Interventional randomized clinical trials to confirm these results are still lacking. [117] showed that supplementation with 5 mg/d of folic acid and 1 mg/d of B12 (typical daily intake: about 500 mcg/day and 3.4 mcg/day, respectively) for eight weeks significantly improved endothelial dilatation, and a similar result was also demonstrated in a 7-year RCT where this combination along with high doses of B6 was provided [118]. Conversely, Burrows et al. HHS Vulnerability Disclosure, Help Micronutrients are essential elements which are found in very small quantities in the human body and include vitamins, minerals and trace elements. Carotenoids are mainly found in plants, bacteria and fungi, with the most important being carotenes and xanthophylls [89]. Vitamin C is a potent ROS scavenger and stimulates neutrophil apoptosis and T-cell maturation, and its increased dietary intake has been associated with lower levels of CRP and PAI-1 [103,104,105]. Oral vitamin D3 supplementation for chronic plaque psoriasis: A randomized, double-blind, placebo-controlled trial. Juhlin L., Edqvist L.E., Ekman L.G., Ljunghall K., Olsson M. Blood glutathione-peroxidase levels in skin diseases: Effect of selenium and vitamin E treatment. In a retrospective observational study including 110 patients on anti-TNF- agents, Di Lernia et al. Finally, n-3 PUFAs lead to a reduced production of TNF-, IL-2, IL-4 and IL-10, often in a dose-dependent manner [43]. However, patients with Vitamin D deficiency should receive Vitamin D oral supplements for prevention of psoriasis-related comorbidities [167]. Chitosan-based nanoformulated (-)-epigallocatechin-3-gallate (EGCG) modulates human keratinocyte-induced responses and alleviates imiquimod-induced murine psoriasiform dermatitis. 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. Lyte J.M., Gabler N.K., Hollis J.H.
Furthermore, -hydroxybutyrate inhibits NLRP3 inflammasome in lipopolysaccharides (LPS)-stimulated human monocytes resulting in the reduction of IL-1 and IL-18 in a dose-dependent manner [186]. 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].
A trial of oral zinc supplementation in psoriasis. Yamashiki M., Nishimura A., Koska Y. Kasim-Karakas S.E., Tsodikov A., Singh U., Jialal I. After a 14-day treatment with the same emulsions, the PASI score decrease was greater in the n-3 group, an effect which was attributed to changes in eicosanoid regulation [225]. An excellent example of the importance of the carbohydrate source are fibers, which are mostly complex carbohydrates. 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]. 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. 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. Green tea polyphenol induces caspase 14 in epidermal keratinocytes via MAPK pathways and reduces psoriasiform lesions in the flaky skin mouse model. 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. Holmer-Jensen J., Karhu T., Mortensen L.S., Pedersen S.B., Herzig K.H., Hermansen K. Differential effects of dietary protein sources on postprandial low-grade inflammation after a single high fat meal in obese non-diabetic subjects. Wolk K., Mallbris L., Larsson P., Rosenblad A., Vingrd E., Sthle M. Excessive body weight and smoking associates with a high risk of onset of plaque psoriasis. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. However, such high doses which cannot readily be implemented in everyday practice doubt the clinical significance of these results. Antiga E., Bonciolini V., Volpi W., Del Bianco E., Caproni M. Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. Mechanisms include reduction of the formation of foam cells by increasing the expression of PPAR-receptors and ATP-binding cassette transporter (ABCA1), suppressing of leukocyte recruitment and decreasing the production of Th-1 derived IFN-, among others [68]. The Katsarou A.I., Kaliora A.C., Papalois A., Chiou A., Kalogeropoulos N., Agrogiannis G., Andrikopoulos N.K. Resveratrol ameliorates imiquimod-induced psoriasis-like skin inflammation in mice. Chambers et al. Indeed, the optimal level of sun exposure to maintain an adequate vitamin D status is yet to be determined, while a number of other factors such as alcohol intake, physical activity and genetic polymorphisms play an important role; in fact, dietary intake seems to be of little significance [113,114]. Effects of treatment for psoriasis on circulating levels of leptin, adiponectin and resistin: A systematic review and meta-analysis. Beta-carotene, found mainly in carrots and tomatoes, reduces the expression of IL-1 and VCAM-1 in LDL receptor knockout mice [95]. In particular, in 11 out of 34 patients, the psoriatic lesions disappeared and 10 out of 34 reached 75% improvement in PASI score [209]. Study on the use of omega-3 fatty acids as a therapeutic supplement in treatment of psoriasis. Finicelli M., Squillaro T., Di Cristo F., Di Salle A., Melone M.A.B., Galderisi U., Peluso G. Metabolic syndrome, mediterranean diet, and polyphenols: Evidence and perspectives. Anemia, serum vitamin B12, and folic acid in patients with rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus. Prevalence of antigliadin IgA antibodies in psoriasis vulgaris and response of seropositive patients to a gluten-free diet. A hyperglycemic diet (5967% of TCV) led to higher CRP concentrations [46] and, in turn, a hypoglycemic diet (1013% of TCV) led to decreased IL-6 levels [47], although such results were not confirmed in some other reports such as that of OBrien et al., where decreases in CRP and SAA levels were attributed to weight loss and not the carbohydrate content of the diet per se [48]. Inhibition of TNF- -mediated endothelial cell-monocyte cell adhesion and adhesion molecules expression by the resveratrol derivative, trans-3,5,41-trimethoxystilbene. 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. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Selenoproteins: Antioxidant selenoenzymes and beyond. Tamura J., Kubota K., Murakami H., Sawamura M., Matsushima T., Tamura T., Saitoh T., Kurabayshi H., Naruse T. Immunomodulation by vitamin B12: Augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment. Wells J., Swaminathan A., Paseka J., Hanson C. Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy-A Review. Trimboli P., Castellana M., Bellido D., Casanueva F.F. Pischon T., Hankinson S.E., Hotamisligil G.S., Rifai N., Willett W.C., Rimm E.B. Upala S., Yong W.C., Theparee T., Sanguankeo A. Yabuzaki J. Carotenoids database: Structures, chemical fingerprints and distribution among organisms. Omega-6 FAs include linoleic acid (LA), mainly found in meat, and arachidonic acid (ARA), found in poultry and eggs [21]. 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]. 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]. As oils of cold-water fish are rich in EPA and DHA, the effect of fish oil consumption and supplementation has been under investigation [211,212,213,214,215,216]. 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-). FAs can be divided in two separate groups [21]. 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]. Anti-inflammatory effects of sodium butyrate on human monocytes: Potent inhibition of IL-12 and up-regulation of IL-10 production. Immune modulation by curcumin: The role of interleukin-10. Based on this data, ketogenic diet is a promising prospect in psoriasis management, but large studies are needed for safe conclusions. A diet with a fiber content of 30 g/d led to a significant reduction in hsCRP [50]. Hsu S., Dickinson D., Borke J., Walsh D.S., Wood J., Qin H., Winger J., Pearl H., Schuster G., Bollag W.B. 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]. and V.L., structuring of the review, writing, and literature review; I.I., E.T., D.V., E.P., A.R., assistance with writing. Paoli A., Mancin L., Giacona M.C., Bianco A., Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. SFAs are primarily found in meat, dairy products, palm and coconut oil and processed foods which are abundant in Western-type diets and have been associated with increased inflammation in a number of studies [22,23,24,25,26]. Lassus A., Dahlgren A.L., Halpern M.J., Santalahti J., Happonen H.P. 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. Del Giglio M., Gisondi P., Tessari G., Girolomoni G. Weight reduction alone may not be sufficient to maintain disease remission in obese patients with psoriasis: A randomized, investigator-blinded study. Lipidomic evidence that lowering the typical dietary palmitate to oleate ratio in humans decreases the leukocyte production of proinflammatory cytokines and muscle expression of redox-sensitive genes. Zhou Y.E., Buchowski M.S., Liu J., Schlundt D.G., Ukoli F., Blot W.J., Hargreaves M.K. Carr A.C., Maggini S. Vitamin C and Immune Function. Ruedemann et al. Bardazzi F., Balestri R., Baldi E., Antonucci A., De Tommaso S., Patrizi A. Similarly, a more recent study by Kolchak et al. A growing number of studies have highlighted the association between obesity and psoriasis [124,125,126,127,128,129,130,131,132,133]. Another trial indicated that oral curcumin administration in combination with visible light phototherapy can improve moderate to severe plaque psoriasis [243], and a similar result was demonstrated with curcumin as an add-on therapy to acitretin [244]. 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. FOIA Reynolds C.M., McGillicuddy F.C., Harford K.A., Finucane O.M., Mills K.H., Roche H.M. Dietary saturated fatty acids prime the NLRP3 inflammasome via TLR4 in dendritic cells-implications for diet-induced insulin resistance. 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]. Balbas G.M., Regana M.S., Millet P.U. National Library of Medicine Similarly, Mutairi et al. Vitamin C is also indispensable for the antioxidant actions of vitamin E, which contributes to T-cell and NK cells activity. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: The diet, obesity, and genes (DiOGenes) study: A randomized, controlled trial. All authors have read and agreed to the published version of the manuscript. Another polyphenol with remarkable effects on psoriasis is epigallocatechin-3-gallate (EGCG), which is the most abundant catechin in green tea and is known to possess anti-inflammatory, antioxidant and antiproliferative properties [248]. A cross-sectional study by Herron et al. The biological role of inflammation in atherosclerosis. Psoriasis is a chronic, immune-mediated inflammatory disease with multifactorial etiology. However, according to an older study in 69 patients, selenium and Vitamin E supplementation for 12 weeks did not reduce psoriasis severity [233]. Michalsson G., Gerdn B., Hagforsen E., Nilsson B., Pihl-Lundin I., Kraaz W., Hjelmquist G., Lf L. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Mayer K., Seeger W., Grimminger F. Clinical use of lipids to control inflammatory disease. 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. Various hypotheses have been made to explain these discrepancies; a main reason is that vitamin D levels are not primarily determined by intake, but rather through sun exposure, a variable which is difficult to ensure in any patient group [201]. A case-control study by Barrea et al.
Renner S., Rath R., Rust P., Lehr S., Frischer T., Elmadfa I., Eichler I. Chiricozzi A., Raimondo A., Lembo S., Fausti F., Dini V., Costanzo A., Monfrecola G., Balato N., Ayala F., Romanelli M., et al. 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. Other studies have evaluated the impact of intramuscular administration of Vitamin B12 on the treatment of psoriasis with inconsistent results. Only two RCTs have been conducted to investigate the efficacy of oral zinc supplementation in patients with psoriasis. Tungland B. Short-Chain Fatty Acid Production and Functional Aspects on Host Metabolism. 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. Responses of inflammatory markers to a low-fat, high-carbohydrate diet: Effects of energy intake. After three months, there was no significant difference in PASI score between the two groups [201]. 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. Markova M., Pivovarova O., Hornemann S., Sucher S., Frahnow T., Wegner K., Machann J., Petzke K.J., Hierholzer J., Lichtinghagen R., et al. They are scavengers of ROS and they can limit the generation of free radicals and inflammatory molecules, serving as potent antioxidants [4]. Takahashi H., Tsuji H., Takahashi I., Hashimoto Y., Ishida-Yamamoto A., Iizuka H. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. Deng Y., Chang C., Lu Q. Frasheri L., Schielein M.C., Tizek L., Mikschl P., Biedermann T., Zink A. Research data have shown that a high BMI diminishes the effectiveness of pharmacological treatment [134,138]. Sakane T., Takada S., Kotani H., Tsunematsu T. Effects of methyl-B12 on the in vitro immune functions of human T lymphocytes. On the other hand, positive associations between lycopene and F2-isoprostane or MDA levels have been shown in large-scale human studies, which were attributed to the fact that lycopene intake came mainly from pasta sauce, ketchup and fast-food consumption and not from tomatoes, its main natural source [96,97]. The effects of protein intake on metabolic derangement and inflammation are rather conflictive, and large-scale studies on the association between long-term habitual protein intake and circulating inflammatory biomarkers are lacking. Effects of Curcuma extract and visible light on adults with plaque psoriasis. Despite the lack of large randomized clinical trials to confirm the effect of different diets in patients with psoriasis, an abundance of research data highlights diet as a potential therapeutic target. 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]. Effect of Combined Treatment With Folic Acid, Vitamin B6, and Vitamin B12 on Plasma Biomarkers of Inflammation and Endothelial Dysfunction in Women. An RCT including 18 patients with severe stable plaque psoriasis showed that fish oil supplementation in combination with UVB has beneficial effects on the clinical manifestations of psoriasis compared to the combination of olive oil with UVB [226]. Curcumin inhibits LPS-induced inflammation in rat vascular smooth muscle cells in vitro via ROS-relative TLR4-MAPK/NF-kappaB pathways. Rapid improvement of clinical manifestations and changes in neutrophil leukotriene profile. Effects of a Mediterranean-style diet on cardiovascular risk factorsA randomized trial. The phenolic compounds in EVOO are capable of diminishing LDL oxidization and possess potent antioxidant properties, with oleuropein also having anti-proliferative properties [7]. Evidence from the Psocare project. Phenol-enriched olive oils improveHDL antioxidant content in hypercholesterolemic subjects: A randomized, double-blind, cross-over, controlled trial. showed that one year of gluten-free diet improves PASI score in 56% of patients with very high levels of IgA-AGA and in 36% of patients with high levels of IgA-AGA [165]. reported that after two years, the proportion of patients receiving the same treatment was only 42.21%, proposing high BMI as an independent predictor of drug failure and withdrawal [138]. Bullo M., Casas R., Portillo M.P., Basora J., Estruch R., Garcia-Arellano A., Lasa A., Juanola-Falgarona M., Aros F., Salas-Salvado J. Dietary glycemic index/load and peripheral adipokines and inflammatory markers in elderly subjects at high cardiovascular risk. Christodoulatos G.S., Spyrou N., Kadillari J., Psallida S., Dalamaga M. The role of adipokines in breast cancer: Current evidence and perspectives. 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. An official website of the United States government. In accordance with these results, a more recent cross-sectional observational study with a larger sample (n = 35.735 patients) by Phan et al. 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. Castaldo G., Rastrelli L., Galdo G., Molettieri P., Rotondi Aufiero F., Cereda E. Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial. The site is secure. Zunino S.J., Peerson J.M., Freytag T.L., Breksa A.P., Bonnel E.L., Woodhouse L.R., Storms D.H. Dietary grape powder increases IL-1beta and IL-6 production by lipopolysaccharide-activated monocytes and reduces plasma concentrations of large LDL and large LDL-cholesterol particles in obese humans. Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis. Huang H., Shen E., Tang S., Tan X., Guo X., Wang Q., Ding H. Increased serum resistin levels correlate with psoriasis: A meta-analysis. A recent meta-analysis of 63 studies, including 2876 psoriasis patients and 2237 healthy controls, showed that patients with psoriasis have decreased levels of adiponectin; on the contrary, another meta-analysis with 521 cases and 482 controls indicated no statistically significant difference in the levels of adiponectin and high-molecular weight adiponectin levels between the two groups [141,147]. 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].
After 8 weeks, treatment with calcipotriol had a more beneficial impact on psoriasis severity.
Furthermore, -hydroxybutyrate inhibits NLRP3 inflammasome in lipopolysaccharides (LPS)-stimulated human monocytes resulting in the reduction of IL-1 and IL-18 in a dose-dependent manner [186]. 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].
A trial of oral zinc supplementation in psoriasis. Yamashiki M., Nishimura A., Koska Y. Kasim-Karakas S.E., Tsodikov A., Singh U., Jialal I. After a 14-day treatment with the same emulsions, the PASI score decrease was greater in the n-3 group, an effect which was attributed to changes in eicosanoid regulation [225]. An excellent example of the importance of the carbohydrate source are fibers, which are mostly complex carbohydrates. 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]. 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. 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. Green tea polyphenol induces caspase 14 in epidermal keratinocytes via MAPK pathways and reduces psoriasiform lesions in the flaky skin mouse model. 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. Holmer-Jensen J., Karhu T., Mortensen L.S., Pedersen S.B., Herzig K.H., Hermansen K. Differential effects of dietary protein sources on postprandial low-grade inflammation after a single high fat meal in obese non-diabetic subjects. Wolk K., Mallbris L., Larsson P., Rosenblad A., Vingrd E., Sthle M. Excessive body weight and smoking associates with a high risk of onset of plaque psoriasis. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. However, such high doses which cannot readily be implemented in everyday practice doubt the clinical significance of these results. Antiga E., Bonciolini V., Volpi W., Del Bianco E., Caproni M. Oral Curcumin (Meriva) Is Effective as an Adjuvant Treatment and Is Able to Reduce IL-22 Serum Levels in Patients with Psoriasis Vulgaris. Mechanisms include reduction of the formation of foam cells by increasing the expression of PPAR-receptors and ATP-binding cassette transporter (ABCA1), suppressing of leukocyte recruitment and decreasing the production of Th-1 derived IFN-, among others [68]. The Katsarou A.I., Kaliora A.C., Papalois A., Chiou A., Kalogeropoulos N., Agrogiannis G., Andrikopoulos N.K. Resveratrol ameliorates imiquimod-induced psoriasis-like skin inflammation in mice. Chambers et al. Indeed, the optimal level of sun exposure to maintain an adequate vitamin D status is yet to be determined, while a number of other factors such as alcohol intake, physical activity and genetic polymorphisms play an important role; in fact, dietary intake seems to be of little significance [113,114]. Effects of treatment for psoriasis on circulating levels of leptin, adiponectin and resistin: A systematic review and meta-analysis. Beta-carotene, found mainly in carrots and tomatoes, reduces the expression of IL-1 and VCAM-1 in LDL receptor knockout mice [95]. In particular, in 11 out of 34 patients, the psoriatic lesions disappeared and 10 out of 34 reached 75% improvement in PASI score [209]. Study on the use of omega-3 fatty acids as a therapeutic supplement in treatment of psoriasis. Finicelli M., Squillaro T., Di Cristo F., Di Salle A., Melone M.A.B., Galderisi U., Peluso G. Metabolic syndrome, mediterranean diet, and polyphenols: Evidence and perspectives. Anemia, serum vitamin B12, and folic acid in patients with rheumatoid arthritis, psoriatic arthritis, and systemic lupus erythematosus. Prevalence of antigliadin IgA antibodies in psoriasis vulgaris and response of seropositive patients to a gluten-free diet. A hyperglycemic diet (5967% of TCV) led to higher CRP concentrations [46] and, in turn, a hypoglycemic diet (1013% of TCV) led to decreased IL-6 levels [47], although such results were not confirmed in some other reports such as that of OBrien et al., where decreases in CRP and SAA levels were attributed to weight loss and not the carbohydrate content of the diet per se [48]. Inhibition of TNF- -mediated endothelial cell-monocyte cell adhesion and adhesion molecules expression by the resveratrol derivative, trans-3,5,41-trimethoxystilbene. 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. Effect of omega-three polyunsaturated fatty acids on inflammation, oxidative stress, and recurrence of atrial fibrillation. Selenoproteins: Antioxidant selenoenzymes and beyond. Tamura J., Kubota K., Murakami H., Sawamura M., Matsushima T., Tamura T., Saitoh T., Kurabayshi H., Naruse T. Immunomodulation by vitamin B12: Augmentation of CD8+ T lymphocytes and natural killer (NK) cell activity in vitamin B12-deficient patients by methyl-B12 treatment. Wells J., Swaminathan A., Paseka J., Hanson C. Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy-A Review. Trimboli P., Castellana M., Bellido D., Casanueva F.F. Pischon T., Hankinson S.E., Hotamisligil G.S., Rifai N., Willett W.C., Rimm E.B. Upala S., Yong W.C., Theparee T., Sanguankeo A. Yabuzaki J. Carotenoids database: Structures, chemical fingerprints and distribution among organisms. Omega-6 FAs include linoleic acid (LA), mainly found in meat, and arachidonic acid (ARA), found in poultry and eggs [21]. 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]. 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]. As oils of cold-water fish are rich in EPA and DHA, the effect of fish oil consumption and supplementation has been under investigation [211,212,213,214,215,216]. 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-). FAs can be divided in two separate groups [21]. 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]. Anti-inflammatory effects of sodium butyrate on human monocytes: Potent inhibition of IL-12 and up-regulation of IL-10 production. Immune modulation by curcumin: The role of interleukin-10. Based on this data, ketogenic diet is a promising prospect in psoriasis management, but large studies are needed for safe conclusions. A diet with a fiber content of 30 g/d led to a significant reduction in hsCRP [50]. Hsu S., Dickinson D., Borke J., Walsh D.S., Wood J., Qin H., Winger J., Pearl H., Schuster G., Bollag W.B. 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]. and V.L., structuring of the review, writing, and literature review; I.I., E.T., D.V., E.P., A.R., assistance with writing. Paoli A., Mancin L., Giacona M.C., Bianco A., Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. SFAs are primarily found in meat, dairy products, palm and coconut oil and processed foods which are abundant in Western-type diets and have been associated with increased inflammation in a number of studies [22,23,24,25,26]. Lassus A., Dahlgren A.L., Halpern M.J., Santalahti J., Happonen H.P. 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. Del Giglio M., Gisondi P., Tessari G., Girolomoni G. Weight reduction alone may not be sufficient to maintain disease remission in obese patients with psoriasis: A randomized, investigator-blinded study. Lipidomic evidence that lowering the typical dietary palmitate to oleate ratio in humans decreases the leukocyte production of proinflammatory cytokines and muscle expression of redox-sensitive genes. Zhou Y.E., Buchowski M.S., Liu J., Schlundt D.G., Ukoli F., Blot W.J., Hargreaves M.K. Carr A.C., Maggini S. Vitamin C and Immune Function. Ruedemann et al. Bardazzi F., Balestri R., Baldi E., Antonucci A., De Tommaso S., Patrizi A. Similarly, a more recent study by Kolchak et al. A growing number of studies have highlighted the association between obesity and psoriasis [124,125,126,127,128,129,130,131,132,133]. Another trial indicated that oral curcumin administration in combination with visible light phototherapy can improve moderate to severe plaque psoriasis [243], and a similar result was demonstrated with curcumin as an add-on therapy to acitretin [244]. 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. FOIA Reynolds C.M., McGillicuddy F.C., Harford K.A., Finucane O.M., Mills K.H., Roche H.M. Dietary saturated fatty acids prime the NLRP3 inflammasome via TLR4 in dendritic cells-implications for diet-induced insulin resistance. 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]. Balbas G.M., Regana M.S., Millet P.U. National Library of Medicine Similarly, Mutairi et al. Vitamin C is also indispensable for the antioxidant actions of vitamin E, which contributes to T-cell and NK cells activity. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors: The diet, obesity, and genes (DiOGenes) study: A randomized, controlled trial. All authors have read and agreed to the published version of the manuscript. Another polyphenol with remarkable effects on psoriasis is epigallocatechin-3-gallate (EGCG), which is the most abundant catechin in green tea and is known to possess anti-inflammatory, antioxidant and antiproliferative properties [248]. A cross-sectional study by Herron et al. The biological role of inflammation in atherosclerosis. Psoriasis is a chronic, immune-mediated inflammatory disease with multifactorial etiology. However, according to an older study in 69 patients, selenium and Vitamin E supplementation for 12 weeks did not reduce psoriasis severity [233]. Michalsson G., Gerdn B., Hagforsen E., Nilsson B., Pihl-Lundin I., Kraaz W., Hjelmquist G., Lf L. Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet. Mayer K., Seeger W., Grimminger F. Clinical use of lipids to control inflammatory disease. 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. Various hypotheses have been made to explain these discrepancies; a main reason is that vitamin D levels are not primarily determined by intake, but rather through sun exposure, a variable which is difficult to ensure in any patient group [201]. A case-control study by Barrea et al.
Renner S., Rath R., Rust P., Lehr S., Frischer T., Elmadfa I., Eichler I. Chiricozzi A., Raimondo A., Lembo S., Fausti F., Dini V., Costanzo A., Monfrecola G., Balato N., Ayala F., Romanelli M., et al. 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. Other studies have evaluated the impact of intramuscular administration of Vitamin B12 on the treatment of psoriasis with inconsistent results. Only two RCTs have been conducted to investigate the efficacy of oral zinc supplementation in patients with psoriasis. Tungland B. Short-Chain Fatty Acid Production and Functional Aspects on Host Metabolism. 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. Responses of inflammatory markers to a low-fat, high-carbohydrate diet: Effects of energy intake. After three months, there was no significant difference in PASI score between the two groups [201]. 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. Markova M., Pivovarova O., Hornemann S., Sucher S., Frahnow T., Wegner K., Machann J., Petzke K.J., Hierholzer J., Lichtinghagen R., et al. They are scavengers of ROS and they can limit the generation of free radicals and inflammatory molecules, serving as potent antioxidants [4]. Takahashi H., Tsuji H., Takahashi I., Hashimoto Y., Ishida-Yamamoto A., Iizuka H. Plasma adiponectin and leptin levels in Japanese patients with psoriasis. Deng Y., Chang C., Lu Q. Frasheri L., Schielein M.C., Tizek L., Mikschl P., Biedermann T., Zink A. Research data have shown that a high BMI diminishes the effectiveness of pharmacological treatment [134,138]. Sakane T., Takada S., Kotani H., Tsunematsu T. Effects of methyl-B12 on the in vitro immune functions of human T lymphocytes. On the other hand, positive associations between lycopene and F2-isoprostane or MDA levels have been shown in large-scale human studies, which were attributed to the fact that lycopene intake came mainly from pasta sauce, ketchup and fast-food consumption and not from tomatoes, its main natural source [96,97]. The effects of protein intake on metabolic derangement and inflammation are rather conflictive, and large-scale studies on the association between long-term habitual protein intake and circulating inflammatory biomarkers are lacking. Effects of Curcuma extract and visible light on adults with plaque psoriasis. Despite the lack of large randomized clinical trials to confirm the effect of different diets in patients with psoriasis, an abundance of research data highlights diet as a potential therapeutic target. 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]. Effect of Combined Treatment With Folic Acid, Vitamin B6, and Vitamin B12 on Plasma Biomarkers of Inflammation and Endothelial Dysfunction in Women. An RCT including 18 patients with severe stable plaque psoriasis showed that fish oil supplementation in combination with UVB has beneficial effects on the clinical manifestations of psoriasis compared to the combination of olive oil with UVB [226]. Curcumin inhibits LPS-induced inflammation in rat vascular smooth muscle cells in vitro via ROS-relative TLR4-MAPK/NF-kappaB pathways. Rapid improvement of clinical manifestations and changes in neutrophil leukotriene profile. Effects of a Mediterranean-style diet on cardiovascular risk factorsA randomized trial. The phenolic compounds in EVOO are capable of diminishing LDL oxidization and possess potent antioxidant properties, with oleuropein also having anti-proliferative properties [7]. Evidence from the Psocare project. Phenol-enriched olive oils improveHDL antioxidant content in hypercholesterolemic subjects: A randomized, double-blind, cross-over, controlled trial. showed that one year of gluten-free diet improves PASI score in 56% of patients with very high levels of IgA-AGA and in 36% of patients with high levels of IgA-AGA [165]. reported that after two years, the proportion of patients receiving the same treatment was only 42.21%, proposing high BMI as an independent predictor of drug failure and withdrawal [138]. Bullo M., Casas R., Portillo M.P., Basora J., Estruch R., Garcia-Arellano A., Lasa A., Juanola-Falgarona M., Aros F., Salas-Salvado J. Dietary glycemic index/load and peripheral adipokines and inflammatory markers in elderly subjects at high cardiovascular risk. Christodoulatos G.S., Spyrou N., Kadillari J., Psallida S., Dalamaga M. The role of adipokines in breast cancer: Current evidence and perspectives. 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. An official website of the United States government. In accordance with these results, a more recent cross-sectional observational study with a larger sample (n = 35.735 patients) by Phan et al. 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. Castaldo G., Rastrelli L., Galdo G., Molettieri P., Rotondi Aufiero F., Cereda E. Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial. The site is secure. Zunino S.J., Peerson J.M., Freytag T.L., Breksa A.P., Bonnel E.L., Woodhouse L.R., Storms D.H. Dietary grape powder increases IL-1beta and IL-6 production by lipopolysaccharide-activated monocytes and reduces plasma concentrations of large LDL and large LDL-cholesterol particles in obese humans. Effect of dietary supplementation with n-3 fatty acids on clinical manifestations of psoriasis. Huang H., Shen E., Tang S., Tan X., Guo X., Wang Q., Ding H. Increased serum resistin levels correlate with psoriasis: A meta-analysis. A recent meta-analysis of 63 studies, including 2876 psoriasis patients and 2237 healthy controls, showed that patients with psoriasis have decreased levels of adiponectin; on the contrary, another meta-analysis with 521 cases and 482 controls indicated no statistically significant difference in the levels of adiponectin and high-molecular weight adiponectin levels between the two groups [141,147]. 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].
After 8 weeks, treatment with calcipotriol had a more beneficial impact on psoriasis severity.