Residents Forum
RF – Role of the Mediterranean Diet in the Treatment of Psoriasis
FR – El papel de la dieta mediterránea en el tratamiento de la psoriasis
E. Berna-Rico
, D. Fernandez-Nieto, A. Gonzalez-Cantero
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Servicio de Dermatologia, Hospital Universitario Ramon y Cajal, Instituto de Investigación Sanitaria del Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
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Gonzalez-Cantero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Berna-Rico" "email" => array:1 [ 0 => "emilioberna2a@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Fernandez-Nieto" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Gonzalez-Cantero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatologia, Hospital Universitario Ramon y Cajal, Instituto de Investigación Sanitaria del Hospital Ramon y Cajal (IRYCIS), Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR – El papel de la dieta mediterránea en el tratamiento de la psoriasis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory disease that is affected by multiple lifestyle-associated factors. In recent years, several studies have demonstrated the ability of certain foods and dietary patterns to modulate different markers related to systemic inflammation,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> which is an important component of moderate-to-severe psoriasis and is closely linked to associated comorbidities. In a meta-analysis of clinical trials, weight loss through diet was associated with a significant decrease in disease severity.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Although these improvements could be attributed to a reduction in obesity-associated systemic inflammation, the results of the included studies showed great heterogeneity, suggesting a role of factors other than weight loss in the observed benefit. Diet composition, as mentioned above, could be one such factor.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a> The Mediterranean diet (MD) is a great source of antioxidant and anti-inflammatory molecules, and has been associated with a decreased risk of cardiovascular and chronic inflammatory diseases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Accordingly, several research groups have investigated the potential benefits of MD in patients with psoriasis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In a cross-sectional study published in 2015 by Barrea et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> poor MD adherence was observed in a significantly higher percentage of psoriasis patients than controls (30.6 and 4.8%, respectively; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Diet adherence was negatively correlated with disease severity as measured by the psoriasis area severity index (PASI). In the multiple regression analysis, consumption of olive oil was one of the main predictors of PASI score, with a correlation coefficient (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span>) of 0.548 (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The largest study in this field is a cross-sectional study published in 2018 in JAMA Dermatology<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> that included 35<span class="elsevierStyleHsp" style=""></span>735 subjects from the NutriNet-Santé cohort. Of the participating subjects, 3557 had psoriasis, which was classified as severe in 878 patients. In the multivariate analysis, after adjusting for variables such as age, sex, weight, and cardiovascular risk factors, the percentage of patients with severe forms of the disease was significantly lower among the groups with the greatest adherence to the diet. Castaldo et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> evaluated the effect of a very low-calorie ketogenic diet for 4 weeks followed by hypocaloric MD for 6 weeks in a group of overweight/obese patients with psoriasis without systemic treatment. The authors observed significant reductions in weight and improvements in PASI and quality of life. Interestingly, they observed no linear correlation between weight loss and PASI, suggesting that the anti-inflammatory effect of ketone bodies and other dietary components contributed to the observed benefits. Finally, a recent study reported an inverse and weight-independent correlation between psoriatic arthritis activity and MD adherence, suggesting a potential benefit of this dietary pattern in these patients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes published studies evaluating the effect of MD in psoriasis and/or psoriatic arthritis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion, the available evidence indicates that MD may be associated with less severe forms of psoriasis and/or psoriatic arthritis. Bearing in mind that reduced severity was independent of body mass index in several studies,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4–7</span></a> it is possible that the beneficial effects of this dietary pattern are due to more than mere weight loss. However, more experimental longitudinal studies will be necessary to consolidate these findings and to precisely define the role of MD in the treatment of this disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This work has not received any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "xpalclavsec1610383" "titulo" => "Keywords" ] 1 => array:2 [ "identificador" => "xpalclavsec1610384" "titulo" => "Palabras clave" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1610383" "palabras" => array:4 [ 0 => "Psoriasis" 1 => "Mediterranean diet" 2 => "Skin" 3 => "Treatment" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: DAPSA, Disease Activity in Psoriasis Arthritis; DLQI, Dermatology Life Quality Index; MD<span class="elsevierStyleItalic">,</span> Mediterranean diet; CI, confidence interval; BMI, body mass index; PASI, Psoriasis Area and Severity Index; PASI50, 50% reduction in baseline PASI; PASI75, 75% reduction in baseline PASI; CRP, C-reactive protein; PREDIMED, prevention with the Mediterranean diet; EVOO, extra-virgin olive oil.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author, year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study design \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Main findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barrea et al., 2015<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, transversal.Adherence evaluated with the PREDIMED questionnaire: <6, low adherence; 6–9, moderate adherence; >9, high adherence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 psoriasis patients without previous systemic treatment.62 age-, sex-, and BMI-matched controls. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low adherence observed in significantly higher percentage of psoriasis patients than controls (30.6% vs. 4.8%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).Negative correlation between PREDIMED and PASI scores (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.576; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).Among PREDIMED items, use of EVOO was an independent predictive factor of PASI (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.548; <span class="elsevierStyleItalic">β</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.741; <span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−7.636; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).Fish consumption was an independent predictive factor of CRP (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.139; <span class="elsevierStyleItalic">β</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.372; <span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.922; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phan et al., 2018<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">France \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, transversal.Adherence evaluated with MEDI-LITE questionnaire (score of 0–18 [complete adherence]); tertiles 1 (0–7), 2 (8–9), and 3 (>10). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 735 subjects from the NutriNet-Santé cohort.3557 patients with psoriasis.878 patients (24.7%) with severe psoriasis. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Univariate analysis: percentage of patients with severe psoriasis was higher in tertile 1 (severe psoriasis, 45.5%; non-severe psoriasis, 36.6%; no psoriasis, 35.6%; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).Multivariate analysis<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a>:• Tertile 2, OR (95% CI) for severe psoriasis: 0.74 (0.61–0.90).• Tertile 3, OR (95%CI) for severe psoriasis: 0.74 (0.60–0.91). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Molina-Leyva et al., 2019<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, transversal.Adherence evaluated with PREDIMED questionnaire. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89 patients with psoriasis receiving systemic treatment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PASI was lower in patients with greater MD adherence. Low adherence, 7 (95% CI 3.6–8.20); moderate adherence, 3.4 (95% CI 1.05–9.45); high adherence, 0.8 (95% CI 0.00–2.57); <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007.Lower CRP in group with greatest MD adherence (3.20<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.73 vs. 2.54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.84 vs. 1.12<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.23; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Korovesi et al., 2019<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Greece \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, transversal.Adherence evaluated with MedDietScore.≤21, low adherence; 21–35, moderate adherence; ≥35, high adherence. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 patients with psoriasis without prior systemic treatment.69 controls matched by age, sex, BMI, and date of inclusion. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MD adherence inversely associated with risk of developing psoriasis<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a> (OR, 0.34; 95% CI 0.13–0.92; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03).MedDietScore negatively correlated with PASI (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.39, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).PASI inversely associated with consumption of legumes, fish, and EVOO (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Castaldo et al., 2020<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Open clinical trial, single-arm.Intervention: ketogenic diet for first 4 weeks, followed by 6 weeks of hypocaloric MD. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 patients with stable plaque psoriasis and overweight, without previous systemic drug treatment. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean PASI change of −10.6 (95% CI −12.8 to −8.4; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001).PASI50 in 97.3% and PASI75 in 64.9%.Mean weight reduction of −9.5% (95% CI −10.5 to −8.4; <span class="elsevierStyleItalic">P</span> < 0.001) and 12.0% (95% CI −13.7 to −10.4; <span class="elsevierStyleItalic">P</span> < 0.001) at end of the ketogenic period and the Mediterranean diet period, respectively.Mean DLQI change, −13.4 (95% CI −17.0 to −9.7; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Case et al., 2020<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Italy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Observational, cross-sectional, multicenter.Adherence evaluated with PREDIMED questionnaire. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">211 patients with psoriatic arthritis. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inverse relationship between DAPSA and PREDIMED score (<span class="elsevierStyleItalic">β</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−3.291; 95% CI −5.884 to −0.698; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.013)<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a>. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Adjusted for age, sex, BMI, smoking, physical activity, educational level, baseline history of cardiovascular disease, diabetes, hypertension, and hypertriglyceridemia.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Adjusted for sex, BMI, and previous treatment with disease-modifying drugs.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Adjusted for age, sex, and BMI.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Studies Evaluating the Effect of the Mediterranean Diet in Psoriasis and/or Psoriatic Arthritis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Environmental risk factors in psoriasis: the point of view of the nutritionist" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Barrea" 1 => "F. Nappi" 2 => "C. Di Somma" 3 => "M.C. Savanelli" 4 => "A. Falco" 5 => "A. Balato" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/ijerph13070743" "Revista" => array:5 [ "tituloSerie" => "Int J Environ Res Public Health" "fecha" => "2016" "volumen" => "13" "paginaInicial" => "743" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27455297" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Upala" 1 => "A. 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Savanelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12967-014-0372-1" "Revista" => array:5 [ "tituloSerie" => "J Transl Med" "fecha" => "2015" "volumen" => "13" "paginaInicial" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25622660" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between Mediterranean anti-inflammatory dietary profile and severity of psoriasis: results from the NutriNet-Santé cohort" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Phan" 1 => "M. Touvier" 2 => "E. Kesse-Guyot" 3 => "M. Adjibade" 4 => "S. Hercberg" 5 => "P. Wolkenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2018.2127" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "1017" "paginaFinal" => "1024" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30046840" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: a proof-of-concept, single-arm, open-label clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Castaldo" 1 => "L. Rastrelli" 2 => "G. Galdo" 3 => "P. Molettieri" 4 => "F. Rotondi Aufiero" 5 => "E. Cereda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nut.2020.110757" "Revista" => array:5 [ "tituloSerie" => "Nutrition" "fecha" => "2020" "volumen" => "74" "paginaInicial" => "110757" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32222582" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mediterranean diet and psoriatic arthritis activity: a multicenter cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Caso" 1 => "L. Navarini" 2 => "F. Carubbi" 3 => "A. Picchianti-Diamanti" 4 => "M.S. Chimenti" 5 => "M. 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Papadavid" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ijd.14523" "Revista" => array:5 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2019" "volumen" => "58" "paginaInicial" => "e164" "paginaFinal" => "e165" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to Mediterranean diet in Spanish patients with psoriasis: cardiovascular benefits?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Molina-Leyva" 1 => "C. Cuenca-Barrales" 2 => "J.J. Vega-Castillo" 3 => "J.C. Ruiz-Carrascosa" 4 => "R. Ruiz-Villaverde" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/dth.12810" "Revista" => array:5 [ "tituloSerie" => "Dermatol Ther" "fecha" => "2019" "volumen" => "32" "paginaInicial" => "e12810" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30632241" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/00017310/0000011400000002/v3_202302211823/S0001731022010237/v3_202302211823/en/main.assets" "Apartado" => array:4 [ "identificador" => "34907" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Foro de Residentes" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011400000002/v3_202302211823/S0001731022010237/v3_202302211823/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731022010237?idApp=UINPBA000044" ]
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