Nutritional recommendations for patients undergoing prolonged glucocorticoid therapy

Abstract

Glucocorticoid (GC) therapy is a common treatment used in rheumatic and autoimmune diseases, owing to its anti-inflammatory and immunosuppressive effects. However, GC therapy can also induce a number of adverse effects, including muscle and bone loss, hypertension, metabolic perturbations and increased visceral adiposity. We review available evidence in this area and provide nutritional recommendations that might ameliorate these adverse effects. Briefly, optimizing calcium, vitamin D, sodium and protein intake and increasing consumption of unprocessed and minimally processed foods, while decreasing the consumption of ultra-processed foods, might counteract some of the specific challenges faced by these patients. Importantly, we identify a dearth of empirical data on how nutritional intervention might impact health-related outcomes in this population. Further research is required to investigate the clinical and therapeutic efficacy of these theory-based recommendations.

Keywords: corticosteroid; diet; food; lifestyle; nutrition; prednisone.

Fig. 1

Adverse effects attributable to prolonged glucocorticoid therapy Prolonged glucocorticoid therapy has important adverse effects in many tissues. These effects include: bone and muscle loss, which increases the risk of bone fractures and sarcopenia; metabolic impairments, which can lead to glucose and lipid dysregulation; increases in adipose tissue and visceral fat, alongside abnormal fat distribution; increased appetite and preference for high-calorie foods; and increased water and sodium retention, alongside increased blood pressure and risk for cardiovascular diseases. Mechanisms are presented in normal text, clinical outcomes in bold text. Ang II: angiotensin II; ENaC: epithelial Na⁺ channel; NO: nitric oxide.