Positive association between insulin resistance and fatty liver disease in psoriasis: evidence from a cross-sectional study

Front Immunol. 2024 Apr 23:15:1388967. doi: 10.3389/fimmu.2024.1388967. eCollection 2024.

Abstract

Background: Fatty liver disease (FLD) is a common comorbidity of psoriasis and is often referred to as non-alcoholic fatty liver disease (NAFLD). However, the role of inflammation or insulin resistance (IR) in FLD is inconclusive. The study aims to explore whether FLD in psoriasis patients is more related to insulin resistance or systemic inflammation level.

Methods: Data for this study were collected from the Shanghai Psoriasis Effectiveness Evaluation Cohort, a prospective cohort that examines psoriasis characteristics in the Chinese population. IR was assessed using the triglyceride glucose (TyG) and TyG-body mass index (TyG-BMI) indicators. Systemic non-specific inflammation was assessed using the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), and systemic immune inflammation index (SII).

Results: The analysis included a total of 647 patients. Subsequent logistic regression analysis revealed that NLR, dNLR, and SII were not significantly associated with FLD in psoriasis patients, while TyG and TyG-BMI showed significant associations with FLD. Subgroup analysis indicated that in the majority of subgroups, TyG and TyG-BMI were significantly associated with FLD, particularly TyG-BMI. Excluding individuals with methotrexate and acitretin resulted in consistent findings with the main analysis. Further analysis revealed a significantly higher diagnosis rate of metabolic-associated fatty liver disease (MAFLD) compared to NAFLD.

Conclusions: Metabolic factors play a crucial role in FLD in patients with psoriasis, and TyG and TyG-BMI are potential predictors of FLD. Therefore, MAFLD can be recommend as a term to describe FLD in psoriasis patients.

Trial registration: https://www.chictr.org.cn/showproj.html?proj=58256, identifier ChiCTR2000036186. A multi-center clinical study of systemic treatment strategies for psoriasis in Chinese population. Registered 31 August 2020.

Keywords: TyG; TyG-BMI; fatty liver disease; insulin resistance; psoriasis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • China
  • Cross-Sectional Studies
  • Female
  • Humans
  • Insulin Resistance*
  • Male
  • Middle Aged
  • Neutrophils / immunology
  • Neutrophils / metabolism
  • Non-alcoholic Fatty Liver Disease* / blood
  • Prospective Studies
  • Psoriasis* / blood
  • Psoriasis* / complications
  • Psoriasis* / immunology

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (No. 82003335, 82073429, 82273510, 82203913), Innovation Program of Shanghai Municipal Education Commission (No.2019-01-07-00-07-E00046), Clinical Research Plan of SHDC (No. SHDC2020CR1014B), Program of Shanghai Academic Research Leader (No. 20XD1403300), Shanghai Municipal Health Commission Project (No.202240369), China Postdoctoral Science Foundation (2023M732651), Shanghai General Hospital Traditional Chinese and Western Medicine Collaborative Guidance Project (no. ZXXT-202212) and Municipal Hospital Diagnosis and Treatment Technology Promotion and Optimization Management Project of SHDC (No. SHDC12023114).