The effect of ketogenic diet versus mediterranean diet on clinical and biochemical markers of inflammation in patients with obesity and psoriatic arthritis

Aikaterini Kountouri; Pelagia Katsimbri; Emmanouil Korakas; Loukia Pliouta; Vasileia Agapitou; Eirini Maratou; George Pavlidis; Ignatios Ikonomidis; Argyro Papathanasi; Sofia Malisova; Dionysios Vlachos; Evangelia Papadavid; Vaia Lambadiari

doi:10.1530/endoabs.99.P292

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Endocrine Abstracts (2024) 99 P292 | DOI: 10.1530/endoabs.99.P292

ECE2024 Poster Presentations Diabetes, Obesity, Metabolism and Nutrition (130 abstracts)

The effect of ketogenic diet versus mediterranean diet on clinical and biochemical markers of inflammation in patients with obesity and psoriatic arthritis

Aikaterini Kountouri ¹ , Pelagia Katsimbri ² , Emmanouil Korakas ¹ , Loukia Pliouta ¹ , Vasileia Agapitou ¹ , Eirini Maratou ³ , George Pavlidis ⁴ , Ignatios Ikonomidis ⁴ , Argyro Papathanasi ⁵ , Sofia Malisova ⁶ , Dionysios Vlachos ⁶ , Evangelia Papadavid ⁵ & Vaia Lambadiari ¹

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¹Attikon University Hospital, Second Department of Internal Medicine, Chaidari, Greece; ²Attikon University Hospital, Rheumatology and Clinical Immunology Unit, Fourth Department of Internal Medicine, Chaidari, Greece; ³Attikon University Hospital, Department of Clinical Biochemistry, Chaidari, Greece; ⁴Attikon University Hospital, Second Cardiology Department, Chaidari, Greece; ⁵Attikon University Hospital, Second department of Dermatology and Venereology, Chaidari, Greece; ⁶Independent Researcher, Athens, Greece

Background: Obesity is over-represented in patients with psoriasis (PSO) and psoriatic arthritis (PsA) and associated with higher disease activity and poorer treatment response. A substantial number of studies have highlighted the beneficial effect of weight loss in PSO and PsA disease activity. However, the data regarding the most efficacious diet pattern are scarce. The aim of our study to evaluate the effectiveness of Mediterranean diet (MD) and Ketogenic diet (KD), in patients with PSA

Methods: Sixteen patients were randomly assigned to start either with MD or KD for a period of 8 weeks. After a 6-week washout interval, the two groups were crossed over to the other type of diet for 8-week period. Disease activity was assessed using the Psoriasis Area and Severity Index (PASI) and the Disease Activity Index for Psoriatic Arthritis (DAPSA) score. Metabolic and disease parameters were evaluated at the beginning and at the end of each diet-intervention.

Results: At baseline, patients presented mean weight of 108.44 kg, mean PASI of 5.09 and a mean DAPSA of 54.02. At the end of the study, MD and KD resulted in significant reduction in weight(P=0.002, P<0.001, respectively), in BMI (P=0.006, P<0.001, respectively), in waist circumference(P=0.001, P<0.001, respectively), in total fat mass (P=0.007, P<0.001, respectively) and in visceral fat (P=0.01, P<0.001, respectively). After KD, patients displayed a significant reduction in PASI (P=0.04), DAPSA (P=0.004), IL-6 (P=0.047), IL-17 (P=0.042) and in IL-23 (P=0.037), whereas no significant differences were observed in these markers after MD (P>0.05), compared to baseline (table 1).


	Baseline	MD	KD	p-value†	p-value*
Weight (Kg)	108.44±19.01	101.21±17.95	98.17±17.46	0.002	< 0.001
BMI(kg/m²)	39.90±7.60	37.40±7.75	36.30±7.33	0.006	< 0.001
WC (cm)	122.96±17.87	118.53±15.71	115.56±15.52	0.001	< 0.001
FatMass (kg)	46.83±12.76	42.30±12.84	40.51±12.80	0.007	< 0.001
Visceral Fat (%)	15.43±4.38	14.18±4.38	13.50±3.81	0.01	< 0.001
PASI	5.09±5.73	3.82±3.93	3.15±4.88	0.278	0.040
DAPSA	46.28±34.89	34.89±30.17	23.30±16.75	0.060	0.004
IL-6	9.85±17.94	8.17±12.85	6.33±12.47	0.666	0.047
IL-17	11.44±20.10	5.29±6.74	4.66±8.72	0.243	0.042
IL-23	23.59±11.04	19.15±9.70	17.86±9.97	0.151	0.037
† comparisons baseline and after MD, * comparisons between baseline and after KD

Conclusion: The 22-week MD-KD diet program in patients with PSA led to beneficial results in markers of inflammation and disease activity. KD had a more significant impact on weight loss and in parameters of disease activity. A larger number of patients and a longer follow-up period may be necessary to fully elucidate the effect of different diets on disease activity in patients with PSO and PsA.