Investigating Adiposity-Related Metabolic Health Phenotypes in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study

Abstract

Background: Obesity and hidradenitis suppurativa (HS) are related through meta-inflammation and are both associated with increased cardiometabolic risk. Notwithstanding, cardiometabolic pathology is not uniform in obesity and a subset of individuals with excess adiposity exhibit a healthy metabolic profile. Whilst the incidence of cardiometabolic endpoints and transitions across different adiposity-related body composition phenotypes within several populations and across different ethnicities have been investigated, data regarding metabolic health (MetH) and body composition phenotypes in individuals with HS are lacking. The objective of this study was to evaluate the relationship between different body composition phenotypes in individuals with HS. Methods: This was a cross-sectional study of 632 individuals with and without HS from a population with a high prevalence of both obesity and HS. A total of four body composition phenotypes were generated based on BMI and metabolic status (defined using either the metabolic syndrome definition or the homeostasis model of insulin resistance (HOMA-IR)): metabolically healthy overweight/obese (MHOWOB), metabolically unhealthy overweight/obese (MUOWOB), metabolically healthy normal weight (MHNW), and metabolically unhealthy normal weight (MUNW). Results: Generally, subjects with HS exhibited a worse metabolic profile with higher levels of indices of central adiposity measures (including Visceral Adiposity Index and waist circumference), systolic blood pressure and markers of insulin resistance, as well as a higher prevalence of the metabolic syndrome. Moreover, when sub-stratified into the different body composition phenotypes, individuals with HS typically also demonstrated adverse metabolic characteristics relative to controls matched for both adiposity and metabolic health, particularly in the normal weight category and despite being classified as metabolically healthy. Being metabolically unhealthy in addition to being overweight/obese increases an individual’s risk of HS. Conclusions: Metabolic risk-assessment should be prioritized in the clinical management of individuals with HS even in those who are lean. Patients attending HS clinics provide a valuable opportunity for targeted cardiovascular risk reduction with respect to the management of both obesity and metabolic health.

Effects of tumor necrosis factor-alpha inhibitors on lipid profiles in patients with psoriasis: a systematic review and meta-analysis

“…Psoriasis is a typical inflammatory skin disease (62). An underlying mechanism for our results may be related to inflammation and lipid metabolism, which has been reported in other inflammatory skin diseases (63,64). Hidradenitis suppurativa is a chronic inflammatory skin disease (63).…”

“…The development of hidradenitis suppurativa may be partly driven by excess visceral adiposity and chronic inflammation ( 63 ). Therefore, the assessment of metabolic risk may be an important component in the clinical management of inflammatory skin diseases ( 64 ). High-density lipoprotein possesses anti-inflammatory effects, while inflammation also reduces high-density lipoprotein levels ( 65 ).…”

Haptoglobin is an independent marker for disease severity and risk for metabolic complications in hidradenitis suppurativa: A prospective study

“…32 For example, HS patients classified as metabolically healthy but with normal weight have significantly higher HOMA-IR levels compared to controls. 32 Moreover, as another HS-related comorbidity, an association of polycystic ovary syndrome with Hp2 alleles has been described. 33,34 Of note, in our HS cohort, four patients had a confirmed diagnosis of polycystic ovary syndrome.…”

“…Importantly, elevated insulin levels and increased insulin resistance are often observed in HS patients, possibly providing a mechanistic link between obesity, insulin resistance, chronic inflammation and HS 31 . HS is a risk factor for metabolic unhealthiness (as defined by HOMA‐IR) independent of body composition phenotypes 32 . For example, HS patients classified as metabolically healthy but with normal weight have significantly higher HOMA‐IR levels compared to controls 32 .…”

“…HS is a risk factor for metabolic unhealthiness (as defined by HOMA‐IR) independent of body composition phenotypes 32 . For example, HS patients classified as metabolically healthy but with normal weight have significantly higher HOMA‐IR levels compared to controls 32 . Moreover, as another HS‐related comorbidity, an association of polycystic ovary syndrome with Hp2 alleles has been described 33,34 .…”