Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis
Abstract
Background/aims The association between NAFLD and psoriasis has never been explored in prospective epidemiological studies. The aim of this 2-phase study was to study the clinical features of NAFLD in patients with psoriasis.Methods Phase 1: Investigation of prevalence and characteristics of NAFLD in an unselected cohort of 142 adult Italian outpatients with psoriasis vulgaris. Phase 2: Comparison of the psoriasis cohort subgroup with NAFLD and an age- and body mass index-matched retrospective cohort of 125 non-psoriasis patients with biopsy proven NAFLD.Results Based on histories, laboratory tests, and ultrasound studies, 84 (59.2%) received clinical diagnosis of NAFLD; 30 had factors potentially associated with liver disease other than NAFLD (e.g., viral hepatitis, significant ethanol, methotrexate use); and 28 (19.7%) had normal livers. Comparison of the normal-liver and NAFLD subgroups revealed that NAFLD in psoriasis patients (Ps-NAFLD) was significantly correlated with metabolic syndrome (p<0.05); obesity (p=0.043); hypercholesterolemia (p=0.029); hypertriglyceridemia (p<0.001); AST/ALT ratio >1 (p=0.019), and psoriatic arthritis (PsA) (p=0.036). The association with PsA remained significant after logistic regression analysis (OR=3.94 [CI, 1.07-14.46]). Compared with the retrospective non-psoriatic NAFLD cohort (controls), Ps-NAFLD patients (cases) were likely to have severe NAFLD reflected by non-invasive NAFLD Fibrosis Scores and AST/ALT >1.Conclusions NAFLD is highly prevalent among psoriasis patients, where it is closely associated with obesity (overall and abdominal), metabolic syndrome, and PsA, and more likely to cause severe liver fibrosis (compared with nonPs-NAFLD). Routine work-up for NAFLD may be warranted in patients with psoriasis, especially when potentially hepatotoxic drug therapy is being considered.
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The same metabolic syndrome pathway occurs in periodontitis, psoriasis, celiac disease, obesity, COPD, and rheumatoid arthritis.
“The same pathway has also been shown to occur in paraodontitis,118 psoriasis,119 celiac disease,120 obesity,121, 122 COPD,123, 124 and rheumatoid arthritis.125”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [119]
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Daugaard, C. A., Iversen, L., & Hjuler, K. F. (2022) · Psoriasis Targets and Therapy · doi:10.2147/ptt.s328572 · Cited by 62 · see citing works
Bellinato, F., Gisondi, P., Mantovani, A., Girolomoni, G., & Targher, G. (2022) · Journal of Endocrinological Investigation · doi:10.1007/s40618-022-01755-0 · Cited by 60 · see citing works
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Abordaje integral de la comorbilidad del paciente con psoriasis
Daudén, E., Castañeda, S., Suárez, C., García‐Campayo, J., Blasco, A. J., Aguilar, M. D., Ferrándiz, C., Puig, L., & Sánchez‐Carazo, J. L. (2012) · Actas Dermo-Sifiliográficas · doi:10.1016/s0001-7310(12)70001-7 · Cited by 58 · see citing works
“Controles: 26 OR = 19,81 (2,41-162,90) BDI ≥ 25 sin enfermedad crónica ni aguda”
BackgroundCheng, H., & Rademaker, M. (2018) · Psoriasis Targets and Therapy · doi:10.2147/ptt.s141629 · Cited by 58 · see citing works
Menter, A., Griffiths, C. E. M., Tebbey, P. W., Horn, E., & Sterry, W. (2010) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/j.1468-3083.2010.03656.x · Cited by 57 · see citing works
Digestive system in psoriasis: an update
Pietrzak, D., Pietrzak, A., Krasowska, D., Borzęcki, A., Franciszkiewicz-Pietrzak, K., Polkowska-Pruszyńska, B., Baranowska, M., & Reich, K. (2017) · Archives of Dermatological Research · doi:10.1007/s00403-017-1775-7 · Cited by 54 · see citing works
“Available evidence suggests that the risk of NAFLD in psoriatics is approximately twice as high as in the general population (48–59%) [58, 60, 115].”
BackgroundExtra-Hepatic Manifestations and Complications of Nonalcoholic Fatty Liver Disease
Ballestri, S., Mantovani, A., Nascimbeni, F., Lugari, S., & Lonardo, A. (2019) · Future Medicinal Chemistry · doi:10.4155/fmc-2019-0003 · Cited by 51 · see citing works
Alcohol, psoriasis, liver disease, and anti‐psoriasis drugs
Cassano, N., Vestita, M. G., Apruzzi, D., & Vena, G. A. (2011) · International Journal of Dermatology · doi:10.1111/j.1365-4632.2011.05100.x · Cited by 51 · see citing works
Evaluation and management of extrahepatic manifestations of nonalcoholic fatty liver disease
Wijarnpreecha, K., Aby, E. S., Ahmed, A., & Kim, D. (2020) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2020.0239 · Cited by 49 · see citing works
“Several studies have shown an increased risk of NAFLD in patients with psoriasis or psoriatic arthritis.(143,144) The exact mechanism for the association remains unclear, but it is postulated that inflammatory cytokines, such as tumor necrosis factor (TNF)-α, play a role in the association between NAFLD and psoriasis.”
BackgroundPsoriasis and Related Disorders
Burden, A. D., & Kirby, B. (2016) · doi:10.1002/9781118441213.rtd0036 · Cited by 48 · see citing works
Non‐alcoholic fatty liver disease and psoriasis – is there a shared proinflammatory network?
Heitmann, J., Frings, V. G., Geier, A., Goebeler, M., & Kerstan, A. (2021) · JDDG Journal der Deutschen Dermatologischen Gesellschaft · doi:10.1111/ddg.14425 · Cited by 46 · see citing works
Maybury, C. M., Samarasekera, E. J., Douiri, A., Barker, J. N., & Smith, C. H. (2014) · British Journal of Dermatology · doi:10.1111/bjd.12905 · Cited by 44 · see citing works
Dawwas, M. F., & Aithal, G. P. (2014) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12912 · Cited by 45 · see citing works
Psoriasis, the liver, and the gastrointestinal tract
Gisondi, P., Giglio, M. D., Cozzi, A., & Girolomoni, G. (2010) · Dermatologic Therapy · doi:10.1111/j.1529-8019.2010.01310.x · Cited by 45 · see citing works
“Nonalcoholic fatty liver disease 48–59 (6,7) 20–30 (2) Crohn’s disease 0.”
BackgroundIntegrated Approach to Comorbidity in Patients With Psoriasis
Daudén, E., Castañeda, S., Suárez, C., García‐Campayo, J., Blasco, A. J., Aguilar, M. D., Ferrándiz, C., Puig, L., & Sánchez‐Carazo, J. L. (2012) · Actas Dermo-Sifiliográficas · doi:10.1016/s1578-2190(12)70829-6 · Cited by 44 · see citing works
Comorbidities in Patients with Psoriatic Arthritis
Haddad, A., & Zisman, D. (2017) · Rambam Maimonides Medical Journal · doi:10.5041/rmmj.10279 · Cited by 42 · see citing works
Psoriasis e hígado graso no alcohólico
Carrascosa, J. M., Bonanad, C., Daudén, E., Botella, R., & Olveira-Martín, A. (2017) · Actas Dermo-Sifiliográficas · doi:10.1016/j.ad.2016.12.017 · Cited by 42 · see citing works
Zai, W., Chen, W., Liu, H., & Ju, D. (2021) · Biomedicines · doi:10.3390/biomedicines9121912 · Cited by 41 · see citing works
“Steatohepatitis promotes the progression of psoriasis in patients with NASH, and obesity exaggerates the severity of psoriasiform dermatitis caused by the Toll-like receptor 7 (TLR-7) agonist imiquimod (IMQ) by promoting IL-17A and IL-22 secretion and IL-1β overexpression in HFD-fed mice [33,45,46].”
BackgroundBiomarkers for methotrexate-induced liver injury: Urinary protein profiling of psoriasis patients
van Swelm, R. P. L., Laarakkers, C. M., Kooijmans-Otero, M., de Jong, E. M. G. J., Masereeuw, R., & Rüssel, F. G. M. (2013) · Toxicology Letters · doi:10.1016/j.toxlet.2013.06.234 · Cited by 37 · see citing works
Liver Stiffness Measurement in Psoriasis: Do Metabolic or Disease Factors Play the Important Role?
Pongpit, J., Porntharukchareon, S., Kaewduang, P., Promson, K., Stitchantrakul, W., Petraksa, S., Thakkinstian, A., Kositchaiwat, C., Rajatanavin, N., & Sobhonslidsuk, A. (2016) · BioMed Research International · doi:10.1155/2016/7963972 · Cited by 36 · see citing works
“Psoriasis was reported to be associatedwith fatty liver and liver fibrosis [7, 8].”
BackgroundResultHigh-Fat Diet–Induced IL-17A Exacerbates Psoriasiform Dermatitis in a Mouse Model of Steatohepatitis
Vasseur, P., Serres, L., Jégou, J., Pohin, M., Delwail, A., Petit-Paris, I., Levillain, P., Favot, L., Samson, M., Yssel, H., et al. (2016) · American Journal Of Pathology · doi:10.1016/j.ajpath.2016.05.012 · Cited by 36 · see citing works
Tabibian, J. H., Lazo, M., Durazo, F. A., Yeh, H. C., Tong, M. J., & Clark, J. M. (2010) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2010.06443.x · Cited by 35 · see citing works
Cardiovascular Risk in Psoriasis: Current State of the Art
Dattilo, G., Borgia, F., Guarneri, C., Casale, M., Bitto, R., Morabito, C., Signorelli, S. S., Katsiki, N., & Cannavò, S. P. (2017) · Current Vascular Pharmacology · doi:10.2174/1570161115666171116163816 · Cited by 34 · see citing works
Singh, J. A., Guyatt, G. H., Ogdie, A., Gladman, D. D., Deal, C. L., Deodhar, A. A., Dubreuil, M., Dunham, J., Husni, M. E., Kenny, S., et al. (2018) · Journal of Psoriasis and Psoriatic Arthritis · doi:10.1177/2475530318812244 · Cited by 34 · see citing works
“In patients with active PsA with concomitant active diabetes who have not received OSM or biologic treatment, an OSM other than MTX is recommended over a TNFi biologic, due to the concern about the higher prevalence of fatty liver disease and liver toxicity with MTX use in this patient population (39,40) (Table 6).”
Tripodi, A., Lombardi, R., Primignani, M., Mura, V. L., Peyvandi, F., & Fracanzani, A. L. (2022) · Biomedicines · doi:10.3390/biomedicines10020249 · Cited by 33 · see citing works
“Other relevant extrahepatic manifestations in NAFLD are neoplasms of the gastrointestinal tract [31,32] and chronic kidney disease [33], which share the same risk factors as type II diabetes, as well as metabolic syndrome, obesity, hypertension, and obstructive sleep apnea [34], even in the absence of obesity or metab…”
BackgroundGau, S., Huang, K., Lee, C., Kuan, Y., Tsai, T., & Lee, C. (2022) · Frontiers in Immunology · doi:10.3389/fimmu.2022.840106 · Cited by 33 · see citing works
“Moreover, coexistence of psoriasis and NAFLD could lead to elevated severity of NAFLD (57).”
BackgroundMontaudié, H., Albert-Sabonnadière, C., Acquacalda, É., Fontas, É., Danré, A., Roux, C. H., Ortonne, J. ‐., Lacour, J. ‐., Euller‐Ziegler, L., & Passeron, T. (2013) · Journal of the European Academy of Dermatology and Venereology · doi:10.1111/jdv.12255 · Cited by 33 · see citing works
Psoriasis and the liver: problems, causes and course
Tula, E., Ergun, T., Seçkin, D., Özgen, Z., & Avşar, E. (2016) · Australasian Journal of Dermatology · doi:10.1111/ajd.12460 · Cited by 32 · see citing works
“6) 9 (50) 4 (57) 30 (56) Acitretin 5 (17) 1 (6) 1 (14) 7 (13) INH 1 (3) 1 (6) 0 (0) 2 (4) Others 0 (0) 3 (17) 0 (0) 3 (6) Acitretin + MTX 3 (10) 0 (0) 1 (14) 4 (7) Acitretin + INH 0 (0) 1 (6) 0 (0) 1 (2) MTX + statins 1 (3) 1 (6) 0 (0) 2 (4) Acitretin + statins 1 (3) 0 (0) 0 (0) 1 (2) MTX + INH 1 (3) 1 (6) 1 (14) 3 (6…”
Old and New Antirheumatic Drugs and the Risk of Hepatotoxicity
Anelli, M. G., Scioscia, C., Grattagliano, I., & Lapadula, G. (2012) · Therapeutic Drug Monitoring · doi:10.1097/ftd.0b013e31826a6306 · Cited by 31 · see citing works
“(3) Environment-related factors: A recent Italian study has evidenced that PsA is independently associated with nonalcoholic fatty liver disease at a higher prevalence than in the general population (59% versus 20%).(48) Patients with nonalcoholic fatty liver disease and chronic alcohol or viral hepatitis are at highe…”
BackgroundPsoriasis and the Life Cycle of Persistent Life Effects
Garshick, M. K., & Kimball, A. B. (2014) · Dermatologic Clinics · doi:10.1016/j.det.2014.09.003 · Cited by 31 · see citing works
SIMONE, C. D., Caldarola, G., Moretta, G., Piscitelli, L., Ricceri, F., & Prignano, F. (2019) · Giornale Italiano di Dermatologia e Venereologia · doi:10.23736/s0392-0488.18.06255-7 · Cited by 31 · see citing works
Measuring psoriatic disease in clinical practice. An expert opinion position paper
Lubrano, E., Cantini, F., Costanzo, A., Girolomoni, G., Prignano, F., Olivieri, I., Scarpa, R., Spadaro, A., Atzeni, F., Narcisi, A., et al. (2015) · Autoimmunity Reviews · doi:10.1016/j.autrev.2015.05.010 · Cited by 30 · see citing works
Belinchón, I., Bellot, P., Romero‐Pérez, D., Romero, I. H., de la Calle, F. M. M., Francés, R., & Ramos, J. M. (2021) · Scientific Reports · doi:10.1038/s41598-021-88043-8 · Cited by 29 · see citing works
Moro, F., SIMONE, C. D., Morciano, A., Tropea, A., Sagnella, F., Palla, C., Scarinci, E., Teti, A., Caldarola, G., D’Agostino, M., et al. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.10.040 · Cited by 29 · see citing works
Self-citationMo, W., Peng, Y., Zheng, Y., Zhao, S., Deng, L., & Fan, X. (2025) · Journal of Nanobiotechnology · doi:10.1186/s12951-025-03259-4 · Cited by 28 · see citing works
“Notably, psoriasis patients have a higher risk of developing NAFLD [158].”
Psoriasis and Nonalcoholic Fatty Liver Disease
Carrascosa, J. M., Bonanad, C., Daudén, E., Botella, R., & Olveira-Martín, A. (2017) · Actas Dermo-Sifiliográficas · doi:10.1016/j.adengl.2017.05.017 · Cited by 28 · see citing works
Cervoni, J., Alby-Lepresle, B., Weil, D., Zhong, P., Aubin, F., Wendling, D., Toussirot, É., Vuitton, L., Carbonnel, F., Blondet, R., et al. (2020) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clirex.2020.100003 · Cited by 28 · see citing works
Can early treatment with biologicals modify the natural history of comorbidities?
Vena, G. A., Vestita, M. G., & Cassano, N. (2010) · Dermatologic Therapy · doi:10.1111/j.1529-8019.2010.01313.x · Cited by 28 · see citing works
Adiponectin in psoriasis and its comorbidities: a review
Ruiyang, B., Panayi, A. C., Wu, R., Zhang, P., & Fu, S. (2021) · Lipids in Health and Disease · doi:10.1186/s12944-021-01510-z · Cited by 27 · see citing works
“Specifically, psoriasis patients have a higher probability of NAFLD [123], while the presence of NAFLD itself may exacerbate the severity of psoriatic skin lesions [124].”
BackgroundXu, X. Y., Su, L., Gao, Y., & Ding, Y. (2017) · PLoS ONE · doi:10.1371/journal.pone.0169952 · Cited by 26 · see citing works
Non-alcoholic Fatty liver Disease in Patients with Psoriasis - Therapeutic Implications
Kłujszo, E. H., Parcheta, P., Witkowska, A. B., & Kręcisz, B. (2019) · Advances in Dermatology and Allergology · doi:10.5114/ada.2019.83983 · Cited by 26 · see citing works
Liver Abnormalities in Patients with Psoriatic Arthritis
Pakchotanon, R., Ye, J. Y., Cook, R. J., Chandran, V., & Gladman, D. D. (2019) · The Journal of Rheumatology · doi:10.3899/jrheum.181312 · Cited by 26 · see citing works
González‐Villanueva, I., DeGracia, C., Planells, M., Poveda, I., Álvarez, P., Schneller‐Pavelescu, L., Betlloch, I., Jemec, G. B. E., Ramos, J. M., & Pascual, J. C. (2020) · Acta Dermato Venereologica · doi:10.2340/00015555-3597 · Cited by 26 · see citing works
Relationship between psoriasis and non-alcoholic fatty liver disease
Narayanasamy, K., Sanmarkan, A. D., Rajendran, K., Annasamy, C., & Ramalingam, S. (2016) · Gastroenterology Review · doi:10.5114/pg.2015.53376 · Cited by 26 · see citing works
“Recent reports have shown that people with psoriasis may be at greater risk for developing of NAFLD [15, 16].”
BackgroundIntersecting Pathways: Nonalcoholic Fatty Liver Disease and Psoriasis Duet—A Comprehensive Review
Costache, D. O., Blejan, H., Cojocaru, D. L., Ioniță, G., Poenaru, M., Constantin, M. M., Costache, A. C., Căruntu, C., Balaban, D. V., & Costache, R. S. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25052660 · Cited by 25 · see citing works
“As in other studies, most patients also had metabolic syndrome, dyslipidemia, and obesity [87].”
ResultNguyen, C. T. H., Kambe, N., Yamazaki, F., Ueda‐Hayakawa, I., Kishimoto, I., & Okamoto, H. (2018) · Journal of Dermatological Science · doi:10.1016/j.jdermsci.2018.01.005 · Cited by 25 · see citing works
Magdaleno‐Tapial, J., Valenzuela‐Oñate, C., Salvador, J. M. O., Martínez‐Doménech, Á., Martínez, M. G., Alonso‐Carpio, M., Tamarit-Garcia, J. J., Moisés Diago, M., Sánchez‐Carazo, J. L., & Pérez‐Ferriols, A. (2019) · Australasian Journal of Dermatology · doi:10.1111/ajd.13175 · Cited by 25 · see citing works
Awosika, O., Eleryan, M. G., Rengifo‐Pardo, M., Doherty, L., Martin, L. W., & Ehrlich, A. (2018) · Europe PMC (PubMed Central) · Cited by 25 · see citing works
Phan, K. H., Onggo, J. R., Charlton, O., & Smith, S. D. (2019) · Australasian Journal of Dermatology · doi:10.1111/ajd.13015 · Cited by 24 · see citing works
NAFLD: comorbidity and associated diseases
Livzan, M. A., Gaus, O. V., Nikolaev, N. A., & Krolevetz, T. S. (2020) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-170-10-57-65 · Cited by 24 · see citing works
“По результатам проспективного популяционного исследования, проведенного в Дании, показано, что у больных псориазом статистически значимо чаще выявлялась НАЖБП, чем у лиц без псориаза (46,2% и 33,3%, соответственно), данные различия сохранялись даже после корректировки по таким факторам риска как курение и / или алкого…”
Psoriasis and fatty liver: a harmful synergy
Olveira, A., Herranz, P., & Montes, M. (2019) · Revista Española de Enfermedades Digestivas · doi:10.17235/reed.2019.6263/2019 · Cited by 22 · see citing works
Kuai, L., Luo, Y., Qu, K., Ru, Y., Luo, Y., Ding, X., Xing, M., Liu, L., Sun, X., Li, X., et al. (2021) · Frontiers in Pharmacology · doi:10.3389/fphar.2021.632414 · Cited by 21 · see citing works
“pulmonary disease, diabetes, obesity, and hyperuricemia (Miele et al., 2009; Li et al., 2015; Yuan et al., 2019; Kovitwanichkanont et al., 2020).”
Zhang, Y., & Fang, X.-M. (2023) · The Chinese Journal of Physiology · doi:10.4103/cjop.cjop-d-22-00131 · Cited by 22 · see citing works
- Authors
- Miele, L., Vallone, S., Cefalo, C., La Torre, G., Di Stasi, C., Vecchio, F. M., D’Agostino, M., Gabrieli, M. L., Vero, V., Biolato, M., Pompili, M., Gasbarrini, G., Rapaccini, G., Amerio, P., De Simone, C., & Grieco, A.
- Affiliations
- Università Cattolica del Sacro Cuore (IT)
- Corresponding author
- Grieco, Antonio
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2009-10
- Volume
- 51
- Issue
- 4
- Pages
- 778-786
- ISSN
- 0168-8278 (ISSN-L)
- OpenAlex
- W2013886298
- Cited by
- 249
- References
- 39
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 13 · 2023: 9 · 2022: 13 · 2021: 18 · 2020: 45 · 2019: 19 · 2018: 13 · 2017: 16 · 2016: 11 · 2015: 13 · 2014: 15 · 2013: 9 · 2012: 13
- FWCI
- 8.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Keywords
- non-alcoholic fatty liver disease, plaque psoriasis, psoriatic arthritis, metabolic syndrome, obesity, hypertriglyceridemia, hypercholesterolemia, liver fibrosis, AST/ALT ratio, hepatotoxic drugs, prevalence, NAFLD severity
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Chronic Disease, Cross-Sectional Studies, Fatty Liver, Female, Humans, Italy, Male, Middle Aged, Obesity, Psoriasis, Cohort Studies, Arthritis, Psoriatic, Case-Control Studies, Metabolic Syndrome, Young Adult
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