Environmental Risk Factors in Psoriasis: The Point of View of the Nutritionist

Abstract

Psoriasis is a common, chronic, immune-mediated skin disease with systemic pro-inflammatory activation, where both environmental and genetic factors contribute to its pathogenesis. Among the risk factors for psoriasis, evidence is accumulating that nutrition plays a major role, per se, in psoriasis pathogenesis. In particular, body weight, nutrition, and diet may exacerbate the clinical manifestations, or even trigger the disease. Understanding the epidemiological relationship between obesity and psoriasis is also important for delineating the risk profile for the obesity-related comorbidities commonly found among psoriatic patients. Moreover, obesity can affect both drug’s pharmacokinetics and pharmacodynamics. Additionally, the overall beneficial effects on the obesity-associated comorbidities, clinical recommendations to reduce weight and to adopt a healthy lifestyle could improve the psoriasis severity, particularly in those patients with moderate to severe disease, thus exerting additional therapeutic effects in the conventional treatment in obese patients with psoriasis. Education regarding modifiable environmental factors is essential in the treatment of this disease and represents one of the primary interventions that can affect the prognosis of patients with psoriasis. The goal is to make psoriatic patients and health care providers aware of beneficial dietary interventions. The aim of this review is to assess the relevance of the environmental factors as modifiable risk factors in psoriasis pathogenesis, with particular regard to the involvement of obesity and nutrition in the management of psoriasis, providing also specific nutrition recommendations.

The role of lipids in psoriasis

“…W kilku badaniach potwierdzono, że pacjenci z łuszczycą spożywają większe ilości cukrów prostych, tłuszczów, n-6 PUFA i kalorii, a mniej białek, węglowodanów złożonych, MUFA, n-3 PUFA i błonnika. Nieprawidłowe nawyki żywieniowe korelowały z występowaniem otyłości, cięższym przebiegiem łuszczycy i obniżeniem jakości życia [80][81][82][83]. W najnowszym badaniu opartym na kwestionariuszu Afifi i wsp.…”

“…On the other hand, they eat less proteins, complex carbohydrates, MUFA, n-3 PUFAs and dietary fibre. Inappropriate eating habits have exhibited a correlation with obesity, more severe course of psoriasis and impairment in the quality of life [80][81][82][83]. In the most recent questionnaire-based study, Afifi et al assessed the eating habits of patients with psoriasis.…”

Adherence to Mediterranean diet in Spanish patients with psoriasis: Cardiovascular benefits?

“…The Mediterranean diet (Barrea et al, ) is a dietary pattern characterized by: (a) High intake of extra virgin olive oil, fruits, vegetables, legumes, cereals, fish, and seafood; (b) Low intake of dairy products, meats, and derivatives; and (c) consumption of moderate amounts of alcohol during the meal in the form of wine. It is a source of antioxidants and monounsaturated fatty acids compounds with anti‐inflammatory properties that are associated with a lower cardiovascular risk.…”

n-3 polyunsaturated fatty acids supplementation in psoriasis: a review

“…The Mediterranean diet is a healthy diet it is characterized by a high intake of fruit and vegetables, legumes, grains and cereals, fish and seafood, and nuts; a low intake of dairy products, meat and meat products; and a moderate ethanol intake mainly in the form of wine and during meals. Extra virgin olive oil (EVOO) is the main added lipid and its increased consumption is reflected in the high monounsaturated to saturated fatty acid intake [28,29]. However, there are few studies that relate to the Mediterranean diet with psoriasis.…”

“…Recent evidence has confirmed that adherence to a healthy diet over time reduces the risk of long-term inflammation [28]. The antioxidants present in the diet, such as omega-3 from fish oil, some vitamins (A, E, and C), and oligoelements (iron, copper, manganese, zinc, and selenium), which decrease oxidative stress and the production of reactive oxygen species, might be of particular relevance mainly in a chronic systemic inflammatory diseases, like psoriasis [29].…”