Can diet help with the management of psoriasis?

Dietary guidelines for people with psoriasis are sparse, focusing primarily on managing their comorbid conditions. Prof. Wendy Hall (King's College London, UK) presented current dietary guidelines and ongoing dietary research [1].

A systematic review of 55 trials totalling more than 4,500 participants with psoriasis concluded that a hypocaloric diet should be recommended in people with psoriasis who are overweight or obese [2]. A gluten-free diet could be recommended in people who have concomitant confirmed coeliac disease or a positive serology for gluten sensitivity. Low-quality observational evidence also showed that Mediterranean diets could be effective, but well-designed clinical trials are needed to confirm this conclusion.

A more recent meta-analysis analysed the effect of dietary interventions in obese participants on psoriasis outcomes, including 6 randomised controlled trials [3]. Dietary intervention (strict caloric restriction) compared with usual care led to reductions in Psoriasis Area and Severity Index (PASI) scores at week 16 (very low-quality intervention). In 2 of these trials, dietary intervention also improved quality-of-life (moderate quality evidence). Furthermore, the combination of diet intervention plus exercise programme compared with information only led to reductions in BMI and higher proportions of participants achieving ≥50% reduction in PASI (moderate quality evidence), but not with achieving ≥75% reduction in PASI.

Prof. Hall continued by describing 2 studies that assess dietary associations with psoriasis [1]. The APPLE study (NCT05448352) is an online, cross-sectional survey collecting data on psoriasis severity, diet, demographics, and lifestyle characteristics. Dietary intakes were measured using the EPIC Food Frequency Questionnaire. In total, 371 participants started the APPLE survey and 270 participants completed the study. The recruited population were mainly White, British, women, and non-smoking with a median age of 40 years. The dietary intake of fibres, fatty acids, and sugars was similar to the overall British population. Overall, 51% of participants were comorbid obese or overweight and 19% had cardiometabolic disease. Regression analyses showed that increasing diet scores were associated with lowered psoriasis severity (P<0.05). For the Mediterranean Diet Score, intake of meat and poultry were positive predictors for psoriasis severity (P<0.05) and intake of fruits, nuts, and legumes were negative predictors of severity (P<0.05).

The METRED-P (NCT05820698) study aims to evaluate the feasibility of implementing a Mediterranean-style diet and/or time-restricted eating as dietary patterns for individuals with psoriasis, with a BMI of 25–50 who were not receiving phototherapy or systemic therapy. The trial will assess adherence to the dietary intervention as well as measures of psoriasis.

In summary, “diet quality is associated with psoriasis severity,” said Prof. Hall [1]. “The work done so far will generate hypotheses for potential dietary targets, possibly including plant-based diets. Ultimately we hope this will lead to evidence-based dietary guidelines for psoriasis management.”

1. 
   
   1. Hall W. Impact of lifestyle interventions in psoriatic disease. IFPA Conference 2024, 27–29 June, Stockholm, Sweden.
   2. Ford AR, et al. JAMA Dermatol. 2018;154(8):934-950.
   3. Ko SH, et al. Cochrane Database Syst Rev. 2019;7(7):CD011972.

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Posted on 17 July 2024