Abstract
Risk of cardiovascular disease (CVD), common in childhood cancer survivors (CCSs), may be affected by diet. We assessed sodium (Na) and potassium (K) intake, estimated from food frequency questionnaires (FFQs) and morning urine spots, and its associations with cardiovascular risk in CCSs. We stratified CCSs into three risk profiles based on (A) personal history (CVD, CVD risk factors, or CVD risk-free), (B) body mass index (obese, overweight, or normal/underweight), and (C) cardiotoxic treatment (anthracyclines and/or chest irradiation, or neither). We obtained an FFQ from 802 and sent a spot urine sample collection kit to 212, of which 111 (52%) returned. We estimated Na intake 2.9 g/day based on spot urine and 2.8 g/day based on FFQ; the estimated K intake was 1.6 g/day (spot urine) and 2.7 g/day (FFQ). CCSs with CVD risk factors had a slightly higher Na intake (3.3 g/day), than CCSs risk free (2.9 g/day) or with CVD (2.7 g/day, p = 0.017), and obese participants had higher Na intake (4.2 g/day) than normal/underweight CCSs (2.7 g/day, p < 0.001). Daily Na intake was above, and daily K intake below, the national recommended levels. Adult survivors of childhood cancer need dietary assistance to reduce Na and increase K intake.
Highlights
Cardiovascular disease (CVD) is the leading non-malignant cause of death in childhood cancer survivors (CCSs) [1,2,3]
The Swiss Childhood Cancer Survivor Study (SCCSS) is a population-based, long-term follow-up study of all childhood cancer patients registered in the Swiss Childhood Cancer Registry (SCCR) with leukemia, lymphoma, central nervous system tumors, malignant solid tumors, or Langerhans cell histiocytosis diagnosed in Switzerland
Personal history of CVD and modifiable cardiovascular risk factors (A) was split into: (1) “CVD” including heart attack, cardiomyopathy, angina pectoris, atrial fibrillation, arteriosclerosis, stroke, transient ischemic attack (TIA), and/or deep venous thrombosis; (2) “CVD risk factors” including hypertension, obesity, diabetes mellitus treated with either tablets or insulin, current smoking, and/or high cholesterol defined as treatment with lipid-lowering medications, or (3) “CVD risk-free” if survivors did not report any of these conditions
Summary
Cardiovascular disease (CVD) is the leading non-malignant cause of death in childhood cancer survivors (CCSs) [1,2,3]. Hypertension, obesity, diabetes mellitus, smoking, and dyslipidemia are primary contributors to CVD [9,10,11] These risk factors are relevant for CCSs and represent important modifiable factors in the development and severity of CVD [12,13,14]. In CCSs, obesity management may substantially reduce the risk of premature cardiac risk: obese CCSs who received cardiotoxic treatment have a nine-times higher risk of developing coronary artery disease, higher than expected under an additive assumption [13]. Na:K ratio in spot or 24 h urine is a biomarker of Na and K intake that is strongly and positively associated with CVD risk. We determine if Na and K intakes are associated with CVD and modifiable cardiovascular risk factors
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