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, 121 (23), 4212-21

Diet Quality of Cancer Survivors and Noncancer Individuals: Results From a National Survey


Diet Quality of Cancer Survivors and Noncancer Individuals: Results From a National Survey

Fang Fang Zhang et al. Cancer.


Background: Patterns of poor nutritional intake may exacerbate the elevated morbidity experienced by cancer survivors. It remains unclear whether cancer survivors adhere to existing dietary guidelines and whether survivors' diets differ from those of individuals without cancer over the long term.

Methods: The authors evaluated dietary intake and quality in 1533 adult cancer survivors who participated in the National Health and Nutrition Examination Survey from 1999 to 2010 compared with dietary intake and quality in 3075 individuals who had no history of cancer and were matched to the cancer survivors by age, sex, and race/ethnicity. Dietary intake was assessed using 24-hour dietary recalls. The 2010 Healthy Eating Index (HEI-2010) was used to evaluate diet quality.

Results: The mean ± standard deviation HEI-2010 total score was 47.2 ± 0.5 in the cancer survivors and 48.3 ± 0.4 in the noncancer group (P = .03). Compared with the noncancer group, cancer survivors had a significantly lower score for empty calories (13.6 vs 14.4; P = .001), which corresponded to worse adherence to dietary intake of calories from solid fats, alcohol, and added sugars. Cancer survivors also had significantly lower dietary intake of fiber than the noncancer group (15.0 vs 15.9 g per day; P = .02). In relation to recommended intake, survivors' mean dietary intake of vitamin D, vitamin E, potassium, fiber, and calcium was 31%, 47%, 55%, 60%, and 73%, respectively; whereas their mean dietary intake of saturated fat and sodium was 112% and 133%, respectively, of the recommended intake.

Conclusions: Cancer survivors had poor adherence to the US Department of Agriculture 2010 Dietary Guidelines for Americans, and their intake patterns were worse than those in the general population for empty calories and fiber.

Keywords: National Health and Nutrition Examination Survey; cancer survivors; diet quality; nutrition; quality of life.

Conflict of interest statement

Conflict of Interests Statement: The authors have no conflicts of interests to disclose.


Figure 1
Figure 1
HEI-2010 total score in adult cancer survivors NHANES 1999-2010 by age, race/ethnicity, education, cigarette smoking, BMI, years from diagnosis, and cancer type. For race/ethnicity, “white” refers to non-Hispanic white, and “black” refers to non-Hispanic black. For education, “low” refers to high school or less, and “high” refers to some college or college graduate.
Figure 2
Figure 2. Dietary Intake of Adult Cancer Survivors and Individuals without a History of Cancer in NHANES 1999-2010 Compared to Recommended Intake
The dark grey bars indicate cancer survivors, and the line-shaded bars indicate non-cancer individuals. The lengths of bars for each nutrient correspond to the percentage of mean intake to the recommended intake × 100. Recommended intake is based on the Dietary Reference Intake (DRI) published by Institute of Medicine. Dietary Guidelines recommendations are used when no quantitative DRI value is available. Nutritional goals are set at 100 when mean intake reaches the recommended intake.

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