Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Steffen L.M., Van Horn L., Daviglus M.L., Zhou X., Reis J.P., Loria C.M., Jacobs D.R., Duffey K.J. reported that after two years, the proportion of patients receiving the same treatment was only 42.21%, proposing high BMI as an independent predictor of drug failure and withdrawal [138]. Moreover, subjects with a body weight increase >10 kg had an RR of 1.72 [129]. However, some other studies have failed to support any beneficial effect of n-3 supplementation on inflammatory biomarkers, with this discrepancy being attributed to the relatively low supplemented daily dose, which did not exceed 6.6 g/d [36,37,38]. Its etiology is considered multifactorial, and it is characterized by the dysregulation of the innate and adaptive immune systems, with the activation of T helper (Th)-1 and Th-17 T cells leading to an increased production of inflammatory cytokines such as interleukins (IL) IL-1, IL-6, IL-23, IL-22, IL-17, and IL-33, tumor necrosis factor alpha (TNF-), and interferon-gamma (IFN-) [6,7]. Carr A.C., Maggini S. Vitamin C and Immune Function. The prevalence and incidence of psoriasis is higher among patients with obesity, while obesity is an important predisposing factor for psoriasis onset, progression and severity. In an RCT by Grimminger et al., 20 patients were hospitalized for acute guttate psoriasis (BSA > 10%) and randomly received either an n-3 lipid emulsion (2.1 g EPA, 2.1 g DHA) or a conventional n-6 lipid emulsion for 10 days. Manning J., Mitchell B., Appadurai D.A., Shakya A., Pierce L.J., Wang H., Nganga V., Swanson P.C., May J.M., Tantin D., et al. In recent decades, numerous studies have focused on the association between the inflammatory process and the development of chronic, non-communicable diseases (NCD), such as obesity, diabetes mellitus, cardiovascular diseases, cancer and autoinflammatory diseases such as rheumatoid arthritis and psoriasis [1]. supported that patients with psoriasis and particularly women are more likely to have increased BMI compared to same-gender full siblings, and a positive correlation was demonstrated between obesity and disease severity as determined by body surface area (BSA) and the Physicians Global Assessment (PGA) [127]. Polyphenols are the most abundant antioxidants in diet, with their main sources being fruits, vegetables, red wine, nuts, green tea, and olive oil. The intervention consisted of a 4-week VLCKD (<500 Kcal/d; 1.2 g of protein/Kg of ideal body weight/d) and a 6-week hypocaloric, low glycemic index, Mediterranean-like diet. Dietary lipids include cholesterol and fatty acids (FAs), with the latter playing a crucial role in inflammation and immunity.
A randomized, double-blind, placebo-controlled study to evaluate the effect of fish oil and topical corticosteroid therapy in psoriasis. On the other hand, micronutrients such as polyphenols and carotenoids seem to possess potent antioxidant properties, however, the high pharmacological doses needed to exert their effects cast doubt on their significance for everyday clinical practice. Pischon T., Hankinson S.E., Hotamisligil G.S., Rifai N., Willett W.C., Rimm E.B. Overview of the molecular determinants contributing to the expression of Psoriasis and Psoriatic Arthritis phenotypes. 1Rheumatology and Clinical Immunology Unit, Fourth Department of Internal Medicine, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; moc.liamg@staklep, 2Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece; moc.liamtoh@ht-roknam (E.K. Low levels of zinc cause increased oxidative stress in endothelial cells in vitro [122]; in vivo, supplementation of zinc in diabetic mice reduced aortic tunica media thickness, VCAM-1 and PAI-1, and increased the expression of Nrf2 and metallothioneins in the aorta, both being powerful antioxidants [123]. Takahashi H., Tsuji H., Takahashi I., Hashimoto Y., Ishida-Yamamoto A., Iizuka H. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. pointed out that obesity had a higher prevalence among psoriatic patients compared to the non-psoriatic population and highlighted that body weight was not increased at the onset of the disease but rather during its course, implying that obesity was a consequence rather than a causal factor [124]. Antiga E., Bonciolini V., Volpi W., Del Bianco E., Caproni M. Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. Fatty acids as macronutrients are key players for immunomodulation, with n-3 polyunsaturated fatty acids having the most beneficial effect, while polyphenols and carotenoids seem to be the most promising antioxidants. Edrisi F., Salehi M., Ahmadi A., Fararoei M., Rusta F., Mahmoodianfard S. Effects of supplementation with rice husk powder and rice bran on inflammatory factors in overweight and obese adults following an energyrestricted diet: A randomized controlled trial. The role of fish oil in psoriasis. Yu G., Rux A.H., Ma P., Bdeir K., Sachais B.S. PMC legacy view Meta-analysis of psoriasis, cardiovascular disease, and associated risk factors. Dalamaga M. Resistin as a biomarker linking obesity and inflammation to cancer: Potential clinical perspectives. National Library of Medicine Orgaz-Molina J., Buendia-Eisman A., Arrabal-Polo M.A., Ruiz J.C., Arias-Santiago S. Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: A case-control study. Improvement in a patient with pustular psoriasis. The ketone metabolite -hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Mayer K., Seeger W., Grimminger F. Clinical use of lipids to control inflammatory disease. In conclusion, evidence from large-scale trials about the clinical significance of carotenoids remains contradicting. Interestingly, the improvement of psoriasis severity in intervention group was achieved with only a slight weight loss [154]. Hohmann C.D., Cramer H., Michalsen A., Kessler C., Steckhan N., Choi K., Dobos G. Effects of high phenolic olive oil on cardiovascular risk factors: A systematic review and meta-analysis. recently conducted a meta-analysis to investigate the efficacy of n-3 fatty acids as monotherapy in patients with psoriasis. Gupta A.K., Ellis C.N., Tellner D.C., Anderson T.F., Voorhees J.J. Double-blind, placebo-controlled study to evaluate the efficacy of fish oil and low-dose UVB in the treatment of psoriasis. Hask G., Pacher P. Endothelial Nrf2 activation: A new target for resveratrol? Other studies have evaluated the impact of intramuscular administration of Vitamin B12 on the treatment of psoriasis with inconsistent results. Omega-6 FAs include linoleic acid (LA), mainly found in meat, and arachidonic acid (ARA), found in poultry and eggs [21]. Again, the unfavorable results can be possible explained by the low doses of EPA (1.8 g and 5.4 g daily) administered, together with the unrestricted dietary fat content, which leads to a lower concentration of EPA in cell membranes due to the competitive action of n-6 PUFAs. In an RCT by Yoshida et al. Below, research data about the association of psoriasis and different dietary regimens will be discussed, along with possible suggestions and implication for treatment options. Lifestyle intervention and weight loss have been associated with the reduction of TNF-, IL-8, IL-6, CRP and MCP-1 levels [160]. Yabuzaki J. Carotenoids database: Structures, chemical fingerprints and distribution among organisms. suggested curcumin as a dietary immunosuppressant in patients with psoriasis due to in vitro inhibition of pro-inflammatory IFN- and IL-17 [239]. [117] showed that supplementation with 5 mg/d of folic acid and 1 mg/d of B12 (typical daily intake: about 500 mcg/day and 3.4 mcg/day, respectively) for eight weeks significantly improved endothelial dilatation, and a similar result was also demonstrated in a 7-year RCT where this combination along with high doses of B6 was provided [118]. Vitamin D intake and season modify the effects of the GC and CYP2R1 genes on 25-hydroxyvitamin D concentrations. 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. Kragballe K., Fogh K. A low-fat diet supplemented with dietary fish oil (Max-EPA) results in improvement of psoriasis and in formation of leukotriene B5. Meng Z., Yan C., Deng Q., Gao D.F., Niu X.L. However, data about more sophisticated nutritional patterns, such as ketogenic, very low-carb or specific macro- and micro-nutrient substitution, are scarce. Crespo M.C., Tom-Carneiro J., Dvalos A., Visioli F. Pharma-nutritional properties of olive oil phenols transfer of new findings to human nutrition. In humans, vitamin E supplementation has been shown to reduce pro-inflammatory cytokines IL-1, IL-6 and TNF- by stimulating the production of cyclic adenosine monophosphate (cAMP) [106]. Inhibition of TNF- -mediated endothelial cell-monocyte cell adhesion and adhesion molecules expression by the resveratrol derivative, trans-3,5,41-trimethoxystilbene. In the same notion, a study in 482 women demonstrated a positive co-relation of the amount of red meat consumption and CRP levels [17], and a cross-sectional study with 553 adults showed that the consumption of processed meat showed positive association with inflammation markers such as IL-6 and TNF- [18]. Bahraini P., Rajabi M., Mansouri P., Sarafian G., Chalangari R., Azizian Z. Turmeric tonic as a treatment in scalp psoriasis: A randomized placebo-control clinical trial. The amount, quality and dietary source of carbohydrates are the factors which determine their inflammatory capacity. Confusion in the nomenclature of ketogenic diets blurs evidence. Estruch R., Mastnez-Gonzlez M.A., Corella D., Salas-Salvad J., Ruiz-Gutirrez V., Covas M.I., Fiol M., Gmez-Gracia E., Lpez-Sabater M.C., Vinyoles E., et al. Lipidomic evidence that lowering the typical dietary palmitate to oleate ratio in humans decreases the leukocyte production of proinflammatory cytokines and muscle expression of redox-sensitive genes. Omega-3 fatty acids are generally considered to have anti-inflammatory capacities compared to omega-6 ones, although this is not always the case. Zhou Y.E., Buchowski M.S., Liu J., Schlundt D.G., Ukoli F., Blot W.J., Hargreaves M.K. Balbas et al. Singh S., Facciorusso A., Singh A.G., Vande Casteele N., Zarrinpar A., Prokop L.J., Grunvald E.L., Curtis J.R., Sandborn W.J. Montonen J., Knekt P., Jrvinen R., Reunanen A. Dietary antioxidant intake and risk of type 2 diabetes. observed marked improvement of itching, erythema and scaling after 8 weeks of treatment with 3 g of n-3 fatty acids supplementation compared to olive oil supplementation [217]. The results showed that n-3 fatty acids led to significant reductions in PASI score, erythema, and scaling.