Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies

Background: Increasing population-based studies have suggested a relationship between psoriasis and metabolic syndrome. Objective: The objective of this study was to perform a systematic review and meta-analysis that synthesizes the epidemiologic associations between psoriasis and metabolic syndrome. Methods: We searched for observational studies from MEDLINE, EMBASE, and Cochrane Central Register from Jan 1, 1980 to Jan 1, 2012. We applied the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines in the conduct of this study. Results: We identified 12 observational studies with a total of 1.4 million study participants fulfilling the inclusion criteria, among whom 41,853 were patients with psoriasis. Based on random-effects modeling of cross-sectional and case-controlled studies, the pooled odds ratio (OR) for metabolic syndrome among patients with psoriasis was 2.26 (95% confidence interval [CI] 1.70-3.01) compared with the general population. Visual inspection of a funnel plot and formal analysis with the Egger test suggested publication bias and absence of small studies in the published literature (P = .03). A dose-response relationship was also observed between psoriasis severity and prevalence of metabolic syndrome. Limitations: No studies to date have assessed incidence of metabolic syndrome among patients with psoriasis. Conclusions: Compared with the general population, psoriasis patients have higher prevalence of metabolic syndrome, and patients with more severe psoriasis have greater odds of metabolic syndrome than those with milder psoriasis. (J Am Acad Dermatol 2013;68:654-62.)