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Diet quality of cancer survivors and non-cancer controls and its association with obesity and neighbourhood environment in Atlantic Canada Gu, Qianqian


Background: Cancer survivors may be motivated to change their diet for weight management and improved survival. However, dietary behaviours and obesity are influenced by a range of individual-level and environmental factors rather than simply individual choices. This study aims to understand the diet quality of cancer survivors and its association with obesity and neighbourhood environment in comparison to non-cancer controls. Methods: A cross-sectional study was conducted with 19,973 participants aged 35 to 69 years from Atlantic Canada. A healthy eating index (HEI) was used to evaluate diet quality using dietary intake collected from a food frequency questionnaire. Obesity was assessed using anthropometric and bio-impedance measures. Neighbourhood environment data were derived from the Canadian dissemination-area-level census data. Multivariable multi-level models were used to investigate HEI and its association with obesity in cancer survivors compared to non-cancer controls. The associations between neighbourhood deprivation, population density and HEI were also explored. Results: Cancer survivors (n = 1930) had a higher mean HEI than non-cancer controls (mean difference: 0.45, 95% CI [0.07, 0.84]). Body mass index, waist circumference, waist-to-hip ratio, body fat percentage, and fat-free mass index were not associated with HEI, while trunk fat percentage had a weak positive association with HEI (0.45, 95% CI [0.08, 0.83]). The diet-obesity relationship did not significantly differ by cancer status. Mean HEI was lower in the most compared to the least socially deprived neighbourhoods (-0.56, 95% CI [-0.88, -0.25]), and in the most compared to the least dense neighbourhoods (-0.39, 95% CI [-0.77, -0.01]), but was not associated with material deprivation. Associations between diet quality, material deprivation and population density significantly differed by urbanicity. In rural areas, diet quality decreased with increasing material deprivation and decreasing population density, while the reverse was true for urban areas. Conclusion: Cancer survivors had a slightly better diet quality than non-cancer controls, but both groups are in need of dietary improvement. Diet was not associated with obesity measures in the cancer and non-cancer groups but was associated with neighbourhood deprivation and population density with evidence of urban-rural differences, suggesting the complexity of dietary behaviour and the need for multi-level interventions.

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