Original article
Psoriasis is independently associated with nonalcoholic fatty liver disease in patients 55 years old or older: Results from a population-based study

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Background

Recent case-control studies observed an increased prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with psoriasis, which is relevant in selecting optimal psoriasis treatment.

Objective

We sought to compare the prevalence of NAFLD in people with psoriasis and those without psoriasis.

Methods

This large prospective population-based cohort study (part of the Rotterdam Study) enrolled elderly participants (>55 years). NAFLD was diagnosed as fatty liver on ultrasonography in the absence of other liver diseases. Participants with psoriasis were identified using a validated algorithm. Multivariable logistic regression model was used to assess whether psoriasis was associated with NAFLD after adjusting for demographic, lifestyle characteristics, and laboratory findings.

Results

In total, 2292 participants were included (mean age 76.2 ± 6.0 years; 58.7% female; mean body mass index 27.4 ± 4.2kg/m2) of whom 118 (5.1%) had psoriasis. The prevalence of NAFLD was 46.2% in patients with psoriasis compared with 33.3% for the reference group without psoriasis (P = .005). Psoriasis was significantly associated with NAFLD; after adjustment for alcohol consumption, pack-years and smoking status, presence of metabolic syndrome, and alanine aminotransferase, psoriasis remained a significant predictor of NAFLD (adjusted odds ratio 1.7, 95% confidence interval 1.1-2.6).

Limitations

This was a cross-sectional study.

Conclusion

Elderly participants with psoriasis are 70% more likely to have NAFLD than those without psoriasis independent of common NAFLD risk factors.

Section snippets

Participants

This study is part of the Rotterdam Study, an ongoing large prospective population-based cohort study, which started in January 1990.15 All inhabitants who were aged 55 years and older, living in Ommoord, a district in Rotterdam (The Netherlands), were invited to participate. The rationale and study design have been described previously.15 Abdominal ultrasonography was introduced to the core protocol at the fifth survey of the Rotterdam Study (February 2009-February 2012), which constitutes the

Study population

Data on psoriasis diagnosis were available for all 3205 participants who underwent abdominal ultrasonography. After excluding cohort members with a history of possible antipsoriatic drug use (eg, medicated shampoos), but no diagnosis of psoriasis in their medical files or during clinical examination from the reference group, 2617 participants remained (Fig 1). In total, 325 participants were excluded for the presence of secondary causes of fatty liver resulting in 2292 eligible participants for

Discussion

In this large population-based cohort study of elderly people, psoriasis was independently associated with NAFLD and increased the likelihood of having NAFLD by approximately 70%. In our study, the prevalence of NAFLD in participants with psoriasis in a general population was significantly higher than in our reference population (46% vs 33%). These prevalence estimates are comparable with results of an Italian case-control study (47%) including 130 patients with psoriasis from a tertiary center

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    The Rotterdam Study is supported by the Erasmus MC University Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly (RIDE); the Ministry of Education, Culture, and Science; the Ministry of Health, Welfare, and Sports; the European Commission (DG XII); and the Municipality of Rotterdam. This study was financially supported by the Foundation for Liver Research (SLO), Rotterdam, The Netherlands.

    Disclosure: Dr Nijsten served as speaker, consultant, and investigator for Abbvie, Janssen, Pfizer, Galderma, Celgene, and Leo Pharma. Dr van der Voort, Dr Koehler, Dr Dowlatshahi, Dr Hofman, Dr Stricker, Dr Janssen, and Dr Schouten have no conflicts of interest to declare.

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