Food insecurity, dietary quality, and cardiovascular risk among early childhood cancer survivors.
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PURPOSE: Childhood cancer survivors (CCS) have 7-times higher risk of cardiovascular mortality than the general population, highlighting the importance of addressing modifiable cardiovascular risk factors. In this study, we aimed to quantify the prevalence of food and nutrition insecurity-known cardiovascular risk factors-among a single-center cohort of early CCS, and explore these factors as drivers of adverse CCS dietary and cardiovascular outcomes. METHODS: Children aged < 18 years and < 1 year off-therapy were enrolled at a quaternary pediatric cancer center. Parents/guardians of participants completed an electronic survey including validated measures of food and nutrition insecurity and dietary quality, measured with the Rapid Prime Dietary Quality Score Screener. Therapeutic (anthracycline or radiation exposure) and clinical cardiovascular risk factors (overweight/obesity, elevated blood pressure, dyslipidemia, or prediabetes/diabetes) were abstracted from the medical record. We descriptively summarized food insecurity prevalence, dietary quality, and cardiovascular risk and examined associations using univariate and multivariable logistic and linear regression analyses. RESULTS: Among 115 enrolled participants with a mean age 8.3 years and mean 5.3 months from end of therapy, 27% (n = 31) lived in food-insecure households and 33% (n = 38) had nutrition insecurity. Mean dietary quality was 27.6/52 (SD 5.3). Participants in food-insecure households experienced significantly lower dietary quality compared to food-secure households on univariate analysis (25.9 vs 28.2, p = 0.04); in multivariable analyses, this difference was not significant. Among the sub-cohort with available medical record abstraction data (n = 97), 84% (n = 81) had ≥ 1 cardiovascular risk factor and 39% had ≥ 2 risk factors. CONCLUSIONS: One in four early CCS lives with food insecurity. These children concurrently experience multiple cardiovascular risk factors and suboptimal dietary quality. Interventions targeting food and nutrition insecurity and other modifiable cardiovascular risk factors have potential to mitigate late effects and advance equity in survivorship outcomes.