{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:58:03Z","timestamp":1761893883730,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006483","name":"Abbvie","doi-asserted-by":"crossref","award":["ABBVIE-18-CONS"],"award-info":[{"award-number":["ABBVIE-18-CONS"]}],"id":[{"id":"10.13039\/100006483","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","award":["RC-2025"],"award-info":[{"award-number":["RC-2025"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Chronic skin ulcers are characterized by an impaired and delayed wound healing process, posing a major economic and healthcare burden. These multifactorial conditions are influenced by both biological, clinical and psychosocial factors. The aim of our cross-sectional study was to investigate the influence of psychosocial and lifestyle factors\u2014specifically adherence to the Mediterranean diet, emotional health, sleep quality and demographic characteristics\u2014on physical symptoms and clinical severity in patients with skin ulcers, using a multidisciplinary approach to identify key predictors of disease burden. Methods: A cross-sectional analysis was conducted on patients with skin ulcers, using data from a monocentric pathology registry. Collected variables included gender, age, dietary habits (specifically, adherence to the Mediterranean diet), sleep disturbances, educational level, anxiety and depressive symptoms, Physician Global Assessment (PGA), Patient Global Assessment (PtGA), and Skindex-17 (a dermatology-specific quality of life measure). Hierarchic multivariate linear regression models were applied to identify predictors of physical symptoms and clinical severity, while simultaneously controlling for potential confounders. Results: Older age, poorer adherence to the Mediterranean diet, and elevated anxiety levels emerged as the strongest predictors of worse physical symptoms, as measured by the Skindex-17. Male sex and more severe depressive symptoms were significantly associated with higher PGA scores. Our data also suggest older age and poorer Mediterranean diet adherence to influence clinical severity. Lastly, sleep disturbances were also found to correlate with patient-reported severity. Conclusions: Our study underscores the impact of psychosocial and behavioral\/lifestyle factors on the clinical burden of skin ulcers through a comprehensive multidisciplinary approach. In particular, our data indicate that dietary patterns and emotional health appear to shape both symptom perception and clinical evaluation, emphasizing the need for holistic management strategies.<\/jats:p>","DOI":"10.3390\/nu17213402","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:50:19Z","timestamp":1761785419000},"page":"3402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mediterranean Diet Adherence, Sleep Disturbances and Emotional Well-Being in Skin Ulcer Burden: Insights from a Monocentric Registry"],"prefix":"10.3390","volume":"17","author":[{"given":"Tonia","family":"Samela","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Unit, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"},{"name":"Clinical Psychology Unit, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Raimondi","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damiano","family":"Abeni","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6888-1778","authenticated-orcid":false,"given":"Maria Beatrice","family":"Pupa","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Chiara","family":"Collina","sequence":"additional","affiliation":[{"name":"Diabetic Foot Outpatient Clinic, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8851-3502","authenticated-orcid":false,"given":"Teresa","family":"Odorisio","sequence":"additional","affiliation":[{"name":"Laboratory of Molecular and Cell Biology, Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0916-7769","authenticated-orcid":false,"given":"Alessia","family":"Paganelli","sequence":"additional","affiliation":[{"name":"Center for Regenerative Medicine and Immunodermatology (CEDRI), Istituto Dermopatico Dell\u2019Immacolata, IDI-IRCCS, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1089\/wound.2023.0150","article-title":"Human Wound and Its Burden: Updated 2022 Compendium of Estimates","volume":"12","author":"Sen","year":"2023","journal-title":"Adv. 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