Photo Credit: Ranee Sornprasitt
A 12-week lifestyle modification program for men with obesity improved plaque psoriasis severity as well as psoriasis-associated erectile dysfunction and metabolic syndrome.
A 12-week lifestyle modification program improved plaque psoriasis severity as well as psoriasis-associated erectile dysfunction (ED) and metabolic syndrome (MeTS), according to findings published in the Irish Journal of Medical Science.
According to study coauthors Ali Mohamed Ali Ismail and Dina E. Hamed, 20% to 50% of patients with psoriasis develop MeTS. In addition, there is a strong link between chronic plaque psoriasis and ED in men.
“Since there are no published studies to clarify the effect of lifestyle changes (exercise and diet intervention) on ED in patients with psoriasis, this lifestyle modification study aims to explore the response of MeTS components and ED to a 12-week lifestyle-modification program in obese men,” the researchers wrote.
Program Design and Implementation
The researchers recruited 60 men from their institution between October 2022 and April 2023. The patients were 32 to 49 years of age with mild-to-severe psoriasis, mild-to-moderate ED, and BMI ranging from 30 to 34.9 kg/m2.
To be included in the study, participants had to have at least three of the following MeTS components:
- Waist circumference ≥ 102 cm
- BP ≥ 130/85 mmHg or regular therapy for high BP
- Serum high-density lipoprotein (HDL) < 40 mg/dL
- Serum triglycerides ≥ 150 mg/dL
- Serum fasting blood glucose level (tested after 6 hours of fasting) ≥ 110 mg/dL
The researchers randomly selected 30 men to receive the lifestyle modification, while the remaining 30 men made no changes to their diet or exercise habits. There were no significant demographic differences between the groups.
Investigators used the Harris-Benedict equation to calculate each patient’s basal metabolic rate (BMR), then subtracted the BMR from 500 kilocalories per day to create a low-calorie diet plan. Patients in the intervention group ate 3 meals per day including fruits, vegetables, and macronutrients (20%-30% fats, 10%-15% proteins, and 55%-65% carbohydrates). Researchers conducted weekly in-person interviews to monitor diet adherence.
These patients also completed 40 minutes of supervised exercise on treadmills.
“Day after day three times weekly, the session was constituted of three stages,” the researchers explained. “Warming-up and cooling-down walking stages conducted at 40%-50% of men’s maximal heart rate, 5 min for each, were done before and after the main exercise stage (a 30-min walk on the treadmill at 60%-70% of men’s maximal heart rate), respectively.”
The primary outcome was change in ED as measured by the Arabic version of the five-item international index of erectile function questionnaire (IIEFQ-5). Secondary outcomes included BMI, MeTS components, and Psoriasis Area and Severity Index (PASI).
Benefits for Patients
Patients who participated in the lifestyle modification program saw improvements in ED, MeTS components, and PASI (Table).
The researchers suspected that weight loss contributed to the improvements in psoriasis severity, as a decrease in adipose tissue is associated with decreased inflammatory cytokines.
“Decreased production of cytokines not only restricts the causative role in the induction of [chronic plaque psoriasis], but also improves low-grade systemic inflammation, which is the common factor in the occurrence of psoriasis-associated comorbidities such as cardiovascular diseases, MeTS, and ED,” the investigators explained.
The MeTS improvements in this study may be attributed to several mechanisms, such as reduced SNS activity, enhanced micro- and macrocirculation, increased nitric oxide and other vasodilating substances, and improved insulin resistance, among others.
The investigators advised that adding diet restriction protocols to treatment with pharmacological therapies could bolster PASI scores in patients with obesity and plaque psoriasis.
“This is the first lifestyle modification study that reported an improvement in ED, MeTS components, and PASI after a 12-week randomized-controlled program of exercise and diet restriction in men with [chronic plaque psoriasis], ED, and MeTS,” Ismail and Hamed concluded.
