{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:44:41Z","timestamp":1786117481482,"version":"build-2736575974"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Excess adiposity drives inflammation and impairs treatment response in psoriasis. We compared the effectiveness of dietary energy restriction, aerobic exercise, and combined diet\u2013exercise interventions in adults with psoriasis and overweight or obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched four English- and four Chinese-language databases from inception to 15 January 2026 for randomized controlled trials of low-energy diet (LED), aerobic exercise (AE), diet plus aerobic exercise (D+AE), or usual care (UC). Primary outcomes were body mass index (BMI), body weight, and waist circumference; secondary outcomes included Psoriasis Area and Severity Index (PASI). A Bayesian random-effects network meta-analysis was performed with UC as the reference; certainty of evidence was assessed with Confidence in Network Meta-Analysis (CINeMA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine trials (1,066 participants) were included. Versus UC, LED produced the most consistent reductions in BMI (mean difference \u22122.89\u202fkg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ; 95% credible interval \u22124.78 to \u22120.73) and body weight (\u22127.97\u202fkg; \u221213.07 to \u22120.81). The AE estimate was informed by only one trial and was highly uncertain. D+AE yielded the most favorable numerical PASI estimate (\u22122.48; \u22126.26 to 1.46), although the credible interval crossed the null. Certainty of evidence was low across outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Low-energy diet showed the most consistent short-term reductions in BMI and body weight, whereas effects on waist circumference and PASI remained uncertain. Given the sparse network and low certainty of evidence, comparisons between lifestyle strategies should be regarded as hypothesis-generating rather than confirmatory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>www.crd.york.ac.uk\/prospero<\/jats:ext-link>\n                      , CRD420261291403.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1912400","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:50:35Z","timestamp":1786024235000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lifestyle interventions targeting adiposity in adults with psoriasis: a systematic review and network meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Ran","family":"Huo","sequence":"first","affiliation":[{"name":"School of Physical Education and Training, Capital University of Physical Education and Sports","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhao","family":"Li","sequence":"additional","affiliation":[{"name":"School of Physical Education, Northeastern University","place":["Shenyang, Liaoning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoran","family":"Luo","sequence":"additional","affiliation":[{"name":"Institute of Physical Culture, Sports and Tourism, Peter the Great St. Petersburg Polytechnic University","place":["Saint Petersburg, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Su","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Sports, Macao Polytechnic University","place":["Macau, Macao SAR, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Competitive Sports, Beijing Sport University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haicheng","family":"Gou","sequence":"additional","affiliation":[{"name":"School of Physical Education and Sports, Central China Normal University","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijie","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Physical Education and Training, Capital University of Physical Education and Sports","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1947","DOI":"10.3390\/life13101947","article-title":"Update on obesity in psoriasis patients","volume":"13","author":"Vata","year":"2023","journal-title":"Life"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1111\/j.1600-0625.2010.01210.x","article-title":"Adipokines and psoriasis","volume":"20","author":"Gerdes","year":"2011","journal-title":"Exp Dermatol"},{"key":"ref3","first-page":"s4","article-title":"Psoriasis and obesity: optimizing pharmacologic treatment and lifestyle interventions","volume":"24","author":"Guo","year":"2025","journal-title":"J Drugs Dermatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1007\/s40261-021-01080-z","article-title":"Impact of body mass index on the efficacy of biological therapies in patients with psoriasis: a real-world study","volume":"41","author":"Pirro","year":"2021","journal-title":"Clin Drug Investig"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/S0140-6736(20)32549-6","article-title":"Psoriasis","volume":"397","author":"Griffiths","year":"2021","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"ljae360.061","DOI":"10.1093\/bjd\/ljae360.061","article-title":"Global epidemiology of psoriasis: global psoriasis atlas 2024 update","volume":"191","author":"Aalemi","year":"2024","journal-title":"Br J Dermatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1016\/j.jaad.2018.11.057","article-title":"Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics","volume":"80","author":"Menter","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2437","DOI":"10.3390\/healthcare13192437","article-title":"Global psoriasis burden 1990\u20132021: evolving patterns and socio-demographic correlates in the global burden of disease 2021 update","volume":"13","author":"Li","year":"2025","journal-title":"Healthcare (Basel)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1186\/s12967-025-07130-w","article-title":"Association of BMI, BMR, BSA, and body weight with psoriasis severity and treatment response: evidence from a real-world cohort","volume":"23","author":"Xu","year":"2025","journal-title":"J Transl Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.3390\/jcm14041087","article-title":"Effectiveness of brodalumab for the treatment of moderate-to-severe psoriasis: a retrospective, real-world multicenter study with a focus on obese and multi-failure patients\u2014IL PSO","volume":"14","author":"Orsini","year":"2025","journal-title":"J Clin Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2461","DOI":"10.1111\/jdv.16915","article-title":"EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris. Part 1: treatment and monitoring recommendations","volume":"34","author":"Nast","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1111\/jdv.16926","article-title":"EuroGuiDerm guideline on the systemic treatment of psoriasis vulgaris. Part 2: specific clinical and comorbid situations","volume":"35","author":"Nast","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1111\/obr.12366","article-title":"Clinical effectiveness of very-low-energy diets in the management of weight loss: a systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Parretti","year":"2016","journal-title":"Obes Rev"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1038\/oby.2006.146","article-title":"The evolution of very-low-calorie diets: an update and meta-analysis","volume":"14","author":"Tsai","year":"2006","journal-title":"Obesity"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1186\/s12966-024-01657-9","article-title":"Comparing caloric restriction regimens for effective weight management in adults: a systematic review and network meta-analysis","volume":"21","author":"Gu","year":"2024","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e13910","DOI":"10.1111\/obr.13910","article-title":"The effect of dietary weight-loss interventions on the inflammatory markers interleukin-6 and TNF-alpha in adults with obesity: a systematic review and meta-analysis of randomized controlled clinical trials","volume":"26","author":"Bulmer","year":"2025","journal-title":"Obes Rev"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.3390\/nu12061899","article-title":"The role of exercise in the interplay between myokines, hepatokines, osteokines, adipokines, and modulation of inflammation for energy substrate redistribution and fat mass loss: a review","volume":"12","author":"Gonzalez-Gil","year":"2020","journal-title":"Nutrients"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.3389\/fphys.2018.01307","article-title":"Physical exercise-induced myokines and muscle-adipose tissue crosstalk: a review of current knowledge and the implications for health and metabolic diseases","volume":"9","author":"Leal","year":"2018","journal-title":"Front Physiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1111\/jdv.70247","article-title":"Impact of weight-loss interventions on psoriasis severity: a systematic review and meta-analysis","volume":"40","author":"Morrow","year":"2025","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1038\/ijo.2015.64","article-title":"Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis","volume":"39","author":"Upala","year":"2015","journal-title":"Int J Obes"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"CD011972","DOI":"10.1002\/14651858.CD011972.pub2","article-title":"Lifestyle changes for treating psoriasis","volume":"2019","author":"Ko","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"35","DOI":"10.2147\/PTT.S294189","article-title":"The Effect of Lifestyle Changes on Disease Severity and Quality of Life in Patients with Plaque Psoriasis: A Narrative Review. Psoriasis (Auckl)","volume":"12","author":"van Acht","year":"2022","journal-title":"Acta Derm Venereol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1111\/bjd.12735","article-title":"Diet and physical exercise in psoriasis: a randomized controlled trial","volume":"170","author":"Naldi","year":"2014","journal-title":"Br J Dermatol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2020","journal-title":"BMJ"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s13063-024-07956-7","article-title":"Defining usual care comparators when designing pragmatic trials of complex health interventions: a methodology review","volume":"25","author":"Turner","year":"2024","journal-title":"Trials"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1001\/jamadermatol.2013.722","article-title":"Effect of weight loss on the severity of psoriasis: a randomized clinical study","volume":"149","author":"Jensen","year":"2013","journal-title":"JAMA Dermatol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"691","DOI":"10.2340\/00015555-1824","article-title":"Effect of weight loss on the cardiovascular risk profile of obese patients with psoriasis","volume":"94","author":"Jensen","year":"2014","journal-title":"Acta Derm Venereol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e1003082","DOI":"10.1371\/journal.pmed.1003082","article-title":"CINeMA: an approach for assessing confidence in the results of a network meta-analysis","volume":"17","author":"Nikolakopoulou","year":"2020","journal-title":"PLoS Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e1080","DOI":"10.1002\/cl2.1080","article-title":"CINeMA: software for semiautomated assessment of the confidence in the results of network meta-analysis","volume":"16","author":"Papakonstantinou","year":"2020","journal-title":"Campbell Syst Rev"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1111\/rssa.12579","article-title":"Multilevel network meta-regression for population-adjusted treatment comparisons","volume":"183","author":"Phillippo","year":"2020","journal-title":"J R Stat Soc Ser A Stat Soc"},{"key":"ref33","volume-title":"Cochrane Handbook for systematic Reviews of Interventions. Version 6.3","author":"Higgins","year":"2022"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1007\/s11845-023-03412-8","article-title":"Erectile dysfunction and metabolic syndrome components in obese men with psoriasis: response to a 12-week randomized controlled lifestyle modification program (exercise with diet restriction)","volume":"193","author":"Ismail","year":"2024","journal-title":"Ir J Med Sci"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"116","DOI":"10.5114\/reum\/162995","article-title":"Effect of low-calorie diet on psoriasis severity index, triglycerides, liver enzymes, and quality of life in psoriatic patients with non-alcoholic fatty liver disease","volume":"61","author":"Ismail","year":"2023","journal-title":"Reumatologia"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s42358-025-00444-9","article-title":"Health-related quality of life significantly improved in obese patients with psoriatic arthritis one year after a structured weight loss intervention","volume":"65","author":"Landgren","year":"2025","journal-title":"Adv Rheumatol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"4563","DOI":"10.3390\/nu15214563","article-title":"Regular exercise improved fatigue and musculoskeletal pain in young adult psoriatic patients without psoriatic arthritis","volume":"15","author":"Diaz","year":"2023","journal-title":"Nutrients"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s42358-022-00243-6","article-title":"Dietetic intervention in psoriatic arthritis: the DIETA trial","volume":"62","author":"Leite","year":"2022","journal-title":"Adv Rheumatol."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1517\/14712598.2014.900541","article-title":"The effect of weight reduction on treatment outcomes in obese patients with psoriasis on biologic therapy: a randomized controlled prospective trial","volume":"14","author":"Al-Mutairi","year":"2014","journal-title":"Expert Opin Biol Ther"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"6390","DOI":"10.3390\/ijms24076390","article-title":"The role of adipokines in the pathogenesis of psoriasis","volume":"24","author":"Kie\u0142bowski","year":"2023","journal-title":"Int J Mol Sci"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s12944-019-1115-3","article-title":"New insights into different adipokines in linking the pathophysiology of obesity and psoriasis","volume":"18","author":"Kong","year":"2019","journal-title":"Lipids Health Dis"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3390\/nu14010119","article-title":"Nutritional therapy in persons suffering from psoriasis","volume":"14","author":"Garbicz","year":"2022","journal-title":"Nutrients"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"450","DOI":"10.5114\/ada.2024.143424","article-title":"Association of psoriasis disease with physical activity and exercise: systematic review and meta-analysis","volume":"41","author":"Zhu","year":"2024","journal-title":"Postepy Dermatol Alergol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"2308","DOI":"10.3390\/ijms27052308","article-title":"Aerobic exercise attenuates epidermal hyperplasia in an obesity-associated psoriasiform dermatitis model","volume":"27","author":"Matsuda","year":"2026","journal-title":"Int J Mol Sci"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1038\/oby.2008.635","article-title":"Waist circumference measurement by site, posture, respiratory phase, and meal time: implications for methodology","volume":"17","author":"Agarwal","year":"2009","journal-title":"Obesity (Silver Spring)"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"144","DOI":"10.3390\/bs9120144","article-title":"Effectiveness and characterization of severely energy-restricted diets in people with class III obesity: systematic review and meta-analysis","volume":"9","author":"Maston","year":"2019","journal-title":"Behav Sci"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/j.jaad.2024.12.016","article-title":"The association between obesity and efficacy of psoriasis therapies: an expert consensus panel","volume":"92","author":"Burshtein","year":"2025","journal-title":"J Am Acad Dermatol"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jaad.2014.02.012","article-title":"Diet and psoriasis: part I. Impact of weight loss interventions","volume":"71","author":"Debbaneh","year":"2014","journal-title":"J Am Acad Dermatol"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"189","DOI":"10.2147\/PTT.S349791","article-title":"Psoriasis and exercise: a review","volume":"12","author":"Yeroushalmi","year":"2022","journal-title":"Psoriasis"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1695306","DOI":"10.3389\/fpubh.2025.1695306","article-title":"Barriers and facilitators to adopting health-promoting lifestyles in patients with psoriasis in China: a qualitative study using the COM-B and SEM","volume":"13","author":"Xing","year":"2025","journal-title":"Front Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1111\/bjd.18979","article-title":"What are the barriers to physical activity in patients with chronic plaque psoriasis?","volume":"183","author":"Auker","year":"2020","journal-title":"Br J Dermatol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"4793","DOI":"10.5826\/dpc.1502a4793","article-title":"Biologic and non-biologic therapies for scalp psoriasis: a network meta-analysis of randomized controlled trials","volume":"15","author":"Kaur","year":"2025","journal-title":"Dermatol Pract Concept"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1111\/jdv.17650","article-title":"Network meta-analyses in psoriasis: overview and critical discussion","volume":"35","author":"Augustin","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"840","DOI":"10.3390\/nu15040840","article-title":"The impact of diet and physical activity on psoriasis: a narrative review of the current evidence","volume":"15","author":"Duchnik","year":"2023","journal-title":"Nutrients"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e426","DOI":"10.1002\/ski2.426","article-title":"Increased physical activity promotes skin clearance, improves cardiovascular and psychological health, and increases functional capacity in patients with psoriasis","volume":"4","author":"Sheppard","year":"2024","journal-title":"Skin Health Dis"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"259","DOI":"10.3945\/ajcn.115.125849","article-title":"Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study","volume":"104","author":"Jensen","year":"2016","journal-title":"Am J Clin Nutr"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1007\/s00228-025-03898-4","article-title":"GLP-1 receptor agonists: emerging therapeutic potential in psoriasis management --current evidence and future outlook","volume":"81","author":"Atiquzzaman","year":"2025","journal-title":"Eur J Clin Pharmacol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s00011-025-02140-2","article-title":"The potential role of GLP-1 receptor agonists in the management of psoriatic disease: a scoping review","volume":"74","author":"Buonanno","year":"2025","journal-title":"Inflamm Res."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1912400\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:50:36Z","timestamp":1786024236000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1912400\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":58,"alternative-id":["10.3389\/fnut.2026.1912400"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1912400","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"1912400"}}