Risk of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis: an updated systematic review and meta-analysis of observational studies

Bellinato, Francesco; Gisondi, Paolo; Mantovani, Alessandro; Girolomoni, Giampiero; Targher, Giovanni

doi:10.1007/s40618-022-01755-0

Cited by 36 publications

(51 citation statements)

References 40 publications

(49 reference statements)

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“…In addition, individuals with psoriasis often have high alcohol consumption which also impacts liver function ( 35 ). Patients with psoriasis have higher risk of NAFLD ( 6 , 7 ), however, studies on risk of psoriasis in individuals with NAFLD are scarce. Importantly, circulating pro-inflammatory cytokines associated with both psoriasis and NAFLD drive a chronic low-grade inflammation that could lead to progression of liver damage and worsening of the psoriatic skin ( 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…The last decades several observational studies have investigated the association between psoriasis and NAFLD ( 6 , 7 ). In the present study, we find a higher risk of psoriasis in individuals with NAFLD and increased liver fat content, however, confounding and reverse causation are inherent limitation in observational studies.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with NAFLD, particularly those with NASH, have increased liver-specific and cardiovascular morbidity and mortality ( 5 ). During the last decade, interest in NAFLD among patients with psoriasis has increased as several observational studies of psoriatic patients have reported higher risk of NAFLD ( 6 , 7 ) even after adjusting for confounders such as obesity and the metabolic syndrome ( 8 – 10 ). The risk of psoriasis in patients with NAFLD is less studied; however, circulating pro-inflammatory cytokines associated with both development of psoriasis and NAFLD could drive a chronic low-grade inflammation potentially linking the two diseases ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Non-alcoholic fatty liver disease is not a causal risk factor for psoriasis: A Mendelian randomization study of 108,835 individuals

Näslund-Koch

Bojesen²,

Gluud³

et al. 2022

Front. Immunol.

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BackgroundPsoriasis is observationally associated with a higher risk of non-alcoholic fatty liver disease (NAFLD); however, the causal relationship between the two diseases remains unclear.ObjectiveWe hypothesized that individuals with NAFLD or elevated liver fat content have higher risk of psoriasis and that NAFLD is a causal risk factor for psoriasis. We tested this using a Mendelian randomization approach.MethodsWe included 108,835 individuals from the Danish general population, including 1,277 individuals with psoriasis and 802 individuals with NAFLD according to ICD codes. To estimate liver fat content, a subset of the participants (N = 7,416) also had a CT scan performed. First, we tested whether a diagnosis of NAFLD or elevated liver fat content was observationally associated with risk of psoriasis. Subsequently, we used the genetic variants PNPLA3 and TM6SF2, both strongly associated with NAFLD and high liver fat content, to test whether NAFLD was causally associated with increased risk of psoriasis.ResultsObservationally, individuals with vs. without a diagnosis of NAFLD had higher risk of psoriasis with an odds ratio of 2.03 (95% confidence interval 1.28-3.21). The risk of psoriasis increased in a stepwise manner with increasing liver fat content with an odds ratio of 5.00 (2.63-9.46) in individuals in the highest quartile of liver fat content compared to individuals in the lowest quartile. In genetic analyses, PNPLA3 and TM6SF2 were both associated with increased risk of NAFLD but not with increased risk of psoriasis.ConclusionObservationally, a diagnosis of NAFLD or elevated liver fat content was associated with higher risk of psoriasis. However, using genetic variants as a proxy for NAFLD, we did not find evidence of a causal relationship between NAFLD and psoriasis. Thus, the observational association between NAFLD and psoriasis is presumably a result of shared confounding factors or reverse causation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Non-alcoholic fatty liver disease is not a causal risk factor for psoriasis: A Mendelian randomization study of 108,835 individuals

Näslund-Koch

Bojesen²,

Gluud³

et al. 2022

Front. Immunol.

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“…There is a significantly increased risk of in-hospital mortality related to alcohol in psoriasis patients with an SMR of 4.46 for men and 5.6 for women [ 4 ]. A recent systematic review and meta-analysis identified 15 studies with 249,933 psoriasis patients with an OR of 1.96 for NAFLD compared with 1,491,402 healthy controls [ 43 ]. This risk was higher in patients with severe psoriasis and psoriatic arthritis potentially due to a greater systemic inflammatory burden and altered metabolic parameters with increasing insulin resistance and obesity.…”

Section: Alcohol Is Implicated In the Comorbidities Associated With P...mentioning

confidence: 99%

Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene

Kearney

Kirby

2022

Am J Clin Dermatol

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Psoriasis patients are at increased risk of harmful alcohol use and alcohol dependency with many deleterious effects. Increasing alcohol use is associated with worsening psoriasis severity, is a risk factor for poor response to systemic treatments and may impact on comorbidities such as psoriatic arthritis, cardiovascular disease, cancer and liver disease. Harmful alcohol use and alcohol dependency can be defined by the updated ICD-11 coding system and screening can be completed using many tools including the Cut down, Annoyed, Guilty, Eye-Opener (CAGE), Alcohol Use Disorders Identification Test (AUDIT) and Michigan Alcohol Screening Test (MAST) questionnaires. Dermatologists may be able to complete brief interventions encouraging alcohol reduction in psoriasis patients. Psoriasis patients may respond to messages of gain with reduced psoriasis severity and loss with reduced cardiovascular risk. It is important for dermatologists to discuss alcohol with all psoriasis patients, to be aware of the impact of alcohol in psoriasis and to familiarise themselves with screening tools, brief intervention and local services available to patients who require specialist input for harmful alcohol use or alcohol dependency.

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“…They are predisposed to liver fibrosis for a variety of reasons, one of which is non-alcoholic fatty liver disease (NAFLD), a prevalent liver disease affecting approximately 25% of the general population (3). NAFLD has been found to be strongly associated with psoriasis in previous meta-analyses (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis

et al. 2022

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BackgroundPatients with psoriasis are more likely than matched controls in the general population to have advanced liver fibrosis; however, our understanding of these patients is limited. There is currently no systematic evaluation of the prevalence and risk factors of liver fibrosis in psoriasis patients.ObjectiveTo evaluate the prevalence of psoriasis patients who are at high or low risk for advanced liver fibrosis and determine the risk factors for developing liver fibrosis.MethodsElectronic searches were conducted using the PubMed, Embase, Scopus, and Cochrane Library databases from the dates of their inception till May 2022, using the PubMed, Embase, Scopus, and Cochrane Library databases. Any observational study describing the prevalence and/or risk factors for liver fibrosis in patients with psoriasis was included.ResultsPatients with psoriasis at high risk for advanced liver fibrosis had a pooled prevalence of 9.66% [95% confidence interval (CI): 6.92–12.75%, I2 = 76.34%], whereas patients at low risk for advanced liver fibrosis had a pooled prevalence of 77.79% (95% CI: 73.23–82.05%, I2 = 85.72%). Studies that recruited methotrexate (MTX)-naïve patients found a lower prevalence of advanced liver fibrosis (4.44, 95% CI: 1.17–9.22%, I2 = 59.34%) than those that recruited MTX-user cohorts (12.25, 95% CI: 6.02–20.08%, I2 = 82.34%). Age, sex, BMI, PASI score, psoriasis duration, MTX cumulative dose, and the prevalence of obesity, MTX users, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were not identified as sources of heterogeneity by meta-regression analysis. The pooled odds ratios for age >50 years, BMI > 30, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome were 2.20 (95% CI: 1.42–3.40, I2 = 0%), 3.67 (95% CI: 2.37–5.68, I2 = 48.8%), 6.23 (95% CI: 4.39–8.84, I2 = 42.4%), 2.82 (95% CI: 1.68–4.74, I2 = 0%), 3.08 (95% CI: 1.90–4.98, I2 = 0%), and 5.98 (95% CI: 3.63–9.83, I2 = 17%), respectively.ConclusionApproximately 10% of the population with psoriasis is at high risk for advanced liver fibrosis, while 78% are at low risk. Patients over the age of 50 with obesity, diabetes, hypertension, dyslipidemia, and/or metabolic syndrome have an increased risk of developing liver fibrosis, necessitating monitoring.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022303886], identifier [CRD42022303886].

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Risk of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis: an updated systematic review and meta-analysis of observational studies

Cited by 36 publications

References 40 publications

Non-alcoholic fatty liver disease is not a causal risk factor for psoriasis: A Mendelian randomization study of 108,835 individuals

Non-alcoholic fatty liver disease is not a causal risk factor for psoriasis: A Mendelian randomization study of 108,835 individuals

Alcohol and Psoriasis for the Dermatologist: Know, Screen, Intervene

Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis

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