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Diet

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises a group of autoimmune disorders characterized by the inflammation of small- to medium-size blood vessels. AAV can affect different organs, such as the kidneys and lungs, and cause a range of symptoms, including fatigue, weight loss, joint pain, and skin rashes.^1,2

Patients with AAV may experience nutritional challenges that are both clinical manifestations of the disease and side effects of immunosuppressive treatments. Close monitoring of the nutritional status of patients can help avoid complications.³

Nutritional Challenges in AAV

Gastrointestinal (GI) problems are frequent in patients with AAV, including diarrhea, pain, bleeding, and malabsorption. Those who have granulomatosis with polyangiitis (GPA) can lose more than 10% of their body weight, even if the GI tract is not involved.³

The various medications used to treat AAV, including Cytoxan® (cyclophosphamide) and corticosteroids, can be the cause of GI symptoms such as nausea and anorexia. Corticosteroids affect bone density and muscle mass and may cause truncal obesity.³

Read more about AAV risk factors

Supplementation for AAV

Calcium and vitamin D supplementation is standard procedure for patients treated with corticosteroids, and prophylaxis with bisphosphonate therapy may be required to prevent bone loss.³

Supplementation with other vitamins, such as vitamin E and vitamin C, has been regarded as potentially useful adjuvant therapy in AAV; however, more studies are needed to clarify the role of these antioxidants and determine whether they elicit a clinical response.⁴

Read more about AAV treatment

Diet Recommendations for AAV

Patients with AAV do not need to follow any specific diet because no evidence has been found that diet affects susceptibility to vasculitis, or that the consumption of certain foods positively or negatively affects the course of the disease.⁵ A healthful, balanced diet is recommended by the American Heart Association for improving overall health.^6,7 Such a diet is rich in protein and vegetables and avoids the consumption of processed foods.⁵

Dietary restrictions and recommendations can be formulated for patients with specific conditions, such as high blood pressure, renal insufficiency, and diabetes, to help them manage their condition.⁶ A dietitian can help them prepare meal plans and address their individual needs.

Patients with high blood pressure should limit their intake of saturated fat, sodium, red meat, sweets, and beverages containing sugar. Instead, their diet should include⁸:

Fruits
Vegetables
Whole grains
Low-fat dairy products
Skinless poultry and fish
Nuts and legumes
Non-tropical vegetable oils

Read more about AAV complications

Patients who have AAV with kidney disease benefit from a diet with limited sodium. Their sodium intake should be less than 2300 mg/d. Some tips for reducing sodium intake include⁹:

Avoiding processed foods, which often contain high levels of sodium
Using herbs and spices rather than salt to add flavor to foods
Choosing low-sodium versions of foods such as canned vegetables and soups
Consuming the right amounts and types of protein
Limiting the consumption of saturated and trans fats

Patients with diabetes should eat a variety of healthful foods, including vegetables, fruits, grains, protein, and dairy. The amount of each should be specified in a meal plan. Foods to limit include those high in saturated and trans fats, sodium, and sugar.¹⁰

Read more about AAV comorbidities

References

1. Qasim A, Patel JB. ANCA positive vasculitis. StatPearls [Internet]. Updated May 29, 2022. Accessed March 14, 2023.

2. ANCA-associated vasculitis. GARD|Genetic and Rare Diseases Information Center. Accessed March 14, 2023.

3. Dellaripa PF, Howard D. Nutritional issues in vasculitis. In: Coleman LA, ed. Nutrition and Rheumatic Disease. Humana Press;2008:215-226. Accessed March 14, 2023.

4. Harper L, Nuttall SL, Martin U, Savage COS. Adjuvant treatment of patients with antineutrophil cytoplasmic antibody-associated vasculitis with vitamins E and C reduces superoxide production by neutrophils. Rheumatology (Oxford). 2002;41(3):274-278. doi:10.1093/rheumatology/41.3.274

5. Vasculitis frequently asked questions. Johns Hopkins Vasculitis Center. Accessed March 14, 2023.

6. Should I be on a particular diet? Vasculitis Foundation. Accessed March 14, 2023.

7. The American Heart Association diet and lifestyle recommendations. American Heart Association. Accessed March 14, 2023.

8. Managing blood pressure with a heart-healthy diet. American Heart Association. Accessed March 14, 2023.

9. Eating right for chronic kidney disease. NIH|National Institute of Diabetes and Digestive and Kidney Diseases. Accessed March 14, 2023.

10. Diabetes diet, eating, & physical activity. NIH|National Institute of Diabetes and Digestive and Kidney Diseases. Accessed March 14, 2023.

Reviewed by Harshi Dhingra, MD, on 3/14/2023.

Diana Diez Gaspar, PharmD, PhD

Diana earned her PhD and PharmD with distinction in the field of Medicinal and Pharmaceutical Chemistry at the Universidade do Porto. She is an accomplished oncology scientist with 10+ years of experience in developing and managing R&D projects and research staff directed to the development of small proteins fit for medical use.

ANCA-Associated Vasculitis (AAV)