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Similarly, according to a casecontrol study, patients with psoriasis have lower 25-hydroxyvitamin D (25(OH)D) levels compared to the control group and are more likely to have 25(OH)D deficiency [194]. Salinthone S., Kerns A.R., Tsang V., Carr D.W. -Tocopherol (vitamin E) stimulates cyclic AMP production in human peripheral mononuclear cells and alters immune function. Loued S., Berrougui H., Componova P., Ikhlef S., Helal O., Khalil A. Extra-virgin olive oil consumption reduces the age-related decrease in HDL and paraoxonase 1 anti-inflammatory activities. Immune modulation by curcumin: The role of interleukin-10. Finally, regarding the B-complex vitamins, a high B6 intake was reversely associated with plasma CRP [115]. Silveira B., Oliveira T., Andrade P.A., Hermsdorff H., Rosa C., Franceschini S. Dietary Pattern and Macronutrients Profile on the Variation of Inflammatory Biomarkers: Scientific Update. Omega-6 FAs include linoleic acid (LA), mainly found in meat, and arachidonic acid (ARA), found in poultry and eggs [21]. evaluated the efficacy of antioxidant supplementation in 58 hospitalized patients with severe erythrodermic and arthropathic forms of psoriasis. Chronic inflammation and increased oxidative stress are contributing factors to many non-communicable diseases. A randomized, double-blind, placebo-controlled study to evaluate the effect of fish oil and topical corticosteroid therapy in psoriasis. Apart from the presence of shared genes (at-risk HLA haplotypes) which has been hypothesized to play a role in the association between CD and psoriasis, the malabsorption caused by CD and the consequent vitamin D deficiency seems to be another factor predisposing to psoriasis onset and severity. The effect of supplementation with selenium and vitamin E in psoriasis. Higher amounts of sun exposure have been associated with a lower risk of vitamin D deficiency; on the other hand, excessive sun exposure is the primary risk factor for skin cancer and generally seems to have a detrimental effect on many cutaneous diseases such as psoriasis [111,112]. Upala S., Yong W.C., Theparee T., Sanguankeo A. Determinants of vitamin D status in Caucasian adults: Influence of sun exposure, dietary intake, sociodemographic, lifestyle, anthropometric, and genetic factors. showed that 4.5 g/d of oral curcuminoid C3 complex as monotherapy had no effect on any of the disease parameters [245]. Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. On the other hand, two RCTs showed that 1.8 g of EPA for 8 weeks or 10 capsules of fish oil three times daily for three weeks did not achieve clinical improvement compared to olive oil supplementation [218,219]. Zhang S., Liu X., Mei L., Wang H., Fang F. Epigallocatechin-3-gallate (EGCG) inhibits imiquimod-induced psoriasis-like inflammation of BALB/c mice. Muscogiuri G., Barrea L., Laudisio D., Pugliese G., Salzano C., Savastano S., Colao A. In a study by Lyte et al. Moreover, plasma EPA levels increased in patients with oily fish intake [211]. Moreover, for each 10 cm increase in waist circumference and 0.1 unit increase in waist-to-hip ratio, the relative risk for psoriasis rose by 24% and 37%, respectively [132]. Inhibition of TNF- -mediated endothelial cell-monocyte cell adhesion and adhesion molecules expression by the resveratrol derivative, trans-3,5,41-trimethoxystilbene. Data about other polyphenols is scarce and is mostly based on experimental animal models. Omentin-1 is another adiponectin with anti-inflammatory properties by inhibiting TNF-. Consumption of extra virgin olive oil improves body composition and blood pressure in women with excess body fat: A randomized, double-blinded, placebo-controlled clinical trial. Obesity can also modify pharmacokinetics of anti-TNF and other biologic agents, leading to increased drug clearance, shorter half-life and lower serum trough drug concentrations [132]. 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. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, inflammation, immunity, nutrients, antioxidants, diet, obesity, psoriasis, arthritis, fatty acids. Page charges were supported by the Hellenic Gu Cancer Group (HGUCG). In the study by Clemmensen et al. conducted a randomized controlled trial to investigate the effect of low-calorie diet on maintenance of psoriasis remission after 12 weeks of methotrexate treatment. After 4 weeks, a significant reduction in PASI score >80% along with the resolution of psoriatic arthralgia were observed [187]. Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease. Apart from its role in T-cell activation, zinc is a cofactor in a range of antioxidant enzymes, especially SOD and the anti-inflammatory SMAD proteins [121]. Michalsson G., Ahs S., Hammarstrm I., Lundin I.P., Hagforsen E. Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer Ki67 + cells in the dermis. Jacobi A., Langenbruch A., Purwins S., Augustin M., Radtke M.A. Psoriasis and comorbid diseases: Implications for management. Kragballe et al. showed that obesity is associated with a two-fold increased risk of psoriasis compared to individuals with normal body weight. A few studies have reported an association between psoriasis and Vitamin B12 deficiency [206,207,208]. Increased consumption of virgin olive oil, nuts, legumes, whole grains, and fish promotes HDL functions in humans. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: Results from an Italian case-control study. Despite, however, having a clear role in the enhancement of the immune system, studies have not proven that supplementation with selenium decreases the risk for cardiovascular mortality [120]. North C.J., Venter C.S., Jerling J.C. Consumption of cooked purple potato (200 g/day containing 288 mg anthocyanins) for 14 days reduced pulse wave velocity, an indicator of endothelial dysfunction, compared with white potato in healthy humans [60]. 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. PREDIMED Study Investigators Polyphenol intake and mortality risk: A re-analysis of the PREDIMED trial. 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. Snekvik I., Smith C.H., Nilsen T.I.L., Langan S.M., Modalsli E.H., Romundstad P.R., Saunes M. Obesity, Waist Circumference, Weight Change, and Risk of Incident Psoriasis: Prospective Data from the HUNT Study. Hussain T.A., Mathew T.C., Dashti A.A., Asfar S., Al-Zaid N., Dashti H.M. Effect of low-calorie versus low-carbohydrate 1016. ketogenic diet in type 2 diabetes. The consumption of EPA (180 mg/d) and DHA (120 mg/d) for six weeks was associated with a reduction in CRP in overweight patients [34], and a similar anti-inflammatory pattern was observed in a study with patients with T2DM, where the supplementation of high doses of n-3 PUFAs led to lower concentrations of IL-2 and TNF- [35]. http://creativecommons.org/licenses/by/4.0/, Janus KinasesSignal Transducer and Activator of Transcription, Nuclear factor erythroid 2-related factor 2, peroxisome proliferator-activated receptor-gamma, retinoic acid receptor/retinoid X receptor. (D)-beta-Hydroxybutyrate inhibits adipocyte lipolysis via the nicotinic acid receptor PUMA-G. Youm Y.H., Nguyen K.Y., Grant R.W., Goldberg E.L., Bodogai M., Kim D., DAgostino D., Planavsky N., Lupfer C., Kanneganti T.D., et al. about navigating our updated article layout. Aleixandre A., Miguel M. Dietary fiber and blood pressure control. Diet and physical exercise in psoriasis: A randomized controlled trial. A trial of oral zinc supplementation in psoriasis. Dangardt F., Osika W., Chen Y., Nilsson U., Gan L.-M., Gronowitz E., Strandvik B., Friberg P. Omega-3 fatty acid supplementation improves vascular function and reduces inflammation in obese adolescents. In vitro studies have shown that resveratrol, through activating the SIRT1 pathway, can induce apoptosis in the HaCaT keratinocyte cell line and inhibit the production of IL-17 by Th-1 cells [246]. In general, fibers slow down carbohydrate uptake and hamper the absorption of dietary lipids [52]. Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis. Vitamin D intake and season modify the effects of the GC and CYP2R1 genes on 25-hydroxyvitamin D concentrations. Kien C.L., Bunn J.Y., Fukagawa N.K., Anathy V., Matthews D.E., Crain K.I., Ebenstein D.B., Tarleton E.K., Pratley R.E., Poynter M.E. reported that selenium and Vitamin E supplementation for 8 weeks resulted in the increase of glutathione peroxidase in patients with psoriasis [232]. Psoriasis is an immune-mediated disease where chronic inflammation plays a key role, a fact which has been consolidated through its established association with obesity, which negatively affects disease incidence, severity and response to treatment. showed that three months of gluten-free diet improves skin biopsy anomalies (reduction in Ki67 positive cells and tissue transglutaminase-tTG expression in dermis) and psoriasis severity (reduction of psoriasis area and PASI score from 5.5 4.5 to 3.6 3) in patients with psoriasis and positive IgA-AGA or IgG-AGA antibodies [163,164]. Apart from low-calorie diets, a number of nutrition strategies and dietary patterns such as gluten-free diet, Mediterranean diet and very-low-carb ketogenic diet have been proposed for weight loss achievement in patients with psoriasis. Vitamin C is also indispensable for the antioxidant actions of vitamin E, which contributes to T-cell and NK cells activity. suggested curcumin as a dietary immunosuppressant in patients with psoriasis due to in vitro inhibition of pro-inflammatory IFN- and IL-17 [239]. Hjgaard P., Glintborg B., Kristensen L.E., Gudbjornsson B., Love T.J., Dreyer L. The influence of obesity on response to tumour necrosis factor- inhibitors in psoriatic arthritis: Results from the DANBIO and ICEBIO registries. Four-weeks of VLCKD resulted in 10% weight loss, 50% reduction in PASI score, improvement of biochemical markers related to psoriasis (folic acid, vitamin B12, cortisol, bilirubin, calcium, LDL, cholesterol) and decreased IL-1 and IL-2 levels [189]. Intake of whole apples or clear apple juice has contrasting effects on plasma lipids in healthy volunteers. Vitamin C promotes maturation of T-cells. Lifestyle intervention and weight loss have been associated with the reduction of TNF-, IL-8, IL-6, CRP and MCP-1 levels [160]. In 24 obese adults, the consumption of 46 g of grape powder for 3 weeks led to a significant decrease in low-density lipoprotein cholesterol (LDL-C) and cholesterol levels and enhanced immune function [58], and a similar result was reproduced in a study by Ravn-Haren et al. Kiecolt-Glaser J.K., Belury M.A., Andridge R., Malarkey W.B., Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: A randomized controlled trial. Moreover, subjects with a body weight increase >10 kg had an RR of 1.72 [129]. Bilia A.R., Bergonzi M.C., Isacchi B., Antiga E., Caproni M. Curcumin nanoparticles potentiate therapeutic effectiveness of acitrein in moderate-to-severe psoriasis patients and control serum cholesterol levels. The .gov means its official. Carnevale R., Nocella C., Cammisotto V., Bartimoccia S., Monticolo R., DAmico A., Stefanini L., Pagano F., Pastori D., Cangemi R., et al. Yang et al. Antioxidant activity from extra virgin olive oil via inhibition of hydrogen peroxide-mediated NADPH-oxidase 2 activation. As a result, the potential role of gluten-free diet in psoriasis has been thoroughly studied. Research data regarding the effect of n-3 polyunsaturated fatty acids on the treatment of psoriasis are inconsistent. Curcumin mediates attenuation of pro-inflammatory interferon and interleukin 17 cytokine responses in psoriatic disease, strengthening its role as a dietary immunosuppressant. ); rg.aou.dem@sitparta (A.R. Phan C., Touvier M., Kesse-Guyot E., Adjibade M., Hercberg S., Wolkenstein P., Chosidow O., Ezzedine K., Sbidian E. Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Sant Cohort. Evidence from the Psocare project. Kantor E.D., Lampe J.W., Kratz M., White E. Lifestyle factors and inflammation: Associations by body mass index. In 80 patients with chronic, stable psoriasis, 34 of whom also had psoriatic arthritis, supplementation with high doses of EPA and DHA for 8 weeks led to decreases in PASI score and a subjective improvement in joint pain [213]. 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. will also be available for a limited time. Several studies have evaluated the efficacy of selenium supplementation in patients with psoriasis. Rajkumar H., Mahmood N., Kumar M., Varikuti S.R., Challa H.R., Myakala S.P. The same group examined the effect of selenium supplementation on TNF-R1 levels as add-on strategy to topical treatment with salicylic acid and dithranol ointment. DCs metabolize sunlight-induced vitamin D3 to program T cell attraction to the epidermal chemokine CCL27. In patients with peripheral artery disease, supplementation with orange and blackcurrant juice for 4 weeks led to a reduction in CRP and plasma fibrinogen [92]; similarly, MDA and 8,12-isoprostane F2a-VI levels were inversely associated with concentrations of individual carotenoids [93]. The first one consists of saturated fatty acids (SFAs), such as palmitic acid and lauric acid, while the second one comprises monounsaturated (MUFAs), such as n-9 oleic acid (OA), and polyunsaturated (PUFAs) fatty acids, such as a-linolenic acid (ALA) and linoleic acid (LA), depending on the number of double bonds they contain. Jin X.H., Ohgami K., Shiratori K., Suzuki Y., Hirano T., Koyama Y., Yoshida K., Ilieva I., Iseki K., Ohno S. Inhibitory effects of lutein on endo toxin-induced uveitis in Lewis rats. In a study by Bardazzi et al., among 33 patients receiving biological agents, patients who put on weight during the 8-month follow-up did not achieve PASI 50, while patients who had a stable weight presented variable response to treatment and those who decreased their weight achieved PASI 90 or PASI 75, even when not responding initially [136]. 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. Armstrong A.W., Harskamp C.T., Armstrong E.J. evaluated the efficacy of a weight loss program with ketogenic diet as a first-line strategy in drug-naive patients with psoriasis. Despite these promising results in general, large-scale trials are still needed to establish benefits for everyday clinical practice and, therefore, the Medical Board of the National Psoriasis Foundation does not include either oral or intravenous fish oil supplementation in the suggested dietary regimens [163]. Stucker M., Memmel U., Hoffmann M., Altmeyer P. Vitamin B12 cream containing avocado oil in the therapy of plaque psoriasis. Licensee MDPI, Basel, Switzerland. However, the lack of human studies prevents any recommendation for these polyphenols to be applied as adjuvant treatment for psoriasis. On the contrary, an open study including 26 patients with psoriasis showed that fish oil supplementation did not improve psoriasis outcomes in any of the patients with plaque-type psoriasis except for one, a fact which was attributed to low dosage of EPA and the absence of dietary fat restriction [216]. Elmadfa I., Rust P., Majchrzak D., Wagner K.H., Genser D., Lettner R., Pinter M. Effects of beta-carotene supplementation on free radical mechanism in healthy adult subjects. A double-blind, randomized, placebo-controlled trial of n-3 fatty acid based lipid infusion in acute, extended guttate psoriasis. Serum lipid profile and inflammatory markers in the aorta of cholesterol-fed rats supplemented with extra virgin olive oil, sunflower oils and oil-products. Renner S., Rath R., Rust P., Lehr S., Frischer T., Elmadfa I., Eichler I. Stroher D.J., Escobar Piccoli Jda C., Gullich A.A., Pilar B.C., Coelho R.P., Bruno J.B., Faoro D., Manfredini V. 14 Days of supplementation with blueberry extract shows anti-atherogenic properties and improves oxidative parameters in hypercholesterolemic rats model. Ni Y.F., Wang J., Yan X.L., Tian F., Zhao J.B., Wang Y.J., Jiang T. Histone deacetylase inhibitor, butyrate, attenuates lipopolysaccharide-induced acute lung injury in mice. The adoption of Western-type diets with a high ratio of saturated fatty acids and a concomitant decrease in n-3 polyunsaturated fatty acids consumption, along with diets with high carbohydrate intake, lead to immune aberration and increased production of pro-inflammatory cytokines which are involved in the pathogenesis of many non-communicable diseases. Apart from aggravating the inflammatory cascade, leptin also induces keratinocyte proliferation, which is a crucial step in the development of the characteristic skin lesions in psoriasis [142,143]; at the same time, it drives T cells toward the Th-1 phenotype. Update of the LIPID MAPS comprehensive classification system for lipids. Obesity, Waist Circumference, Weight Change, and the Risk of Psoriasis in Women: Nurses Health Study II. Yabuzaki J. Carotenoids database: Structures, chemical fingerprints and distribution among organisms. Low- and high-dose plant and marine (n-3) fatty acids do not affect plasma inflammatory markers in adults with metabolic syndrome. Effects of a Mediterranean-style diet on cardiovascular risk factorsA randomized trial. Indisputably, however, nutrition can be an additional therapeutic tool in psoriasis management, and this underlines the need for more, large-scale, randomized trials to confirm the beneficial effects of more dietary patterns and the underlying pathophysiological mechanisms, so as to understand which regimen fits each patient, and offer physicians and patients safe, feasible and individualized alternative approaches to alleviate the disease burden. Moudgil S., Mahajan R., Narang T., Sachdeva N., Dayal D., Dogra S. Central obesity and dyslipidemia in Pediatric psoriasis patients: An observational study from India. OBrien K.D., Brehm B.J., Seeley R.J., Bean J., Wener M.H., Daniels S., DAlessio D.A. Merola J.F., Han J., Li T., Qureshi A.A. No association between vitamin D intake and incident psoriasis among US women. Carotenoids serve primarily as potent antioxidants, being able to quench radicals and singlet oxygen, interact with nuclear receptors RAR/RXR (retinoic acid receptor/retinoid X receptor) to enhance immune pathways, and inhibit the pro-inflammatory NF-B pathway [90]. official website and that any information you provide is encrypted Based on this data, ketogenic diet is a promising prospect in psoriasis management, but large studies are needed for safe conclusions. In addition, in some studies where no correlation between vitamin D and PASI was found, analysis was limited to only one measurement per person and not on repeated measurements over a follow-up period, while the relationship between PASI and 25(OH)D has not been shown to be linear, either. A previous meta-analysis, including 13 retrospective case-control and 3 prospective case-control studies, showed a relative risk of 1.66 (95% CI 1.461.89) for obesity among patients with psoriasis compared with controls and, even more importantly, a hazard ratio of 1.18 (95% CI: 1.141.23) for new onset obesity among psoriasis patients, indicating again the double role of obesity both as a cause and a repercussion of psoriatic disease [133]. This review aims to present the effect of strictly structured dietary nutrients, that are known to affect glucose/lipid metabolism and insulin responses, on chronic inflammation and immunity, and to discuss the utility of nutritional regimens as possible therapeutic tools for psoriasis and psoriatic arthritis. The same factors were examined in a recent meta-analysis, including 7 prospective studies and 17.637 patients; for each 5 units increase in BMI and for each 5 kg of weight gain, the relative risk of psoriasis increased by 19% and 11%, respectively.