Final Project Submission

Partners: Sora Johnson

Title. Messages About Diet Quality and Ultraprocessed Foods Aren’t Reaching Cancer Survivors, a Population Especially Vulnerable to Dietary Choices

Legend. In this infographic, statistics and other key numbers are indicated in large black type, with data from NHANES 1999-2016 and other sources cited on the image. General text and illustrative figures are in blue. Pink text reflects ultraprocessed foods, and a pink color is also used to highlight the silhouettes of survivors who will develop late effects from the toxicity of their treatment. Purple text indicates the key take-home messages summarizing this infographic, while green text highlights the benefits of a healthy diet.

Abstract

Cancer survivors have an increased risk of developing chronic comorbidities due to the toxicity of their treatments.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 they 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 average ultraprocessed food consumption among cancer survivors. Despite the release of four dietary guidelines during this time addressing the detrimental components of ultraprocessed foods, the consumption of these remained high, at 55%. Our work highlights the limited impact of dietary guidelines among cancer survivors, emphasizing the need for better messaging about the importance of diet quality, in addition to targeted intervention programs in this vulnerable group.

Keywords

cancer survivors; dietary guidelines; NHANES; ultraprocessed foods; diet quality

Highlights

• Research on ultraprocessed food intake among cancer survivors suggests the Dietary Guidelines are not reaching this vulnerable group.
• Although a healthy diet can help prevent late-term effects from treatment, cancer survivors still consumed excess ultraprocessed foods.

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.^1-4 Ultraprocessed foods are high in unhealthy fats, refined starches, sugars, and salt, and low in dietary fibers and micronutrients: in other words, poor dietary choices for this group.⁵ We utilized data from the National Health and Nutrition Examination Survey (1999-2016) to determine the consumption of ultraprocessed foods among 4527 cancer survivors, examining the average over time using self-reported 24-hour dietary recalls. All data analyzed was weighted according to NHANES analytic guidelines so that infographic results are representative of the United States population at the time of each survey year. Despite the release of four dietary guidelines over this period addressing the detrimental properties of ultraprocessed foods like unhealthy fats, sugars, and salts, the consumption of these remained high, at 55% of total calories. 

Based on our findings that cancer survivors were consuming large amounts of ultraprocessed foods and had poor adherence to the Dietary Guidelines for Americans, we targeted our infographic towards providers and care teams who work with cancer survivors. Statistics and other key numbers are indicated in large black type to highlight our findings and their importance, while general text and illustrative figures are in blue. We used pink text for the words “ultraprocessed foods,” to make this key word of our graphic stand out; the same color is also used to highlight the silhouettes of survivors who will develop late effects from the toxicity of their treatment. We chose to do this to emphasize the detrimental impacts of the components of ultraprocessed foods, arguably in line with treatment late effects. Purple text indicates the key take-home messages summarizing this infographic, while green text was chosen to highlight the benefits of a healthy diet.

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. In order to maintain the visual appeal of our infographic and stay focused in our message to providers, we chose to present only a small number of statistics and facts. 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. 

References.

1.     American Cancer Society. Long-Term Side Effects of Cancer. Accessed 10-14-2022, https://www.cancer.org/treatment/survivorship-during-and-after-treatment/long-term-health-concerns/long-term-side-effects-of-cancer.html

2.     Klonoff-Cohen H, Polavarapu M. Existence of late-effects instruments for cancer survivors: A systematic review. PLOS ONE. 2020;15(2):e0229222. doi:10.1371/journal.pone.0229222

3.     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. Jun 1 2018;4(6):783-790. doi:10.1001/jamaoncol.2018.0126

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. Dec 2016;74(12):737-748. doi:10.1093/nutrit/nuw045

5.     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. Nov 16 2020;11(6):1569-1582. doi:10.1093/advances/nmaa082

6.     National Center for Health Statistics. NHANES Questionnaires, Datasets, and Related Documentation. Centers for Disease Control and Prevention. Accessed 12–14-22, https://wwwn.cdc.gov/nchs/nhanes/default.aspx

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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Self Reflection

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