Circadian Syndrome Superior Predictor to Metabolic Syndrome of Prevalent Psoriasis

Circadian syndrome is superior in its ability to predict psoriasis compared to metabolic syndrome, according to recent findings, with depressive symptoms, increased blood pressure, and elevated waist circumference contributing more to this predictive ability.¹

These conclusions resulted from new research conducted to evaluate the link between circadian syndrome and metabolic syndrome with the prevalent skin disease, using comparisons between both conditions for predictions.

This research was led by Yunfan Gu from the Traditional Chinese and Western Medicine Hospital of Wuhan’s department of dermatology at the Huazhong University of Science and Technology in China. Gu et al. noted that circadian syndrome has previously been found to be strongly connected to stroke, coronary heart disease, and endocrine disruption.²

“Therefore, we hypothesize that (circadian syndrome) should be considered a new psoriasis risk group besides (metabolic syndrome) and may be able to represent psoriasis caused by unhealthy lifestyle habits better than (metabolic syndrome),” Gu and colleagues wrote. “To answer this question, We utilized data on the population from the National Health and Nutrition Examination Survey (NHANES) to build machine learning (ML) models.”

Background and Design

The investigators implemented 3 stages in their study, the first of which utilizing data from the NHANES database for the purposes of using multiple logistic regression analyses to assess the aforementioned association. In their research’s second stage, the team looked at variables found in the initial stage and then used 5 machine learning algorithms for comparisons of the predictive performance of both metabolic and circadian syndrome for psoriasis.

In their last stage, the investigators implemented Mendelian randomization (MR) analyses of genome-wide association study (GWAS) summary statistics for the purposes of evaluating any causal link between the components of circadian syndrome and the skin disease.

NHANES is a cross-sectional survey which receives updates every 2 years by the Centers for Disease Control and Prevention. NHANES is used to assess the health and nutritional status of both adult and children civilians within the US using physical exams, questionnaires, and lab tests.

There were 40,816 participants from 4 survey cycles included by the research team. Following their exclusion of incomplete data, the team’s final sample included 9,531 subjects.

Metabolic syndrome had been diagnosed using the 2009 criteria from several different health organizations, with the requirement being at least 3 of the following: elevated blood pressure or antihypertensive therapy; elevated waist circumference; reduced HDL cholesterol or treatment for such a condition; elevated fasting blood glucose or treatment; and elevated triglycerides or treatment.

Seven components were used for circadian syndrome: depressive symptoms, diminished sleep duration, and the five metabolic syndrome components. Those who had 4 or more of these elements were considered to have circadian syndrome. Diagnoses of psoriasis were confirmed by subjects’ affirmative responses to whether a healthcare provider had ever indicated the existence of psoriasis.

Findings

Overall, there were 9,531 participants eligible for the investigators’ research. The research team reported that there were substantial correlations identified between metabolic syndrome (OR = 1.53, 95%CI: 1.07–2.17, P = .02), circadian syndrome (OR = 1.40, 95%CI: 1.02–1.91, P = .039), and psoriasis.

The investigators noted the superior performance of the predictive models for circadian syndrome compared to those used for metabolic syndrome. They highlighted that the Categorical Features+Gradient Boosting model for circadian syndrome had led to the highest accuracy of predictions (area under the precision-recall curve = .969).

Out of all the circadian syndrome elements, the research team found that increased waist circumference, increased blood pressure, symptoms of depression, and lack of sleep had been shown to be the most significant predictors of psoriasis. Using inverse variance weighted methods, the team reported major causal connections between hypertension (OR = 1.68, 95%CI: 1.19−2.37, P = .003), waist circumference (OR = 1.52, 95%CI: 1.34−1.73, P = 1.35e-10), symptoms of depression (OR = 1.39, 95%CI: 1.17−1.65, P = 1.51e-4), and diminished sleep (OR = 2.03, 95%CI: 1.21–3.39, P = .007) with an increased psoriasis risk.

“To summarize, both the MetS and CircS were positively associated with psoriasis in NHANES data from 4 cycles,” they wrote. “Moreover, CircS demonstrated superior predictive ability for prevalent psoriasis compared to MetS, with elevated blood pressure, depression symptoms, and elevated WC contributing more to the prediction.”

References

1. ^{Gu Y, Ye X, Zhao W, He S, Zhang W, Zeng X. The circadian syndrome is a better predictor for psoriasis than the metabolic syndrome via an explainable machine learning method - the NHANES survey during 2005-2006 and 2009-2014. Front Endocrinol (Lausanne). 2024 Jun 26;15:1379130. doi: 10.3389/fendo.2024.1379130. PMID: 38988999; PMCID: PMC11233539.}
2. ^{Shi Z, Tuomilehto J, Kronfeld-Schor N, Alberti G, Stern N, El-Osta A, et al. The Circadian Syndrome Is a Significant and Stronger Predictor for Cardiovascular Disease than the Metabolic Syndrome-The NHANES Survey during 2005-2016. Nutrients. (2022) 14:5317. doi: 10.3390/nu14245317.}