AGGRESSIVE WEIGHT LOSS PROGRAM WITH A KETOGENIC INDUCTION PHASE FOR THE TREATMENT OF CHRONIC PLAQUE PSORIASIS

Abstract

Chronic plaque psoriasis is an inflammatory skin disease associated with obesity,characterized by low-grade inflammation. Weight loss (WL) has been demonstrated to reduce psoriasis severity and inflammation. Very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and keton bodies likely have anti-inflammatory proprieties. We evaluate the efficacy of an aggressive WL program with a ketogenic induction phase as first-line treatment of chronic plaque psoriasis. We conducted a single-arm trial conducted (NCT03531528). Adult overweight/obese patients (N=37)with stable chronic plaque psoriasis underwent a 10-week two-phase WL program consisting in a 4-week protein-sparing, VLCKD (<500 kcal/day; 1.2 grams of protein/kg of ideal body weight/day) and a 6-week balanced, hypocaloric (25-30 kcal/kg of ideal body weight/day), low glycemic index, Mediterranean-like diet. The primary endpoint was the reduction in the Psoriasis Area and Severity Index (PASI) at week 10. Major secondary endpoints included:improvement of PASI 50% and 75%,reduction in body surface area (BSA) involved,improvement of itch severity (visual-analogue scale) and Dermatology Life Quality Index (DLQI) at week 10. With a mean body weight reduction of 12.0%,dietary intervention resulted in a significant reduction in PASI: mean change, -10.6 [95%CI, -12.8 to -8.4] (P<0.001). A reduction in PASI 50% and 75% was recorded in 36 (97.3%) and 24 (64.9%) patients, respectively. Treatment resulted also in a significant reduction of BSA involved and an improvement in itch severity and DLQI (P<0.001 for all). In adult overweight patients with stable chronic plaque psoriasis an aggressive dietary WL program consisting in a ketogenic regimen followed by a balanced, hypocaloric Mediterranean-like diet appeared an efficacious first-line strategy for improving disease severity. Comparative studies with other dietary regimens and long-term efficacy data are warranted.