The association between weight-adjusted waist index and psoriasis in adults: results from NHANES 2009-2014

The association between weight-adjusted waist index and psoriasis in adults: results from NHANES 2009-2014 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The association between weight-adjusted waist index and psoriasis in adults: results from NHANES 2009-2014 Xiya Zhao, Junqin Li, Xinhua Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3610828/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background Evidence has indicated that the correlation between obesity and psoriasis is likely multifactorial in nature.Previously, no reports have been made regarding the correlation between weight-adjusted waist index (WWI) and psoriasis. Methods In this cross-sectional research, we examined a cohort of adult participants who provided comprehensive data related to WWI and psoriasis, gathered during the 2009–2014 National Health and Nutrition Examination Survey (NHANES). The calculation for WWI involved dividing waist circumference (WC) by the square root of body weight. We explored the association between WWI and psoriasis through multivariate linear regression modeling and subgroup analyses. The smoothing curve fitting was also applied . Results The study included 15,920 participants aged over 19 years, of whom 438 had a history of psoriasis.It revealed a notable positive correlation between WWI and psoriasis(OR = 1.226; 95% CI, 1.071–1.404, P < 0.05).The quartile with the highest WWI value (OR = 1.551; 95% CI, 1.127–2.135, P < 0.05) had a significantly increased risk of developing psoriasis by 55.1% compared with the quartile with the lowest WWI value. A positive nonlinear connection between WWI and psoriasis was observed in the smoothed curve fitting results. Conclusion Among U.S. adults, levels of WWI are positively associated with increased odds of developing psoriasis.We propose that adopting obesity management strategies based on the WWI could be beneficial in lowering the risk of psoriasis. Psoriasis Weight-adjusted waist index Obesity NHANES Cross-sectional study Figures Figure 1 Figure 2 Introduction Psoriasis, most notably affecting the skin and joints, is a systemic inflammatory disease characterized by adaptive and innate immune alterations[ 1 ]. The pathogenesis of this condition is significantly influenced by tumor necrosis factor alpha, T cells, and dendritic cells.[ 2 ].The global burden of psoriasis is a key WHO research mandate, affecting more than 60 million adults and children worldwide[ 3 ].In psoriasis, circulating pro-inflammatory mediators lead to a widespread inflammatory response, often accompanied by comorbidities such as cardiovascular disease(CVD) and metabolic syndrome [ 4 ]. Obesity, a serious condition worldwide, is generally defined as excess body fat that is detrimental to health. The Global Burden of Disease organization reports that global obesity affected a significant population with 107.7 million children and 603.7 million adults in 2015[ 5 ]. The most commonly reported subtypes of obesity include metabolically healthy obesity, metabolically abnormal obesity, normal weight obesity, and muscle-sparing obesity[ 6 ].Multiple cardiometabolic imaging studies indicate that normal weight or overweight individuals are often burdened with ectopic fat accumulation in normal lean tissues (liver, heart, skeletal muscle, and other areas). Evidence is mounting that weight gain and obesity were risk factors for the onset of psoriasis[ 8 ].The sequence of causation between psoriasis and obesity remains elusive. The notable factors contributing to this complex relationship may include pronounced social isolation, unhealthy dietary patterns, depressive tendencies, increased alcohol intake, and reduced physical activity among individuals with psoriasis[ 9 ]. Higher body mass index (BMI) is linked to an increased likelihood of psoriasis occurrence[ 10 – 12 ].Furthermore,objective measures of psoriasis severity demonstrate a positive dose-dependent relationship with obesity[ 13 , 14 ].There is an association between obesity and low efficacy of anti-psoriasis medications[ 15 ].Indeed,reduction of body mass through dietary modifications and physical activity contributes positively to the severity and incidence of psoriasis[ 16 ]. Park et al. introduced a novel ergometric method, the weight-adjusted waist index (WWI), as a means of overcoming the limitations of BMI or waist circumference (WC)[ 17 ]. High WWI values appear to correlate with adverse body composition outcomes, signifying high fat mass, low muscle mass, and low bone mass [ 18 ].With the potential to be a comprehensive and validated index of obesity, the WWI has merit in predicting the risk of certain diseases (e.g.cardiovascular-metabolic disease, diabetes mellitus, osteoarthritis, and erectile dysfunction)[ 19 – 22 ].And yet, there are no studies examining the effects of WWI on people with psoriasis. Thereby,this study’s intention was to examine the correlation between WWI and psoriasis among US adults through the 2009–2014 NHANES. Methods Survey population The National Center for Health Statistics (NCHS) undertakes a broad survey—the National Health and Nutrition Examination Survey (NHANES), which is updated every two years to assess the nutritional and healthy status of the U.S. ambulatory population. The study adopted a stratified multi-stage probability strategy and recruited a relatively large number of participants.The Ethics Review Board of NCHS endorsed the work and informed consent was signed by all participants. Baseline information for this research was gathered from the 2009–2014 NHANES data. 30,468 participants took part in this round of surveys, with a final total of 15,920 subjects enrolled in the study after excluding individuals with a history of psoriasis, missing statistical information on the WWI, and individuals younger than or equal to 19 years of age. The detailed participant inclusion process for the study is depicted in Fig. 1 . Evaluation of weight-adjusted-waist index The WWI serves as a metric for assessing obesity. Health technicians trained in body measurements measured waist circumference and weight at a mobile examination center. The following equation was used to identify the weight-adjusted waist index: \(\frac{waist circumference （cm）}{\sqrt{weigℎt（kg）}}\) In our analysis, we regarded WWI as a continuous variable and grouped participants according to WWI quartiles for subsequent investigation. WWI served as an exposure indicator in our research. Covariates of interest We conducted subgroup analyses employing stratified multivariate logistic regression models, categorizing factors including sex (male/female), age (tertile), race (Mexican American/other Hispanic/non-Hispanic white/non-Hispanic black/other race), educational attainment (less than high school/high school/high school or more/other), smoking (yes/no), alcohol consumption (yes/no), body mass index (< 25 kg/m 2 ,normal weight/25-29.9kg/m 2 ,overweight/≥30 kg/m 2 obese), and the following five categories of comorbidities (Yes/No): diabetes, congestive heart failure, coronary heart disease, stroke, and cancer.Furthermore, these stratification factors were considered as potential effect modifiers, and we incorporated an interaction term via likelihood ratio test to assess variations in associations among different subgroups. Absent values for continuous variables were entered as medians, and missing values for categorical variables were entered as patterns of existing cases. Detailed measurement protocols for these variables can be accessed on the website www.cdc.gov/nchs/nhanes/ . Statistical analysis NHANES, designed to yield data representative of the noninstitutionalized civilian population in the United States, guided our statistical analysis. We adhered to CDC guidelines, incorporating NHANES sampling weights and addressing the complexities of multistage cluster surveys. Weighted multiple linear regression analyses were used to explore the linear association between WWI and psoriasis incidence. Similarly, we utilized smoothed curve fitting to detect nonlinear effects of WWI on psoriasis Our study included three models: Model 1, without covariate adjustments; Model 2, adjusted for sex, race, and age; and Model 3, adjusted for all covariates. Subgroup analyses were also conducted. Significance was determined at p < 0.05. For statistical analysis, we utilized R ( http://www.r-project.org ) and EmpowerStats ( http://www.empowerstats.com ). Results Baseline characteristics This study consisted of 15,920 participants.Table 1 shows data on the clinical and demographic profile of the study population with or without psoriasis. The mean age of patients with psoriasis was (55.18 ± 16.43) years, 49.32% were male, and the mean WWI was (11.207 ± 0.843). On the other hand, the mean age of patients without psoriasis was (48.59 ± 17.51) years, 48.78% were males and the mean WWI was (11.029 ± 0.841). It can be seen that WWI differed significantly between the two groups (p < 0.05). Compared to the group without a history of psoriasis, the group with a history of psoriasis was significantly older, had a higher percentage of non-Hispanic whites and those with a high school education or higher, a higher percentage of comorbidities including stroke, coronary artery disease, diabetes mellitus, congestive heart failure, and cancer, a higher prevalence of cigarette smoking and alcohol abuse, and higher levels of BMI. However, there were no significant differences in WWI with and without psoriasis by gender, educational level, and presence of stroke (all p > 0.05). Table 1. Baseline Characteristics of Patients With and Without Psoriasis Variable History of Psoriasis (n = 438 [2.8%]) No History of Psoriasis (n = 15482 [97.2%]) P Value Age (years) 52.183 ± 16.426 48.586 ± 17.511 <0.001 Gender (%) 0.825 Men 49.315 48.779 Women 50.685 51.221 Race (%) <0.001 Mexican American 8.904 14.346 Other Hispanic 9.817 9.850 Non-Hispanic White 57.991 42.404 Non-Hispanic Black 11.187 21.360 Other Races 12.100 12.040 Education level(%) 0.492 Less than high school 21.461 24.338 High school or GED 22.831 22.058 Above high school 55.708 53.501 Others 0.000 0.103 Smoking(%) 57.991 43.815 <0.001 Alcohol use(%) 24.586 17.142 <0.001 BMI (kg/m2 ) 29.782 ± 6.789 28.904 ± 6.776 0.003 Comorbidities(%) Diabetes 16.895 11.685 <0.001 Congestive heart failure. 6.164 2.694 <0.001 Coronary artery disease 7.763 3.611 <0.001 Stroke 3.269 3.881 0.478 Cancer 15.753 9.005 <0.001 WWI 11.207 ± 0.843 11.029 ± 0.841 <0.001 Mean ± SD for continuous variables: the p-value was calculated by weighted linear regression model. % for categorical variables: the p-value was calculated by a weighted chi-square test. BMI, body mass index; WWI, weight-adjusted-waist index. Association between WWI and psoriasis. As depicted in Table 2, a favorable correlation between WWI and the risk of psoriasis was evident in this study. This connection remained consistent even in the unadjusted model 1. (OR=1.285; 95% CI, 1.148-1.439, p<0.05) and the fine-tuned model 2 (OR=1.226; 95% CI, 1.071-1.404, p0.05). In our sensitivity analysis, we converted WWI from a continuous variable to a categorical variable (quartiles). In Model 2, participants in the quartile with the highest WWI value (OR=1.551; 95% CI, 1.127-2.135, p<0.05) had a significantly increased risk of developing psoriasis by 55.1% compared to the WWI value in the smallest quartile. Likewise, individuals in the middle quartile exhibited a heightened risk of psoriasis, although this association did not reach statistical significance. Table 2. The association between WWI and psoriasis. Model 1 Model 2 Model 3 OR(95% CI) P value OR(95% CI) P value OR(95% CI) P value WWI 1.285 (1.148, 1.439) 0.00001 1.226 (1.071, 1.404) 0.00310 1.011 (0.840, 1.216) 0.91141 WWI quartiles Quartile 1 Reference Reference Reference Quartile 2 1.343 (1.003, 1.797) 0.04758 1.271 (0.942, 1.714) 0.11647 1.201 (0.860, 1.679) 0.28243 Quartile 3 1.343 (1.003, 1.797) 0.04758 1.239 (0.906, 1.694) 0.17992 1.028 (0.710, 1.487) 0.88519 Quartile 4 1.768 (1.340, 2.332) 0.00005 1.551 (1.127, 2.135) 0.00711 1.061 (0.701, 1.606) 0.77970 P for trend 0.00008 0.01046 0.98707 Model 1, no covariates were adjusted. Model 2, age, sex, and race were adjusted. Model 3, age, sex, race, education level, smoking status, drinking status, BMI, diabetes, congestive heart failure,coronary artery disease, stroke and cancer were adjusted. 95% CI, 95% confidence interval; OR, odds ratio;WWI, weight-adjusted-waist index. p < 0.05 was considered statistically significant. As shown in Table 3,further subgroup analyses and interaction tests showed that the association between WWI and psoriasis was not consistent in the overall population. In subgroup analyses stratified by sex, there was an independent and significant positive association between WWI and psoriasis in men (OR = 1.031; 95% CI, 1.002-1.061, p<0.05), but the association was not statistically significant in women in all models. In the age (tertile) subgroups, only the oldest group, WII, was positively associated with psoriasis. When subgroups were examined by BMI,a substantial positive association between WWI and psoriasis was detected in both the overweight group and obese group within the unadjusted model. WWI remained positively associated with psoriasis risk in smokers, non-drinkers, non-coronary heart disease and non-diabetic populations. Table3. Subgroup analysis for the association between WWI and psoriasis. WWI Model 1 Model 2 Model 3 OR (95% CI) P value OR (95% CI) P value OR (95% CI) P value gender Men 1.496 (1.262, 1.773) <0.0001 1.355 (1.098, 1.671) 0.0046 1.165 (0.866, 1.568) 0.3131 Women 1.162 (0.990, 1.363) 0.0655 1.136 (0.953, 1.355) 0.1546 0.925 (0.726, 1.180) 0.5308 Age Tertile 1 1.043 (0.821, 1.325) 0.7314 1.118 (0.860, 1.454) 0.4052 1.003 (0.680, 1.480) 0.9866 Tertile 2 1.139 (0.918, 1.413) 0.2384 1.114 (0.892, 1.392) 0.3401 1.148 (0.842, 1.566) 0.3820 Tertile 3 1.410 (1.149, 1.731) 0.0010 1.429 (1.151, 1.775) 0.0012 1.007 (0.757, 1.340) 0.9606 BMI =25, =30 1.243 (1.015, 1.523) 0.0353 1.118 (0.887, 1.408) 0.3441 0.934 (0.717, 1.217) 0.6137 Smoke YES 1.317 (1.132, 1.532) 0.0004 1.205 (1.009, 1.439) 0.0398 0.953 (0.752, 1.208) 0.6896 NO 1.212 (1.021, 1.438) 0.0276 1.196 (0.979, 1.461) 0.0802 1.082 (0.806, 1.453) 0.6004 Alcohol YES 1.361 (1.045, 1.773) 0.0224 1.139 (0.835, 1.554) 0.4104 0.924 (0.624, 1.368) 0.6921 NO 1.268 (1.098, 1.463) 0.0012 1.203 (1.015, 1.427) 0.0329 1.028 (0.834, 1.268) 0.7953 Coranary heart disease YES 1.002 (0.631, 1.590) 0.9943 0.965 (0.578, 1.611) 0.8922 0.917 (0.536, 1.569) 0.7521 NO 1.269 (1.129, 1.428) <0.0001 1.237 (1.075, 1.423) 0.0030 1.024 (0.846, 1.240) 0.8075 Diabetes YES 1.214 (0.882, 1.673) 0.2342 1.166 (0.811, 1.677) 0.4068 1.211 (0.762, 1.923) 0.4177 NO 1.248 (1.100, 1.416) 0.0006 1.202 (1.035, 1.396) 0.0157 0.979 (0.799, 1.199) 0.8343 Model 1: no covariates were adjusted. Model 2: age, gender, and race were adjusted. Model 3: age, sex, race, education level, smoking status, drinking status, BMI, diabetes, congestive heart failure,coronary artery disease, stroke and cancer were adjusted. In the subgroup analysis stratified by gender and age, the model is not adjusted for sex and age, respectively. 95% CI, 95% confidence interval; OR, odds ratio;WWI, weight-adjusted-waist index. p < 0.05 was considered statistically significant. Figure 2 shows the smoothed curve fit with adjustments based on the covariates (gender, age, and race). The results show a positive nonlinear relationship across the entire range of the WWI. Discussion This finding investigated the correlation between WWI and psoriasis in non-hospitalized Americans.In our cross-sectional analysis of 15920 participants, we found that individuals with higher WWI exhibited an elevated likelihood of psoriasis. Subgroup analyses showed that none of the stratification variables had a discernible impact on the consistency of the relationship between WWI and psoriasis, and the positive association persisted.As far as we know, this study is the first attempt to focus on the relationship between WWI and psoriasis. The modulation between psoriasis and obesity involves multiple factors and mechanisms. A study uncovered a noteworthy correlation between psoriasis and obesity in twins, hinting at a shared genetic underpinning for both conditions [ 23 ]. To illustrate certain variations in the Fat mass and obesity associated(FTO) gene, responsible for regulating body fat mass, have been linked to a heightened risk of obesity and an association with higher Psoriasis Area and Severity Index(PASI) scores in psoriasis patients[ 24 , 25 ].Since adipose tissue is a vital endocrine organ that releases soluble factors influencing inflammation and immunity, the expansion of adipose tissue and its release of proinflammatory agents can potentially exacerbate psoriasis[ 26 ].Ikeda et al. discovered a synergistic exacerbation of inflammation in psoriatic skin due to obesity and dyslipidemia[ 27 ]. Moreover, obesity has a notable impact on the composition and functionality of inflammatory cells within the skin.Obese patients with psoriasis often exhibit elevated levels of resistin and leptin[ 28 , 29 ].They also observed that metabolic disorders related to leptin, inflammatory factors and palmitic acid contribute to increased activation of epidermal keratin-forming cells[ 27 ]. Christ et al. showed in a study that Western diet induced myeloid progenitors to undergo sustained transcriptomic and epigenomic reprogramming, leading to proliferation and an innate immune response increases [ 30 ].The immunopathogenesis of psoriasis depends on the key role of the IL-17/IL-23 axis.Obese women appear to have higher blood levels of IL-17 and IL-23 compared to slim women[ 31 ].Emerging data suggest that IL-17 and subpopulations of IL-17-producing cells (e.g., Th17) are determinant in the induction and development of obesity [ 32 ].Nakamizo et al. detailed the buildup of γδ T cells that produce interleukin IL-17a in psoriatic lesions, a response triggered by the consumption of a high-fat diet, which led to worsening of psoriatic dermatitis [ 33 ]. An independent study revealed that a prolonged high-density lipoprotein (HDL) diet, continuing for more than nine months, triggered the aggregation of specific CD11c + macrophages in the skin. This aggregation was facilitated through a mechanism dependent on epidermal fatty acid-binding protein (E-FABP)[ 34 ]. Adipose tissue triggers the release of IL-6, an important mediator influencing the polarization of CD4 + T cells to Th17 cells [ 35 ].In addition, obesity affects the microbiome [ 36 , 37 ]. Recent studies have shown that the microbiome - i.e., all microorganisms living on the internal and external surfaces of the human body - has a strong influence on human autoimmune diseases [ 38 ]. Obesity has been commonly assessed in the past with indices such as BMI and WC, which have been shown to be associated with psoriasis. In a Norwegian prospective study of 369 patients with psoriasis, the relative risks of BMI, WC, and waist-to-hip ratio were 1.22(95%CI 1.11–1.34), 1.26 (95% CI 1.15–1.39), and 1.18 (95% CI 1.07–1.31) respectively, and the relative risk for those who gained 10 kilograms or more in weight compared with those who were weight stable was 1.72(95% CI 1.15–2.58)[ 39 ]. In multivariate analyses, each incremental unit increase in BMI was associated with a statistically significant 9% increase in the risk of developing psoriasis and a 7% increase in the risk of an increased PASI.[ 40 ]. Compared with people of normal weight, obesity leads to a two-fold increased risk of developing psoriasis.In an analysis of the Taiwan National Health Interview Survey and the National Health Insurance database, an adjusted HR of 1.34 (95% CI 1.05–1.71) and an adjusted HR of 2.70 (95% CI 1.95–3.72) were observed for participants with a BMI of 25.0–29.0 relative to those with a BMI of 18.5–22.9[ 41 ]. A notable correlation was observed among psoriasis patients between their BMI and WC before undergoing phototherapy, and their PASI scores.[ 42 ].The results of a 2013 study showed that weight loss through a low-energy diet (800 − 100 kcal/day) moderately reduces PASI and improves patients' quality of life[ 43 ].The WWI, the new obesity index, primarily reflects the actual situation of centrally located obesity as a result of weight adjustment.While the centrally obese group had a predominant accumulation of visceral fat, visceral fat is associated with adipocyte hypertrophy and the production of pro-inflammatory immune mediators, including adipokines (e.g. resistin and leptin) as well as cytokines (e.g. IL-6 and tumor necrosis factor-α)[ 44 ].The strengths of the WWI in assessing psoriasis are thus demonstrated. WWI proved to be correlated with various diseases. Initially reported, an observed non-linear positive correlation emerged between WWI levels and the risk of CVD and all-cause mortality [ 17 ]. It is worth noting that individuals with psoriasis face an elevated risk of CVD, a prevalent contributor to morbidity and mortality in psoriasis cases, and a recognized cardiovascular risk factor [ 45 , 46 , 47 ]. High serum IL-17A levels are linked to greater mortality from coronary heart disease[ 48 ]. Moreover, an intriguing finding indicated a non-linear positive relationship between WWI and hypertension [ 49 ].Significantly, the angiotensin-converting enzyme (ACE) gene, a pivotal component of the renin-angiotensin system, has been extensively associated with psoriasis[ 50 – 55 ]. Endothelin-1 might contribute to the onset of hypertension among individuals with psoriasis.[ 56 ]. Other evidence suggests that higher WWI is associated with a higher prevalence of stroke [ 57 ]. Individuals afflicted with psoriasis face an elevated susceptibility to cerebrovascular diseases(stroke), which is related to the severity of the psoriasis condition [ 58 – 61 ]. Atherosclerosis is the main pathologic change that precedes stroke. Notably, patients with psoriasis exhibit greater arterial stiffness than healthy controls [ 62 , 63 ].Both atherosclerosis and coronary artery disease are chronic inflammatory conditions characterized by the involvement of immune cells, including Th1 and Th17 cells, along with the infiltration of inflammatory factors at all stages of the diseases[ 64 ]. Meanwhile, research has indicated a positive correlation between WWI and the prevalence of non-alcoholic fatty liver disease (NAFLD) as well as liver fibrosis in adults in the U.S.[ 65 ]. A comprehensive systematic review and meta-analysis conducted in 2015 revealed that individuals with psoriasis face twice the risk of developing NAFLD compared to controls [ 66 ]. The inflammatory association between psoriasis and NAFLD is referred to as the "liver-skin axis" [ 67 ]. IL-17 induces hepatic stellate cell activation, which in turn produces collagen [ 68 ]. Thus, this action of IL-17 accelerates the transition from basic hepatic steatosis to steatohepatitis [ 67 , 68 ]. In summary ,it is reasonable to hypothesize that WWI may be positively associated with the incidence of psoriasis. This research possesses multiple notable strengths. First, the NHANES data contains a large sample that is representative of the U.S. population, making our results reliable. Secondly, we conducted rigorous adjustments for numerous potential confounding variables in our multivariate logistic regression analyses. Additionally, we carried out subgroup analyses to enhance the precision of the associations between risk factors and the prevalence of psoriasis. Nonetheless, it's equally crucial to acknowledge certain constraints of this study.Firstly, since this was a cross-sectional study, it was not possible to determine temporality and therefore causality. Next, the reliance on self-reported history of psoriasis may have reduced the accuracy of prevalence estimates. In addition, the sample in this analysis exclusively comprised participants from the United States, which did not consider variations in both prevalence and risk factors among different countries and ethnic groups. Therefore, it may not serve as an adequate representation of global demographics. Conclusion The study findings revealed a pronounced link between elevated WWI levels and an augmented risk of psoriasis in the U.S. adult population. Further studies are essential to validate the outcomes of this research. Abbreviations WWI Weight-adjusted waist index NHANES National health and nutrition examination survey WC Waist circumference BMI Body mass index NCHS National center for health statistics CVD Cardiovascular disease FTO Fat mass and obesity associated PASI Psoriasis Area and Severity Index HDL High-density lipoprotein E-FABP Epidermal fatty acid-binding protein ACE The angiotensin-converting enzyme NAFLD Non-alcoholic fatty liver disease Declarations Acknowledgments We would like to thank all participants in this study. Author Contributions. All named authors contributed to the final paper as follows: Xiya Zhao contributed to the concept and design, statistical analysis, and drafting of the manuscript. Dr.Junqin Li contributed to the statistical analysis and drafting of the manuscript. Dr. Xinhua LI contributed to the concept and design and resolution of any discrepancies in study eligibility criteria. Funding. This study and the publication of this paper are gratefully acknowledged with financial support from the Taiyuan Science and Technology Project Program (202213). Data availability statement Publicly available datasets were analyzed in this study. This data can be found here: www.cdc.gov/nchs/nhanes/. Consent for publication Not applicable. Competing interests All authors declare that they have no competing financial interests. Ethics statement This study was reviewed and approved by NCHS Ethics Review Board.The patients/participants provided their written informed consent to participate in this study.This study conformed with the Helsinki Declaration of 1964, as revised in 2013, concerning human rights. References Wu JJ, Kavanaugh A, Lebwohl MG, Gniadecki R, Merola JF.Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis. J Eur Acad Dermatol Venereol. 2022;36(6):797-806. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. 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Cao S, Hu X, Shao Y, Wang Y, Tang Y, Ren S, Li X.Relationship between weight-adjusted-waist index and erectile dysfunction in the United State: results from NHANES 2001-2004.Front Endocrinol(Lausanne).2023 ;14:1128076. Lønnberg AS, Skov L, Skytthe A, Kyvik KO, Pedersen OB, Thomsen SF.Association of Psoriasis With the Risk for Type 2 Diabetes Mellitus and Obesity. JAMA Dermatol. 2016;152(7):761-7. Purzycka-Bohdan D, Kisielnicka A, Bohdan M, Szczerkowska-Dobosz A, Sobalska-Kwapis M, Nedoszytko B, Nowicki RJ.Analysis of the Potential Genetic Links between Psoriasis and Cardiovascular Risk Factors. Int J Mol Sci. 2021;22(16):9063. Tupikowska-Marzec M, Kolačkov K, Zdrojowy-Wełna A, Słoka NK, Szepietowski JC, Maj J.The Influence of FTO Polymorphism rs9939609 on Obesity, Some Clinical Features, and Disturbance of Carbohydrate Metabolism in Patients with Psoriasis. Biomed Res Int. 2019;2019:7304345. Kunz M, Simon JC, Saalbach A. Psoriasis: Obesity and Fatty Acids. Front Immunol. 2019;10:1807. 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Zafiriou E, Daponte AI, Siokas V, Tsigalou C, Dardiotis E, Bogdanos DP.Depression and Obesity in Patients With Psoriasis and Psoriatic Arthritis: Is IL-17-Mediated Immune Dysregulation the Connecting Link? Front Immunol. 2021;12:699848. Nakamizo S, Honda T, Adachi A, Nagatake T, Kunisawa J, Kitoh A, Otsuka A, Dainichi T, Nomura T, Ginhoux F, et al. High fat diet exacerbates murine psoriatic dermatitis by increasing the number of IL-17-producing gammadelta T cells. Sci Rep. 2017;7:14076. Zhang Y, Li Q, Rao E, Sun Y, Grossmann ME, Morris RJ, Cleary MP, Li B.Epidermal fatty acid binding protein promotes skin inflammation induced by high-fat diet. Immunity. 2015;42:953–64. Ruddy MJ, Wong GC, Liu XK, Yamamoto H, Kasayama S, Kirkwood KL, Gaffen SL.Functional Cooperation Between Interleukin-17 and Tumor Necrosis Factor-Alpha Is Mediated by CCAAT/enhancer-binding Protein Family Members. J Biol Chem. 2004;279:2559–67. Kau AL, Ahern PP, Griffin NW, Goodman AL, Gordon JI. Human nutrition, the gut microbiome and the immune system. Nature. 2011;474:327–36. Ley RE, Bäckhed F, Turnbaugh P, Lozupone CA, Knight RD, Gordon JI. Obesity alters gut microbial ecology. Proc Natl Acad Sci USA. 2005;102:11070–5. Woo V, Alenghat T. Host-microbiota interactions: epigenomic regulation. Curr Opin Immunol. 2017;44:52–60. Snekvik I, Smith CH, Nilsen TIL, Langan SM, Modalsli EH, Romundstad PR, Saunes M.Obesity, Waist Circumference, Weight Change, and Risk of Incident Psoriasis: Prospective Data from the HUNT Study. J Invest Dermatol. 2017 ;137(12):2484-2490. Wolk K, Mallbris L, Larsson P, Rosenblad A, Vingård E, Ståhle M.Excessive body weight and smoking associates with a high risk of onset of plaque psoriasis. Acta Derm Venereol. 2009;89(5):492-7. Dai YX, Shen YJ, Chou YJ, Chang YT, Chen TJ, Li CP, Wu CY.Obesity, but Not Metabolic Diseases, Is Associated with Risk of Psoriasis: A Population-Based Cohort Study in Taiwan. Dermatology. 2020;236(6):521-528. Tobin AM, Hackett CB, Rogers S, Collins P, Richards HL, O'Shea D, Kirby B. Body mass index, waist circumference and HOMA-IR correlate with the Psoriasis Area and Severity Index in patients with psoriasis receiving phototherapy. Br J Dermatol. 2014;171(2):436-8. Jensen P, Zachariae C, Christensen R, Geiker NR, Schaadt BK, Stender S, Hansen PR, Astrup A, Skov L. Effect of weight loss on the severity of psoriasis: a randomized clinical study. JAMA Dermatol. 2013 ;149(7):795-801. Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008 ;93(11 Suppl 1):S57-63. Gelfand JM, Troxel AB, Lewis JD, Kurd SK, Shin DB, Wang X, Margolis DJ, Strom BL.The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol. 2007 ;143(12):1493-9. Ogdie A, Yu Y, Haynes K, Love TJ, Maliha S, Jiang Y, Troxel AB, Hennessy S, Kimmel SE, Margolis DJet al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis. 2015;74(2):326-32. Boehncke WH, Boehncke S, Tobin AM, Kirby B.The 'psoriatic march': a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol. 2011 ;20(4):303-7. Sun J, Yu H, Liu H, Pu D, Gao J, Jin X, Liu X, Yan A. Correlation of pre-operative circulating inflammatory cytokines with restenosis and rapid angiographic stenotic progression risk in coronary artery disease patients underwent percutaneous coronary intervention with drug-eluting stents. J Clin Lab Anal. 2020 ;34(3):e23108. Li Q, Qie R, Qin P, Zhang D, Guo C, Zhou Q, Tian G, Liu D, Chen X, Liu L,et al. Association of weight-adjusted-waist index with incident hypertension: The Rural Chinese Cohort Study. Nutr Metab Cardiovasc Dis. 2020 ;30(10):1732-1741. Ramezani M, Zavattaro E, Sadeghi M. Angiotensin-converting enzyme gene insertion/deletion polymorphism and susceptibility to psoriasis: a systematic review and meta-analysis. BMC Med Genet. 2020;21(1):8. Weger W, Hofer A, Wolf P, El-Shabrawi Y, Renner W, Kerl H, Salmhofer W.The angiotensin-converting enzyme insertion/deletion and the endothelin -134 3A/4A gene polymorphisms in patients with chronic plaque psoriasis. Exp Dermatol. 2007;16(12):993-8. Veletza S, Karpouzis A, Giassakis G, Caridha R, Papaioakim M.Assessment of insertion/deletion polymorphism of the angiotensin converting enzyme gene in psoriasis. J Dermatol Sci. 2008 ;49(1):85-7. Lamba G, Palaniswamy C, Singh T, Shah D, Lal S, Vinnakota R, Charrow EJ, Forman L.Psoriasis induced by losartan therapy: a case report and review of the literature. Am J Ther. 2011;18(3):e78-80. Silva IMS, Assersen KB, Willadsen NN, Jepsen J, Artuc M, Steckelings UM.The role of the renin-angiotensin system in skin physiology and pathophysiology. Exp Dermatol. 2020 ;29(9):891-901. Song GG, Bae SC, Kim JH, Lee YH. The angiotensin-converting enzyme insertion/deletion polymorphism and susceptibility to rheumatoid arthritis, vitiligo and psoriasis: A meta-analysis. J Renin Angiotensin Aldosterone Syst. 2015 Mar;16(1):195-202. Bonifati C, Mussi A, Carducci M, Pittarello A, D'Auria L, Venuti A, Bagnato A, Salani D, Fazio M, Ameglio F. Endothelin-1 levels are increased in sera and lesional skin extracts of psoriatic patients and correlate with disease severity. Acta Derm Venereol. 1998;78(1):22-6. Ye J, Hu Y, Chen X, Yin Z, Yuan X, Huang L, Li K. Association between the weight-adjusted waist index and stroke: a cross-sectional study. BMC Public Health. 2023;23(1):1689. Kaye JA, Li L, Jick SS. Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis. Br J Dermatol. 2008;895-902. Li WQ, Han JL, Manson JE, Rimm EB, Rexrode KM, Curhan GC, Qureshi AA. Psoriasis and risk of nonfatal cardiovascular disease in U.S. women: a cohort study. Br J Dermatol. 2012;166(4):811-8. Chiang CH, Huang CC, Chan WL, Huang PH, Chen YC, Chen TJ, Chung CM, Lin SJ, Chen JW, Leu HB. Psoriasis and increased risk of ischemic stroke in Taiwan: a nationwide study. J Dermatol. 2012;39(3):279-81. Siegel D, Devaraj S, Mitra A, Raychaudhuri SP, Raychaudhuri SK, Jialal I. Inflammation, atherosclerosis, and psoriasis. Clin Rev Allergy Immunol. 2013;44(2):194-204. Gisondi P, Fantin F, Del Giglio M, Valbusa F, Marino F, Zamboni M, Girolomoni G.Chronic plaque psoriasis is associated with increased arterial stiffness. Dermatology. 2009;218(2):110-3. Choi BG, Kim MJ, Yang HS, Lee YW, Choe YB, Ahn KJ. Assessment of Arterial Stiffness in Korean Patients With Psoriasis by Cardio-Ankle Vascular Index. Angiology. 2017;68(7):608-613. Garshick MS, Ward NL, Krueger JG, Berger JS. Cardiovascular Risk in Patients With Psoriasis: JACC Review Topic of the Week. J Am Coll Cardiol. 2021;77(13):1670-1680. Hu Q, Han K, Shen J, Sun W, Gao L, Gao Y. Association of weight-adjusted-waist index with non-alcoholic fatty liver disease and liver fibrosis: a cross-sectional study based on NHANES. Eur J Med Res. 2023;28(1):263. Candia R, Ruiz A, Torres-Robles R, Chávez-Tapia N, Méndez-Sánchez N, Arrese M. Risk of non-alcoholic fatty liver disease in patients with psoriasis: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015 ;29(4):656-62. Balak DMW, Piaserico S, Kasujee I. Non-Alcoholic Fatty Liver Disease (NAFLD) in Patients with Psoriasis: A Review of the Hepatic Effects of Systemic Therapies. Psoriasis (Auckl). 2021 ;11:151-168. Ruiz de Morales JMG, Puig L, Daudén E, Cañete JD, Pablos JL, Martín AO, Juanatey CG, Adán A, Montalbán X, Borruel N, et al. Critical role of interleukin (IL)-17 in inflammatory and immune disorders: An updated review of the evidence focusing in controversies. Autoimmun Rev. 2020 ;19(1):102429. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor invited by journal 21 Nov, 2023 Submission checks completed at journal 21 Nov, 2023 First submitted to journal 14 Nov, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3610828","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":257232482,"identity":"0c759fb8-f6b3-4924-b50d-dd292a255866","order_by":0,"name":"Xiya Zhao","email":"","orcid":"","institution":"Ninth Clinical College of Medicine, Shanxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiya","middleName":"","lastName":"Zhao","suffix":""},{"id":257232483,"identity":"9e9f17f3-11ac-429a-a67e-a100951977c2","order_by":1,"name":"Junqin Li","email":"","orcid":"","institution":"Department of Dermatology, Taiyuan Central Hospital, Shanxi Medical University,","correspondingAuthor":false,"prefix":"","firstName":"Junqin","middleName":"","lastName":"Li","suffix":""},{"id":257232484,"identity":"b6190fce-0b41-42aa-9e42-cd0aa2c93cfb","order_by":2,"name":"Xinhua Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYFAC5oYDDAYMCUDGARBJGPAwMMK0sCUQrwVEAxXzGBDnLHuJxMbDPAV38gyOn/n84eEOOwb+9m78lvFIJDYcnGHwrNjgTO42icQzyQwSZ85uIKjlwAeDw4kbDuRuY0hsY2YwkMglQksCSMv5N48/JLbVE6kFbMuNHAaJxLbDRGg58xDkl8OJM288MwNqOc5D0C/s7cmHP/P8OZzYdz758cefbdVy/O29+LUwCCSgWYtfOQjwHyCsZhSMglEwCkY4AAA+NFFmMWellAAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Dermatology, Taiyuan Central Hospital, Shanxi Medical University,","correspondingAuthor":true,"prefix":"","firstName":"Xinhua","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2023-11-14 14:44:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3610828/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3610828/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50510537,"identity":"272e186a-3a93-4248-b69b-24ea525dd18b","added_by":"auto","created_at":"2024-02-01 16:04:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":245173,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of participants selection. NHANES, National Health and Nutrition Examination Survey.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3610828/v1/8ff29f583651c5703a59e63c.png"},{"id":50510535,"identity":"652ebeca-877f-45b3-b2d3-2d43913a0427","added_by":"auto","created_at":"2024-02-01 16:04:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36190,"visible":true,"origin":"","legend":"\u003cp\u003eThe nonlinear associations between WWI and psoriasis. The solid red line represents the smooth curve fit between variables. Blue bands represent the 95% of confidence interval from the fit.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3610828/v1/248476d540ef6b207b593a6f.png"},{"id":50511074,"identity":"f4fe20d2-41d3-4169-85d4-57e37c9fc571","added_by":"auto","created_at":"2024-02-01 16:12:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":467115,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3610828/v1/af463d21-1a11-44c2-9717-4aba704f63dc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The association between weight-adjusted waist index and psoriasis in adults: results from NHANES 2009-2014","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePsoriasis, most notably affecting the skin and joints, is a systemic inflammatory disease characterized by adaptive and innate immune alterations[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The pathogenesis of this condition is significantly influenced by tumor necrosis factor alpha, T cells, and dendritic cells.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].The global burden of psoriasis is a key WHO research mandate, affecting more than 60\u0026nbsp;million adults and children worldwide[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].In psoriasis, circulating pro-inflammatory mediators lead to a widespread inflammatory response, often accompanied by comorbidities such as cardiovascular disease(CVD) and metabolic syndrome [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObesity, a serious condition worldwide, is generally defined as excess body fat that is detrimental to health. The Global Burden of Disease organization reports that global obesity affected a significant population with 107.7\u0026nbsp;million children and 603.7\u0026nbsp;million adults in 2015[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The most commonly reported subtypes of obesity include metabolically healthy obesity, metabolically abnormal obesity, normal weight obesity, and muscle-sparing obesity[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].Multiple cardiometabolic imaging studies indicate that normal weight or overweight individuals are often burdened with ectopic fat accumulation in normal lean tissues (liver, heart, skeletal muscle, and other areas).\u003c/p\u003e \u003cp\u003eEvidence is mounting that weight gain and obesity were risk factors for the onset of psoriasis[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].The sequence of causation between psoriasis and obesity remains elusive. The notable factors contributing to this complex relationship may include pronounced social isolation, unhealthy dietary patterns, depressive tendencies, increased alcohol intake, and reduced physical activity among individuals with psoriasis[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Higher body mass index (BMI) is linked to an increased likelihood of psoriasis occurrence[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].Furthermore,objective measures of psoriasis severity demonstrate a positive dose-dependent relationship with obesity[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].There is an association between obesity and low efficacy of anti-psoriasis medications[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Indeed,reduction of body mass through dietary modifications and physical activity contributes positively to the severity and incidence of psoriasis[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePark et al. introduced a novel ergometric method, the weight-adjusted waist index (WWI), as a means of overcoming the limitations of BMI or waist circumference (WC)[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. High WWI values appear to correlate with adverse body composition outcomes, signifying high fat mass, low muscle mass, and low bone mass [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].With the potential to be a comprehensive and validated index of obesity, the WWI has merit in predicting the risk of certain diseases (e.g.cardiovascular-metabolic disease, diabetes mellitus, osteoarthritis, and erectile dysfunction)[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].And yet, there are no studies examining the effects of WWI on people with psoriasis.\u003c/p\u003e \u003cp\u003eThereby,this study\u0026rsquo;s intention was to examine the correlation between WWI and psoriasis among US adults through the 2009\u0026ndash;2014 NHANES.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey population\u003c/h2\u003e \u003cp\u003eThe National Center for Health Statistics (NCHS) undertakes a broad survey\u0026mdash;the National Health and Nutrition Examination Survey (NHANES), which is updated every two years to assess the nutritional and healthy status of the U.S. ambulatory population. The study adopted a stratified multi-stage probability strategy and recruited a relatively large number of participants.The Ethics Review Board of NCHS endorsed the work and informed consent was signed by all participants. Baseline information for this research was gathered from the 2009\u0026ndash;2014 NHANES data. 30,468 participants took part in this round of surveys, with a final total of 15,920 subjects enrolled in the study after excluding individuals with a history of psoriasis, missing statistical information on the WWI, and individuals younger than or equal to 19 years of age. The detailed participant inclusion process for the study is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of weight-adjusted-waist index\u003c/h2\u003e \u003cp\u003eThe WWI serves as a metric for assessing obesity. Health technicians trained in body measurements measured waist circumference and weight at a mobile examination center.\u003c/p\u003e \u003cp\u003eThe following equation was used to identify the weight-adjusted waist index:\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\frac{waist circumference （cm）}{\\sqrt{weigℎt（kg）}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eIn our analysis, we regarded WWI as a continuous variable and grouped participants according to WWI quartiles for subsequent investigation. WWI served as an exposure indicator in our research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCovariates of interest\u003c/h2\u003e \u003cp\u003eWe conducted subgroup analyses employing stratified multivariate logistic regression models, categorizing factors including sex (male/female), age (tertile), race (Mexican American/other Hispanic/non-Hispanic white/non-Hispanic black/other race), educational attainment (less than high school/high school/high school or more/other), smoking (yes/no), alcohol consumption (yes/no), body mass index (\u0026lt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e,normal weight/25-29.9kg/m\u003csup\u003e2\u003c/sup\u003e,overweight/\u0026ge;30 kg/m\u003csup\u003e2\u003c/sup\u003eobese), and the following five categories of comorbidities (Yes/No): diabetes, congestive heart failure, coronary heart disease, stroke, and cancer.Furthermore, these stratification factors were considered as potential effect modifiers, and we incorporated an interaction term via likelihood ratio test to assess variations in associations among different subgroups. Absent values for continuous variables were entered as medians, and missing values for categorical variables were entered as patterns of existing cases. Detailed measurement protocols for these variables can be accessed on the website \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.cdc.gov/nchs/nhanes/\" target=\"_blank\"\u003ewww.cdc.gov/nchs/nhanes/\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.cdc.gov/nchs/nhanes/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eNHANES, designed to yield data representative of the noninstitutionalized civilian population in the United States, guided our statistical analysis. We adhered to CDC guidelines, incorporating NHANES sampling weights and addressing the complexities of multistage cluster surveys. Weighted multiple linear regression analyses were used to explore the linear association between WWI and psoriasis incidence. Similarly, we utilized smoothed curve fitting to detect nonlinear effects of WWI on psoriasis Our study included three models: Model 1, without covariate adjustments; Model 2, adjusted for sex, race, and age; and Model 3, adjusted for all covariates. Subgroup analyses were also conducted. Significance was determined at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. For statistical analysis, we utilized R (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.r-project.org\u003c/span\u003e\u003cspan address=\"http://www.r-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and EmpowerStats (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.empowerstats.com\u003c/span\u003e\u003cspan address=\"http://www.empowerstats.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study consisted of 15,920 participants.Table 1 shows data on the clinical and demographic profile of the study population with or without psoriasis. The mean age of patients with psoriasis was (55.18 \u0026plusmn; 16.43) years, 49.32% were male, and the mean WWI was (11.207 \u0026plusmn; 0.843). On the other hand, the mean age of patients without psoriasis was (48.59 \u0026plusmn; 17.51) years, 48.78% were males and the mean WWI was (11.029 \u0026plusmn; 0.841). It can be seen that WWI differed significantly between the two groups (p \u0026lt; 0.05). Compared to the group without a history of psoriasis, the group with a history of psoriasis was significantly older, had a higher percentage of non-Hispanic whites and those with a high school education or higher, a higher percentage of comorbidities including stroke, coronary artery disease, diabetes mellitus, congestive heart failure, and cancer, a higher prevalence of cigarette smoking and alcohol abuse, and higher levels of BMI. However, there were no significant differences in WWI with and without psoriasis by gender, educational level, and presence of stroke (all \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Baseline Characteristics of Patients With and Without Psoriasis\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\"\u003e\n \u003cp\u003eHistory of Psoriasis\u003c/p\u003e\n \u003cp\u003e(n = 438 [2.8%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\"\u003e\n \u003cp\u003eNo History of Psoriasis\u003c/p\u003e\n \u003cp\u003e(n = 15482 [97.2%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u0026nbsp;\u003c/em\u003eValue\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e52.183 \u0026plusmn; 16.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e48.586 \u0026plusmn; 17.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eGender (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e49.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e48.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e50.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e51.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eRace\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eMexican American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e8.904\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e14.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eOther Hispanic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e9.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e9.850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eNon-Hispanic White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e57.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e42.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eNon-Hispanic Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e11.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e21.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eOther Races\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e12.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e12.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eEducation level(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e21.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e24.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eHigh school or GED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e22.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e22.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eAbove high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e55.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e53.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eSmoking(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e57.991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e43.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol use(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e24.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e17.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m2 )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e29.782 \u0026plusmn; 6.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e28.904 \u0026plusmn; 6.776\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eComorbidities(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e16.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e11.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eCongestive heart failure.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e6.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e2.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eCoronary artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e7.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e3.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e3.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e3.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e0.478\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e15.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e9.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.113144758735444%\" valign=\"top\"\u003e\n \u003cp\u003eWWI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.45757071547421%\" valign=\"top\"\u003e\n \u003cp\u003e11.207 \u0026plusmn; 0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.45424292845258%\" valign=\"top\"\u003e\n \u003cp\u003e11.029 \u0026plusmn; 0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.97504159733777%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMean \u0026plusmn; SD for continuous variables: the p-value was calculated by weighted linear regression model. % for categorical variables: the p-value was calculated by a weighted chi-square test. BMI, body mass index; WWI, weight-adjusted-waist index.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between WWI and psoriasis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs depicted in Table 2, a favorable correlation between WWI and the risk of psoriasis was evident in this study. This connection remained consistent even in the unadjusted model 1. (OR=1.285; 95% CI, 1.148-1.439, p\u0026lt;0.05) and the fine-tuned model 2 (OR=1.226; 95% CI, 1.071-1.404, p\u0026lt;0.05). In the fully adjusted model (Model 3), which accounted for all confounders, the association between WII and psoriasis became nonsignificant (OR=1.011; 95% CI, 0.840-1.216, p\u0026gt;0.05). In our sensitivity analysis, we converted WWI from a continuous variable to a categorical variable (quartiles). In Model 2, participants in the quartile with the highest WWI value (OR=1.551; 95% CI, 1.127-2.135, p\u0026lt;0.05) had a significantly increased risk of developing psoriasis by 55.1% compared to the WWI value in the smallest quartile. Likewise, individuals in the middle quartile exhibited a heightened risk of psoriasis, although this association did not reach statistical significance.\u003c/p\u003e\n\u003cp\u003eTable 2. The association between WWI and psoriasis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"616\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.26488706365503%\" valign=\"top\"\u003e\n \u003cp\u003eOR(95% CI) P value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.26488706365503%\" valign=\"top\"\u003e\n \u003cp\u003eOR(95% CI) P value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.47022587268994%\" valign=\"top\"\u003e\n \u003cp\u003eOR(95% CI) P value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eWWI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.285 (1.148, 1.439) 0.00001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.226 (1.071, 1.404) 0.00310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003e1.011 (0.840, 1.216) 0.91141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eWWI quartiles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eQuartile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eQuartile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.343 (1.003, 1.797) 0.04758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.271 (0.942, 1.714) 0.11647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003e1.201 (0.860, 1.679) 0.28243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eQuartile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.343 (1.003, 1.797) 0.04758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.239 (0.906, 1.694) 0.17992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003e1.028 (0.710, 1.487) 0.88519\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eQuartile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.768 (1.340, 2.332) 0.00005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e1.551 (1.127, 2.135) 0.00711\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003e1.061 (0.701, 1.606) 0.77970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.8130081300813%\" valign=\"top\"\u003e\n \u003cp\u003eP for trend\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;0.00008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.341463414634145%\" valign=\"top\"\u003e\n \u003cp\u003e0.01046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.504065040650406%\" valign=\"top\"\u003e\n \u003cp\u003e0.98707\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModel 1, no covariates were adjusted. Model 2, age, sex, and race were adjusted. Model 3, age, sex, race, education level, smoking status, drinking status, BMI, diabetes, congestive heart failure,coronary artery disease, stroke and cancer were adjusted. 95% CI, 95% confidence interval; OR, odds ratio;WWI, weight-adjusted-waist index. p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eAs shown in Table 3,further subgroup analyses and interaction tests showed that the association between WWI and psoriasis was not consistent in the overall population. In subgroup analyses stratified by sex, there was an independent and significant positive association between WWI and psoriasis in men (OR = 1.031; 95% CI, 1.002-1.061, p\u0026lt;0.05), but the association was not statistically significant in women in all models. In the age (tertile) subgroups, only the oldest group, WII, was positively associated with psoriasis. When subgroups were examined by BMI,a substantial positive association between WWI and psoriasis was detected in both the overweight group and obese group within the unadjusted model. WWI remained positively associated with psoriasis risk in smokers, non-drinkers, non-coronary heart disease and non-diabetic populations.\u003c/p\u003e\n\u003cp\u003eTable3. Subgroup analysis for the association between WWI and psoriasis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"738\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eWWI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003eModel 1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.61344537815126%\" valign=\"top\"\u003e\n \u003cp\u003eOR\u0026nbsp;(95% CI) P value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.27731092436975%\" valign=\"top\"\u003e\n \u003cp\u003eOR\u0026nbsp;(95% CI) P value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.109243697478995%\" valign=\"top\"\u003e\n \u003cp\u003eOR\u0026nbsp;(95% CI) P value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003egender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.496 (1.262, 1.773) \u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.355 (1.098, 1.671) 0.0046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.165 (0.866, 1.568) 0.3131\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.162 (0.990, 1.363) 0.0655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.136 (0.953, 1.355) 0.1546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.925 (0.726, 1.180) 0.5308\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eTertile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.043 (0.821, 1.325) 0.7314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.118 (0.860, 1.454) 0.4052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.003 (0.680, 1.480) 0.9866\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eTertile 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.139 (0.918, 1.413) 0.2384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.114 (0.892, 1.392) 0.3401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.148 (0.842, 1.566) 0.3820\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eTertile 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.410 (1.149, 1.731) 0.0010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.429 (1.151, 1.775) 0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.007 (0.757, 1.340) 0.9606\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.213 (0.949, 1.551) 0.1225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.007 (0.722, 1.404) 0.9686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.993 (0.671, 1.469) 0.9702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;=25, \u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.264 (1.020, 1.566) 0.0323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.210 (0.915, 1.598) 0.1808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.268 (0.922, 1.744) 0.1447\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;=30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.243 (1.015, 1.523) 0.0353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.118 (0.887, 1.408) 0.3441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.934 (0.717, 1.217) 0.6137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eSmoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.317 (1.132, 1.532) 0.0004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.205 (1.009, 1.439) 0.0398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.953 (0.752, 1.208) 0.6896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.212 (1.021, 1.438) 0.0276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.196 (0.979, 1.461) 0.0802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.082 (0.806, 1.453) 0.6004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.361 (1.045, 1.773) 0.0224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.139 (0.835, 1.554) 0.4104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.924 (0.624, 1.368) 0.6921\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.268 (1.098, 1.463) 0.0012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.203 (1.015, 1.427) 0.0329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.028 (0.834, 1.268) 0.7953\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eCoranary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.002 (0.631, 1.590) 0.9943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e0.965 (0.578, 1.611) 0.8922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.917 (0.536, 1.569) 0.7521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.269 (1.129, 1.428) \u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.237 (1.075, 1.423) 0.0030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.024 (0.846, 1.240) 0.8075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.214 (0.882, 1.673) 0.2342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.166 (0.811, 1.677) 0.4068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e1.211 (0.762, 1.923) 0.4177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.37669376693767%\" valign=\"top\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.100271002710027%\" valign=\"top\"\u003e\n \u003cp\u003e1.248 (1.100, 1.416) 0.0006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.829268292682926%\" valign=\"top\"\u003e\n \u003cp\u003e1.202 (1.035, 1.396) 0.0157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.693766937669377%\" valign=\"top\"\u003e\n \u003cp\u003e0.979 (0.799, 1.199) 0.8343\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModel 1: no covariates were adjusted. Model 2: age, gender, and race were adjusted. Model 3:\u0026nbsp;age, sex, race, education level, smoking status, drinking status, BMI, diabetes, congestive heart failure,coronary artery disease, stroke and cancer were adjusted.\u003c/p\u003e\n\u003cp\u003eIn the subgroup analysis stratified by gender and age, the model is not adjusted for sex and age, respectively.\u003c/p\u003e\n\u003cp\u003e95% CI, 95% confidence interval; OR, odds ratio;WWI, weight-adjusted-waist index. p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eFigure 2 shows the smoothed curve fit with adjustments based on the covariates (gender, age, and race). The results show a positive nonlinear relationship across the entire range of the WWI.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis finding investigated the correlation between WWI and psoriasis in non-hospitalized Americans.In our cross-sectional analysis of 15920 participants, we found that individuals with higher WWI exhibited an elevated likelihood of psoriasis. Subgroup analyses showed that none of the stratification variables had a discernible impact on the consistency of the relationship between WWI and psoriasis, and the positive association persisted.As far as we know, this study is the first attempt to focus on the relationship between WWI and psoriasis.\u003c/p\u003e \u003cp\u003eThe modulation between psoriasis and obesity involves multiple factors and mechanisms. A study uncovered a noteworthy correlation between psoriasis and obesity in twins, hinting at a shared genetic underpinning for both conditions [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. To illustrate certain variations in the Fat mass and obesity associated(FTO) gene, responsible for regulating body fat mass, have been linked to a heightened risk of obesity and an association with higher Psoriasis Area and Severity Index(PASI) scores in psoriasis patients[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].Since adipose tissue is a vital endocrine organ that releases soluble factors influencing inflammation and immunity, the expansion of adipose tissue and its release of proinflammatory agents can potentially exacerbate psoriasis[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].Ikeda et al. discovered a synergistic exacerbation of inflammation in psoriatic skin due to obesity and dyslipidemia[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Moreover, obesity has a notable impact on the composition and functionality of inflammatory cells within the skin.Obese patients with psoriasis often exhibit elevated levels of resistin and leptin[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].They also observed that metabolic disorders related to leptin, inflammatory factors and palmitic acid contribute to increased activation of epidermal keratin-forming cells[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Christ et al. showed in a study that Western diet induced myeloid progenitors to undergo sustained transcriptomic and epigenomic reprogramming, leading to proliferation and an innate immune response increases [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].The immunopathogenesis of psoriasis depends on the key role of the IL-17/IL-23 axis.Obese women appear to have higher blood levels of IL-17 and IL-23 compared to slim women[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].Emerging data suggest that IL-17 and subpopulations of IL-17-producing cells (e.g., Th17) are determinant in the induction and development of obesity [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].Nakamizo et al. detailed the buildup of γδ T cells that produce interleukin IL-17a in psoriatic lesions, a response triggered by the consumption of a high-fat diet, which led to worsening of psoriatic dermatitis [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. An independent study revealed that a prolonged high-density lipoprotein (HDL) diet, continuing for more than nine months, triggered the aggregation of specific CD11c\u0026thinsp;+\u0026thinsp;macrophages in the skin. This aggregation was facilitated through a mechanism dependent on epidermal fatty acid-binding protein (E-FABP)[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Adipose tissue triggers the release of IL-6, an important mediator influencing the polarization of CD4\u0026thinsp;+\u0026thinsp;T cells to Th17 cells [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].In addition, obesity affects the microbiome [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Recent studies have shown that the microbiome - i.e., all microorganisms living on the internal and external surfaces of the human body - has a strong influence on human autoimmune diseases [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObesity has been commonly assessed in the past with indices such as BMI and WC, which have been shown to be associated with psoriasis. In a Norwegian prospective study of 369 patients with psoriasis, the relative risks of BMI, WC, and waist-to-hip ratio were 1.22(95%CI 1.11\u0026ndash;1.34), 1.26 (95% CI 1.15\u0026ndash;1.39), and 1.18 (95% CI 1.07\u0026ndash;1.31) respectively, and the relative risk for those who gained 10 kilograms or more in weight compared with those who were weight stable was 1.72(95% CI 1.15\u0026ndash;2.58)[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In multivariate analyses, each incremental unit increase in BMI was associated with a statistically significant 9% increase in the risk of developing psoriasis and a 7% increase in the risk of an increased PASI.[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Compared with people of normal weight, obesity leads to a two-fold increased risk of developing psoriasis.In an analysis of the Taiwan National Health Interview Survey and the National Health Insurance database, an adjusted HR of 1.34 (95% CI 1.05\u0026ndash;1.71) and an adjusted HR of 2.70 (95% CI 1.95\u0026ndash;3.72) were observed for participants with a BMI of 25.0\u0026ndash;29.0 relative to those with a BMI of 18.5\u0026ndash;22.9[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. A notable correlation was observed among psoriasis patients between their BMI and WC before undergoing phototherapy, and their PASI scores.[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].The results of a 2013 study showed that weight loss through a low-energy diet (800\u0026thinsp;\u0026minus;\u0026thinsp;100 kcal/day) moderately reduces PASI and improves patients' quality of life[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].The WWI, the new obesity index, primarily reflects the actual situation of centrally located obesity as a result of weight adjustment.While the centrally obese group had a predominant accumulation of visceral fat, visceral fat is associated with adipocyte hypertrophy and the production of pro-inflammatory immune mediators, including adipokines (e.g. resistin and leptin) as well as cytokines (e.g. IL-6 and tumor necrosis factor-α)[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].The strengths of the WWI in assessing psoriasis are thus demonstrated.\u003c/p\u003e \u003cp\u003eWWI proved to be correlated with various diseases. Initially reported, an observed non-linear positive correlation emerged between WWI levels and the risk of CVD and all-cause mortality [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It is worth noting that individuals with psoriasis face an elevated risk of CVD, a prevalent contributor to morbidity and mortality in psoriasis cases, and a recognized cardiovascular risk factor [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. High serum IL-17A levels are linked to greater mortality from coronary heart disease[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Moreover, an intriguing finding indicated a non-linear positive relationship between WWI and hypertension [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].Significantly, the angiotensin-converting enzyme (ACE) gene, a pivotal component of the renin-angiotensin system, has been extensively associated with psoriasis[\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Endothelin-1 might contribute to the onset of hypertension among individuals with psoriasis.[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Other evidence suggests that higher WWI is associated with a higher prevalence of stroke [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Individuals afflicted with psoriasis face an elevated susceptibility to cerebrovascular diseases(stroke), which is related to the severity of the psoriasis condition [\u003cspan additionalcitationids=\"CR59 CR60\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Atherosclerosis is the main pathologic change that precedes stroke. Notably, patients with psoriasis exhibit greater arterial stiffness than healthy controls [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e].Both atherosclerosis and coronary artery disease are chronic inflammatory conditions characterized by the involvement of immune cells, including Th1 and Th17 cells, along with the infiltration of inflammatory factors at all stages of the diseases[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Meanwhile, research has indicated a positive correlation between WWI and the prevalence of non-alcoholic fatty liver disease (NAFLD) as well as liver fibrosis in adults in the U.S.[\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. A comprehensive systematic review and meta-analysis conducted in 2015 revealed that individuals with psoriasis face twice the risk of developing NAFLD compared to controls [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The inflammatory association between psoriasis and NAFLD is referred to as the \"liver-skin axis\" [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. IL-17 induces hepatic stellate cell activation, which in turn produces collagen [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Thus, this action of IL-17 accelerates the transition from basic hepatic steatosis to steatohepatitis [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. In summary ,it is reasonable to hypothesize that WWI may be positively associated with the incidence of psoriasis.\u003c/p\u003e \u003cp\u003eThis research possesses multiple notable strengths. First, the NHANES data contains a large sample that is representative of the U.S. population, making our results reliable. Secondly, we conducted rigorous adjustments for numerous potential confounding variables in our multivariate logistic regression analyses. Additionally, we carried out subgroup analyses to enhance the precision of the associations between risk factors and the prevalence of psoriasis. Nonetheless, it's equally crucial to acknowledge certain constraints of this study.Firstly, since this was a cross-sectional study, it was not possible to determine temporality and therefore causality. Next, the reliance on self-reported history of psoriasis may have reduced the accuracy of prevalence estimates. In addition, the sample in this analysis exclusively comprised participants from the United States, which did not consider variations in both prevalence and risk factors among different countries and ethnic groups. Therefore, it may not serve as an adequate representation of global demographics.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study findings revealed a pronounced link between elevated WWI levels and an augmented risk of psoriasis in the U.S. adult population. Further studies are essential to validate the outcomes of this research.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWWI Weight-adjusted waist index\u003c/p\u003e\n\u003cp\u003eNHANES National health and nutrition examination survey\u003c/p\u003e\n\u003cp\u003eWC Waist circumference\u003c/p\u003e\n\u003cp\u003eBMI Body mass index\u003c/p\u003e\n\u003cp\u003eNCHS National center for health statistics\u003c/p\u003e\n\u003cp\u003eCVD Cardiovascular disease\u003c/p\u003e\n\u003cp\u003eFTO Fat mass and obesity associated\u003c/p\u003e\n\u003cp\u003ePASI Psoriasis Area and Severity Index\u003c/p\u003e\n\u003cp\u003eHDL High-density lipoprotein\u003c/p\u003e\n\u003cp\u003eE-FABP Epidermal fatty acid-binding protein \u003c/p\u003e\n\u003cp\u003eACE The angiotensin-converting enzyme \u003c/p\u003e\n\u003cp\u003eNAFLD Non-alcoholic fatty liver disease\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all participants in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll named authors contributed to the final paper as follows: Xiya Zhao contributed to the concept and design, statistical analysis, and drafting of the manuscript. Dr.Junqin Li contributed to the statistical analysis and drafting of the manuscript. Dr. Xinhua LI contributed to the concept and design and resolution of any discrepancies in study eligibility criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study and the publication of this paper are gratefully acknowledged with financial support from the Taiyuan Science and Technology Project Program (202213).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePublicly available datasets were analyzed in this study. This data can be found here: www.cdc.gov/nchs/nhanes/.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing financial interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by NCHS Ethics Review Board.The patients/participants provided their written informed consent to participate in this study.This study conformed with the Helsinki Declaration of 1964, as revised in 2013, concerning human rights.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu JJ, Kavanaugh A, Lebwohl MG, Gniadecki R, Merola JF.Psoriasis and metabolic syndrome: implications for the management and treatment of psoriasis. 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Autoimmun Rev. 2020 ;19(1):102429. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Psoriasis, Weight-adjusted waist index, Obesity, NHANES, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-3610828/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3610828/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEvidence has indicated that the correlation between obesity and psoriasis is likely multifactorial in nature.Previously, no reports have been made regarding the correlation between weight-adjusted waist index (WWI) and psoriasis.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional research, we examined a cohort of adult participants who provided comprehensive data related to WWI and psoriasis, gathered during the 2009\u0026ndash;2014 National Health and Nutrition Examination Survey (NHANES). The calculation for WWI involved dividing waist circumference (WC) by the square root of body weight. We explored the association between WWI and psoriasis through multivariate linear regression modeling and subgroup analyses. The smoothing curve fitting was also applied .\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 15,920 participants aged over 19 years, of whom 438 had a history of psoriasis.It revealed a notable positive correlation between WWI and psoriasis(OR\u0026thinsp;=\u0026thinsp;1.226; 95% CI, 1.071\u0026ndash;1.404, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).The quartile with the highest WWI value (OR\u0026thinsp;=\u0026thinsp;1.551; 95% CI, 1.127\u0026ndash;2.135, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) had a significantly increased risk of developing psoriasis by 55.1% compared with the quartile with the lowest WWI value. A positive nonlinear connection between WWI and psoriasis was observed in the smoothed curve fitting results.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAmong U.S. adults, levels of WWI are positively associated with increased odds of developing psoriasis.We propose that adopting obesity management strategies based on the WWI could be beneficial in lowering the risk of psoriasis.\u003c/p\u003e","manuscriptTitle":"The association between weight-adjusted waist index and psoriasis in adults: results from NHANES 2009-2014","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-01 16:04:50","doi":"10.21203/rs.3.rs-3610828/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvited","content":"","date":"2023-11-21T13:08:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-11-21T13:06:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2023-11-14T14:34:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83a1af76-d6d8-4317-907e-d2cf0d097fe6","owner":[],"postedDate":"February 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-02-01T16:04:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-01 16:04:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3610828","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3610828","identity":"rs-3610828","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}