Manual of Clinical Nutrition Management III- 20 Copyright © 2013 Compass Group, Inc.
CORTICOSTEROID THERAPY
Discussion
Corticosteroids, in the synthetic forms of natural hormones, are potent anti-inflammatory medications that
can be given orally or by injection. They can produce severe side effects, such as hypertension, high blood
glucose levels, an increased risk of infection, osteoporosis, fluid retention, decreased ability to heal wounds
and fragile skin. Widely used corticosteroid preparations are prednisone, prednisolone, hydrocortisone,
methylprednisone, and dexamethasone (1).
Indications
Corticosteroids are used as (1):
immunosuppressive therapy for organ transplant recipients
short term management of various inflammatory and allergic disorders: rheumatoid arthritis,
collagen disease, dermatologic disease and autoimmune disorders (eg, systemic lupus
erythematosus)
treatment of ulcerative colitis, acute exacerbations of multiple sclerosis, and palliation in some
leukemias and lymphomas
Approaches
Dietary interventions may be needed for side effects of corticosteroids.
Table III-6: Dietary Interventions for Side Effects of Corticosteroids
Problem Recommendation
Decreased calcium absorption
Osteroporosis (“glucocorticoid arthritis”), thought to result
from decreased intestinal absorption and increased renal
excretion of calcium
Ensure calcium intake (dietary or by
supplementation) to meet Dietary Reference
Intake for age.Increase sunshine exposure or dietary vitamin D.Hyperglycemia (steroid induced glucose intolerance) Adjust diet accordingly.
May require insulin or oral glucose lowering
medication.Edema; hypertension due to water retention May need sodium-restricted diet (2).
Weight gain due to increased appetite Behavioral strategies for dealing with increased
appetite.
See “Calorie-Controlled Diet for Weight
Management”, in Section IC.Exercise.
Negative nitrogen balance secondary to increased protein
catabolism
High-protein diet: 1 to 2 g/kgAdequate energy: 30 to 35 kcal/kgReferences
- Corticosteroids. Nursing 2003 Drug Handbook. 23rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins Publishers 2003: 7 01 - 721.
- Escott-Stump S. Nutrition and Diagnosis-Related Care. 5th ed. Baltimore, Md: Williams & Wilkins; 2002: 317.