Even more interestingly, a study by Kyriakou et al. Low- and high-dose plant and marine (n-3) fatty acids do not affect plasma inflammatory markers in adults with metabolic syndrome. Kettler A.H., Baughn R.E., Orengo I.F., Black H., Wolf J.E., Jr. Update of the LIPID MAPS comprehensive classification system for lipids. Sabat R., Philipp S., Hoflich C., Kreutzer S., Wallace E., Asadullah K., Volk H.D., Sterry W., Wolk K. Immunopathogenesis of psoriasis. A cohort study from Italy including patients who received systemic treatment for plaque psoriasis for the first time showed that the percentage of patients achieving reduction of PASI score >75% was 30% lower in obese patients compared to individuals with normal BMI [134]. 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. The consumption of oily fish led to modest significant clinical improvement compared to white fish diet. Diet and psoriasis. Christodoulatos G.S., Spyrou N., Kadillari J., Psallida S., Dalamaga M. The role of adipokines in breast cancer: Current evidence and perspectives. 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]. A diet with a fiber content of 30 g/d led to a significant reduction in hsCRP [50]. Adorini L. Immunomodulatory effects of vitamin D receptor ligands in autoimmune diseases. Morris M.S., Sakakeeny L., Jacques P.F., Picciano M.F., Selhub J. Vitamin B-6 intake is inversely related to, and the requirement is affected by, inflammation status. Farras M., Fernandez-Castillejo S., Rubio L., Arranz S., Catalan U., Subirana I., Romero M.P., Castaner O., Pedret A., Blanchart G., et al. A prospective study by Merola et al., including 70,743 female nurses who completed semi-quantitative food frequency questionnaires in 1994, 1998, 2004 and 2006, showed no association between vitamin D intake and the development of psoriasis [199]. 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]. Effect of omega-3 fatty acids on disease severity in patients with psoriasis: A systematic review. A recent meta-analysis of six RCTs confirmed that weight loss following lifestyle interventions improves psoriasis compared with controls, with a mean change in PASI score of 2.59. Singh S., Facciorusso A., Singh A.G., Vande Casteele N., Zarrinpar A., Prokop L.J., Grunvald E.L., Curtis J.R., Sandborn W.J. Gregori S., Casorati M., Amuchastegui S., Smiroldo S., Davalli A.M., Adorini L. Regulatory T cells induced by 1 alpha,25-dihydroxyvitamin D3 and mycophenolate mofetil treatment mediate transplantation tolerance. Vitamins C and E are associated with a reduction in coronary artery disease, but their supplementation in high pharmacological doses seems to bear no additional benefit [107]. Suwannalert P., Boonsiri P., Khampitak T., Khampitak K., Sriboonlue P., Yongvanit P. The levels of lycopene, alpha-tocopherol and a marker of oxidative stress in healthy northeast Thai elderly. Effect of virgin olive oil and thyme phenolic compounds on blood lipid profile: Implications of human gut microbiota. After 12 weeks, the intervention group showed a greater improvement in median PASI score, along with a significant reduction in IL-22 serum concentration compared to the placebo group [241]. Then, we discuss the most recent research data on the impact of obesity on psoriatic disease, and whether and how different dietary patterns and food components may prove beneficial in the course of the disease and emerge as possible therapeutic options along with the conventional pharmacologic treatment. Yang et al. Since fruits are also rich in other components, such as vitamins and fiber, some studies in animal models have used purified polyphenol extracts to address their role more specifically. reported that the intramuscular administration of vitamin B12 for 10 days led to clinical improvement of psoriasis. Balbas G.M., Regana M.S., Millet P.U. The ketone metabolite -hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. 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. 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. Harari A., Harats D., Marko D., Cohen H., Barshack I., Kamari Y., Gonen A., Gerber Y., Ben-Amotz A., Shaish A. SFAs are also related to inflammasome-mediated inflammation, as it was shown in a mouse model, where animals fed with a high-fat diet (45% PA) showed enhanced TLR4-dependent NLRP3-inflammasome activation and IL-1 secretion from dendritic cells [29]. According to a recent review form Upala et al., including 12 studies, the results regarding the efficacy of n-3 PUFAs supplementation in the severity of psoriasis are still uncertain [221]. Bittiner S.B., Tucker W.F., Cartwright I., Bleehen S.S. A double-blind, randomised, placebo-controlled trial of fish oil in psoriasis. reported that low selenium concentration is associated with increased severity of psoriasis in patients with disease duration more than three years [230]. Vitamin A is present both in plants (carrots and red peppers) as carotenoids and in eggs, liver and milk as retinol, with both forms being processed to its active form, which is retinoic acid. Another concern about vitamin D is the fact that its plasma levels are affected by various determinants. 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. Peripheral blood regulatory T cell measurements correlate with serum vitamin D level in patients with psoriasis. 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 beneficial effect of olive oil and, especially, extra virgin olive oil (EVOO) has been demonstrated in a number of studies [72,73,74,75,76,77]. Among the latter, many studies have suggested that nutrition can play a crucial role both in disease pathogenesis and treatment through its effects on chronic inflammation obesity has been recognized as a major risk factor for psoriasis development and progression, and weight loss regimens, together with other dietary interventions such as gluten-free diet or Mediterranean diet seem to offer substantial beneficial results in the course of the disease. Ggebakan O., Kohl A., Osterhoff M.A., van Baak M.A., Jebb S.A., Papadaki A., Martinez J.A., Handjieva-Darlenska T., Hlavaty P., Weickert M.O., et al. As a result, the potential role of gluten-free diet in psoriasis has been thoroughly studied. Such results by single studies have been confirmed in a large meta-analysis including 54 studies and 19.372 patients, which showed that obesity is associated with 60% higher odds of inadequate response to anti-TNF treatment as compared to normal BMI; for each unit increment of BMI, there is an augmentation in odds of failure by 6.5% [137]. Similarly, another recent study investigated the effect of low-calorie ketogenic diet in 30 patients with psoriasis by evaluating clinical symptoms, biochemical markers, metabolomic profile and inflammatory markers (IL-2, IL-4, IL-1, TNF-, IFN-). Lutein, found mainly in broccoli and spinach, has a beneficial impact on arterial stiffness and decreases IL-6, TNF- and prostaglandin E2 (PGE2) [94]. Similarly, Mutairi et al. ); rg.aou.dem@sitparta (A.R. Interventional randomized clinical trials to confirm these results are still lacking. 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]. Castaldo G., Galdo G., Rotondi Aufiero F., Cereda E. Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis. However, according to an older study in 69 patients, selenium and Vitamin E supplementation for 12 weeks did not reduce psoriasis severity [233]. In patients with cystic fibrosis, beta-carotene decreased MDA levels at the dose of 1 mg/kg/d, but not at 10 mg/d [98]. Omega-6 FAs include linoleic acid (LA), mainly found in meat, and arachidonic acid (ARA), found in poultry and eggs [21]. 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. Similarly, a case-controlled study by Naldi et al. Castaldo G., Pagano I., Grimaldi M., Marino C., Molettieri P., Santoro A., Stillitano I., Romano R., Montoro P., DUrsi A.M., et al. Fahy E., Subramaniam S., Murphy R.C., Nishijima M., Raetz C.R., Shimizu T., Spener F., van Meer G., Wakelam M.J., Dennis E.A. In this cascade, inflammation plays a cardinal role by promoting hyper-proliferation and angiogenesis, leading to the typical skin lesions and the articular involvement of psoriatic arthritis [8]. A few studies have investigated the efficacy of n-3 fatty acids supplementation in combination with other treatments for psoriasis [226,227,228]. Sanchez-Rodriguez E., Lima-Cabello E., Biel-Glesson S., Fernandez-Navarro J.R., Calleja M.A., Roca M., Espejo-Calvo J.A., Gil-Extremera B., Soria-Florido M., de la Torre R., et al. Similarly, another case-control study, which included 37 patients, showed that selenium supplementation as add-on treatment to narrowband UVB therapy did not significantly improve psoriasis severity (assessed by PASI score) and TNF-R1 and CRP concentrations compared to placebo [234].
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