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Observational Study
. 2021 Jun 10;13(6):1997.
doi: 10.3390/nu13061997.

Association of Trimethylamine N-Oxide (TMAO) with the Clinical Severity of Hidradenitis Suppurativa (Acne Inversa)

Luigi Barrea  1   2 , Giovanna Muscogiuri  2   3   4 , Gabriella Pugliese  2   3 , Giulia de Alteriis  3 , Maria Maisto  5 , Marianna Donnarumma  6 , Gian Carlo Tenore  5 , Annamaria Colao  2   3   4 , Gabriella Fabbrocini  6 , Silvia Savastano  2   3
Affiliations
Observational Study

Association of Trimethylamine N-Oxide (TMAO) with the Clinical Severity of Hidradenitis Suppurativa (Acne Inversa)

Luigi Barrea et al. Nutrients. .

Abstract

In this case-control, cross-sectional, observational study, we evaluated circulating trimethylamine n-oxide (TMAO) levels, a gut-derived metabolite associated with inflammation and cardiometabolic risk, in patients with hidradenitis suppurativa (HS), a highly disabling inflammatory skin disease associated with an elevated prevalence of comorbidities, especially cardiovascular and metabolic diseases. In this study, we enrolled 35 naive-treatment patients with HS and 35 controls, matched for sex, age, and body mass index (BMI). HS Sartorius score was 49.0 (33.0-75.0), while according to the Harley system 12 and 23 patients presented grade 1 and grade 2 severity, respectively. HS patients had a lower adherence to the Mediterranean diet (MD) (p = 0.002), lower phase angle (PhA) (p < 0.001), and higher circulating TMAO levels (p < 0.001) than the control group. HS patients with grade 2 rather than grade 1 of Harley grade severity showed a higher BMI (p = 0.007), waist circumference (p = 0.016), total energy intake (p = 0.005), and lower PhA (p < 0.001) and adherence to the MD (p = 0.003). Of interest, patients with Hurley grade 2 of severity exhibited higher circulating TMAO levels (p < 0.001) compared to grade 1. Circulating TMAO levels showed a positive correlation with HS Sartorius score even after adjustment for confounding covariates, including BMI, waist circumference, adherence to the MD, total energy intake, and PhA (r = 0.570, p = 0.001). Using a linear regression model, circulating TMAO levels and PhA were the main predictors of the clinical severity of HS.

Keywords: Mediterranean diet; acne inversa; hidradenitis suppurativa; nutritionist; phase angle; trimethylamine n-oxide (TMAO).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Difference in circulating TMAO levels between HS patients and control group. Difference was analyzed by Student’s paired t-test. Results were expressed as mean ± SD. A p value in bold type denotes a significant difference (p < 0.05). HS, hidradenitis suppurativa; TMAO, trimethylamine n-oxide.
Figure 2
Figure 2
Difference in circulating TMAO levels in HS patients between Hurley grade 1 vs. Hurley grade 2. Difference was analyzed by Student’s impaired t-test. Results were expressed as mean ± SD. A p value in bold type denotes a significant difference (p < 0.05). TMAO, trimethylamine n-oxide.
Figure 3
Figure 3
Partial correlation between HS Sartorius score and the circulating TMAO levels. HS Sartorius score was positively associated with the circulating TMAO levels, after adjusting for BMI, waist circumference, PREDIMED score, total energy intake, and PhA. Correlations between variables were performed using Pearson r correlation coefficients. A p value in bold type denotes a significant difference (p < 0.05). HS, Hidradenitis Suppurativa; TMAO, trimethylamine n-oxide.
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References

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