Examining diet quality and patient-reported outcomes in myeloproliferative neoplasms: Results from a cross-sectional observational study

Abstract INTRODUCTION: Patients with myeloproliferative neoplasms (MPNs) experience substantial symptom burden, elevated cardiovascular disease (CVD) risk, and chronic inflammation. Poor diet quality may increase the risk of CVD and exacerbate fatigue, psychological distress, and overall quality of life (QOL) impairments, yet the role of diet quality in MPN management remains understudied. While healthy dietary patterns have been shown to reduce CVD risk and improve symptom control in cancer populations, limited data exist on the dietary quality of MPN patients and their association with patient-reported outcomes. We therefore conducted a cross-sectional analysis among newly diagnosed MPN patients to characterize diet quality and evaluate associations between diet quality and patient-reported outcomes. METHODS: We conducted a cross-sectional secondary analysis among adults with newly diagnosed MPN (essential thrombocythemia [ET], polycythemia vera [PV], myelofibrosis [MF], or chronic myeloid leukemia [CML]) who reported diet and patient-reported outcomes in an observational study at a tertiary academic center. Patients completed validated questionnaires assessing QOL (Functional Assessment of Cancer Therapy [FACT-G] and the 12-Item Short Form Physical and Mental Component Scores [SF-12 PCS/MCS]), psychological distress (Hospital Anxiety and Depression Scale [HADS-A/D]), and symptom burden (MPN Symptom Assessment Form Total Symptom Score [MPN SAF TSS]). Dietary intake was assessed using the Automated Self-Administered 24-hour Dietary Assessment (ASA-24), and diet quality was evaluated using the Healthy Eating Index 2020 (HEI-2020) score (range: 0-100, with higher scores indicating greater alignment with the Dietary Guidelines for Americans). Spearman's rank correlation coefficients (ρ) were calculated to examine associations between diet quality and patient-reported outcomes, followed by multivariable linear regression to evaluate associations adjusted for age, MPN subtype, education, income, and household size. RESULTS: Of the 35 MPN patients enrolled, 13 (MPN sub-types: n=2 ET, n=4 PV, n=1 MF, n=6 CML) completed the ASA-24 and were included in the analysis. Participants were on average 67.4 ± 8.5 years, predominantly White (92%), female (46%), and on-treatment at study enrollment (92%). Mean energy intake was 2041 ± 480 kcal/day. Mean HEI-2020 score was 59.3 ± 14.3, indicating suboptimal diet quality and poor alignment to dietary guidelines. The HEI sub-components with the highest compliance (%) to dietary guidelines were total protein foods (85%), refined grains (78%), and added sugars (77%), while the HEI sub-components with the lowest compliance were sodium (38%), whole grains (42%), and dairy (45%). We found no significant correlations between HEI scores and patient-reported outcomes (p>0.05; FACT-G: ρ=-0.17; HADS-A: ρ=0.24; HADS-D: ρ=0.19; SF-12 PCS: ρ=-0.38; SF-12 MCS: ρ=-0.14; MPN SAF TSS ρ=0.15). In adjusted models, higher diet quality (per 10-point increase in HEI-2020 score) was not significantly associated with quality of life (FACT-G: β = –6.18 ± 3.67, p = 0.143), anxiety (HADS-A: β = 2.12 ± 1.34, p = 0.165), depression (HADS-D: β = 1.23 ± 1.15, p = 0.326), physical health (SF-12 PCS: β = –2.50 ± 1.49, p = 0.143), mental health (SF-12 MCS: β = –3.80 ± 1.70, p = 0.066), or symptom burden (MPN-SAF TSS: β = 2.70 ± 3.27, p = 0.440). CONCLUSIONS: We found suboptimal diet quality with poor alignment to recommended dietary guidelines in patients with MPNs. Despite this, diet quality was not significantly associated with patient-reported outcomes. However, the small sample size and cross-sectional study design limit our interpretation. These results support the need for dietary interventions in MPN populations and underscore the importance of conducting larger studies to clarify the role of nutrition and behavioral modification on disease outcomes.