Dietary Patterns and Cardiovascular Disease Risk in Childhood Cancer Survivors: St. Jude Lifetime Cohort

项目摘要 美国儿童癌症幸存者的数量每年都在增加。据估计， 到2020年将有50万儿童癌症幸存者。儿童癌症幸存者的风险增加 发展慢性健康状况，部分原因是由于他们以前的癌症治疗。他们开发了这些 患病年龄较低，患病率高于一般人群。非癌症的主要原因 儿童癌症幸存者的发病率和死亡率最高的疾病是心血管疾病（CVD）。有力证据 支持健康的饮食，如阻止高血压的饮食方法（DASH）和谨慎的模式 饮食，降低了一般人群中CVD的风险，这表明饮食应该是CVD的优先领域 在一般人群中进行管理和预防。然而，目前尚不清楚饮食是否具有类似的 对CVD高危儿童癌症幸存者的有益影响。很少有研究检查 饮食与儿童癌症幸存者任何不良健康结果的关系。大多数都很小， 仅评估营养状况，或侧重于青少年或年轻人，而不是长期老化的成年人 儿童癌症幸存者为了缩小我们对饮食在心血管疾病中的作用的认识差距， 儿童癌症的成年幸存者，我们建议调查饮食模式是否与癌症的发生有关。 圣犹达终身队列研究（SJLIFE）中的CVD风险。SJLIFE是一项回顾性队列研究， 儿童癌症幸存者的前瞻性终身随访。这项研究收集了参与者的 社会人口统计学、健康行为和病史以及来自医疗记录的癌症治疗数据。饮食 使用食物频率问卷进行评估。参与者还接受全面的医疗 在圣裘德儿童研究医院进行检查，以评估健康状况，包括心血管疾病。我们 我将研究两种相互补充的饮食模式：1）DASH评分基于 坚持一套饮食建议，证明可以降低血压，并与降低风险有关。 一般人群中的CVD;和2）通过因子分析得出的研究特定饮食模式， 确定儿童癌症幸存者特定的饮食模式。我们将推导并描述两种饮食模式 - DASH饮食和研究特定的饮食模式（目标1）;评估饮食模式与 心血管疾病风险（目标2）;并研究高、低血压人群的饮食模式与心血管疾病风险之间的关系。 潜在CVD风险组。我们的研究将提供急需的信息， 健康饮食对心血管疾病风险的影响，以及可能从饮食干预中受益的幸存者的特征。 此外，我们的研究将大大有助于开发新的CVD预防策略， 为儿童癌症幸存者提供基于证据和风险的饮食建议，这将指导临床医生 和幸存者维持健康和生活质量。

PROJECT SUMMARY 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.