Diet and Exercise Interventions in Pediatric Cancer Survivors and Effects on Cardiometabolic Disease Risk and Inflammaging Biomarkers: A Systematic Review

The population of pediatric cancer survivors (PCSs) in the United States has been steadily increasing over the last decade. However, due to cancer-related treatment and subsequent lifestyle behaviors related to diet and physical activity, PCSs are burdened by accelerated biological aging leading to early onset of chronic diseases. The accelerated aging process may be due to "inflammaging," a phenomenon associated with cardiometabolic disease risk factors, including chronic inflammation and changes in gut microbiome structure and function. This systematic review was conducted to explore the literature as it relates to the impact of diet and/or exercise interventions in survivors of a pediatric cancer on markers of inflammaging and cardiometabolic risk markers. PubMed, CINAHL, and clinicaltrials.gov were searched for relevant interventional trials. Studies were included if they contained 1) an intervention arm that included survivors of a pediatric cancer, 2) an intervention that contained a dietary and/or exercise intervention, and 3) outcomes related to cardiometabolic disease risk or inflammaging. Bias was assessed using the Cochrane "Risk of Bias Tool" or "Risk of Bias In Nonrandomized Studies of Interventions," and extracted data were qualitatively reported. Of the 16 studies identified, 2 studies employed a diet intervention, 6 studies employed an exercise intervention, and the remaining 8 implemented a combined diet and exercise intervention. Exercise was associated with an improvement in glucose homeostasis, yet results were inconsistent across studies. Decreases in body mass index and increases in lean body mass were reported in some diet and exercise interventions. Cautionary interpretation of the outcomes is warranted as the studies had a high risk of bias. Future studies in this area should include trials with a rigorous design, larger sample sizes, and increased accessibility of the intervention to address the chronic disease burden among this group of cancer survivors. The study and protocol were registered in PROSPERO (CRD42024511586).