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Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort.
JAMA Dermatol. 2018 09 01; 154(9):1017-1024.JD

Abstract

Importance

Psoriasis is a chronic inflammatory disease. The Mediterranean diet has been shown to reduce chronic inflammation and has a positive effect on the risk of metabolic syndrome and cardiovascular events. Thus, we hypothesized a positive effect on the onset and/or severity of psoriasis.

Objective

To assess the association between a score that reflects the adhesion to a Mediterranean diet (MEDI-LITE) and the onset and/or severity of psoriasis.

Design, Setting, and Participants

The NutriNet-Santé program is an ongoing, observational, web-based questionnaire cohort study launched in France in May 2009. The present study was performed within the framework of the NutriNet-Santé program, with data collected and analyzed between April 2017 and June 2017. Patients with psoriasis were identified via a validated online self-completed questionnaire and then categorized by disease severity: severe psoriasis, nonsevere psoriasis, and psoriasis-free. Data on dietary intake (including alcohol) were gathered during the first 2 years of participation in the cohort to calculate the MEDI-LITE score (ranging from 0 for no adherence to 18 for maximum adherence). Potentially confounding variables (eg, age, sex, physical activity, body mass index, tobacco use, and a history of cardiovascular disease) were also recorded. Analyses used adjusted multinomial logistic regression to estimate the risk of having severe psoriasis or nonsevere psoriasis compared with being psoriasis-free.

Results

Of the 158 361 total NutriNet-Santé participants, 35 735 (23%) replied to the psoriasis questionnaire. The mean (SD) age of the respondents was 47.5 (14.0) years; 27 220 (76%) of the respondents were women. Of these 35 735 respondents, 3557 (10%) individuals reported having psoriasis. The condition was severe in 878 cases (24.7%), and 299 (8.4%) incident cases were recorded (those arising more than 2 years after participant inclusion in the cohort). After adjustment for confounding factors, a significant inverse relationship was found between the MEDI-LITE score and having severe psoriasis: odds ratio (OR), 0.71; 95% CI, 0.55-0.92 for the MEDI-LITE score's second tertile (score of 8 to 9); and OR, 0.78; 95% CI, 0.59-1.01 for the third tertile (score of 10 to 18).

Conclusions and Relevance

Patients with severe psoriasis displayed low levels of adherence to the Mediterranean diet; this finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis. If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis.

Authors+Show Affiliations

Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France.Nutritional Epidemiology Research Team (EREN-CRESS), Paris 13 University, INSERM (U1153), INRA (U1125), CNAM, COMUE Sorbonne Paris Cité, Bobigny, France.Nutritional Epidemiology Research Team (EREN-CRESS), Paris 13 University, INSERM (U1153), INRA (U1125), CNAM, COMUE Sorbonne Paris Cité, Bobigny, France.Nutritional Epidemiology Research Team (EREN-CRESS), Paris 13 University, INSERM (U1153), INRA (U1125), CNAM, COMUE Sorbonne Paris Cité, Bobigny, France.Nutritional Epidemiology Research Team (EREN-CRESS), Paris 13 University, INSERM (U1153), INRA (U1125), CNAM, COMUE Sorbonne Paris Cité, Bobigny, France. Department of Public Health, Avicenne Hospital (AP-HP), Bobigny, France.Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France. Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France.Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France. Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France. Clinical Investigation Center 1430, INSERM, Créteil, France.Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France. Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France.Department of Dermatology, Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France. Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE), EA7379, Paris-Est University, UPEC, DHU VIC, Créteil, France. Clinical Investigation Center 1430, INSERM, Créteil, France.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30046840

Citation

Phan, Céline, et al. "Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort." JAMA Dermatology, vol. 154, no. 9, 2018, pp. 1017-1024.
Phan C, Touvier M, Kesse-Guyot E, et al. Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort. JAMA Dermatol. 2018;154(9):1017-1024.
Phan, C., Touvier, M., Kesse-Guyot, E., Adjibade, M., Hercberg, S., Wolkenstein, P., Chosidow, O., Ezzedine, K., & Sbidian, E. (2018). Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort. JAMA Dermatology, 154(9), 1017-1024. https://doi.org/10.1001/jamadermatol.2018.2127
Phan C, et al. Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort. JAMA Dermatol. 2018 09 1;154(9):1017-1024. PubMed PMID: 30046840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis: Results From the NutriNet-Santé Cohort. AU - Phan,Céline, AU - Touvier,Mathilde, AU - Kesse-Guyot,Emmanuelle, AU - Adjibade,Moufidath, AU - Hercberg,Serge, AU - Wolkenstein,Pierre, AU - Chosidow,Olivier, AU - Ezzedine,Khaled, AU - Sbidian,Emilie, PY - 2018/7/27/pubmed PY - 2019/9/13/medline PY - 2018/7/27/entrez SP - 1017 EP - 1024 JF - JAMA dermatology JO - JAMA Dermatol VL - 154 IS - 9 N2 - Importance: Psoriasis is a chronic inflammatory disease. The Mediterranean diet has been shown to reduce chronic inflammation and has a positive effect on the risk of metabolic syndrome and cardiovascular events. Thus, we hypothesized a positive effect on the onset and/or severity of psoriasis. Objective: To assess the association between a score that reflects the adhesion to a Mediterranean diet (MEDI-LITE) and the onset and/or severity of psoriasis. Design, Setting, and Participants: The NutriNet-Santé program is an ongoing, observational, web-based questionnaire cohort study launched in France in May 2009. The present study was performed within the framework of the NutriNet-Santé program, with data collected and analyzed between April 2017 and June 2017. Patients with psoriasis were identified via a validated online self-completed questionnaire and then categorized by disease severity: severe psoriasis, nonsevere psoriasis, and psoriasis-free. Data on dietary intake (including alcohol) were gathered during the first 2 years of participation in the cohort to calculate the MEDI-LITE score (ranging from 0 for no adherence to 18 for maximum adherence). Potentially confounding variables (eg, age, sex, physical activity, body mass index, tobacco use, and a history of cardiovascular disease) were also recorded. Analyses used adjusted multinomial logistic regression to estimate the risk of having severe psoriasis or nonsevere psoriasis compared with being psoriasis-free. Results: Of the 158 361 total NutriNet-Santé participants, 35 735 (23%) replied to the psoriasis questionnaire. The mean (SD) age of the respondents was 47.5 (14.0) years; 27 220 (76%) of the respondents were women. Of these 35 735 respondents, 3557 (10%) individuals reported having psoriasis. The condition was severe in 878 cases (24.7%), and 299 (8.4%) incident cases were recorded (those arising more than 2 years after participant inclusion in the cohort). After adjustment for confounding factors, a significant inverse relationship was found between the MEDI-LITE score and having severe psoriasis: odds ratio (OR), 0.71; 95% CI, 0.55-0.92 for the MEDI-LITE score's second tertile (score of 8 to 9); and OR, 0.78; 95% CI, 0.59-1.01 for the third tertile (score of 10 to 18). Conclusions and Relevance: Patients with severe psoriasis displayed low levels of adherence to the Mediterranean diet; this finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis. If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis. SN - 2168-6084 UR - https://www.unboundmedicine.com/medline/citation/30046840/Association_Between_Mediterranean_Anti_inflammatory_Dietary_Profile_and_Severity_of_Psoriasis:_Results_From_the_NutriNet_Santé_Cohort_ L2 - https://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.2127 DB - PRIME DP - Unbound Medicine ER -