Abstract
Greater body mass index (BMI) has been associated with increased risk of psoriasis in case–control and cross-sectional studies, however, the evidence from prospective studies has been limited. We conducted a systematic review and dose–response meta-analysis of different adiposity measures and the risk of psoriasis to provide a more robust summary of the evidence based on data from prospective studies. PubMed and Embase databases were searched for relevant studies up to August 8th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The summary relative risk (RR) for a 5 unit increment in BMI was 1.19 (95% CI 1.10–1.28, I2 = 83%, n = 7). The association appeared to be stronger at higher compared to lower levels of BMI, pnonlinearity < 0.0001, and the lowest risk was observed at a BMI around 20. The summary RR was 1.24 (95% CI 1.17–1.31, I2 = 0%, pheterogeneity = 0.72, n = 3) per 10 cm increase in waist circumference, 1.37 (95% CI 1.23–1.53, I2 = 0%, pheterogeneity = 0.93, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.11 (95% CI 1.07–1.16, I2 = 47%, pheterogeneity = 0.15, n = 3) per 5 kg of weight gain. Adiposity as measured by BMI, waist circumference, waist-to-hip ratio, and weight gain is associated with increased risk of psoriasis.
Highlights
Psoriasis is a chronic immune-mediated inflammatory skin disease which is characterized by patches of abnormal skin, which typically are red, itchy and scaly [1]
The method described by Greenland and Longnecker [56] was used for the dose–response analysis and studyspecific slopes and 95% confidence intervals (CIs) were computed from the natural logs of the relative risks (RRs) and CIs across categories of adiposity measures
The mean level of body mass index (BMI), waist circumference, waist-to-hip ratio, and weight gain in each category was assigned to the corresponding relative risk for each study and for studies that reported these measures by ranges, we estimated the midpoint in each category as the average of the lower and upper bounds
Summary
Psoriasis is a chronic immune-mediated inflammatory skin disease which is characterized by patches of abnormal skin, which typically are red, itchy and scaly [1]. A large number of cross-sectional and case–control studies have reported a positive association between adiposity and the risk of psoriasis [28–42]. A meta-analysis from 2012 suggested a positive association between obesity (BMI of C 30 kg/m2) and psoriasis [43], it was largely based on cross-sectional and case–control studies, study designs which can be difficult to rely on for causal inferences because (1) the temporality of the association between the exposure and the disease is not clear in cross-sectional studies, and (2) because case– control studies may be hampered by recall and selection biases. Recently several prospective studies have reported on the association between body mass index (BMI, kg/m2), abdominal fatness (waist circumference or waist-to-hip ratio) or weight changes and the risk of psoriasis [17, 44–49]. Given the limited number of prospective studies and lack of data on abdominal fatness in previous meta-analyses on adiposity and psoriasis we conducted a systematic review and dose–response meta-analysis of prospective studies to clarify the strength and shape of the dose–response relationship between different measures of adiposity and the risk of psoriasis
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