Metabolic syndrome prevalent in SG patients with psoriasis

There is a high prevalence of metabolic syndrome (MetS) in patients with psoriasis in Singapore, which is nearly threefold higher than the general population, a study has shown. However, no association exists between disease severity and presence of MetS.

“Abdominal obesity seemed to play an integral role in an increased prevalence of MetS, and physicians need to be aware of the rising trend of abdominal obesity in Asia,” the researchers said.

A total of 338 patients with psoriasis (70.4 percent men) were included in the analysis, majority of whom were Chinese (67.5 percent) while the rest were Malay (15.4 percent) and Indian (17.2 percent). MetS prevalence stood at 45.3 percent, with those aged >50 years (44 percent) constituting the highest proportion of patients with the said condition. [Singapore Med J 2019;doi:10.11622/smedj.2019152]

Malay ethnicity was significantly associated with hypertriglyceridaemia, elevated fasting plasma glucose and abdominal obesity, while Indian ethnicity correlated with lower high-density lipoprotein cholesterol. Abdominal obesity was higher among Indian and Malay patients compared to Chinese patients, and this finding was consistent to that of the National Health Survey. [Singapore Fam Physician 2012;38:8-13]

“Focused therapies can be employed to target abdominal obesity, especially among Malay and Indian patients, such as referral to physiotherapists and sport trainers for tailored exercise programmes, and early referrals to dieticians to improve low levels of low-density lipoprotein cholesterol in Indian patients and elevated fasting plasma glucose levels in Malay patients,” the researchers said.

Of note, no significant association was found between psoriasis severity and risk of MetS.

MetS prevalence in the current study was higher compared to that in the UK (34.2 percent), Japan (25.2 percent), Taiwan (22.5 percent) and Italy (30.1 percent), and this was potentially driven by the varying criteria used for diagnosing MetS among the various populations. [Diabetes Care 2004;27:1182-1186; J Dermatol Sci 2010;57:143-144; Arch Dermatol 2008;144:1571-1575; Br J Dermatol 2007;157:68-73]

Criteria for MetS diagnosis have been proposed by several organizations, including the National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III guidelines, International Diabetes Foundation, World Health Organization and European Group for the Study of Insulin Resistance. [JAMA 2001;285:2486-2497]

“For Asians, a lower waist circumference cutoff point for men and women is represented in the modified NCEP-ATP III guidelines, and this was the defining criterion used in our study,” the researchers noted.

“In view of the rising trend of abdominal obesity in Asia, these findings suggest that perhaps the NCEP-ATP III criteria should be used instead of the modified criteria to prevent any unintended ‘inflation’ of the prevalence of MetS,” they added.

The present cross-sectional study included patients with psoriasis, aged 18–69 years, who attended a tertiary dermatology referral centre in Singapore from October 2007 to February 2009. The researchers measured the patients’ fasting glucose, lipids, blood pressure, body mass index, and Psoriasis Area and Severity Index. MetS was diagnosed in the presence of ≥3 criteria of the modified NCEP-ATP III.

“Early identification and subsequent referral of these subgroups to dieticians and nurses for lifestyle modifications and exercise may reduce their risk of developing cardiovascular disease,” the researchers said.