Nutritonal evaluation of pemphigus foliaceus patients on long term glucocorticoid therapy

Abstract

Our objective was to compare food intake and nutritional status of Pemphigus Foliaceus patients (PG) on long term glucocorticoid therapy to a Control Group (CG). Fourteen PG female inpatients receiving prednisone (0.33 +/- 0.22mg/kg) for at least 12 months and twelve CG subjects were submitted to nutritional evaluation, including anthropometry, urinary creatinine determination and serum biochemical measurements, besides 48-h-based food intake records. Groups were compared by Chi-square, Mann-Whitney and "t" tests. PG patients and CG were paired, respectively, in relation to age (24.7 +/- 14.1 vs. 22.0 +/- 12.0 years), body mass index (25.8 +/- 6.4 vs. 24.0 +/- 5.6kg/m2), daily protein intake (132.9 +/- 49.8 vs. 95.2 +/- 58.9g), and serum albumin (median; range) (3.8; 3.5-4.1 vs. 3.8; 3.6-5.0g/dl). However, PG patients had lower height-creatinine index (64.8 +/- 17.6 vs. 90.1 +/- 33.4%), and higher daily energy (3080 +/- 1099 vs. 2187 +/- 702kcal) and carbohydrate (376.8 +/- 135.8 vs. 242.0 +/- 80.7g) intakes. Despite high food, protein and energy consumption, PG patients on long term glucocorticoid therapy had lower body muscle mass than controls, while showing high body fat stores. These findings are possibly related to combined metabolic effects of long term corticotherapy and inflammatory disease plus corticosteroid-induced increased appetite.

Intervenção fisioterapêutica promove melhora na qualidade de vida de indivíduos com pênfigo

“…Também concordando com a literatura, em 100% dos casos, o tratamento medicamentoso preconiza o efeito anti-inflamatório e imunossupressor dos glicocorticóides conciliado a dieta hipossódica [7][8][9][10][11][12] .…”

“…De acordo com a dose administrada e tempo de tratamento os glicocorticóides geram efeitos colaterais por ação na maior parte das glândulas do corpo, alterando consequentemente o metabolismo orgânico [7][8][9][10][11][12] . A alteração metabólica pode causar síndrome de Cushing iatrogênica, acúmulo de gordura centripetamente, redução da tolerância a carboidratos, fragilidade vascular e cutânea, miopatias, fraqueza muscular, hipertensão arterial, osteoporose, maior suscetibilidade a infecções, alterações psiquiátricas, até mesmo hipertensão arterial e, ocasionalmente, hipocalemia e hirsutismo e/ou virilização 13 .…”

Serum lipids of pemphigus foliaceus patients on long-term glucocorticoid therapy

“…To accurately estimate the consumed nutrients, kitchen utensils (plates, glasses, and spoons) and containers of known capacity were used. A registered dietician calculated daily food and energy intake using a PC program, and the food tables utilized were obtained from the U.S. Department of Agriculture, Handbook n o 8,1980, with some regional foods added 6 . Daily energy expenditure was determined by HarrisBenedict formula 14 , and daily energy intake was calculated through actual energy intake x 100/ basal energy expenditure.…”

Pemphigus: a disease stamped in the skin

“…In the treatment is common to use glucocorticoids, due to its antiinflammatory and immunosuppressive proprieties. Although effective in controlling the disease, glucocorticoids can lead to side effects, changing the organic metabolism, which, in turn, can cause accumulation of centripetal fat, reduce the tolerance to carbohydrates, vascular and skin fragility, muscle weakness, hypertension, osteoporosis and increased susceptibility to infections [6]. Thus, there are significant changes in the quality of life of patient, including the absence from work and social life, by the side effects of medications such as the characteristics of the disease [7].…”