Role of Nutrition and Adherence to the Mediterranean Diet in the Multidisciplinary Approach of Hidradenitis Suppurativa: Evaluation of Nutritional Status and Its Association with Severity of Disease

Abstract

Hidradenitis suppurativa (HS) is a chronic, inflammatory and debilitating skin disorder. The exacerbating factors of HS include nutrition and adiposity. We aimed to investigate the relationships between body composition and the adherence to the Mediterranean diet (MD) with the severity of HS in a sample of naive-treatment patients with HS. In this case⁻controlled, cross-sectional study, we enrolled 41 HS patients and 41 control subjects. Body composition was evaluated by a bioelectrical impedance analysis (BIA) phase-sensitive system. PREvención con DIeta MEDiterránea (PREDIMED) and the 7-day food records were used to evaluate the degree of adherence to the MD and dietary pattern, respectively. The clinical severity was assessed by using the Sartorius HS score. HS patients had a worse body composition, in particular lower phase angle (PhA) (p < 0.001), and a lower adherence to the MD than controls, in spite of no differences in energy intake between the two groups. The receiver operator characteristic (ROC) analysis showing a value of PhA of ≤ 5.7 and a PREDIMED score of ≤ 5.0 identified HS patients with the highest clinical severity of the disease. After adjusting for sex, age, body mass index (BMI), and total energy intake, the HS Sartorius score maintained negative correlations with PhA (p < 0.001), PREDIMED score, and n-3 polyunsaturated fatty acids (p = 0.005). The results of the multivariate analysis showed PhA and PREDIMED score were the major determinants of HS Sartorius score, explaining 82.0% and 30.4% of its variability, respectively (p < 0.001). Novel associations were demonstrated between PhA and the degree of adherence to the MD with the HS severity. PhA and PREDIMED score might represent possible markers of severity of HS in a clinical setting.

Keywords: 7-day food records; Hidradenitis Suppurativa; Mediterranean diet; body composition; nutrition; phase angle.

Figure 1

Flow chart of the studied subjects. Abbreviation: HS, Hidradenitis suppurativa.

Figure 2

ROC analysis was performed to determine the cut off values of the PhA (a) and the PREDIMED score (b) that were predictive of the highest Sartorius HS scores (above the median value 51) (Figure 2a,b). A p value in bold type denotes a significant difference (p < 0.05). ROC, receiver operating characteristic; PhA, phase angle.

Figure 3

Differences in HS Sartorius scores across the PREDIMED categories. Higher HS Sartorius scores were evidenced in low adherers compared with average-higher adherers (p < 0.001).

Figure 4

Correlation between HS Sartorius score and PREDIMED score, after adjusting for sex, age, BMI and total energy intake. The highest HS Sartorius score was significantly associated with the lowest score of PREDIMED score (r = –0.552, p < 0.001), and this correlation remained significant also after adjusting for sex, age, BMI and total energy intake (r = –0.454, p = 0.005). A p value in bold type denotes a significant difference (p < 0.05).