Abstract
In this case-control, cross-sectional, observational study, we evaluated circulating trimethylamine n-oxide (TMAO) levels, a gut-derived metabolite associated with inflammation and cardiometabolic risk, in patients with hidradenitis suppurativa (HS), a highly disabling inflammatory skin disease associated with an elevated prevalence of comorbidities, especially cardiovascular and metabolic diseases. In this study, we enrolled 35 naive-treatment patients with HS and 35 controls, matched for sex, age, and body mass index (BMI). HS Sartorius score was 49.0 (33.0–75.0), while according to the Harley system 12 and 23 patients presented grade 1 and grade 2 severity, respectively. HS patients had a lower adherence to the Mediterranean diet (MD) (p = 0.002), lower phase angle (PhA) (p < 0.001), and higher circulating TMAO levels (p < 0.001) than the control group. HS patients with grade 2 rather than grade 1 of Harley grade severity showed a higher BMI (p = 0.007), waist circumference (p = 0.016), total energy intake (p = 0.005), and lower PhA (p < 0.001) and adherence to the MD (p = 0.003). Of interest, patients with Hurley grade 2 of severity exhibited higher circulating TMAO levels (p < 0.001) compared to grade 1. Circulating TMAO levels showed a positive correlation with HS Sartorius score even after adjustment for confounding covariates, including BMI, waist circumference, adherence to the MD, total energy intake, and PhA (r = 0.570, p = 0.001). Using a linear regression model, circulating TMAO levels and PhA were the main predictors of the clinical severity of HS.
Highlights
Trimethyilamine N-oxide (TMAO) is a gut-derived metabolite that depends on the function of the intestinal barrier and is associated with an increased risk of metabolic syndrome, cardiovascular disease, and mortality [1]
In this case-control, cross-sectional, observational study, we evaluated circulating trimethylamine n-oxide (TMAO) levels, a gut-derived metabolite associated with inflammation and cardiometabolic risk, in patients with hidradenitis suppurativa (HS), a highly disabling inflammatory skin disease associated with an elevated prevalence of comorbidities, especially cardiovascular and metabolic diseases
All participants completed the study protocol, including nutritional and dermatological assessments. The nutritionist evaluated both patients with HS and controls with anthropometric and nutritional assessments, bioelectrical impedance analysis (BIA) measurements, and blood sampling for the assessment of circulating TMAO levels
Summary
Trimethyilamine N-oxide (TMAO) is a gut-derived metabolite that depends on the function of the intestinal barrier and is associated with an increased risk of metabolic syndrome, cardiovascular disease, and mortality [1]. Among gut-derived metabolites, TMAO has been associated with oxidative stress and lowgrade chronic inflammation through the dysregulation of specific molecular inflammatory pathways [3]. Increased circulating TMAO levels have been frequently associated with non-alcoholic fatty liver disease, and chronic kidney diseases, and inflammatory bowel disease [4]. HS onset generally occurs after puberty, with the highest incidence in the third decade of life. It affects both sexes, HS is mainly diffused among women [8]. Clinical skin lesions and their chronicity play an important role in establishing the diagnosis of patients with HS, but reliable and accurate diagnostic tests are still lacking [14]
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