Abstract
Purpose: A high-quality diet improves mental health outcomes in non-cancer populations.
Prostate cancer survivors are vulnerable for poorer mental health and may benefit from
following a high-quality diet. This cross-sectional study examined eating behaviour, adherence
to the Mediterranean diet (Med-diet), and mental health in prostate cancer survivors. Multiple
regression analysis explored associations between eating behaviour as well as associations
between Med-diet adherence and mental health.
Methods: An online survey was employed and Med-diet adherence was measured with the
Mediterranean Adherence Screener (MEDAS), mental health was evaluated with the
Depression Anxiety Stress Scale 21 (DASS-21), food choice with a selection of questions from
the American Cancer Society’s nutrition and activity quiz, and behavioural intention regarding
following healthy and unhealthy eating principles over the next 4 weeks.
Results: Most survivors (n=70, 71.9±6.7 yrs) were ≥3-years post-diagnosis, retired (79%), had a
prostatectomy (43%) or had completed hormone therapy (45%). Adherence to a Med-Diet was
low with 70% having a MEDAS score of <5.0 (4.7±1.9). Unhealthy food choices were limited by
most including salt intake (84%), high-energy baked goods (89%), fried foods (74%), and
alcohol (83%). Few survivors met recommended intake for vegetables (3%), nuts and seeds
(33%), legumes (37%), and fish (40%). Multiple regression analysis found no association
between MEDAS and DASS-21 sub-scale scores. Lower intent to limit unhealthy eating
behaviour was associated with higher DASS-21 depression (β=-0.569, p<0.001), anxiety (β=-
0.648, p<0.001) and stress sub-scale scores (β=-0.442, p=0.001) in unadjusted and adjusted
models (covariates: age, body mass index, physical activity, comorbidities).
Discussion: While the majority of survivors limited unhealthy food choices, they were not
meeting a number of recommended food guidelines and had low adherence to the Med-diet.
Significant associations between mental health and eating behaviour intent in these survivors
highlights the need for dietetic support to enhance diet quality and its associated health benefits
in those with poorer mental health. Further research is warranted to explore the direction of
these associations and the role of diet in supporting mental health of prostate cancer survivors.