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Box 10 Nutritional regimen with corticosteroids

From: French recommendations for the management of systemic necrotizing vasculitides (polyarteritis nodosa and ANCA-associated vasculitides)

A salt-free and/or sugar-free diet has not been scientifically shown to be of value in the fight against the secondary effects of corticosteroid therapy
What has been shown
Need for a sufficient intake of vitamin D and calcium: 1 g of calcium and 800 IU of vitamin D per day
Limitation of overall calorie intake if one wishes to avoid or limit corticosteroid-induced weight gain; it is important to advise patients to avoid snacking outside regular meals
This is often done with a weak level of evidence
A low-salt diet has been periodically recommended. The purpose is to limit an increase in arterial pressure. The majority of physicians only agree that a salt-free diet may turn out to be more harmful than beneficial, specifically among the elderly or for doses lower than 15–20 mg/day of prednisone equivalent
Potassium supplement: at high doses (bolus, prednisone ≥ 1 mg/kg/day), and in cases of potassium-reducing medications given in combination (guidance by a nephrologist if GFR < 30 ml/min), a supplement may be required
The following does not rely on any evidence
A low-sugar diet with an elevated glycemic index in order to limit the risk of corticosteroid-induced diabetes; other risk factors (dosage, family history, obesity, age) are more significant
A protein-rich diet to limit corticosteroid myopathy; above all, it is necessary to recommend physical exercise
All in all, balanced nutrition and sufficient physical exercise seem to be the best prescription