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The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
 |
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
Given the association of psoriasis – particularly more severe disease – and increases in BMI, most of our patients would be recommended for diabetes screening based on standard recommendations.
|
Dr. Joel M. Gelfand |
Therefore, dermatologists have the opportunity to educate patients with psoriasis and initiate appropriate screenings (or refer them to primary care physicians), which can result in better health outcomes through evidence-based interventions.
Dr. Joel M. Gelfand is from the department of dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine. He made this comments in an accompanying editorial (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2016.0670). Dr. Gelfand declared consultancies for Abbvie, AstraZeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant, and Pfizer; research grant support from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron, and Pfizer (to the trustees of the University of Pennsylvania); and having received payment for continuing medical education work related to psoriasis. He is is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma.
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
The statistically significant association between psoriasis and both obesity and type 2 diabetes comes down to genetics, according to a large population-based study of twins.
Across the entire cohort of 33,588 Danish twins, researchers found the prevalence of psoriasis was 53% higher in individuals with type 2 diabetes, while the prevalence of psoriasis was 81% higher in individuals with a body mass index of at least 35, after adjustment for confounders such as sex, age, and smoking (JAMA Dermatol. 2016 April 27. doi:10.1001/jamadermatol.2015.6262).
Among the 449 twin pairs discordant for psoriasis, the risk for obesity was more than double in the twin with psoriasis compared to the unaffected twin, although this was significant only among dizygotic pairs, not monozygotic pairs.
The twin analysis also found that the risk of type 2 diabetes was the same between twins with and without psoriasis.
“Increased plasma levels of tumor necrosis factor, tumor necrosis factor receptors, and interleukin 6, which have important roles in the pathogenesis of psoriasis, have been found to be linked with obesity,” wrote Dr. Ann Sophie Lønnberg of the department of dermato-allergology, Gentofte Hospital, University of Copenhagen, and her associates.
“The association between type 2 diabetes mellitus and psoriasis also might be owing to increased tumor necrosis factor production from psoriatic inflammation and low-grade obesity inflammation, because it contributes to insulin resistance,” they wrote.
While obesity and type 2 diabetes are known comorbidities of psoriasis, Dr. Lønnberg and colleagues said this was the first study, to their knowledge, to explore the contribution of genetic and environmental factors to this interaction, and they suggested that future studies could look for genes and epigenetic factors that might underlie these associations.
Their analysis showed the genetic correlation between psoriasis and type 2 diabetes was 0.13, while the environmental correlation was 0.10. Similarly, the genetic correlation between psoriasis and BMI was 0.12, while environmental correlation was –0.05.
No conflicts of interest were declared.
FROM JAMA DERMATOLOGY
Key clinical point: The prevalence of both type 2 diabetes and psoriasis is significantly higher in individuals with psoriasis.
Major finding: The risk of obesity is twofold higher in a twin with psoriasis compared to the co-twin without psoriasis.
Data source: Cross-sectional, population-based study of 33,588 Danish twins, including 449 pairs discordant for psoriasis.
Disclosures: No conflicts of interest were declared.
