doi: 10.1111/cea.12505 Clinical & Experimental Allergy, 45, 908–919 ORIGINAL ARTICLE Asthma and Rhinitis © 2015 John Wiley & Sons Ltd Effects of short-term oral corticosteroid intake on dietary intake, body weight and body composition in adults with asthma – a randomized controlled trial B. S. Berthon 1 , P. G. Gibson 1 , P. McElduff 2 , L. K. MacDonald-Wicks 3 and L. G. Wood 1 1 Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, 3 School of Health Sciences, University of Newcastle and 2 School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Clinical & Experimental Allergy Correspondence: Dr Bronwyn Berthon, Centre for Asthma and Respiratory Disease, Level 2, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, Newcastle, NSW 2305, Australia. E-mail: bronwyn.berthon@newcastle. edu.au Cite this as: B. S. Berthon, P. G. Gibson, P. McElduff, L. K. MacDonald- Wicks and L. G. Wood, Clinical & Experimental Allergy, 2015 (45) 908–919. Summary Background Oral corticosteroids (OCS) are an efficacious treatment for asthma exacerba- tions, yet risk of adverse effects may decrease patient adherence to therapy. In particular, changes in appetite and dietary intake, which lead to weight gain and changes in body composition, are considered undesirable. Objective To determine whether 10-day OCS therapy in adults with asthma causes changes in leptin, appetite, dietary intake, body weight and body composition. Methods Double-blinded, placebo-controlled randomized cross-over trial of 10 days pred- nisolone (50 mg) in adults with stable asthma (n = 55) (ACTRN12611000562976). Pre- and post-assessment included spirometry, body weight, body composition measured by dual-energy X-ray absorptiometry and bioelectrical impedance analysis, appetite mea- sured using a validated visual analogue scale (VAS) and dietary intake assessed using 4-day food records. Leptin was measured as a biomarker of appetite and eosinophils as an adherence biomarker. Outcomes were analysed by generalized linear mixed models. Results Subject adherence was confirmed by a significant decrease in blood eosinophils (9 10 9 /L) following prednisolone compared to placebo [Coef. À0.29, 95% CI: (À0.39, À0.19) P < 0.001]. There was no difference in serum leptin (ng/mL) [Coef. 0.13, 95% CI: (À3.47, 3.72) P = 0.945] or appetite measured by VAS (mm) [Coef. À4.93, 95% CI: (À13.64, 3.79) P = 0.267] following prednisolone vs. placebo. There was no difference in dietary intake (kJ/day) [Coef. 255, 95% CI: (À380, 891) P = 0.431], body weight (kg) [Coef. À0.38, 95% CI: (À0.81, 0.05) P = 0.083] or body fat (%) [Coef. À0.31, 95% CI: (À0.81, 0.20) P = 0.230]. Symptoms including sleep and gastrointestinal disturbance were reported significantly more often during prednisolone vs. placebo. Conclusions and Clinical Relevance Short-term OCS in stable asthma did not induce significant changes in appetite, dietary intake, body weight or composition, although other adverse effects may require medical management. This evidence may assist in increasing medication adherence of asthmatics prescribed OCS for exacerbations. Keywords appetite, asthma, corticosteroids, diet, leptin Submitted 3 October 2014; revised 2 November 2014; accepted 12 November 2014 Introduction Oral corticosteroids (OCS) are an extremely effective anti-inflammatory medication, prescribed in various conditions, including asthma [1]. Unfortunately their efficacy is shadowed by their adverse event profile, which includes minor to life-threatening adverse effects [1]. Serious adverse effects of OCS include osteoporosis, arterial hypertension, diabetes, psychosis, lipodystrophy (morphological changes of fat accumulation in facial, dorsocervical and abdominal region), hypothalamic– pituitary–adrenal (HPA) axis suppression, cataracts, glaucoma, skin thinning, easy bruising and myopathy [1, 2]. Less serious effects may include anxiety or mood changes, nausea, vomiting, anorexia or increased appe- tite, weight gain or weight loss, stomach bloating or