Role of Nutrition and Adherence to the Mediterranean Diet in the Multidisciplinary Approach of Hidradenitis Suppurativa: Evaluation of Nutritional Status and Its Association with Severity of Disease

Abstract

Hidradenitis suppurativa (HS) is a chronic, inflammatory and debilitating skin disorder. The exacerbating factors of HS include nutrition and adiposity. We aimed to investigate the relationships between body composition and the adherence to the Mediterranean diet (MD) with the severity of HS in a sample of naive-treatment patients with HS. In this case–controlled, cross-sectional study, we enrolled 41 HS patients and 41 control subjects. Body composition was evaluated by a bioelectrical impedance analysis (BIA) phase-sensitive system. PREvención con DIeta MEDiterránea (PREDIMED) and the 7-day food records were used to evaluate the degree of adherence to the MD and dietary pattern, respectively. The clinical severity was assessed by using the Sartorius HS score. HS patients had a worse body composition, in particular lower phase angle (PhA) (p < 0.001), and a lower adherence to the MD than controls, in spite of no differences in energy intake between the two groups. The receiver operator characteristic (ROC) analysis showing a value of PhA of ≤ 5.7 and a PREDIMED score of ≤ 5.0 identified HS patients with the highest clinical severity of the disease. After adjusting for sex, age, body mass index (BMI), and total energy intake, the HS Sartorius score maintained negative correlations with PhA (p < 0.001), PREDIMED score, and n-3 polyunsaturated fatty acids (p = 0.005). The results of the multivariate analysis showed PhA and PREDIMED score were the major determinants of HS Sartorius score, explaining 82.0% and 30.4% of its variability, respectively (p < 0.001). Novel associations were demonstrated between PhA and the degree of adherence to the MD with the HS severity. PhA and PREDIMED score might represent possible markers of severity of HS in a clinical setting.

Dietary Intervention: An Essential Part of the Management of Patients Affected by Hidradenitis Suppurativa

“…In our opinion dietary patterns may have an important role in the management of HS, and the patients should be informed by experts about the most appropriate dietary plan for their clinical status. In line with our recent study, we suggest evaluation of individual nutritional status as an essential part in the management of HS patients [2]. In fact, in HS patients, the clinical severity (HS Sartorius score) was negatively and statistically significantly associated with both phase angle (PhA) values and adherence to the Mediterranean diet (MD) [2].…”

“…The parameter is a sign of cellular integrity and of water distribution in body fluids [4, 5]. PhA values are lower in a substantial group of inflammatory diseases, including also skin conditions such as psoriasis and HS [2, 6, 7].…”

“…In 2018, Phan et al [9] demonstrated how this dietary regimen can slow the progression of psoriasis, and it is advisable in pregnant women as it potentially decreases the risk of atopy in their offspring [10]. Compared to the control group, HS patients showed different dietary habits tending to a pro-inflammatory status characterized by a lower intake of complex carbohydrate, monounsaturated fatty acids, and n–3 polyunsaturated fatty acids, and a higher consumption of saturated fatty acid and n–6 polyunsaturated fatty acids [2]. Moreover, low adherers to the MD had a statistically significantly higher score in the HS Sartorius scale [2].…”

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“…Considering a type I (alpha) error of 0.05 (95%), and a type II (beta) of 0.05, and the calculated power size was 95%, the minimum number of cases required for a statistical power of 95% was of 40 cases. The calculation of sample size and power were performed while using Sample Size Calculator Clinical Calc (https://clincalc.com/stats/samplesize.aspx), as previously reported in other studies [24][25][26].…”

Reply to: “Studies on the role of diet in the management of hidradenitis suppurativa are needed”

“…3 While promising, the study did not use validated disease assessment measures other than pain scores, a control group was lacking, and placebo response rates are historically quite high in trials evaluating HS. 4 Barrea et al 5 report lower adherence to a Mediterranean diet and worse body composition in HS patients compared with controls and link higher Sartorius scores to less adherence. While this highlights important population characteristics, the study was unable to address many confounding factors such as reduced socioeconomic status in HS patients that is linked to impaired access to healthy foods.…”