(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.

Lupus nephritis (LN) mortality rates have decreased overall from 1999, but researchers identified a significant increase from 2015 to 2019 among those who are non-White and those living in large central metropolitan areas. Study results were presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021. 

Although large strides have been made in research and therapy during the previous 20 years, systemic lupus erythematosus (SLE) mortality still remains disproportionately high relative to general population mortality.

Researchers sought to analyze mortality trends from 1999 to 2019 and identify population characteristics associated with LN mortality, using information from the US Centers for Disease Control and Prevention (CDC)’s WONDER database. 

Data for SLE and LN mortality were categorized by race, ethnicity, and urbanization. Race and ethnicity data were classified into the following groups: Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaska Native, and non-Hispanic Asian/Pacific Islander. Urbanization was defined by population size: large central metropolitan, large fringe metropolitan, medium metropolitan, small metropolitan, micropolitan, and nonmetropolitan, based on 2006 urbanization data.

There were a total of 25,973 deaths from SLE and 8899 deaths from LN between 1999 and 2019. According to the joinpoint regression analysis, the SLE age-standardized mortality rate continuously decreased from 1999 through 2009, plateaued between 2009 and 2012, and again decreased from 2012 to 2015. The rates of LN underwent an overall 26.1% decrease in 21 years; however, LN mortality rates significantly increased from 2015 to 2019.

Researchers found that although Black individuals only account for 12.8% of the US population, they accounted for 38% of all LN deaths. Lupus nephritis mortality among Black patients was 6-fold higher than among White patients, and more than 2-fold higher than among all other racial and ethnic groups. Lupus nephritis mortality was also significantly higher among Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander groups than among the White group.

The large central metropolitan area had the highest mortality rate, accounting for 35.1% of LN deaths (P <.05 relative to all other areas), followed by medium metropolitan areas.

The researchers concluded, “Studies are urgently needed to understand reasons underlying these disparities and the recent worsening trend.”

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

Yen E, Rajkumar S, Sharma R, et al. Lupus nephritis mortality in the United States, 1999-2019: profound disparities by race/ethnicity and place of residence and a recent worsening trend. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0454.

This article originally appeared on Rheumatology Advisor