(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.

Novel calcineurin inhibitor voclosporin maintained meaningful reductions in proteinuria, with a stable estimated glomerular filtration rate (eGFR), in patients with lupus nephritis, according to an interim analysis of the AURORA 2 extension study, presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 5 to 9, 2021.

Previously, phase 3 AURORA 1 and phase 2 AURA-LV studies suggested that voclosporin compared with mycophenolate mofetil and low-dose steroids alone significantly increased kidney response and reduced proteinuria in patients with lupus nephritis.

The current report provided data on the second interim analysis of the ongoing AURORA 2 study, a 2-year, blinded, and controlled extension study.

All participants in the AURORA 1 trial had biopsy-proven lupus nephritis, and those who completed the 12 months’ trial were eligible to continue in the 18 months’ AURORA 2 trial with the same randomized treatment of voclosporin or placebo, in addition to mycophenolate mofetil and low-dose oral steroids.

The extension study included 116 patients in the voclosporin group and 100 patients in the placebo group. Of these, 90 patients in the treatment group and 78 patients in the placebo group had received 30 months of total treatment and were included in the current interim analysis.

Mean urine protein creatinine ratio at pretreatment baseline in AURORA 1 was 3.94 mg per mg in the voclosporin group and 3.87 mg per mg in the placebo group. Least-squares mean changes in urine protein creatinine ratio from pretreatment baseline to 30 months were -3.32 mg per mg for the voclosporin group and -2.55 mg per mg for the placebo group.

The researchers noted a small, expected, and early decrease in mean eGFR in the first 4 weeks of treatment in AURORA 1, after which the rates remained stable through month 30.   

There were no unexpected new adverse events among individuals in the voclosporin group compared with those in the control group. Infection with COVID-19 was reported in 6 patients in the voclosporin group and 10 patients in the placebo group, with 2 and 6 patients, respectively, reporting serious COVID-19 infection.

“Patients in the voclosporin treatment arm maintained meaningful reductions in proteinuria with no change in mean eGFR at 30 months of treatment. Additional AURORA 2 efficacy and safety data will be provided at the conclusion of the study,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of 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

Saxena A, Cohen S, Mela C, Coeshall A. Voclosporin for lupus nephritis: interim analysis of the AURORA 2 extension study. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 1425.

This article originally appeared on Rheumatology Advisor