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Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis

International Journal of Obesity volume 39, pages 1197–1202 (2015)Cite this article

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Abstract

Background:

Psoriasis is a chronic inflammatory disease of the skin with joint manifestations. Greater psoriasis severity and lower response to treatment have been linked to obesity. However, the effect of weight reduction by non-pharmacologic intervention on disease severity is still questionable. This is a systematic review and meta-analysis of randomized controlled trials (RCTs) on the effect of dietary and lifestyle weight loss interventions on psoriasis severity.

Methods:

We comprehensively searched PubMed/MEDLINE, EMBASE and CENTRAL from their inception to August 2014. Inclusion criteria were RCTs that examined lifestyle intervention by diet or exercise in overweight or obese patients with psoriasis and measured the severity of psoriasis as an outcome compared with controls. Two authors independently assessed article quality and extracted the data.

Results:

Out of 12 full-text articles, 7 RCTs involving 878 participants met our inclusion criteria. Five of these RCTs were included in the meta-analysis, which was based on the random-effects model. There was a greater reduction in the Psoriasis Area Severity Index (PASI) score in patients receiving weight loss intervention than in controls, with a pooled mean difference of −2.49 (95% confidence interval (CI), −3.90 to −1.08; P=0.004). More participants in the intervention group than in the control group achieved a 75% reduction in the PASI score, with a pooled odds ratio of 2.92 (95% CI, 1.39–6.13; P=0.005).

Conclusion:

Nonpharmacologic, nonsurgical weight loss intervention is associated with reduction in the severity of psoriasis in overweight or obese patients. However, more RCTs with more participants are needed to provide better quality of evidence.

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References

  1. Christophers E . Psoriasis—epidemiology and clinical spectrum. Clin Exp Dermatol 2001; 26: 314–320.

    Article  CAS  Google Scholar 

  2. Kurd SK, Gelfand JM . The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003–2004. J Am Acad Dermatol 2009; 60: 218–224.

    Article  Google Scholar 

  3. Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ . Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol 2005; 141: 1537–1541.

    Article  Google Scholar 

  4. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM . Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Investig Dermatol 2013; 133: 377–385.

    Article  CAS  Google Scholar 

  5. Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58: 826–850.

    Article  Google Scholar 

  6. Thakolwiboon S, Upala S, Geeratragool T, Benjatikul N, Uathaya M, Tripipitsiriwat A et al. The factors affecting quality of life in Thai psoriasis patients. J Med Assoc Thai 2013; 96: 1344–1349.

    PubMed  Google Scholar 

  7. Margolis D, Bilker W, Hennessy S, Vittorio C, Santanna J, Strom BL . The risk of malignancy associated with psoriasis. Arch Dermatol 2001; 137: 778–783.

    CAS  PubMed  Google Scholar 

  8. Gelfand JM, Berlin J, Van Voorhees A, Margolis DJ . Lymphoma rates are low but increased in patients with psoriasis: results from a population-based cohort study in the United Kingdom. Arch Dermatol 2003; 139: 1425–1429.

    Article  Google Scholar 

  9. Khalid U, Hansen PR, Gislason GH, Lindhardsen J, Kristensen SL, Winther SA et al. Psoriasis and new-onset diabetes: a Danish nationwide cohort study. Diabetes Care 2013; 36: 2402–2407.

    Article  CAS  Google Scholar 

  10. Ungprasert P, Sanguankeo A, Upala S, Suksaranjit P . Psoriasis and risk of venous thromboembolism: a systematic review and meta-analysis. QJM 2014; 107: 793–797.

    Article  CAS  Google Scholar 

  11. Xu T, Zhang YH . Association of psoriasis with stroke and myocardial infarction: meta-analysis of cohort studies. Br J Dermatol 2012; 167: 1345–1350.

    Article  CAS  Google Scholar 

  12. Setty AR, Curhan G, Choi HK . Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses’ Health Study II. Arch Intern Med 2007; 167: 1670–1675.

    Article  Google Scholar 

  13. Armstrong AW, Harskamp CT, Armstrong EJ . The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. Nutr Diabetes 2012; 2: e54.

    Article  CAS  Google Scholar 

  14. Cassano N, Galluccio A, De Simone C, Loconsole F, Massimino SD, Plumari A et al. Influence of body mass index, comorbidities and prior systemic therapies on the response of psoriasis to adalimumab: an exploratory analysis from the APHRODITE data. J Biol Regul Homeost Agents 2008; 22: 233–237.

    CAS  PubMed  Google Scholar 

  15. Naldi L, Addis A, Chimenti S, Giannetti A, Picardo M, Tomino C et al. Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Evidence from the Psocare project. Dermatology 2008; 217: 365–373.

    Article  Google Scholar 

  16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62: e1–34.

    Article  Google Scholar 

  17. Higgins JPT, Green S (eds), (2008 Cochrane Handbook for Systematic Reviews of Interventions. Wiley: Hoboken, NJ, USA pp 672.

    Book  Google Scholar 

  18. Higgins JP, Thompson SG, Deeks JJ, Altman DG . Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.

    Article  Google Scholar 

  19. Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomoni G . Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. Am J Clin Nutr 2008; 88: 1242–1247.

    CAS  PubMed  Google Scholar 

  20. Kimball AB, Alavian C, Alora-Palli M, Bagel J . Weight loss in obese patients with psoriasis can be successfully achieved during a course of phototherapy. J Eur Acad Dermatol Venereol 2012; 26: 1582–1584.

    CAS  PubMed  Google Scholar 

  21. Jensen P, Zachariae C, Christensen R, Geiker NR, Schaadt BK, Stender S et al. Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol 2013; 149: 795–801.

    Article  Google Scholar 

  22. Di Minno MN, Peluso R, Iervolino S, Russolillo A, Lupoli R, Scarpa R et al. Weight loss and achievement of minimal disease activity in patients with psoriatic arthritis starting treatment with tumour necrosis factor alpha blockers. Ann Rheum Dis 2014; 73: 1157–1162.

    Article  CAS  Google Scholar 

  23. Guida B, Napoleone A, Trio R, Nastasi A, Balato N, Laccetti R et al. Energy-restricted, n-3 polyunsaturated fatty acids-rich diet improves the clinical response to immuno-modulating drugs in obese patients with plaque-type psoriasis: a randomized control clinical trial. Clin Nutr 2014; 33: 399–405.

    Article  CAS  Google Scholar 

  24. Al-Mutairi N, Nour T . The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial. Expert Opin Biol Ther 2014; 14: 749–756.

    Article  CAS  Google Scholar 

  25. Naldi L, Conti A, Cazzaniga S, Patrizi A, Pazzaglia M, Lanzoni A et al. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol 2014; 170: 634–642.

    Article  CAS  Google Scholar 

  26. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014; 129 (Suppl 2): S102–S138.

    Article  Google Scholar 

  27. Dowlatshahi EA, van der Voort EA, Arends LR, Nijsten T . Markers of systemic inflammation in psoriasis: a systematic review and meta-analysis. Br J Dermatol 2013; 169: 266–282.

    Article  CAS  Google Scholar 

  28. Chen YJ, Wu CY, Shen JL, Chu SY, Chen CK, Chang YT et al. Psoriasis independently associated with hyperleptinemia contributing to metabolic syndrome. Arch Dermatol 2008; 144: 1571–1575.

    PubMed  Google Scholar 

  29. Bardazzi F, Balestri R, Baldi E, Antonucci A, De Tommaso S, Patrizi A . Correlation between BMI and PASI in patients affected by moderate to severe psoriasis undergoing biological therapy. Dermatol Ther 2010; 23 (Suppl 1): S14–S19.

    Article  Google Scholar 

  30. Hossler EW, Wood GC, Still CD, Mowad CM, Maroon MS . The effect of weight loss surgery on the severity of psoriasis. Br J Dermatol 2013; 168: 660–661.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Matthew Roslund for his contribution to this review.

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Author notes

  1. S Upala and A Sanguankeo: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Bassett Medical Center, Columbia University College of Physicians and Surgeons, Cooperstown, NY, USA

    S Upala & A Sanguankeo

  2. Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    S Upala & A Sanguankeo

Authors
  1. S Upala
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Correspondence to A Sanguankeo.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Upala, S., Sanguankeo, A. Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis. Int J Obes 39, 1197–1202 (2015). https://doi.org/10.1038/ijo.2015.64

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