Nutrition: a key environmental dietary factor in clinical severity and cardio-metabolic risk in psoriatic male patients evaluated by 7-day food-frequency questionnaire

Journal of Translational Medicine

Sep 2015

DOI: 10.1186/s12967-015-0658-y

Citations:76

Influential Citations:7

Observational Studies (Human)

Enhanced Details

Methods

Design: cross-sectional case-control observational study. Participants: 41 adult treatment-naïve male psoriasis patients and 41 age- and BMI-matched healthy controls (Caucasian). Ages: 52.1±11.1 vs 49.7±10.0 years. Psoriasis severity assessed by PASI; dietary intake quantified by 7-day food records; anthropometric and metabolic/liver markers measured.

Results

Psoriatic men consumed more total and simple carbohydrates, total fat, PUFA and cholesterol, and less protein, complex carbohydrates, MUFA, n-3 PUFA and fiber than controls, with no difference in total energy or SFA. They had worse metabolic profiles (CRP, HoMA-IR), higher VAI and FLI, and greater prevalence of hepatic steatosis. PASI score correlated with anthropometric measures, glucose and lipid profiles, liver function tests, cardio-metabolic indices, and most dietary components (except protein and total carbohydrates). In multivariable analyses, MUFA intake was the strongest dietary predictor of PASI score (lower MUFA associated with higher PASI; β = −0.635, p < 0.001; r2 = 0.387); FLI also predicted PASI (p < 0.001). Metabolic syndrome presence was predicted by higher PASI score (OR 1.794; 95% CI 1.242–2.591; p = 0.002). Conclusion: Dietary macronutrient patterns are linked to psoriasis severity and cardio-metabolic risk, with MUFA intake playing a key role. A MUFA-rich diet may help modulate inflammation and metabolic risk in psoriasis; FLI may serve as an early cardio-metabolic risk marker. Nutritionists should play a central role in psoriasis management.

Limitations

Male-only sample (selection bias) and small sample size; cross-sectional design limits causal inference; use of surrogate markers (VAI, FLI) with partial validation (FLI reliability not fully established); results may not generalize to women or other populations.

Abstract

BackgroundWestern dietary pattern is included among the environmental dietary factors involved in the pathogenesis of psoriasis. Nutritional data collection methods and gender differences might affect the association between diet and psoriasis. The 7-day food records is considered the “gold standard” of self-administered food frequency questionnaires. In this study, we evaluated the differences in the dietary intake, anthropometric measurements and cardio-metabolic risk profile in a group of psoriatic patients compared with an age and Body Mass Index (BMI)-matched control group. In addition, in the group of psoriatic patients we investigated the association between the dietary intake and clinical severity of psoriasis.MethodsCross-sectional case control observational study. A total of 82 adult males, 41 treatment-naïve patients with psoriasis and 41 healthy subjects matched for age and BMI were included in the study. The clinical severity of psoriasis was by assessed by Psoriasis Area and Severity Index (PASI) score. The dietary interview data were collected by a 7-day food records. Anthropometric measures, glucose and lipid profile, liver function tests and C-reactive protein levels were measured. Homeostasis Model Assessment of Insulin Resistance (HoMA-IR), Visceral Adiposity Index (VAI) and the Fatty Liver Index (FLI) were calculated.ResultsPsoriatic patients consumed a higher percentage of total and simple carbohydrates, total fat, polyunsaturated fatty acid (PUFA) and n-6/n-3 PUFAs ratio, and cholesterol, while the consumption of protein, complex carbohydrates, monounsaturated fatty acid (MUFA), n-3 PUFA and fiber was lower than in the control group. In addition, psoriatic patients presented altered anthropometric measurements, glucose and lipid profile, liver function tests, and elevated values of HoMA-IR, VAI and FLI. PASI score well correlated with anthropometric measures, glucose and lipid profile, liver function tests, cardio-metabolic indices, and the dietary components, except for protein and total carbohydrates. At logistic regression analysis between PASI score and MUFA, MetS presence was well predicted only by higher PASI score (OR = 1.794; p = 0.002; CI 1.242–2.591). At multiple regression analysis, MUFA was the best predictor of PASI score (r2 = 0.387, β = −0.635, t = −5.127, p < 0.001).ConclusionDifferences in dietary intake were observed in adult male psoriatic patients compared with the controls. These differences were associated to the severity of the psoriasis and cardio-metabolic risk. FLI represented an early indicator of the cardio-metabolic risk profile in psoriatic patients, and dietary MUFA were major predictor of the clinical severity of psoriasis, while the association between psoriasis and metabolic syndrome appeared to be independent of MUFA intake. The low MUFA consumption might act as a possible adjunctive mechanism in increasing the inflammation milieu of psoriatic patients. show less