Association between Post-Diagnosis Dietary Quality and Mortality in Prostate Cancer Survivors: Insights from NHANES 2005-2018

Abstract

Background: Limited and inconsistent evidence is available on the association between dietary quality and mortality in prostate cancer (PCa) survivors. The present study aimed to elucidate the association between dietary quality, measured by the Healthy Eating Index (HEI), and mortality outcomes in PCa survivors. Methods: We analyzed data from 460 PCa survivors, representing a population of 2.25 million, derived from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The HEI-2020 total and component scores were calculated based on the 24-hour dietary recall interviews, and a qualified score indicates a higher diet quality. The Weighted Cox Proportional Hazards Models were employed to evaluate the association between HEI-2020 and mortality outcomes. Results: After adjusting for potential confounders, no significant association was observed between the total HEI-2020 score and all-cause, cancer-specific, or non-cancer mortality. As for the components, a qualified fatty acid score (indicating higher consumption of poly- and monounsaturated fatty acids), and a qualified added sugars score (indicating lower consumption) were associated with reduced risk of all-cause mortality (HR 0.64 and 0.54, 95%CI: 0.41 - 1.00 and 0.31 - 0.94, respectively) and cancer-specific mortality (HR 0.33 and 0.40, 95%CI: 0.14 - 0.79 and 0.17 - 0.92, respectively, all P < 0.05). Conversely, a qualified sodium score (indicating limited consumption) was associated with an increased risk of all-cause and non-cancer mortality (HR 1.81 and 2.25, 95%CI: 1.05 - 3.12 and 1.31 - 3.85, respectively). Additionally, a qualified green and beans score (indicating higher consumption) was associated with an increased risk of cancer-specific mortality (HR 2.18, 95%CI: 1.11 - 4.31). Conclusions: Higher HEI-2020 scores do not uniformly translate to a reduced mortality risk among PCa survivors, and recommendations should focus on balanced dietary habits that emphasize healthier fat sources and reduced added sugars intake to enhance long-term survival and quality of life for this population. These results also highlight the need for further research with a larger sample size to develop tailored dietary assessments and recommendations for PCA survivors.