Disproportionate burden of poor diet quality among individuals diagnosed with oropharyngeal cancer during critical periods of cancer care: The U-DINE study

Abstract

Background

Poor diet quality is a key modifiable determinant of health at all stages of life, with significant implications for individuals diagnosed with oropharyngeal cancer (OPC), in whom swallowing difficulties and treatment side effects often restrict diet. Understanding diet quality and specific dietary inadequacies faced by this population during critical periods of cancer care is crucial to identifying interventions to improve cancer outcomes in a rapidly growing population of cancer survivors.

Methods

Between February 2022 and April 2024, diet was assessed using two non-consecutive 24-hour recalls by a trained registered dietitian among 68 individuals at diagnosis and 113 long-term survivors (≥18 months after treatment) treated at MD Anderson Cancer Center or Michael E. DeBakey Veterans Affairs Medical Center. Diet quality scores were calculated based on the Healthy Eating Index (HEI-2020), reflecting adherence to the 2015 to 2020 Dietary Guidelines for Americans, and the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations. Daily intakes of 21 food components of dietary guidelines were calculated using averages from two dietary interviews.

Results

Among individuals at the time of OPC diagnosis (mean age, 60 years), the mean HEI-2020 was 49.3 out of 100, which is nearly 50% below the optimal score and 19% lower than the mean score of 61 for generally healthy U.S. adults of similar age. Among long-term survivors (65 ± 8 years old), mean scores were similarly low at 48.3. Mean WCRF/AICR adherence scores were 2.2 out of 5 for individuals at diagnosis, and 2.8 for long-term survivors, 44% to 56% below the WCRF/AICR optimal score. Major dietary insufficiencies included suboptimal intake of fruits, vegetables, whole grains, greens and beans, dairy, healthy fats, and excessive consumption of sodium, saturated fats, and ultra-processed foods.

Conclusions

Our findings highlight poor diet quality among individuals with OPC both at diagnosis and during long-term survivorship, underscoring the need for targeted dietary interventions during critical periods of cancer care.