title: Nutrition and psoriasis: is there any association between the severity of the disease and adherence to the Mediterranean diet?
abstract: BACKGROUND
  Many studies have evaluated the role of individual nutrients on the development of psoriasis. However, only few studies have investigated the effect of a healthy eating pattern, such as the Mediterranean diet. In this study, we aimed to investigate the relationship between adherence to the Mediterranean diet, the body composition and the severity of psoriasis in a group of naïve-treatment patients with psoriasis.
  
  
  METHODS
  This is a cross-sectional case-control observational study. Sixty-two patients (49 males and 13 females, mean age: 50.2±10.5yrs) affected with mild-to-severe psoriasis were consecutively enrolled. Sixty-two age-, sex- and body mass index (BMI)-matched healthy subjects served as control group. A validated 14-item questionnaire (PREDIMED: PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the Mediterranean diet. The severity of psoriasis was by assessed by standardized Psoriasis Area and Severity Index (PASI) score and C-reactive protein (CRP) levels. Body composition was analyzed with bioelectrical impedance analysis.
  
  
  RESULTS
  A higher percentage of psoriatic patients had a lower PREDIMED score compared to the control group (30.6% vs 4.8%). PASI score was significantly associated with the percentage of fat mass (FM%) and CRP levels. PASI score and CRP levels were significantly associated with the dietary components included in the PREDIMED questionnaire or with the PREDIMED score. At multiple regression analysis, the major predictor of PASI score were FM among BIA parameters, (r(2)=0.537, β=0.740, p<0.001), and FM (r(2)=0.537, β=0.603, p<0.001) and PREDIMED score (r(2)=0.599, β=-0.296, p=0.007) among anthropometric measures, FM and PREDIMED score. Finally, among all items of the PREDIMED questionnaire, EVOO (r(2)=0.548, β=-0.741, p<0.001), and fish consumption (r(2)=0.139, β=-0.372, p=0.005) have an independent predictive value for PASI score and CRP levels.
  
  
  CONCLUSIONS
  This is the first study to evaluate the association between adherence to the Mediterranean diet and the severity of psoriasis. Moreover, our study highlights the usefulness of the assessment of body composition by bioelectrical impedance analysis in the evaluation of the psoriatic patients.
authors.affiliation: I.O.S. & COLEMAN Srl, Naples, Italy. luigi.barrea@unina.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Barrea
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Dermatology, Federico II University Medical School of Naples, Via Sergio Pansini 5, Naples, 80131, Italy. nicola.balato@unina.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Balato
authors.affiliation: IRCCS SDN, Napoli Via Gianturco 113, Naples, 80143, Italy. cdisomma@unina.it.
authors.forename: Carolina
authors.initials: C
authors.lastname: Di Somma
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, Naples, 80131, Italy. pmacchia@unina.it.
authors.forename: Paolo Emidio
authors.initials: PE
authors.lastname: Macchia
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Dermatology, Federico II University Medical School of Naples, Via Sergio Pansini 5, Naples, 80131, Italy. maddy.napolitano@gmail.com.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Napolitano
authors.affiliation: I.O.S. & COLEMAN Srl, Naples, Italy. cristysav@hotmail.com.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Savanelli
authors.affiliation: Department of Clinical and Experimental Medicine, Second University of Naples, Via Costantinopoli, Naples, 84-80138, Italy. katherine.esposito@unina2.it.
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, Naples, 80131, Italy. colao@unina.it.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, Naples, 80131, Italy. sisavast@unina.it.
authors.forename: Silvia
authors.initials: S
authors.lastname: Savastano
mesh_terms: D000328:Adult; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011565:Psoriasis / Q000503:physiopathology / Q000517:prevention & control*; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D002097:C-Reactive Protein