title: Bioelectrical phase angle and psoriasis: a novel association with psoriasis severity, quality of life and metabolic syndrome.
abstract: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental factors, show multiple bidirectional associations, with important metabolic implications in psoriatic patients. Besides body mass index (BMI) as a measure of obesity, data on phase angle (PhA), a direct measure by bioelectrical impedance analysis (BIA), used as a marker of cellular health and a predictor of morbidity and mortality in various diseases, are still lacking in psoriasis. In this case-control, cross-sectional study, we investigated the PhA in 180 pairs of adult psoriatic patients and healthy controls, evaluating also the potential use of the PhA as marker of the clinical severity, the quality of life, and the presence of the MetS in psoriatic patients.
  
  
  
  Anthropometric measures, metabolic profile and bioelectrical variables were evaluated. The clinical severity was assessed by standardized psoriasis area and severity index (PASI) score and c-reactive protein (CRP) levels, and the quality of life was evaluated by dermatology life quality index (DLQI). MetS was diagnosed according to Adult Treatment Panel III.
  
  
  
  Psoriatic patients presented smaller PhA (p < 0.001) and higher prevalence MetS compared with controls. The PhA was significantly associated with number of parameters of MetS in both groups (p < 0.001). After adjusting for BMI, this association remained significant in psoriatic patients only (p < 0.001). Among psoriatic patients, the PhA was the major index value for the diagnosis of MetS (OR 5.87, 95 % CI 5.07-6.79) and was inversely associated with both PASI score and DLQI, independently of BMI (p < 0.001). At multiple regression analysis, the PhA well predicted the PASI score and DLQI. Based on ROC curves, the most sensitive and specific cutoffs of PhA to predict the highest PASI score and the lowest DQLI were ≤4.8° and ≤4.9°, respectively.
  
  
  
  We reported that psoriatic patients presented small PhAs, with a novel association between PhA, clinical severity, quality of life in psoriatic patients, and MetS. Further studies are required to validate the PhA's prognostic ability in assessing the clinical severity and MetS in 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 Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Paolo Emidio
authors.initials: PE
authors.lastname: Macchia
authors.affiliation: IRCCS SDN, Napoli Via Gianturco 113, 80143, Naples, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Di Somma
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Dermatology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Napolitano
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Dermatology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Balato
authors.affiliation: I.O.S. & COLEMAN Srl, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Falco
authors.affiliation: I.O.S. & COLEMAN Srl, Naples, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Savanelli
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Dermatology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Balato
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
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, 80131, Naples, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Savastano
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000503:physiopathology*; D008875:Middle Aged; D016017:Odds Ratio; D011565:Psoriasis / Q000150:complications* / Q000503:physiopathology*; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Dermatology life quality index (DLQI); Environmental factors; Metabolic syndrome (MetS); Phase angle (PhA); Psoriasis area and severity index (PASI) score