Lifestyle interventions targeting adiposity in adults with psoriasis: a systematic review and network meta-analysis
Abstract
Objective: Excess adiposity drives inflammation and impairs treatment response in psoriasis. We compared the effectiveness of dietary energy restriction, aerobic exercise, and combined diet-exercise interventions in adults with psoriasis and overweight or obesity.
Methods: 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).
Results: Nine trials (1,066 participants) were included. Versus UC, LED produced the most consistent reductions in BMI (mean difference -2.89 kg/m2; 95% credible interval -4.78 to -0.73) and body weight (-7.97 kg; -13.07 to -0.81). The AE estimate was informed by only one trial and was highly uncertain. D+AE yielded the most favorable numerical PASI estimate (-2.48; -6.26 to 1.46), although the credible interval crossed the null. Certainty of evidence was low across outcomes.
Conclusion: 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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,066 participants or records.
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