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

项目总结 美国儿童癌症幸存者的数量每年都在增加。据估计，将有 到2020年，将有50万儿童癌症幸存者。儿童癌症幸存者面临更高的风险 出现慢性健康状况的可能性，部分是由于他们以前接受过癌症治疗。他们开发出这些 儿童患病的年龄较小，发病率高于一般人群。非癌症的主要致病因素 儿童癌症幸存者的发病率和死亡率是心血管疾病(CVD)。强有力的证据 支持健康饮食，如停止高血压的饮食方法(DASH)和谨慎模式 饮食，降低了普通人群患心血管疾病的风险，表明饮食应该是心血管疾病的优先领域 在普通人群中的管理和预防。然而，目前还不清楚饮食是否也有类似的作用 对患心血管疾病风险较高的儿童癌症幸存者的有益影响。很少有研究考察过 儿童癌症幸存者饮食与任何不良健康后果的关系。其中大多数都很小， 只评估营养状况，或侧重于青少年或年轻人，而不是长期老龄化的成年人 儿童癌症的幸存者。为了弥合我们对饮食在心血管疾病中的作用的理解上的这一知识差距 作为儿童癌症的成年幸存者，我们建议调查饮食模式是否与 圣裘德终身队列研究中的心血管疾病风险研究(SJLIFE)。SJLIFE是一项长期的回顾性队列研究 儿童癌症幸存者与前瞻性的终生随访。这项研究收集了参与者的 来自医疗记录的社会人口、健康行为、病史和癌症治疗数据。饮食 是使用食物频率问卷进行评估的。参与者还将接受全面的医疗检查 在圣犹大儿童研究医院进行检查，以评估包括心血管疾病在内的健康状况。我们 我将考察两种相辅相成的饮食模式：1)基于 坚持一系列饮食建议可以降低血压并降低患糖尿病的风险。 普通人群中的心血管疾病；以及2)通过因素分析得出的研究特定的饮食模式，可能 确定儿童癌症幸存者特有的饮食模式。我们将派生并描述两种饮食模式 -DASH饮食和特定于研究的饮食模式(目标1)；评估饮食模式和 心血管疾病风险(目标2)；并调查饮食结构与心血管疾病风险之间的关系。 潜在的心血管疾病风险组。我们的研究将提供急需的信息，以了解 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，我们的研究将对开发新的心血管疾病预防策略和 对儿童癌症幸存者的循证和基于风险的饮食建议，这将指导临床医生 和幸存者关于保持健康和生活质量的建议。

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.