Impact of metabolic status on the incidence of psoriasis: a Korean nationwide cohort study

Abstract

Growing evidence suggests that obesity is a risk factor for incident psoriasis. This study was aimed to evaluate the association of obesity and metabolic status with the incidence of psoriasis. A total of 418,057 adults were followed-up using a nationwide prospective cohort study in Korea. Participants were stratified based on the body mass index categories and metabolic condition. During the follow-up visit, 11054 (2.6%) cases were found to have psoriasis. Diabetes, hypertension, hyperlipidemia, and obesity were all found to be risk factors for incident psoriasis. The metabolically unhealthy non-obese (MUNO) subjects (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.22–1.37) and metabolically unhealthy obese subjects (MUO; HR, 1.33; 95% CI, 1. 26–1.41) had a significantly higher risk of psoriasis incidence as compared to metabolically healthy non-obese subjects. The risk of psoriasis development was found to be high among the MUNO and MUO subjects in both sexes and all age groups. In conclusion, the metabolic health status was significantly associated with an increased risk of psoriasis in both obese and non-obese individuals. However, further studies are needed to evaluate whether the control of metabolic parameters can lower the incidence of psoriasis.

Increased risk of psoriasis in subjects with abdominal obesity: A nationwide population‐based study

“…In addition, a nested case–control study from the UK General Practice Research Database found an increase in psoriatic risk in obese patients of approximately 30% . Furthermore, a previous nationwide prospective cohort study in Korea demonstrated that BMI and metabolic status increased the risk of psoriasis . A meta‐analysis of prospective studies suggested that higher BMI and WC resulted in 19% and 24% increases in relative risk of psoriasis, respectively .…”

“…In obese individuals, saturated fatty acid overflow causes insulin resistance and activates inflammatory pathways . Inflammatory fatty tissue induces low‐grade systemic inflammation, which causes insulin resistance and endothelial dysfunction by releasing pro‐inflammatory cytokines and chemokines, including TNF‐α, IL‐1β, IL‐6, CCL2, CCL3, CXCL8 and leptins . The inflammatory environment caused by obesity plays a crucial role in triggering the onset of psoriasis, in which Th1 and Th17 lymphocytes play key roles .…”

“…7,8 Although previous studies have demonstrated associations between psoriasis, obesity and metabolic disorders, the precise nature of the association and its mechanism have not been determined. 9 Although several epidemiological studies have implicated obesity as an independent risk factor for psoriasis, other reports have suggested that obesity may be a result rather than an etiological factor of psoriasis. 8,9 Previous studies have indicated that activated macrophages from adipose tissue stimulate the secretion of cytokines, such as tumor necrosis factor (TNF)-a, interleukin (IL)-1, IL-6 and IL-8, which may be involved in the development of psoriasis.…”

Risk factors for increased serum creatinine level in patients with psoriasis treated with cyclosporine in a real‐world practice

“…Risk factors such as HTN, long treatment duration, and high cumulative doses of CsA were not associated with increased SCr levels. As psoriasis has been associated with a high incidence of metabolic diseases including HTN (Kim et al, 2017;Wan et al, 2018), the effects of these diseases on nephrotoxicity during the CsA treatment has important clinical implications. However, a significant association between HTN and nephrotoxicity was not revealed in our study, although a positive correlation between HTN and changes in the SCr levels in the first course of treatment was noted.…”

“…In patients with psoriasis who are treated with CsA, nephrotoxicity is associated with longer term administration, a larger cumulative dose, and a higher daily dose (Coresh et al, 2001). Other risk factors include older age, male sex, obesity, hypertension (HTN), diabetes mellitus (DM), and concomitant use of nephrotoxic drugs (Colombo, Cassano, Bellia, & Vena, 2013;El-Bassossy & Eid, 2018;Kim et al, 2017;Maza et al, 2011;Rodier, Ribstein, Parer-Richard, & Mimran, 1991;Wan et al, 2018). Although intermittent treatment with CsA with 12-week courses has been generally recommended, there is still controversy regarding the optimal treatment strategy to prevent CsA nephrotoxicity (Colombo et al, 2013;Nast et al, 2015).…”