[Systemic corticosteroid therapy: patients' adherence to dietary advice and relationship between food intake and corticosteroid-induced lipodystrophy].
OBJECTIVE
No data is available about: 1) the adherence of corticosteroid-treated patients to dietary advice provided by physicians; 2) the relationship between food intake and the corticosteroid-induced lipodystrophy (CIL).


METHODS
We conducted a cohort study in 2 French tertiary centers between June 2003 and May 2005 and enrolled all consecutive patients starting long-term systemic corticosteroid therapy. They received individual dietary advice from a qualified dietetician and were asked to record on a standardized questionnaire everything they ate during one week of the first and third months of treatment, including details of each meal. Each questionnaire was analysed by two qualified dieteticians for daily calorie, carbohydrate, fat, protein and sodium intake. Moreover, 3 investigators assessed the development of CIL from standardized patients' photographs. The relationship between food intake and CIL was investigated by a multiple logistic regression model.


RESULTS
Eighty-eight patients were included and 80 were monitored until at least month 3 (women: 76%, mean age: 59.1+/-18.7 years). Most patients (65%) had giant-cell arteritis or connective tissue disease. The mean initial dosage of prednisone was 54+/-17 mg/day and the mean M3 dosage was 31+/-15 mg/day. Most patients were adherent to dietary advice during the first 3 months of therapy except for protidic ration which was below expected value. Sodium restriction was more strictly followed by women than by men. Multivariate analysis showed independent relationship between CIL and higher calorie intake (>30 kcal/kg/day). No relationship was evidenced between carbohydrate, protein, fat or sodium intake and the risk of CIL.


CONCLUSIONS
During the first 3 months of therapy, corticosteroid-treated patients are adherent to dietary advice. A calorie-controlled alimentation could be beneficial to limit the risk of CIL.
Fardet
L
L
Service de médecine interne, Horloge 2, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France. laurence.fardet@sat.aphp.fr
Flahault
A
A
Kettaneh
A
A
Tiev
K-P
KP
Tolédano
C
C
Lebbe
C
C
Cabane
J
J
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D004032:Diet; D015930:Diet Records; D005260:Female; D006801:Humans; D008060:Lipodystrophy / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones