ArticleFrontiers in nutrition2026
Longitudinal relationships of malnutrition risk, sleep disturbance, and fear of cancer recurrence in thyroid cancer patients: a cross-lagged panel model.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Although papillary thyroid carcinoma (PTC) is generally associated with favorable survival, postoperative recovery often involves persistent nutritional, psychological, and behavioral challenges. Malnutrition risk, fear of cancer recurrence (FCR), and sleep disturbance are all clinically relevant in thyroid cancer survivorship, yet their temporal interrelationships remain unclear. This study aimed to examine the longitudinal reciprocal relationships among malnutrition risk, FCR, and sleep disturbance in patients after PTC surgery. Methods: A prospective longitudinal study enrolled 940 patients with PTC from January 2024 to September 2025. Assessments were conducted at 3 days, 1 month, 3 months, and 6 months after surgery; 893 participants completed all four assessments. Malnutrition risk was measured using the Patient-Generated Subjective Global Assessment, FCR using the FCR-4, and sleep disturbance using the Pittsburgh Sleep Quality Index. Longitudinal measurement invariance was tested prior to structural modeling. A cross-lagged panel model was then used to evaluate autoregressive and cross-lagged associations among the three constructs across four waves. Results: Malnutrition risk gradually increased over time, whereas FCR and sleep disturbance decreased. All three variables showed significant autoregressive effects across adjacent waves. FCR was consistently prospectively associated with subsequent sleep disturbance across all intervals. Sleep disturbance was prospectively associated with subsequent FCR during the later follow-up periods only. The association between malnutrition risk and FCR was stage-dependent. Conclusion: Malnutrition risk, FCR, and sleep disturbance showed dynamic and stage-dependent longitudinal relationships during postoperative recovery in patients with PTC. These findings support repeated screening and integrated supportive care that includes nutritional monitoring, sleep management, and assessment of FCR.
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