Sodium and Potassium Intakes and Cardiovascular Risk Profiles in Childhood Cancer Survivors: The SCCSS-Nutrition Study

Fabiën N Belle, Christina Schindera, Idris Guessous, Maja Beck Popovic, Marc Ansari, Claudia E Kuehni, Murielle Bochud, Fabiën N Belle, Christina Schindera, Idris Guessous, Maja Beck Popovic, Marc Ansari, Claudia E Kuehni, Murielle Bochud

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.

Keywords: Europe; Swiss Childhood Cancer Registry; cardiovascular disease; childhood cancer survivors; diet; food frequency questionnaire; nutrition; potassium; sodium; urine spot.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Bland–Altman plot of (a) average sodium and (b) potassium intake based on the intake calculated with a food frequency questionnaire 1 and a morning fasting spot urine in 111 childhood cancer survivors of the SCCSS-Nutrition study. FFQ—food frequency questionnaire; SCCSS—Swiss Childhood Cancer Survivor Study. Y = 0 is the line of perfect average agreement, the hollow circles (○) represent females and the black diamonds (♦) represent males. 1 Sodium (Na) intake based on food frequency questionnaire (FFQ) data was calculated with the equation: (8.20 + 0.38 × FFQ in males)/2.54 and (4.55 + 0.67 × FFQ in females)/2.54, with 1 g Na = 2.54 g salt (NaCl) [25]. Na intake is clustered by sex due to this equation. Intake based on FFQ data only gives a mean daily intake of 1.9 g ± 0.8.
Figure 2
Figure 2
Cardiovascular risk profile B—correlation between BMI and sodium 1 (a) and potassium (b) measurements by food frequency questionnaire (FFQ) and morning fasting spot urine samples. BMI—body mass index; FFQ—food frequency questionnaire. 1 Sodium (Na) intake based on FFQ data was calculated with the equation: (8.20 + 0.38 × FFQ in males)/2.54 and (4.55 + 0.67 × FFQ in females)/2.54, with 1 g Na = 2.54 g salt (NaCl) see [25]. Intake based on FFQ data only gives a mean daily intake of 1.9 g ± 0.8.

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