The Metabolomic Profile of a Healthy Lifestyle Mediates Psoriasis Risk and Predicts Multiple Comorbidities

Psoriasis is increasingly recognized as a systemic metabolic condition with complex immunometabolic mechanisms. While a healthy lifestyle is associated with reduced psoriasis risk, it remains unclear whether and how metabolomic changes mediate this association. We leveraged metabolomic data on 327 NMR biomarkers from 275,326 UK Biobank participants to investigate how lifestyle and metabolism relate to psoriasis and its comorbidities. We constructed a healthy lifestyle score incorporating ten modifiable behaviors and identified a comprehensive metabolomic profile comprising 112 NMR features associated with healthy living. This metabolomic profile mediated 37.5% to 46.1% of the total effect of lifestyle on psoriasis risk. Notably, three biomarkers--GlycA, PUFA/MUFA ratio, and creatinine--were identified as key mediators with shared genetic architectures with psoriasis, particularly involving the MHC region, underscoring the pivotal role of T-cell activation and antigen-presentation in the immunometabolic axis of psoriasis and suggesting a novel "metabolic-renal" pathway contributing to disease progression. Furthermore, maintaining a healthy lifestyle and a favorable metabolomic profile helped prevent severe comorbidities in individuals with psoriasis, with GlycA emerging as a promising prognostic biomarker for future clinical application. These findings establish a mechanistic connection between lifestyle, metabolism, and psoriasis pathogenesis, highlighting metabolism-oriented lifestyle modification as a strategy for psoriasis and related comorbidity management.