Dietary patterns and knowledge-attitude-practice factors are associated with late recurrence of non-muscle-invasive...

The influence of long-term dietary habits on bladder cancer (BC) recurrence beyond the first postoperative year remains unclear, particularly in populations with distinct dietary traditions. This study investigated the associations between dietary knowledge, attitudes, and practices (KAP) and late recurrence (≥12 months after transurethral resection of bladder tumor, TURBT) in a coastal Zhejiang population.

This retrospective case-control study included 264 patients with non-muscle-invasive bladder cancer (NMIBC), comprising 85 cases with recurrence ≥12 months post-TURBT and 179 recurrence-free controls who were frequency-matched for age, sex, tumor stage, and follow-up duration. Tumor grade was not a matching criterion but was adjusted for in multivariable analyses. Dietary KAP was assessed using a structured questionnaire, and habitual dietary intake was evaluated using a culturally adapted food frequency questionnaire (FFQ). Multivariable logistic regression was used to identify independent dietary factors associated with recurrence.

Patients in the recurrence group had significantly lower dietary knowledge scores (5.9 vs. 7.3, p < 0.001) and less favorable attitudes (28.7 ± 5.8 vs. 32.4 ± 4.9, p = 0.003) than controls. High consumption of preserved seafood (≥1/week: aOR = 2.15, 95% CI: 1.28-3.62), low intake of cruciferous vegetables (<1 serving/week: aOR = 2.41, 95% CI: 1.42-4.10), and inadequate daily water intake (<1.0 L/day: aOR = 2.58, 95% CI: 1.38-4.82) were independently associated with increased recurrence risk, with significant dose-response trends (all p-for trend <0.05). Higher knowledge scores correlated significantly with adherence to protective dietary practices.

In this coastal Zhejiang population, poor dietary knowledge, unfavorable attitudes, and specific dietary patterns- particularly high preserved seafood intake, low cruciferous vegetable consumption and inadequate hydration- were independently associated with late BC recurrence. These findings support incorporating culturally tailored dietary education into routine survivorship care for patients with BC.