Idhifa Approved for Some With Acute Myeloid Leukemia

TUESDAY, Aug. 1, 2017 (HealthDay News) — Idhifa (enasidenib) has been approved by the U.S. Food and Drug Administration to treat adults with a specific genetic mutation that leads to relapsed or refractory acute myeloid leukemia (AML).

The mutation in the IDH2 gene can be diagnosed with a newly approved companion diagnostic, the RealTime IDH2 Assay, the agency said in a news release Tuesday.

“The use of Idhifa was associated with a complete remission in some patients and a reduction in the need for both red cell and platelet transfusions,” said Dr. Richard Pazdur, director of the FDA’s Oncology Center of Excellence.

AML is a rapidly progressing cancer that begins in the bone marrow and causes an abnormally high number of white blood cells. More than 21,000 people in the United States are projected to be diagnosed with the disease this year, and more than 10,000 are likely to die from it, the U.S. National Cancer Institute estimates.

Idhifa is designed to block enzymes that foster cell growth. The drug was clinically evaluated in a trial of nearly 200 people with relapsed or refractory AML whose IDH2 mutations were detected by the newly approved diagnostic. After a minimum of six months of treatment, 34 percent of trial participants no longer required blood transfusions, the FDA said.

Common side effects of the drug included nausea, vomiting, diarrhea, elevated levels of bilirubin (a byproduct of the liver as red blood cells are broken down) and loss of appetite.

The drug’s label will contain a boxed warning of a deadly side effect called differentiation syndrome, with possible symptoms including fever, difficulty breathing, lung inflammation and rapid weight gain.

Women who are pregnant or breast-feeding shouldn’t take the drug, the agency warned, as it could harm a developing fetus or newborn.

Idhifa is produced by Celgene Corp., in Summit, N.J. The RealTime IDH2 Assay is produced by Chicago-based Abbott Laboratories.

More information

The FDA has more about these approvals.

Women Who Gain Weight Between Babies at Higher Risk for Diabetes

TUESDAY, Aug. 1, 2017 (HealthDay News) — Women who gain weight after having a baby may be more likely to develop diabetes during their next pregnancy, a new study suggests.

Women’s weight before conception and how much they gain during pregnancy are known risk factors for gestational diabetes, the study authors explained. Gestational diabetes is a form of high blood sugar diagnosed during pregnancy. It can cause complications for both mother and baby.

Led by Linn Sorbye of the University of Bergen in Norway, researchers investigated the diabetes risk among women who had been pregnant once or twice before.

The study involved about 24,200 women who gave birth between 2006 and 2014. The researchers considered the women’s previous history of gestational diabetes and body mass index (BMI) when they got pregnant again. BMI is an estimate of body fat based on weight and height. A BMI of 30 is considered obese.

About 36 percent of the women gained more than 1 BMI unit of weight between the start of their first pregnancy and their second, the study found. These women were more likely than women whose weight was stable to develop diabetes during a second pregnancy.

Women who gained twice as much weight had double the risk for gestational diabetes. And the risk rose fivefold for women who had the greatest weight gain, the researchers found.

These risks were most striking among women whose weights were normal before their first pregnancy. The study showed, however, that overweight women who lost weight after delivery reduced their risk of diabetes during another pregnancy.

The study was published Aug. 1 in the journal PLOS Medicine.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases provides more information on gestational diabetes.

Do Your Pearly Whites Sometimes Cause You Pain?

TUESDAY, Aug. 1, 2017 (HealthDay News) — Do you feel a sharp pain when you eat or drink something cold or hot? You may have sensitive teeth, a common problem caused by a number of factors.

Gum recession is the most common cause. When the gum starts to recede, the tooth’s root becomes exposed, resulting in sensitivity, explained Jane Cotter, assistant professor at the Texas A&M College of Dentistry.

Other causes include toothbrush abrasion, tooth decay or faulty restorations, treatment for gum disease, excessive grinding or excessive bleaching.

“What you eat and drink can also cause your teeth to become more sensitive,” Cotter said in a school news release. “Sodas — both diet and regular — energy drinks, fruit juice, wine and coffee can all worsen your teeth sensitivity. Acidic foods, such as citrus fruits, are also active in this sense, but less than with liquids.”

There are a number of ways to deal with sensitive teeth.

“There are several over-the-counter toothpastes that have potassium nitrate or calcium phosphate that can help with sensitivity when used daily,” Cotter said. “The use of fluoride gels and rinses are also helpful for sensitivity. Be sure you’re using a soft-bristle toothbrush or mechanical toothbrush to help control the pressure when brushing.”

If none of those approaches work, talk with your dentist, she advised. Before doing so, make a record of tooth sensitivity details such as duration, type of pain, triggers and location.

“Tooth sensitivity is an indication of a change in the tooth or supporting tissue,” Cotter said. “Whether it’s tooth decay, infection or dentin hypersensitivity, it should be addressed.”

More information

The American Dental Association has more on dental health.

Novel Procedure Improves Kidney Transplant Success

WEDNESDAY, Aug. 2, 2017 (HealthDay News) — A new treatment might open the door for more patients with advanced kidney disease to get a transplant, a preliminary study suggests.

Of the 100,000-plus Americans waiting for a donor kidney, about one-third are “sensitized,” said Dr. Robert Montgomery, director of the Transplant Institute at NYU Langone in New York City.

Those patients face a tough situation: They harbor immune system antibodies that are primed to attack a donor organ.

The antibodies can form when a person is exposed to foreign tissue, Montgomery explained. So a patient who’s had a prior kidney transplant may be highly sensitized — meaning they have a large number of the offending antibodies.

It can also happen to patients who’ve had blood transfusion or ever been pregnant, Montgomery said.

It’s almost impossible to find a compatible donor for those patients. But they might be able to receive a kidney from an incompatible donor if they first undergo an extensive “desensitization” process.

That involves various treatments — including IV drugs called immune globulin and rituximab — that try to quash the antibodies that would attack the donor organ.

Now the new research suggests a simple approach — an infusion of a particular enzyme hours before the transplant — could offer a better alternative.

Researchers found that the treatment — dubbed IdeS — quickly wiped out the dangerous antibodies, allowing all but one of 25 patients to have a successful transplant.

The study’s findings were published in the Aug. 2 issue of the New England Journal of Medicine. Funding for the study came from the company developing IdeS — Hansa Medical.

Montgomery, who was not involved in the study, said he’s “never seen anything like it.”

“When you give this, all of the antibodies are gone,” Montgomery said. “I’m hopeful that this will turn out to be a game-changer.”

However, he stressed, many questions remain.

Critically, the enzyme does not banish the antibodies forever. They come back, Montgomery said — and the results of that comeback vary from patient to patient.

In the study, 10 patients had an episode of antibody-mediated rejection anywhere from two weeks to five months after their transplant. That means antibodies started to attack the new kidney.

Those patients were all successfully treated with standard anti-rejection drugs, according to the researchers.

Still, it’s not yet clear how the patients will fare in the long term, said Dr. Julie Ingelfinger, a professor at Harvard Medical School in Boston.

Ingelfinger, who wrote an editorial published with the study, echoed Montgomery’s cautious optimism.

If larger, longer studies bolster the current findings, she said, “this could potentially be practice-changing.”

“But,” Ingelfinger stressed, “only time will tell.”

Dr. Stanley Jordan, the lead researcher on the study, agreed that more work is necessary.

But the findings mark another step forward for patients like these, according to Jordan, who is medical director of the kidney transplant program at Cedars-Sinai, in Los Angeles.

Traditionally, highly sensitized patients in need of a kidney have languished on waiting lists because it’s so hard to find a compatible donor.

But in the past 15 years or so, desensitization has emerged as an alternative.

Last year, a landmark study proved that patients who receive transplants after desensitization live significantly longer than those who stay on dialysis.

“The outcomes have been good,” Jordan said.

But, he added, there’s clearly room for improvement.

Ingelfinger agreed. “The desensitization protocols now in use are time-consuming, and they don’t always work,” she said, noting that they can leave dangerous antibodies behind.

Desensitization adds about $20,000 to $30,000 to the cost of the transplant, according to the University of Wisconsin’s transplant center.

The new approach is quite different, Ingelfinger said.

Patients receive one infusion of an enzyme called IdeS four to six hours before the transplant.

The enzyme is derived from a strain of Streptococcus bacteria, and it essentially chops up the antibodies that would attack the organ.

Jacobs acknowledged that the source “sounds scary,” but stressed that patients do not receive the bacteria itself — but an engineered version of the enzyme.

In all, 25 U.S. and Swedish patients received an infusion of IdeS before their kidney transplant. All but one had a successful transplant, and none had detectable antibodies immediately afterward.

IdeS patients still received additional treatment — including a week of immune globulin and rituximab infusions.

And as with all transplants, they needed standard anti-rejection drugs.

Because IdeS so readily banishes the offending antibodies, it might make transplants feasible for even the most highly sensitized patients, Montgomery said.

But the “$65,000 question” remains, he said: Can it extend the survival of the donor kidney and, ultimately, patients’ lives?

IdeS is still experimental, and the only way patients could receive it is through a clinical trial. It will be “a few years” before it could be more widely available, Montgomery said.

More information

The National Kidney Foundation has more on kidney transplantation.

Massive Dinosaur With Armor Had Camouflage, Scientists Say

THURSDAY, Aug. 3, 2017 (HealthDay News) — Canadian scientists are hailing a newly identified type of armored dinosaur that had camouflage to defend against predators.

The well-preserved, 110-million-year-old specimen, called Borealopelta markmitchelli, is a type of nodosaur, researchers said.

Despite being the “dinosaur equivalent of a tank,” the 18-foot-long, more than 2,800-pound creature also had a common form of camouflage called countershading, meaning its underside was lighter than the back, researchers reported in the Aug. 3 issue of the journal Current Biology.

That suggests that even with its heavy armor, the nodosaur was on meat-eating dinosaurs’ menus.

“Strong predation on a massive, heavily armored dinosaur illustrates just how dangerous the dinosaur predators of the Cretaceous must have been,” scientist Caleb Brown said in a journal news release. He’s with the Royal Tyrrell Museum of Paleontology in Alberta.

The nodosaur was found in Alberta and is on display at the museum. Researchers called it the best-preserved armored dinosaur ever found and one of the world’s best dinosaur specimens.

“This nodosaur is truly remarkable in that it is completely covered in preserved scaly skin, yet is also preserved in three dimensions, retaining the original shape of the animal,” Brown said.

“The result is that the animal looks almost the same today as it did back in the Early Cretaceous. You don’t need to use much imagination to reconstruct it; if you just squint your eyes a bit, you could almost believe it was sleeping. … It will go down in science history as one of the most beautiful and best preserved dinosaur specimens — the Mona Lisa of dinosaurs,” Brown added.

The specimen’s condition made it possible to document the pattern and shape of scales and armor on its body. Using chemical analysis of organic compounds in its scales, the researchers discovered the dinosaur had reddish-brown-colored skin with countershading across its body.

That surprised the scientists because the dinosaur is far larger than countershaded animals living now.

Researchers are now examining the preserved contents of its gut to find out about its last meal and are working to learn more about its body armor.

The specimen was found in March 2011 by a miner who noticed something unusual in rock formations and called the museum to take a look. With laborious work over five years, the scientists found that the rocks held an armored dinosaur.

More information

The Encyclopedia of Alabama has more on nodosaurs.

Geneticists Repair Mutation in Human Embryo

WEDNESDAY, Aug. 2, 2017 (HealthDay News) — In a first-ever experiment, geneticists have successfully modified a human embryo to remove a mutation that causes a life-threatening heart condition.

This is the first study to demonstrate that a gene-editing technique can be used in human embryos to convert mutant genes back to their normal version, the researchers said.

The new procedure tackled a genetic mutation in human embryos that causes hypertrophic cardiomyopathy, an inherited condition in which the heart muscle becomes abnormally thick.

The mutation was successfully repaired in 72 percent of 18 embryos that were created in a lab using sperm from a male donor who carries the hereditary heart condition, said team member Dr. Paula Amato. She is an adjunct associate professor of obstetrics and gynecology at Oregon Health & Science University (OHSU) in Portland.

The procedure also might work in other genetic diseases caused when a person has one good copy and one mutated copy of a gene, Amato said. These include cystic fibrosis and cancers caused by mutated BRCA genes.

“This embryo gene correction method, if proven safe, can potentially be used to prevent transmission of genetic disease to future generations,” Amato said.

But while the procedure is considered to be the first of its kind, human trials are not currently allowed in the United States.

Hereditary hypertrophic cardiomyopathy occurs in about one out of every 500 adults, and is passed along when a person winds up with one good copy and one mutated copy of a gene called MYBPC3, the researchers said.

There’s a 50 percent chance that the children of a parent with the disease will inherit the genetic mutation for the disease, according to a Mayo Clinic estimate.

People with hypertrophic cardiomyopathy are at increased risk of heart failure and sudden heart death. The condition is the most common cause of sudden death in otherwise healthy young athletes, researchers said in background notes.

To repair the problem, the research team “broke” the mutated version of the MYPBC3 gene inside human embryos, using technology that allows scientists to snip a specific target sequence on a mutant gene.

Scientists discovered that when this occurs, a DNA repair process employed within human embryos activates to fix the broken gene, using the normal copy of the gene as a template.

The result: an embryo with two healthy copies of the gene that, if implanted in a woman and allowed to gestate, should result in a baby free from risk of hereditary cardiomyopathy. Further, any children descended from that baby should also be free from this genetic risk.

The researchers found that when they performed this procedure, all the cells in corrected embryos wound up containing two normal copies of the gene, Amato said.

The new report was published Aug. 2 in the journal Nature.

According to senior researcher Shoukhrat Mitalipov, “Every generation on would carry this repair because we’ve removed the disease-causing gene variant from that family’s lineage.” Mitalipov is director of the Center for Embryonic Cell and Gene Therapy at OHSU.

“By using this technique, it’s possible to reduce the burden of this heritable disease on the family and eventually the human population,” he said in a journal news release.

Amato added that researchers did not observe any “off-target effects,” or unintended genetic changes caused by altering the mutated MYPBC3 gene.

The researchers broke the mutated gene using a technology called CRISPR-Cas9. Essentially, the process uses genetic techniques to target sequences of DNA inside the mutant gene. Those targeted sequences are then snipped using Cas9, an enzyme that functions like a pair of molecular scissors.

Until now, CRISPR-Cas9 has been used as a lab tool to help scientists understand the impact that a mutation has on disease, said Donna Arnett, dean of the University of Kentucky College of Public Health. Researchers use it to introduce a mutation into genes and then study the effects of that mutation.

This new research project is a “first-of-its-kind” use of the technology to attempt to correct a mutation in human embryos, said Arnett, a spokeswoman for the American Heart Association.

The process was tested on 18 lab-created embryos using sperm from the male donor and eggs donated by 12 healthy young women, the study said. These embryos all carried one good copy and one mutant copy of MYPBC3.

“The results were encouraging,” Arnett said. “There are still many scientific details to work out, but this technology offers the potential to cure monogenetic diseases in embryos in the future, leading to normal, healthy infants.”

Used in conjunction with pre-implantation genetic diagnosis, this procedure could improve the efficiency and success of in-vitro fertilization by requiring fewer IVF cycles to produce a genetically healthy embryo, Amato suggested.

“You would minimize the risk to the woman undergoing ovarian stimulation, and certainly decrease the cost as well,” Amato said.

Researchers will next focus on testing the safety and improving the efficiency of the CRISPR-Cas9 process, possibly by using other genetic tools in combination with it, Mitalipov said. After that, they could proceed to human trials, in which the corrected embryos would be implanted with the goal of establishing pregnancy.

In the United States, the U.S. Food and Drug Administration is prohibited from considering clinical trials related to germline genetic modification, Amato said. In addition, the U.S. National Institutes of Health are not allowed to use federal funds to promote embryo research.

It is possible that human trials could occur in another country with laws allowing such procedures, Mitalipov said.

More information

For more on CRISPR-Cas9, visit the Wellcome Genome Campus.

New Treatment Approved for Acute Myeloid Leukemia

THURSDAY, Aug. 3, 2017 (HealthDay News) — The combination chemotherapy drug Vyxeos (daunorubicin and cytarabine) has been approved by the U.S. Food and Drug Administration as the first treatment for certain high-risk types of acute myeloid leukemia (AML).

AML is an aggressive blood cancer that forms in the bone marrow.

“Vyxeos combines two commonly used chemotherapies into a single formulation that may help some patients live longer than if they were to receive the two therapies separately,” said Dr. Richard Pazdur, director of the FDA’s Oncology Center of Excellence.

In a news release Thursday, the agency said more than 21,000 people will be diagnosed this year with AML, and more than 10,000 will die from it, according to projections from the U.S. National Cancer Institute.

The new therapy is sanctioned for high-risk forms of newly-diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC). People with either disease have a very low life expectancy, the FDA said.

Vyxeos was evaluated in clinical trials involving 309 people with either form of AML. Those given Vyxeos lived an average of 9.6 months, compared with 5.9 months among those who took an inactive placebo.

The therapy’s most common side effects included bleeding, fever, low white blood-cell count, rash, tissue swelling and nausea. Some users had episodes of serious allergic-like hypersensitivity reactions or dangerous bleeding, the agency said.

Women who are pregnant or breast-feeding shouldn’t take Vyxeos, the FDA added.

Approval of the drug was granted to the Irish firm Jazz Pharmaceuticals.

More information

To learn more about this approval, visit the FDA.

2 of 3 U.S. Patients Keep Unused Painkillers After Surgery

WEDNESDAY, Aug. 2, 2017 (HealthDay News) — Surgery patients are usually prescribed opioids to ease postoperative pain, but more than two-thirds end up with leftover narcotics and don’t get rid of them, according to a new report.

Moreover, most patients who have the extra opioid pills don’t lock them away, but leave them accessible to possible abuse by others, the researchers said.

“We were surprised to find that the number was as high as it was,” said lead researcher Dr. Mark Bicket. He is an assistant professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore.

“It’s likely that we — as physicians who care for patients with pain after surgery — need to do a better job of educating patients about how to take pain medication, how to store that medication and what to do with it once they’re done with the medication,” Bicket added.

Saving unneeded narcotic pain pills for a rainy day when you might be in pain may be adding to the nation’s opioid epidemic, the study authors suggested.

That’s because unused narcotics may end up in the hands of people who misuse or sell them, said Dr. Gary Deutsch. He is a surgical oncologist at Northwell Health Cancer Institute in Lake Success, N.Y. Deutsch was not involved with the new study, but was familiar with the findings.

The 2015 National Survey on Drug Use and Health found that nearly 4 million Americans took opioids (such as Oxycontin or Percocet) for non-medical reasons every month.

More than 2 million people in the United States are addicted to prescription painkillers, according to federal reports.

Opioids do, however, have their place in managing pain after surgery, Bicket said.

“Opioid medications for pain after surgery are an essential treatment,” he said. “We have evidence that there are patients who legitimately need these medications, and sometimes pain after surgery has been undertreated.”

For their report, Bicket and his colleagues reviewed six previously published studies that included a total of more than 800 patients who had various types of surgery.

Across the six studies, 67 percent to 92 percent of patients said they had unused narcotic painkiller pills. Moreover, 42 percent to 71 percent of the pills prescribed weren’t taken, according to the patient reports.

Most patients stopped or didn’t use the pills because their pain was under control, and 16 percent to 29 percent said they didn’t take them because of the side effects.

In two studies that looked at how unused painkillers were stored, 73 percent to 77 percent of the participants said their prescription opioids were not kept in locked containers, which is recommended by the U.S. Food and Drug Administration.

Most patients intended to keep their unused pills, and only about 9 percent of the patients said they planned to get rid of their pills using the recommended FDA procedures, Bicket’s team found.

According to the American Academy of Family Physicians, all opioids should be stored in their original packaging inside a locked cabinet, lockbox or a location where others can’t easily get to them.

In addition, many communities have programs to help dispose of unused narcotics, Bicket said. These include take-back programs run by local hospitals or the police.

“Opioids are something to be concerned about given the current opioid crisis,” Bicket said.

Deutsch said, “We need to reflect on our practices. Are we giving too many pills to our patients? Are we not gauging our patients’ pain tolerance appropriately?”

Maybe patients don’t need 30 or 40 pills after surgery. Maybe they need only 10, Deutsch suggested.

Doctors don’t get training in how to manage narcotic painkillers, he said. “We base it on experience,” he explained.

“I’ve gone to limiting these medications for ambulatory [out-patient] operations, because I find that the vast majority of patients do not require them and can get by with just an over-the-counter medication, such as Tylenol or Advil,” Deutsch said.

The report was published online Aug. 2 in the journal JAMA Surgery.

This type of study, called a meta-analysis, tries to find common themes across several studies. The researchers said the methods used in the studies they reviewed were not of the best quality and the questionnaires completed by patients varied in form, structure, phrasing and timing. Therefore, the authors acknowledge that further study is needed.

More information

For more on how to store and dispose of unused opioids, visit the American Academy of Family Physicians.

Drug for Kidney Disease Tied to Infection Risk

TUESDAY, Aug. 1, 2017 (HealthDay News) — A drug used for some cases of kidney disease can raise the risk of serious infections, researchers say.

A clinical trial was stopped early when researchers discovered that patients on the drug — a corticosteroid called methylprednisolone — suffered a concerning number of serious side effects. Most often, that meant severe infections, including pneumonia and meningitis.

Overall, nearly 15 percent of patients on the drug had a serious “adverse event” over two years, the investigators found.

That compared with 3 percent of patients given placebo pills, the researchers reported.

The study focused on patients with a form of kidney disease called immunoglobulin A (IgA) nephropathy. It arises when IgA — an immune system protein — builds up in the kidneys, leading to inflammation.

Methylprednisolone and other corticosteroids suppress the immune system and quell inflammation related to severe allergies, asthma, arthritis and other conditions. Some small studies had suggested they can help treat IgA nephropathy.

Since the drugs dampen the immune response, it’s no surprise that infections would be a side effect, kidney disease experts said.

“What was alarming was the magnitude of the risk,” said Dr. Michelle O’Shaughnessy, who wrote an editorial published with the study. “It was greater than we might have anticipated.”

Yet the findings should not spell the end of corticosteroids for IgA nephropathy, said O’Shaughnessy, a kidney disease specialist at Stanford University.

She noted that when the trial was stopped, there were signals that methylprednisolone was also benefiting patients. Those on the drug had a lower risk of progressing to severe kidney disease or dying from the condition.

The issue, O’Shaughnessy explained, is that only a relatively small number of patients had developed kidney complications at that point in the trial. So no firm conclusions can be made.

“The infection risk shows up early, soon after patients begin taking the drug,” O’Shaughnessy said. “But any benefits would take a longer time to show up.”

Dr. Vlado Perkovic, the senior researcher on the trial, agreed.

Since corticosteroids might help some patients with IgA nephropathy, studies should keep looking into safer ways to deliver them, said Perkovic, of the George Institute for Global Health, in Australia.

For now, he said, “caution” should be used in prescribing corticosteroids for IgA nephropathy, and patients should be told of the risks so they can make an “informed choice.”

As it stands, only a minority of IgA nephropathy patients would be on a corticosteroid, O’Shaughnessy said. (She noted that in the United States, prednisone is the predominant one.)

A mainstay of treatment is blood pressure control with drugs like ACE inhibitors, to help limit damage to the kidneys, O’Shaughnessy explained. Patients may also take a diuretic to help remove excess fluid from the blood.

Current guidelines say a six-month course of corticosteroids can be considered for some patients. But the guidelines are based on small studies.

This latest trial put corticosteroids to a tougher test.

Perkovic’s team randomly assigned 262 patients to a course of either methylprednisolone pills or an inactive placebo.

The trial was stopped when it became clear that patients on the drug had a five-times higher rate of adverse effects — mainly infections.

At that point, though, the treated patients’ rate of kidney complications was lower. Just under 6 percent (eight participants) had progressed to severe kidney disease or died, compared with 16 percent (20) of placebo patients, according to the report.

Where does that leave patients and doctors? O’Shaughnessy said it will be important to think about each individual situation.

A younger patient in otherwise good health may have a high risk of eventually progressing to end-stage kidney disease and needing dialysis. For that person, O’Shaughnessy said, the possible benefits of corticosteroids may outweigh the infection risk.

But for an elderly person in poor health, she said, the risk of a dangerous infection may weigh more heavily.

The state of the kidney disease matters, too. Over time, IgA nephropathy can cause irreversible scarring of the kidney tissue. For patients with a lot of scarring, corticosteroids would be unlikely to help; for those with inflammation but little scarring, the drugs would likely be more effective, O’Shaughnessy suggested.

IgA nephropathy is thought to be an autoimmune disease, according to the U.S. National Institutes of Health (NIH). That means it’s caused by an abnormal immune system attack on the kidneys.

A person can have the disease for years without knowing it, the NIH says. When signs do arise, they can include blood or protein buildup in the urine.

About 20 percent to 40 percent of adults with IgA nephropathy progress to end-stage kidney disease within 10 to 20 years, according to the NIH.

The study results appear in the Aug. 1 issue of the Journal of the American Medical Association. Pfizer Pharmaceuticals provided the study drug.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has an overview of IgA nephropathy.

Rich, Well

TUESDAY, Aug. 1, 2017 (HealthDay News) — The Mediterranean diet — rich in fruits, vegetables, fish, olive oil, nuts and whole grains — has long been hailed as a heart-healthy eating plan. But new research suggests its health benefits may be limited to the rich and well-educated.

For the study, a team of Italian scientists reviewed diets, income and education level of nearly 19,000 men and women.

The investigators found the Mediterranean diet was associated with about a 60 percent lower risk of heart disease and stroke among those with higher incomes and more education. The same was not true for those with fewer resources — even though they followed a similar eating plan.

Healthy habits — such as getting regular exercise, routine check-ups, and not smoking — are more common among people with higher incomes. But the study findings held up even after the researchers accounted for these variables and others, such as marital status and body mass index (a measurement based on height and weight).

The team investigated other possible explanations for this healthy diet disparity. The findings showed that the wealthier participants ate less meat and consumed more fish and whole grains than those with lower incomes.

The more affluent people also ate a greater variety of fruits and vegetables, which provided more antioxidants and other essential nutrients. The researchers concluded that food quality may be as important for health as how much people eat and how often.

“Money may provide access to a larger variety of foods typical of the Mediterranean diet, such as fruits and vegetables, thus obtaining more adequate intake of essential nutrients,” said the study’s leader, Giovanni de Gaetano. He’s head of the department of epidemiology and prevention at the I.R.C.C.S. Neuromed Institute in Pozzilli, Italy.

Many of the most nutritionally valuable foods in the Mediterranean diet — including fish, olive oil and produce — aren’t cheap.

“Let’s think about a five-member family who wants to attain to the five-a-day portion of fruits and vegetables,” de Gaetano said. “This sounds quite expensive.”

Cooking methods also differed among the study participants. The people with more money and education were more likely to prepare their vegetables in healthier ways, which preserve their nutritional value.

Joan Salge Blake is a clinical associate professor and dietetic internship director at Boston University. She said the more affluent “are more likely to have better health care, access to a variety of diverse fruits and vegetables, and an overall understanding about the role of lifestyle and diet in disease prevention.”

So, she added, “costs and access to healthy foods will clearly impact the quality of a person’s diet and lifestyle.”

That doesn’t mean individuals and families on a tight budget can’t afford to follow the Mediterranean diet, Salge Blake stressed. She offered the following budget-friendly advice:

Look for variety and sales. When it comes to overall diet quality, the more fruit and veggies on your plate, the better. Choose produce that is on sale, which will stretch your food dollar.Buy in-season. Produce tastes a lot better when it’s in season. It’s also much less expensive. Bottom line: you’re more likely to eat fruit if it’s sweet and you’ll probably load up on veggies if they are more flavorful. Don’t overcook. How you cook vegetables can affect their nutritional value. “Typically, the less cooking time will cause the least loss of nutrients,” Salge Blake said.Consider frozen and canned foods. “Canned fish and frozen veggies and fruit are oftentimes more affordable than fresh, and can pack an equal, if not more, nutrient punch per bite,” Salge Blake said. Try affordable alternatives. Olive oil is considered a staple of the Mediterranean diet but it’s pricey. “Other plant oils — such as soybean oil — are healthy and affordable, so you don’t have to consume only olive oil,” Salge Blake said. She noted the Mediterranean diet contains legumes, such as dried beans and peas, which are extremely affordable.

The study was published online July 31 in the International Journal of Epidemiology.

More information

The American Heart Association has more about the Mediterranean diet.