Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies

Published:January 28, 2013DOI:


      Increasing population-based studies have suggested a relationship between psoriasis and metabolic syndrome.


      The objective of this study was to perform a systematic review and meta-analysis that synthesizes the epidemiologic associations between psoriasis and metabolic syndrome.


      We searched for observational studies from MEDLINE, EMBASE, and Cochrane Central Register from Jan 1, 1980 to Jan 1, 2012. We applied the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines in the conduct of this study.


      We identified 12 observational studies with a total of 1.4 million study participants fulfilling the inclusion criteria, among whom 41,853 were patients with psoriasis. Based on random-effects modeling of cross-sectional and case-controlled studies, the pooled odds ratio (OR) for metabolic syndrome among patients with psoriasis was 2.26 (95% confidence interval [CI] 1.70-3.01) compared with the general population. Visual inspection of a funnel plot and formal analysis with the Egger test suggested publication bias and absence of small studies in the published literature (P = .03). A dose-response relationship was also observed between psoriasis severity and prevalence of metabolic syndrome.


      No studies to date have assessed incidence of metabolic syndrome among patients with psoriasis.


      Compared with the general population, psoriasis patients have higher prevalence of metabolic syndrome, and patients with more severe psoriasis have greater odds of metabolic syndrome than those with milder psoriasis.

      Key words

      Abbreviations used:

      AOR (adjusted odds ratio), CI (confidence interval), FFA (free fatty acid), NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III), OR (odds ratio)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gelfand J.M.
        • Weinstein R.
        • Porter S.B.
        • Neimann A.L.
        • Berlin J.A.
        • Margolis D.J.
        Prevalence and treatment of psoriasis in the United Kingdom: a population-based study.
        Arch Dermatol. 2005; 141: 1537-1541
        • Kurd S.K.
        • Gelfand J.M.
        The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003-2004.
        J Am Acad Dermatol. 2009; 60: 218-224
        • Gelfand J.M.
        • Neimann A.L.
        • Shin D.B.
        • Wang X.
        • Margolis D.J.
        • Troxel A.B.
        Risk of myocardial infarction in patients with psoriasis.
        JAMA. 2006; 296: 1735-1741
        • Mehta N.N.
        • Azfar R.S.
        • Shin D.B.
        • Neimann A.L.
        • Troxel A.B.
        • Gelfand J.M.
        Patients with severe psoriasis are at increased risk of cardiovascular mortality: cohort study using the General Practice Research Database.
        Eur Heart J. 2010; 31: 1000-1006
        • Qureshi A.A.
        • Choi H.K.
        • Setty A.R.
        • Curhan G.C.
        Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses.
        Arch Dermatol. 2009; 145: 379-382
        • Ford E.S.
        • Giles W.H.
        • Dietz W.H.
        Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey.
        JAMA. 2002; 287: 356-359
        • Hu G.
        • Qiao Q.
        • Tuomilehto J.
        • Balkau B.
        • Borch-Johnsen K.
        • Pyorala K.
        Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women.
        Arch Intern Med. 2004; 164: 1066-1076
        • Olufadi R.
        • Byrne C.D.
        Clinical and laboratory diagnosis of the metabolic syndrome.
        J Clin Pathol. 2008; 61: 697-706
      1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • Donato K.A.
        • Eckel R.H.
        • Franklin B.A.
        • et al.
        Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
        Circulation. 2005; 112: 2735-2752
      2. The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation 2006.

        • Gami A.S.
        • Witt B.J.
        • Howard D.E.
        • Erwin P.J.
        • Gami L.A.
        • Somers V.K.
        • et al.
        Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies.
        J Am Coll Cardiol. 2007; 49: 403-414
        • Giovannucci E.
        Metabolic syndrome, hyperinsulinemia, and colon cancer: a review.
        Am J Clin Nutr. 2007; 86: s836-s842
        • Friedewald V.E.
        • Cather J.C.
        • Gelfand J.M.
        • Gordon K.B.
        • Gibbons G.H.
        • Grundy S.M.
        • et al.
        AJC editor’s consensus: psoriasis and coronary artery disease.
        Am J Cardiol. 2008; 102: 1631-1643
        • Cohen A.D.
        • Sherf M.
        • Vidavsky L.
        • Vardy D.A.
        • Shapiro J.
        • Meyerovitch J.
        Association between psoriasis and the metabolic syndrome. A cross-sectional study.
        Dermatology. 2008; 216: 152-155
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • Olkin I.
        • Williamson G.D.
        • Rennie D.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Micha R.
        • Wallace S.K.
        • Mozaffarian D.
        Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis.
        Circulation. 2010; 121: 2271-2283
        • DerSimonian R.
        • Laird N.
        Meta-analysis in clinical trials.
        Control Clin Trials. 1986; 7: 177-188
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Al-Mutairi N.
        • Al-Farag S.
        • Al-Mutairi A.
        • Al-Shiltawy M.
        Comorbidities associated with psoriasis: an experience from the Middle East.
        J Dermatol. 2010; 37: 146-155
        • Augustin M.
        • Reich K.
        • Glaeske G.
        • Schaefer I.
        • Radtke M.
        Co-morbidity and age-related prevalence of psoriasis: Analysis of health insurance data in Germany.
        Acta Derm Venereol. 2010; 90: 147-151
        • Bongiorno M.R.
        • Doukaki S.
        • Rizzo D.
        • Arico M.
        The prevalence of the obesity in patients with moderate to severe psoriasis in Sicily populations.
        J Eur Acad Dermatol Venereol. 2010; 24: 92-93
        • Chen Y.J.
        • Shen J.L.
        • Wu C.Y.
        • Chang Y.T.
        • Chen C.M.
        • Lee F.Y.
        Elevated plasma osteopontin level is associated with occurrence of psoriasis and is an unfavorable cardiovascular risk factor in patients with psoriasis.
        J Am Acad Dermatol. 2009; 60: 225-230
        • Chen Y.J.
        • Wu C.Y.
        • Shen J.L.
        • Chu S.Y.
        • Chen C.K.
        • Chang Y.T.
        • et al.
        Psoriasis independently associated with hyperleptinemia contributing to metabolic syndrome.
        Arch Dermatol. 2008; 144: 1571-1575
        • Gisondi P.
        • Tessari G.
        • Conti A.
        • Piaserico S.
        • Schianchi S.
        • Peserico A.
        • et al.
        Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study.
        Br J Dermatol. 2007; 157: 68-73
        • Langan S.M.
        • Seminara N.M.
        • Shin D.B.
        • Troxel A.B.
        • Kimmel S.E.
        • Mehta N.N.
        • et al.
        Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom.
        J Invest Dermatol. 2012; 132: 556-562
        • Love T.J.
        • Qureshi A.A.
        • Karlson E.W.
        • Gelfand J.M.
        • Choi H.K.
        Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003-2006.
        Arch Dermatol. 2011; 147: 419-424
        • Mebazaa A.
        • El Asmi M.
        • Zidi W.
        • Zayani Y.
        • Cheikh Rouhou R.
        • El Ounifi S.
        • et al.
        Metabolic syndrome in Tunisian psoriatic patients: prevalence and determinants.
        J Eur Acad Dermatol Venereol. 2011; 25: 705-709
        • Nisa N.
        • Qazi M.A.
        Prevalence of metabolic syndrome in patients with psoriasis.
        Indian J Dermatol Venereol Leprol. 2010; 76: 662-665
        • Sommer D.M.
        • Jenisch S.
        • Suchan M.
        • Christophers E.
        • Weichenthal M.
        Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis.
        Arch Dermatol Res. 2006; 298: 321-328
        • Takahashi H.
        • Takahashi I.
        • Honma M.
        • Ishida-Yamamoto A.
        • Iizuka H.
        Prevalence of metabolic syndrome in Japanese psoriasis patients.
        J Dermatol Sci. 2010; 57: 143-144
        • Zhao Y.F.
        • Feng D.D.
        • Chen C.
        Contribution of adipocyte-derived factors to beta-cell dysfunction in diabetes.
        Int J Biochem Cell Biol. 2006; 38: 804-819
        • Quaranta M.
        • Burden A.D.
        • Griffiths C.E.
        • Worthington J.
        • Barker J.N.
        • Trembath R.C.
        • et al.
        Differential contribution of CDKAL1 variants to psoriasis, Crohn’s disease and type II diabetes.
        Genes Immun. 2009; 10: 654-658
        • Wolf N.
        • Quaranta M.
        • Prescott N.J.
        • Allen M.
        • Smith R.
        • Burden A.D.
        • et al.
        Psoriasis is associated with pleiotropic susceptibility loci identified in type II diabetes and Crohn disease.
        J Med Genet. 2008; 45: 114-116
        • Chen Y.F.
        • Chang J.S.
        PTPN22 C1858T and the risk of psoriasis: a meta-analysis.
        Mol Biol Rep. 2012; 39 (Epub 2012 Apr 28): 7861-7870
        • Kaur S.
        • Zilmer K.
        • Kairane C.
        • Kals M.
        • Zilmer M.
        Clear differences in adiponectin level and glutathione redox status revealed in obese and normal-weight patients with psoriasis.
        Br J Dermatol. 2008; 159: 1364-1367
        • Shibata S.
        • Saeki H.
        • Tada Y.
        • Karakawa M.
        • Komine M.
        • Tamaki K.
        Serum high molecular weight adiponectin levels are decreased in psoriasis patients.
        J Dermatol Sci. 2009; 55: 62-63
        • Coimbra S.
        • Oliveira H.
        • Reis F.
        • Belo L.
        • Rocha S.
        • Quintanilha A.
        • et al.
        Circulating levels of adiponectin, oxidized LDL and C-reactive protein in Portuguese patients with psoriasis vulgaris, according to body mass index, severity and duration of the disease.
        J Dermatol Sci. 2009; 55: 202-204
        • Wang Y.
        • Chen J.
        • Zhao Y.
        • Geng L.
        • Song F.
        • Chen H.D.
        Psoriasis is associated with increased levels of serum leptin.
        Br J Dermatol. 2008; 158: 1134-1135
        • Boehncke S.
        • Thaci D.
        • Beschmann H.
        • Ludwig R.J.
        • Ackermann H.
        • Badenhoop K.
        • et al.
        Psoriasis patients show signs of insulin resistance.
        Br J Dermatol. 2007; 157: 1249-1251
        • Koczan D.
        • Guthke R.
        • Thiesen H.J.
        • Ibrahim S.M.
        • Kundt G.
        • Krentz H.
        • et al.
        Gene expression profiling of peripheral blood mononuclear leukocytes from psoriasis patients identifies new immune regulatory molecules.
        Eur J Dermatol. 2005; 15: 251-257
        • Azfar R.S.
        • Gelfand J.M.
        Psoriasis and metabolic disease: epidemiology and pathophysiology.
        Curr Opin Rheumatol. 2008; 20: 416-422
        • Grundy S.M.
        Pre-diabetes, metabolic syndrome, and cardiovascular risk.
        J Am Coll Cardiol. 2012; 59: 635-643