(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.

Individuals with gout were found to exhibit greater lumbosacral spine (LS) monosodium urate (MSU) deposition and intercritical inflammation, according to research results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

The investigators recruited 75 individuals with gout, 72 of whom completed the study. Age was similar among the control (61.8±3.8 years), nontophaceous (64.0±6.1 years), and tophaceous (60.4±11.0 years) groups (P =.81), ranging from 45 to 80 years. Exclusion criteria included spondyloarthropathy, rheumatoid arthritis, active spinal malignancy, urate-lowering treatment (ULT) of 6 months or more, and calcium pyrophosphate dihydrate crystal deposition disease. The ACR gout classification criteria of serum urate level greater than 6.8 mg/dL or greater than 6.0 if patients received ULT for less than 6 months were applied at study entry. The researchers collected demographic information, Aberdeen back pain scale, gout history, serum urate level, C-reactive protein level, and erythrocyte sedimentation rate (ESR). To assess MSU deposition, dual-energy CT (DECT) of the lumbosacral spine was performed.

Body mass index differed significantly between the control (28.3±6.5), nontophaceous (34.1±7.2), and tophaceous (29.5±4.5) groups (P =.03), as did creatinine level (1.0±0.2 mg/dL, 1.4±0.7 mg/dL, and 1.4±0.6 mg/dL, respectively; P <.05). Individuals with gout exhibited higher mean serum urate levels (control, 5.3±1 mg/dL, nontophaceous, 8.5±1.7 mg/dL, and tophaceous, 8.5±1.6 mg/dL; P <.05) and ESR (control, 13.7±13.8 mm/h, nontophaceous, 26.5±19.4 mm/h, and tophaceous, 25.1±15.7 mm/h; P <.05). MSU volumes were larger among those with gout compared with the control group (5.23±6.9 cm3 vs 2.2±1.2 cm3, respectively; P =.03) and greater among the tophaceous vs the nontophaceous group (6.0±8.9 cm3 vs 4.4±4.3 cm3). Use of highly specific DECT settings to eliminate artifact confirmed greater deposition among those with gout despite decreasing the number of individuals with MSU (n=29; control, 0/9; tophaceous with deposition, 2/9; nontophaceous with deposition 1/11). Back pain was reported more frequently by patients with gout.  Spinal DECT did not demonstrate frank tophi in any patient.

The study authors concluded, “[Patients with] gout have significantly greater intercritical inflammation and [lumbosacral spine] MSU deposition than control [participants]” and report a “trend toward greater deposition among patients with tophi.”

Disclosure: This clinical trial was supported by Horizon Therapeutics plc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. 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

Toprover M, Mechlin M, Slobodnick A, et al. Assessing the extent of lumbosacral spinal urate deposition in patients with tophaceous and nontophaceous gout compared with non-gout controls using dual-energy CT (DECT). Poster presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 467.

This article originally appeared on Rheumatology Advisor