Risk of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis: an updated systematic review and meta-analysis of observational studies

G. Targher,G. Girolomoni,F. Bellinato,P. Gisondi,A. Mantovani

doi:10.1007/s40618-022-01755-0

Abstract

PurposeChronic plaque psoriasis is associated with the presence of non-alcoholic fatty liver disease (NAFLD), but the magnitude of this association remains currently uncertain. We aimed to investigate the magnitude of the association between psoriasis and the risk of prevalent and incident NAFLD, and to assess whether psoriasis severity and/or psoriatic arthritis are associated with a greater risk of NAFLD.MethodsA systematic review and meta-analysis of observational studies evaluating the association between psoriasis and NAFLD, as diagnosed by imaging or International Classification of Diseases codes was performed. Literature search on PubMed, Scopus and Web of Science on May 3, 2021 was undertaken. Studies using liver biopsy were not available. For the meta-analysis, the random-effects modelling was adopted.ResultsWe identified 15 observational (case–control and cross-sectional) studies for a total of 249,933 patients with psoriasis (49% with NAFLD) and 1,491,402 controls (36% with NAFLD). Psoriasis was associated with prevalent NAFLD (n = 11 studies; pooled random-effects odds ratio [OR] 1.96, 95% CI 1.70–2.26; I2 = 97%, p < 0.01). Psoriatic patients with NAFLD had a higher mean psoriasis area and severity index (PASI) than their counterparts without NAFLD (n = 8 studies, pooled weighted mean difference: 3.93, 95% CI 2.01–5.84; I2 = 88%, p < 0.01). The risk of NAFLD was marginally higher in patients with psoriatic arthritis than in those with psoriasis alone (n = 5 studies, pooled random-effects OR 1.83, 95% CI 0.98–3.43; I2 = 64%, p = 0.03). Sensitivity analyses did not alter these findings. Funnel plot did not show any significant publication bias. A major limitation of the study was the high degree of heterogeneity across studies.ConclusionPsoriasis is associated with prevalent NAFLD and this risk parallels the severity of psoriasis.

Highlights

Chronic plaque psoriasis is a common, immune-mediated, inflammatory skin disease affecting nearly 3% of adults in the general population in Western countries [1]
The primary outcome measure of the meta-analysis was the risk of having non-alcoholic fatty liver disease (NAFLD) in patients with chronic plaque psoriasis and non-psoriatic control subjects
The psoriasis severity, as assessed by psoriasis area and severity index (PASI) score, in patients with and without NAFLD was displayed as weighted mean difference (WMD) and 95% confidence intervals (95% CIs) for the changes of mean PASI score between psoriatic patients with and without coexisting NAFLD

Summary

Introduction

Chronic plaque psoriasis is a common, immune-mediated, inflammatory skin disease affecting nearly 3% of adults in the general population in Western countries [1]. There are only two small meta-analyses (published in 2015 and 2019, respectively) that have investigated the association between psoriasis and risk of prevalent NAFLD [9, 10] These two small meta-analyses reported that psoriasis is associated with an increased risk of prevalent NAFLD, but the available data on the association of NAFLD with the severity of psoriasis or psoriatic arthritis remain inconclusive. As discussed in detail below, in the last 2 years, new observational studies examining the association between psoriasis (and its severity) and the risk of NAFLD have been published

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