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1218 CLINICAL REPORT Relationship of Visceral Fat and Adipokines with Cardiometabolic Diseases in Psoriasis Nasrin GOOLAM MAHYOODEEN 1 , Nigel J. CROWTHER 2 , Lushen PILLAY 3 , Tracy SNYMAN 2 , Marketa TOMAN 2 , Sheetal DAYA 4 and Mohammed TIKLY 1 Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, 2 Department of Chemical Pathology, National Health Laboratory Service and Faculty of Health Sciences, 3 Department of Dermatology, Faculty of Health Sciences, and 4 Department of Radiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa 1 As part of a larger cross-sectional, case-control study on cardiometabolic diseases in psoriasis this study investigated the association of visceral fat and se­ rum adipokines with psoriasis and cardiometabolic diseases. A total of 103 patients with psoriasis and 98 controls, matched for body mass index, ethnicity and sex, were recruited over 15 months. Abdominal visceral fat was measured by computerized tomo­ graphy. Logistic regression analysis revealed that visceral fat was associated with psoriasis (odds ratio (95% confidence interval): 1.56 (1.15, 2.11)), hyper­ triglyceridaemia (1.67 (1.22, 2.28)), low high-density lipoprotein (1.63 (1.19, 2.22)) and type 2 diabetes (1.77 (1.24, 2.54)), (p  < 0.005 for all). These respec­ tive associations were linked to serum interleukin-6, adiponectin, tumour necrosis factor and insulin resis­ tance. Psoriasis was associated with type 2 diabetes (7.94 (2.64, 23.9)), independent of visceral fat. These data suggest that visceral fat and its mediators play a key role in psoriasis-associated cardiometabolic di­ seases. Psoriasis itself is associated with an increased risk of type 2 diabetes. Key words: psoriasis; cardiometabolic disease; cardiovascular disease; visceral fat; adipokines; metabolic syndrome. Accepted Oct 2, 2019; E-published Oct 3, 2019 Acta Derm Venereol 2019; 99: 1218–1223. Corr: Nasrin Goolam Mahyoodeen, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, PO Box Bertsham 2013, Jo- hannesburg, South Africa. E-mail: [email protected] T here is strong epidemiological evidence demonstra- ting that patients with psoriasis have an increased risk of cardiometabolic diseases (CMDs) (1–3). In particular, psoriasis has been shown to be associated with obesity (4), particularly abdominal obesity (5), type 2 diabetes (T2D), hypertension, coronary artery disease and de- creased life expectancy (6). The pathological basis for the link between psoriasis and CMDs is not fully under- stood. One hypothesis is that the chronic inflammatory state of psoriasis triggers a “psoriatic march”, whereby the pro-inflammatory milieu leads to insulin resistance and endothelial cell dysfunction, predisposing to CMDs (7). Chronic inflammation predisposes to accelerated atherosclerosis and other CMDs (8) via pro-inflammatory mediators and activated immune cells. Obesity has been shown to be associated with low-grade chronic inflamma- doi: 10.2340/00015555-3327 Acta Derm Venereol 2019; 99: 1218–1223 SIGNIFICANCE Abdominal obesity is common in patients with psoriasis. This study examined the relationship of abdominal fat, measured by computed tomography, in relation to meta- bolic diseases in a cohort of 103 patients with psoriasis and 98 control subjects. The results showed that increased visceral fat and related hormones were associated with an increased risk of psoriasis, type 2 diabetes and abnormal levels of lipids. Psoriasis was a risk factor for type 2 diabe- tes independent of abdominal fat. These findings show the importance of abdominal fat as a risk factor for psoriasis and metabolic diseases. tion (9). Adipocytes of visceral fat are immunologically active and secrete mainly pro-inflammatory adipokines, including leptin, visfatin, and resistin (10). Adiponectin, in contrast, has been shown to improve insulin sensiti- vity and have anti-inflammatory properties (11). Other pro-inflammatory factors that are produced mainly by macrophages within visceral fat include tumour necrosis factor (TNF), interleukin (IL)-1, and IL-6, all of which have been shown to directly or indirectly affect endothelial cell function and insulin sensitivity (12). Patients with psoriasis have high levels of inflammatory markers, with C-reactive protein (CRP) (13), leptin (14) and TNF serum concentrations being significantly higher than in controls, whilst adiponectin levels are lower (14). While previous studies have separately shown an increased prevalence of CMDs (1), adipokine dysregulation (15) and increased visceral fat in psoriasis (16), to date no studies have assessed these relationships in a single cohort. The aim of the present study was therefore to determine whether psoriasis is associated with increased visceral adiposity and inflammation and whether visceral adipose tissue mediates the relationship between psoriasis and CMDs. METHODS This was a cross-sectional case-control study of consenting adult psoriasis patients, 18 years and older, including those with psoriatic arthritis (PsA) recruited from the Dermatology and Rheumatology clinics at 3 academic hospitals in Johannesburg, South Africa from January 2015 to September 2016. The diagnosis of psoriasis and/or PsA was made by a dermatologist and/or rheumatologist. Exclusion criteria were human immunodeficiency virus infec- tion, inflammatory arthritis due to another cause, and pregnancy. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.