded to calorie intake from solid fats, alcohol, and added sugars. They also had an intake of only 60% the recommended amount of fiber, which was significantly lower than the group without a cancer history (15.0 vs 15.9 g per day; P = .02).

Survivors only consumed 31% of the recommended dietary intake of vitamin D, 47% of vitamin E, 55% of potassium, and 73% of calcium. They also had significantly high intake of saturated fat and sodium, which was 112% and 133%, respectively, of the recommended amount.

Adherence to federal guidelines was particularly poor concerning intake of green vegetables and whole grains.

“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,” lead author Fang Fang Zhang, MD, PhD, assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University, said in a statement.

The study also found that survivors with an education of high school or less and current smokers had significantly worse diet quality.

Of the four major cancer types in the US—breast, prostate, lung, and colon—survivors of breast cancer had the best diet quality while survivors of lung cancer had the worst.

The authors noted that nutrition is one of the few modifiable factors that can prevent or delay long-term morbidities experienced by cancer survivors.

“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,” Zhang said.

Zhang F, Shanshan L, John E, et al. Diet quality of cancer survivors and noncancer individuals: Results from a national survey [published online October 13, 2015]. Cancer. doi: 10.1002/cncr.29488