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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 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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“Because this patient is overweight, and likely has steatohepatitis, a known risk factor for increased hepatotoxicity from MTX, MTX is a less attractive option.(115) In addition, her moderate alcohol intake and current medications may also increase the likelihood of liver toxicity from MTX.”
BackgroundPsoriasis: classical and emerging comorbidities
de Oliveira, M. D. F. S. P., Rocha, B. D. O., & Duarte, G. V. (2015) · Anais Brasileiros de Dermatologia · doi:10.1590/abd1806-4841.20153038 · Cited by 369
Metabolic-associated Fatty Liver Disease (MAFLD): A Multi-systemic Disease Beyond the Liver
Kaya, E., & Yilmaz, Y. N. (2021) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2021.00178 · Cited by 241
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Medical comorbidity associated with psoriasis in adults: a population-based study
Yang, Y., Keller, J. J., & Lin, H. (2011) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2011.10494.x · Cited by 174
Recognizing and managing comorbidities in psoriatic arthritis
Ogdie, A., Schwartzman, S., & Husni, M. E. (2015) · Current Opinion in Rheumatology · doi:10.1097/bor.0000000000000152 · Cited by 173
Hepatotoxicity related to antirheumatic drugs
Aithal, G. P. (2011) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2010.214 · Cited by 170
“A prospective study from Italy confirmed that the prevalence of non-alcoholic fatty liver disease (NAFLD) is higher in patients with psoriasis (with no exposure to methotrexate or steroids) than in the general population (59% versus 20%), and the occurrence of NAFLD was associated with metabolic syndrome, obesity and…”
BackgroundNon-alcoholic Fatty Liver Disease: Growing Burden, Adverse Outcomes and Associations
Kumar, R., Priyadarshi, R., & Anand, U. (2019) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2019.00051 · Cited by 176
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Psoriasis, psoriatic arthritis, and rheumatoid arthritis: Is all inflammation the same?
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Cardiometabolic comorbidities in RA and PsA: lessons learned and future directions
Ferguson, L. D., Siebert, S., McInnes, I. B., & Sattar, N. A. (2019) · Nature Reviews Rheumatology · doi:10.1038/s41584-019-0256-0 · Cited by 160
Psoriasis and comorbidities: links and risks
Chiu, M. W., & Ni, C. S. (2014) · Clinical Cosmetic and Investigational Dermatology · doi:10.2147/ccid.s44843 · Cited by 156
Distinguishing rheumatoid arthritis from psoriatic arthritis
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Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis
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Comorbidities in Psoriatic Arthritis
Husni, M. E. (2015) · Rheumatic Disease Clinics of North America · doi:10.1016/j.rdc.2015.07.008 · Cited by 131
“However, among patients with psoriasis, patients with concomitant PsA have the highest risk for NAFLD.(88,89) Increased prevalence of NAFLD was also associated with metabolic syndrome, hypercholesterolemia, hypertriglyceridemia, obesity, and psoriasis severity.”
BackgroundComorbidities in Psoriasis Patients
Kim, N., Thrash, B., & Menter, A. (2010) · Seminars in Cutaneous Medicine and Surgery · doi:10.1016/j.sder.2010.01.002 · Cited by 126
“14,46 Several drugs commonly used in the treatment of psoriasis, in particular methotrexate, are hepatotoxic.”
BackgroundRelationship between Non-Alcoholic Fatty Liver Disease and Psoriasis: A Novel Hepato-Dermal Axis?
Mantovani, A., Gisondi, P., Lonardo, A., & Targher, G. (2016) · International Journal of Molecular Sciences · doi:10.3390/ijms17020217 · Cited by 124
“[20] found a NAFLD prevalence of 59.”
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“41,42 The lower prevalence observed in the PSOLAR population may reflect the design of the case report form, which allows for proactive inquiry about only certain hepatic conditions.”
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“, gender, BMI, alcohol intake, smoking status) (Abedini et al., 2015; Gisondi et al., 2009, 2016; Madanagobalane and Anandan, 2012; Miele et al., 2009; Rosenberg et al., 2007; van der Voort et al., 2014, 2016; Yang et al., 2011).”
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Laharie, D., Sénéschal, J., Schaeverbeke, T., Doutre, M. ‐., Longy‐Boursier, M., Pellegrin, J., Chabrun, É., Villars, S., Zerbib, F., & de Lédinghen, V. (2010) · Journal of Hepatology · doi:10.1016/j.jhep.2010.04.043 · Cited by 111
“Guidelines for monitoring methotrexate liver toxicity should be revisited and harmonized [46,47] focusing on the other risk factors for liver fibrosis such as high alcohol consumption or metabolic syndrome [35].”
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“Psoriasis NAFLD, ALD, and AIH Cytokines and hepatokines (?) [137, 139, 141-143]”
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“To further understand whether psoriasis was independently associated with NAFLD we tried to adjust confounding factors such as diabetes, obesity, and hypertension, which may also increase the occurrence of NAFLD.”
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Self-citationPatients with psoriasis are at a higher risk of developing nonalcoholic fatty liver disease
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Busting the myth of methotrexate chronic hepatotoxicity
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Association of Psoriasis With Comorbidity Development in Children With Psoriasis
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Psoriasis and inflammatory bowel disease: links and risks
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Psoriasis and non‐alcoholic fatty liver disease
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Non‐alcoholic fatty liver disease fibrosis score in patients with psoriasis
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A “systems medicine” approach to the study of non-alcoholic fatty liver disease
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Abordaje integral de la comorbilidad del paciente con psoriasis
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“Controles: 26 OR = 19,81 (2,41-162,90) BDI ≥ 25 sin enfermedad crónica ni aguda”
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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
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 56
“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 35
Alcohol, psoriasis, liver disease, and anti‐psoriasis drugs
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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 52
“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) · Wiley eBooks · doi:10.1002/9781118441213.rtd0036 · Cited by 47
Non‐alcoholic fatty liver disease and psoriasis – is there a shared proinflammatory network?
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Psoriasis, the liver, and the gastrointestinal tract
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“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
Comorbidities in Patients with Psoriatic Arthritis
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Psoriasis e hígado graso no alcohólico
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“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
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
“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
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Cardiovascular Risk in Psoriasis: Current State of the Art
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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
“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
“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 34
“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
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
“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
“(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
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
Measuring psoriatic disease in clinical practice. An expert opinion position paper
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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
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 36
“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 27
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
Can early treatment with biologicals modify the natural history of comorbidities?
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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 28
“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
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 27
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
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
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
“Recent reports have shown that people with psoriasis may be at greater risk for developing of NAFLD [15, 16].”
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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
“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
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
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Phan, K. H., Onggo, J. R., Charlton, O., & Smith, S. D. (2019) · Australasian Journal of Dermatology · doi:10.1111/ajd.13015 · Cited by 24
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
“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
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
“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
Metadata
- 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 › Hepatology › 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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