The number of childhood cancer survivors in the United States is increasing each year. It is estimated there will
be 500,000 childhood cancer survivors by the year 2020. Childhood cancer survivors are at an increased risk
of developing chronic health conditions, in part, due to their previous cancer treatment. They develop these
conditions at younger ages and at higher rates than the general population. The leading cause of non-cancer
morbidity and mortality in childhood cancer survivors is cardiovascular disease (CVD). Strong evidence
supports that a healthy diet, such as the Dietary Approaches to Stop Hypertension (DASH) and prudent pattern
diet, lowers the risk of CVD in the general population, suggesting diet should be a priority area for CVD
management and prevention in the general population. However, it is unknown whether diet has similarly
beneficial effects in childhood cancer survivors who are at high risk for CVD. Few studies have examined the
relation of diet to any adverse health outcomes in childhood cancer survivors. Most of these were small,
evaluated nutritional status only, or focused on adolescents or young adults, rather than long-term aging adult
survivors of childhood cancer. To close this knowledge gap in our understanding of the role of diet in CVD in
adult survivors of childhood cancer, we propose to investigate whether dietary patterns are associated with the
risk of CVD in the St. Jude Lifetime Cohort Study (SJLIFE). SJLIFE is a retrospective cohort study of long-term
survivors of childhood cancer with prospective lifetime follow-up. The study collected participants'
sociodemographic, health behavior, and medical history and cancer treatment data from medical records. Diet
is assessed using a food frequency questionnaire. Participants also undergo comprehensive medical
examinations at St. Jude Children's Research Hospital for assessment of health conditions, including CVD. We
will examine two dietary patterns that are complementary to each other: 1) DASH score based on the
adherence to a set of dietary recommendations proven to lower blood pressure and related to lower risk of
CVD in the general population; and 2) study-specific dietary patterns derived by factor analysis that may
identify childhood cancer survivor-specific dietary patterns. We will derive and characterize two dietary patterns
– DASH diet and study-specific dietary patterns (Aim 1); assess the relationship between dietary patterns and
CVD risk (Aim 2); and investigate the association between dietary patterns and risk of CVD in high- and low-
underlying CVD risk groups. Our study will provide much-needed information regarding the magnitude of
impact of a healthy diet on CVD risk, and characteristics of survivors who may benefit from dietary intervention.
Moreover, our study will significantly contribute to the development of new CVD prevention strategies and
evidence- and risk-based dietary recommendations for childhood cancer survivors, which will guide clinicians
and survivors on maintaining their health and quality of life.
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