2-D Plot Submission

Partners. Sora Johnson

Title. Trends in Percentage of Calories from Ultraprocessed Foods Over Nine NHANES Cycles (1999-2016): Comparing Different Income to Poverty Level Ratios

Legend. Data source: 24-hour dietary recalls, self-reported income from the National Health and Nutrition Examination Survey (1999-2016). Each line represents ultraprocessed food consumption of participants living at different income/poverty level ratios. Ratios calculated based on national poverty level at time of survey administration. Line types: red long-short dash, living at/below poverty level; orange long dash, living above poverty level up to two times the poverty level; green square long dash, living above two times poverty level up to three times, blue square, living above three times poverty level, up to four times; and purple regular, living above four times poverty level.

2-D Plot Revision

Partner: Sora Johnson

Title. Percentage of Calories from Ultraprocessed Foods Among Cancer Survivors Do Not Differ by Poverty Income Ratio: Visualizing Trends from Nine NHANES Cycles (1999-2016)

Legend. Data source: 24-hour dietary recalls, self-reported income from the National Health and Nutrition Examination Survey (1999-2016). Each line represents ultraprocessed food consumption of participants living at different ratios of income/poverty level. Ratios calculated based on national poverty level at time of survey administration. Line types: red long-short dash, living at/below poverty level; orange long dash, living above poverty level up to two times the poverty level; green square long dash, living above two times poverty level up to three times, blue square, living above three times poverty level, up to four times; and purple regular, living above four times poverty level.

Abstract

Cancer survivors have an increased risk of developing chronic comorbidities due to the toxicity of the treatments they receive [1]. A survivor’s diet is a modifiable life factor known to prevent many of these comorbidities [2-4]. The consumption of ultraprocessed foods is thus of concern, since these foods are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients. [5]. We used dietary data from the National Health and Nutrition Examination Survey (1999-2016) to examine ultraprocessed food consumption over time among different income/poverty level ratios. Despite the release of several dietary guidelines addressing the detrimental properties of ultraprocessed foods, consumption remained steady within the cancer survivor population, with little meaningful differences between income to poverty level ratios. Our work highlights the limited impact of dietary guidelines among cancer survivors, emphasizing the need to develop and evaluate more targeted intervention programs in this vulnerable group.

1. American Cancer Society. Long-Term Side Effects of Cancer. Secondary Long-Term Side Effects of Cancer  2022. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/long-term-health-concerns/long-term-side-effects-of-cancer.html.

2. Van Blarigan EL, Fuchs CS, Niedzwiecki D, et al. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol 2018;4(6):783-90 doi: 10.1001/jamaoncol.2018.0126.

3. Hurtado-Barroso S, Trius-Soler M, Lamuela-Raventós RM, Zamora-Ros R. Vegetable and Fruit Consumption and Prognosis Among Cancer Survivors: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr 2020;11(6):1569-82 doi: 10.1093/advances/nmaa082.

4. Schwedhelm C, Boeing H, Hoffmann G, Aleksandrova K, Schwingshackl L. Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutr Rev 2016;74(12):737-48 doi: 10.1093/nutrit/nuw045.

5. Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition 2018;21(1):5-17 doi: 10.1017/s1368980017000234.

Abstract

Cancer survivors have an increased risk of developing chronic comorbidities due to the toxicity of the treatments they receive [1]. A survivor’s diet is a modifiable life factor known to prevent many of these comorbidities [2-4]. The consumption of ultraprocessed foods is thus of concern, since these foods are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients. [5]. We used dietary data from the National Health and Nutrition Examination Survey (1999-2016) to examine ultraprocessed food consumption over time among different ratios of income/poverty level. Despite the release of several dietary guidelines addressing the detrimental properties of ultraprocessed foods, consumption remained steady within the cancer survivor population, with little meaningful differences between income to poverty level ratios. Our work highlights the limited impact of dietary guidelines among cancer survivors, emphasizing the need to develop and evaluate more targeted intervention programs in this vulnerable group.

1. American Cancer Society. Long-Term Side Effects of Cancer. Secondary Long-Term Side Effects of Cancer  2022. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/long-term-health-concerns/long-term-side-effects-of-cancer.html.

2. Van Blarigan EL, Fuchs CS, Niedzwiecki D, et al. Association of Survival With Adherence to the American Cancer Society Nutrition and Physical Activity Guidelines for Cancer Survivors After Colon Cancer Diagnosis: The CALGB 89803/Alliance Trial. JAMA Oncol 2018;4(6):783-90 doi: 10.1001/jamaoncol.2018.0126.

3. Hurtado-Barroso S, Trius-Soler M, Lamuela-Raventós RM, Zamora-Ros R. Vegetable and Fruit Consumption and Prognosis Among Cancer Survivors: A Systematic Review and Meta-Analysis of Cohort Studies. Adv Nutr 2020;11(6):1569-82 doi: 10.1093/advances/nmaa082.

4. Schwedhelm C, Boeing H, Hoffmann G, Aleksandrova K, Schwingshackl L. Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutr Rev 2016;74(12):737-48 doi: 10.1093/nutrit/nuw045.

5. Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition 2018;21(1):5-17 doi: 10.1017/s1368980017000234.

Keywords

cancer survivors; dietary guidelines; NHANES; poverty/income ratio; ultraprocessed foods

Keywords

cancer survivors; dietary guidelines; NHANES; ratio of poverty/income; ultraprocessed foods

Highlights

• Our research on ultraprocessed food intake among cancer survivors and across different incomes and years shows unchanging levels over time. 
• Are Dietary Guidelines actually impacting those vulnerable to a poor diet? Our research on ultraprocessed food intake among cancer survivors suggests they are not. 

Highlights

• Our research on ultraprocessed food intake among cancer survivors and across different incomes and years shows unchanging levels over time. 
• Are Dietary Guidelines actually impacting those vulnerable to a poor diet? Our research on ultraprocessed food intake among cancer survivors suggests they are not. 

Visual Brief

Why aren’t the Dietary Guidelines for Americans impacting the diets of cancer survivors? Diet is especially important in this population, given the toxicity of radiation and chemotherapy and the known protective effects of a healthy diet. Ultraprocessed foods are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients. Despite this, the consumption of these foods has remained consistent among survivors, with no changes noticeable even when considering different income to poverty level ratios. We utilized nine cycles of data from the National Health and Nutrition Examination Survey (1999-2016), examining average ultraprocessed food consumption over time among different income to poverty level ratios. Poverty levels were representative of the national poverty level at the time of survey administration. Participants were grouped based on the ratio of their self-reported family income level to the national poverty level. Dietary data was collected from self-reported 24-hour recalls. We created this visual showing ultraprocessed food consumption over a seventeen-year time period, with different lines depicting the intake levels for different income to poverty level ratio groups. Average ultraprocessed food consumption remained steady over the years, with little meaningful differences between income to poverty level ratios, despite the release of several new dietary guidelines addressing fats, sugars, and salts over the time period covered in this study. Limitations of this study include the self-reported nature of the data, as well as a lack of consideration of other confounders that might affect diet access and quality. Future research on ultraprocessed food intake trends should consider adding other socioeconomic indicator variables, in addition to assessing other diet quality factors. However, our research still highlights the limited impact of the dietary guidelines on the cancer survivor population, emphasizing the need to develop and evaluate more targeted intervention programs in this vulnerable group.

Visual Brief

Why aren’t the Dietary Guidelines for Americans impacting the diets of cancer survivors? Diet is especially important in this population, given the toxicity of radiation and chemotherapy and the known protective effects of a healthy diet. Ultraprocessed foods are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients. Despite this, the consumption of these foods has remained consistent among survivors, with no changes noticeable even when considering different ratios of income to poverty level. We utilized nine cycles of data from the National Health and Nutrition Examination Survey (1999-2016), examining average ultraprocessed food consumption over time among different ratios of income to poverty level. Poverty levels were representative of the national poverty level at the time of survey administration. Participants were grouped based on the ratio of their self-reported family income level to the national poverty level. Dietary data was collected from self-reported 24-hour recalls. We created this visual showing ultraprocessed food consumption over a seventeen-year time period, with different lines depicting the intake levels for different groups of income-to-poverty-level ratios. Average ultraprocessed food consumption remained steady over the years, with little meaningful differences between income to poverty level ratios, despite the release of several new dietary guidelines addressing fats, sugars, and salts over the time period covered in this study. Limitations of this study include the self-reported nature of the data, as well as a lack of consideration of other confounders that might affect diet access and quality. Future research on ultraprocessed food intake trends should consider adding other socioeconomic indicator variables, in addition to assessing other diet quality factors. However, our research still highlights the limited impact of the dietary guidelines on the cancer survivor population, emphasizing the need to develop and evaluate more targeted intervention programs in this vulnerable group.

Peer Feedback Review

When providing feedback on your partner’s initial submission, please comment on ways the visual can be improved with respect to the 4 E’s. Keep your responses to 1-2 sentences per principle. Use the template shown here to structure your feedback, which should be posted as a comment below.

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• Evidence: Please enter your comment here.
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Self Reflection

Please reflect on what revisions you have made to your visual and abstract. Respond to the following questions regarding questions you have made in 1-2 sentences each. Use the template shown here to structure your feedback, which should be posted as a comment below.

• What changes did you make when revising your visual?
Based on feedback I received, I changed the wording of my y axis and my title to make the focus of my visual more clear including the fact that the percentage of UPF graphed was the percentage of total calories in the diet.

• What changes did you make when revising your general/scientific description? Why?
For both the scientific and the general description, I changed the wording of all of the statements where I referred to poverty, instead using the phrase “ratio of income to poverty level), to make it more clear what the word ratio was referring to.