Electronic Theses and Dissertations Archive

Date

2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Social & Behavioral Sciences

Committee Chair

Latrice Pichon

Committee Member

Marian Levy

Committee Member

Yimei Li

Committee Member

Yong Yang

Abstract

Background: Adult childhood cancer survivors (CCS) face an elevated risk for metabolic syndrome (MetS), contributing to adverse long-term cardiovascular outcomes. Dietary behaviors are modifiable risk factors for MetS, yet investigations remain limited in this at-risk population. Notably, gaps persist in evidence regarding how overall adherence to preventive dietary behaviors and sex differences relate to MetS within the context of social determinants of health (SDOH). Methods: This retrospective, cross-sectional study analyzed baseline data from adult CCS enrolled in the St. Jude Lifetime Cohort. Dietary adherence was assessed using the Alternative Healthy Eating Index-2010 (AHEI-2010), derived from a validated block food frequency questionnaire. MetS was defined using National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria based on standardized clinical and laboratory measures. Multivariable logistic regression models evaluated associations between AHEI -2010 total score, individual components, and MetS. Effect modification by sex was assessed using an interaction term. Models sequentially were adjusted for individual socioeconomic status, neighborhood-level disadvantage (2019 Area Deprivation Index), clinical, and behavioral factors. Results: MetS was present among 18.6% of survivors in the overall baseline sample (n = 5,044), with low adherence to multiple preventive dietary patterns. Higher AHEI -2010 total scores were associated with lower odds of MetS in minimally adjusted models. This inverse association attenuated and became non-significant after further adjustment. Sex did not modify the association between overall dietary adherence and MetS. In fully adjusted models, clinical factors emerged as significant correlates of MetS, including older age at diagnosis, longer time since diagnosis, and radiation exposure, while meeting physical activity guidelines was protective. Neighborhood-level socioeconomic disadvantage demonstrated a consistent association with MetS and remained the only significant social factor after full adjustment. Conclusions: Among CCS, dietary behaviors and MetS are shaped by a complex interplay of individual, behavioral, clinical, and environmental factors. Although sex did not modify the association between dietary adherence and MetS outcomes, sex- and gender-informed approaches are still warranted for understanding behavioral patterns among CCS and designing effective interventions. Future behavioral interventions should be grounded in theoretical frameworks to provide a deeper understanding of the context in which behavior-disease relationships interact in CCS.

Comments

Data is provided by the student.”

Library Comment

Dissertation or thesis originally submitted to ProQuest/Clarivate.

Notes

Open Access

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