(HealthDay News) — The diet and physical activity guideline for the prevention of cancer has been updated by the American Cancer Society; the guideline was published online in CA: A Cancer Journal for Clinicians.

Cheryl L. Rock, PhD, RD, from the University of California at San Diego, and colleagues note that the new guideline was developed to reflect the most current scientific evidence related to dietary and activity patterns and cancer risk.

The guideline includes four recommendations for individuals, the first of which is achieving and maintaining a healthy body weight throughout life and avoiding weight gain in adult life. Secondly, the importance of physical activity is emphasized: Adults should engage in 150 to 300 minutes of moderate-intensity physical activity per week, and exceeding the upper limit is optimal; sedentary activity should be limited. A healthy eating pattern should be followed at all ages, including eating a variety of vegetables, fruits, and whole grains and limiting or avoiding red and processed meats, sugar-sweetened beverages, and highly processed foods. Alcohol is best avoided; those who choose to drink alcohol should limit their consumption to 1 drink per day for women and 2 for men. Public, private, and community organizations should work to increase access to affordable nutritious food, provide opportunities for physical activity, and limit alcohol.


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“The guideline continues to reflect the current science that dietary patterns, not specific foods, are important to reduce the risk of cancer and improve overall health,” Laura Makaroff, DO, vice president of the American Cancer Society, said in a statement.


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Reference

Rock CL, Thomson C, Gansler T, et al. American Cancer Society Guideline for Diet and Physical Activity for cancer prevention. CA.

Allopurinol demonstrates noninferiority and comparable safety to febuxostat in the treatment of gout, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

The current double-blind, multicenter, randomized, 72-week trial included patients with gout (serum urate [SU] ≥6.8 mg/dL). Patients were randomly assigned 1:1 to receive allopurinol or febuxostat. All study participants had hyperuricemia that persisted despite treatment with allopurinol, and at least one-thirds had chronic kidney disease (CKD) stage 3. The 3 phases of the trial were urate-lowering therapy (ULT) titration (weeks 0-24), a maintenance phase (weeks 25-48), and an observation phase with continued ULT (weeks 49-72).

Daily doses of allopurinol and febuxostat were 100 mg (max 800 mg) and 40 mg (max 120 mg, reduced to 80 mg), respectively. Anti-inflammatory prophylaxis was administered at the discretion of the site investigator.

Primary endpoint was the number of participants who experienced at least 1 flare in the observation phase, with noninferiority indicated by a less than 8% difference. Secondary endpoints included serious adverse events, the number achieving SU less than 6 mg/dL by the end of maintenance, and the tolerability and efficacy in CKD stage 3.

A total of 940 patients with gout were included in the study; 20% of participants withdrew before study completion. During the observation phase, 35% of patients receiving allopurinol compared with 42% of those receiving febuxostat had at least 1 flare (P <.001 for noninferiority). A total of 80% of participants achieved SU less than 6.0 mg/dL, with 92% achieving serum urate less than 6.8 mg/dL.

Serious adverse events did not differ between those with and without CKD.

Researchers concluded that “allopurinol, when dosed appropriately as part of a treat-to-target strategy, is noninferior to febuxostat in the treatment of gout.” They indicated that both therapies demonstrated efficacy, with “80% of patients achieving and maintaining SU goals after 1 year and more than 90% achieving SU [less than] 6.8 mg/dL.” Researchers also noted that “no evidence of increased cardiovascular toxicity with febuxostat compared [with] allopurinol.” Furthermore, researchers indicated that “the comparative efficacy and safety of these [2] agents extended to patients with CKD stage 3.”

Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Patients with end-stage kidney disease (ESKD) who contract the novel coronavirus disease 2019 (COVID-19) have a high mortality rate, according to findings from an early case series published in the Journal of the American Society of Nephrology.

Syed Ali Husain, MD, MPH, and colleagues from Columbia University in New York studied the presentation and outcomes among 59 patients on dialysis (57 on hemodialysis and 2 on peritoneal dialysis) admitted to their medical center with COVID-19 during March 9, 2020 to April 8, 2020. Patients had a median age of 63 years, 56% were male, and 75% were Hispanic. Most patients had other comorbidities associated with COVID-19 risk. All but 1 patient had hypertension, 69% had diabetes, 46% had coronary artery disease, 54% were overweight or obese, 17% had pulmonary disease, and 32% were current or former smokers. Five patients had a previous kidney transplant, but none were currently receiving chronic immunosuppressive therapies.

The most common presenting symptoms of COVID-19 were similar to those observed in the general population: fever (49%), cough (39%), dyspnea (36%), and fatigue/malaise (22%). Fewer patients reported gastrointestinal symptoms (15%), chills (10%), myalgia (7%), or altered mental status (8%). Initial radiographs showed multifocal or bilateral opacities in 59%, unilateral opacities in 10%, and no acute findings in 19%.

Eight patients received mechanical ventilation at a median 1.5 days from admission, 40 had no ventilation, and 11 had a “do not intubate” advanced directive.


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Of the 59 patients, 18 (30.5%) died at a median 6 days after hospitalization, including 3 out of 4 mechanically ventilated patients and all 11 patients with a “do not intubate” order. Patients who died were significantly older than survivors (median age 75 vs 62 years), had a higher median Charlson comorbidity index (8 vs 7), and presented with higher white blood cell counts (median 7.5 vs 5.73 x 1000/µL) and C-reactive protein levels (median 163 vs 80.3 mg/L), the investigators reported. They acknowledged that much more data are needed before recommendations can be made.

“In conclusion, hospitalized patients with ESKD and COVID-19 displayed high mortality, although many who died had advanced directives against intubation,” Dr Hussain’s team stated. “This study reinforces the need to consider the ESKD population as a high-risk, highly vulnerable population and the need to take appropriate infection control measures to prevent the spread of COVID-19 in this group.”

Reference

Valeri AM, Robbins-Juarez SY, Stevens JS, et al. Presentation and outcomes of patients with ESKD and COVID-19 [published online May 28, 2020]. J Am Soc Nephrol. doi: 10.1681/ASN.2020040470

Reference

O’Dell J, Neogi T, Pillinger M, et al. Urate lowering therapy in the treatment of gout: a multicenter, randomized, double-blind comparison of allopurinol and febuxostat using a treat-to-target strategy. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 1900.

This article originally appeared on Rheumatology Advisor