Associations between Diet Quality and Risk of Mortality among Cancer Survivors, Results from NHANES 1999-2018

Document Type

Conference Proceeding

Publication Date

7-1-2026

Publication Title

Curr Dev Nutr

Keywords

plant protein, adult, all cause mortality, blue rubber bleb nevus, cancer diagnosis, cancer mortality, cancer risk, cancer survivor, cardiovascular disease, conference abstract, controlled study, diet quality, dietary intake, ethnicity, Fabaceae, female, Healthy Eating Index, human, male, malignant neoplasm, middle aged, mortality, mortality risk, sea food, United States, whole grain

Abstract

Objectives: Evidence has suggested that better diet quality is beneficial for specific cancer survivors. Further investigation is needed regarding the overall diet quality, adherence to the dietary guideline, and their associations with mortality. We evaluated the association between diet quality and mortality (all-cause, cardiovascular disease (CVD) and cancer) among adult cancer survivors in the US. Methods: The National Health and Nutrition Examination Survey (NHANES) 1999-2018 cohort was followed through 31 December 2019. Adults aged 19 years and above and reported a history of cancer diagnosis were identified as cancer survivors (n= 2,887). Diet quality, measured by Health Eating Index (HEI)-2020, was assessed using reliable dietary intake data collected through 24-h dietary recalls. Mortality outcomes including all-cause, CVD- and cancer-specific mortality were determined via linkage with the National Death Index. Cox regression model was applied to estimate hazard ratios (HR) and 95% confidence intervals (CIs). Results: The mean HEI-2020 total score was 51.9 out of 100, with particularly low component scores for greens and beans (1.36 out of 5), whole grains (2.87 out of 10), seafood and plant proteins (2.27 out of 5), and total fruits (2.33 out of 5). Every 5-point increase in HEI-2020 total score was associated with a 6% lower risk of all-cause mortality (HR=0.94, 95% CI, 0.92-0.97) and a 7% lower risk of cancer-specific mortality (HR=0.93, 95% CI, 0.89-0.98), adjusting for age, sex and race/ethnicity. In fully adjusted analyses, every 5-point increase in HEI-2020 total score was associated with a 3% reduction in the risk of all-cause mortality (HR=0.97, 95% CI: 0.95-1.00). No significant associations were observed between HEI-2020 total score and cancer- and CVD-specific mortality among cancer survivors. Conclusions: Our findings indicate that better dietary quality may reduce risk of mortality among adult cancer survivors. Further studies are needed to confirm our results. Funding Sources: N/A.

Volume

10

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