Food insecurity, dietary quality, and cardiovascular risk in early childhood cancer survivors.

Abstract

10060 Background: Childhood cancer survivors (CCS) experience cardiovascular (CV) mortality 7 times higher than the general population. Low-income and Black CCS experience significantly higher all-cause and CV mortality than peers. Food insecurity, a modifiable CV risk factor associated with lower dietary quality, has not been investigated as a potential driver of adverse CCS CV outcomes. We characterized and assessed associations between food insecurity, dietary quality, and CV risk conditions in a prospective cohort of early CCS. Methods: Children< 18 years with a hematologic, solid, or central nervous system malignancy < 12 months from completion of cancer-directed therapy were recruited at a quaternary academic pediatric cancer center. Parents/guardians completed a single-timepoint survey including validated measures of food insecurity and dietary quality. Clinical CV risk (systolic or diastolic blood pressure ≥95 th percentile, body mass index ≥85 th percentile, dyslipidemia, or impaired glucose tolerance) and therapeutic CV risk (receipt of anthracycline, chest radiation, or total body irradiation) was abstracted from the medical record. Descriptive statistics summarized dietary quality and prevalence of food insecurity. A t-test compared associations between food security status and dietary quality, followed by multivariable linear regression adjusted for age, sex, race/ethnicity, income, and diagnosis type. Logistic regression compared associations between food security status and presence of clinical CV risk conditions. Results: Of 135 eligible participants, 119 (88%) consented to participation and 115 (97%) completed surveys, with no missing food security or dietary data. Participants were a mean age 6.5 years and mean 4.8 months from end of therapy. Twenty-seven percent (n = 31, 95% CI: 19-36%) of participants lived in food-insecure households. Mean child dietary quality was 27.6 (SD 5.3) on a 52-point scale (higher scores reflect higher quality, US adult mean score 35.0). Dietary quality was significantly lower for participants in food-insecure households compared to food-secure households on univariate analysis (25.9 vs 28.2, p = 0.04); in multivariable analyses, this difference was no longer significant. Among the subcohort (n = 97) consented to medical record abstraction, 84% (n = 81) had a CV risk factor (47% [n = 38] clinical conditions, 26% [n = 21] therapeutic exposures, and 27% [n = 22] both). Frequency of clinical CV risk conditions did not differ between children with and without food insecurity (58% vs 63%, p = 0.61). Conclusions: One in four children in early cancer survivorship lives with food insecurity. These children concurrently experience multiple CV risk factors and suboptimal dietary quality. Interventions targeting food insecurity and other modifiable CV risk factors are urgently needed to mitigate CV late effects and advance equity in survivorship outcomes.