Relevance. Metabolic syndrome is more common in patients with psoriasis than in people without psoriasis, with more than twice the odds. Their coexistence is associated with increased cardiovascular risk and requires comprehensive prevention. Objective. To summarise current evidence on pathogenetic mechanisms, risk stratification tools and preventive interventions in obesity-associated metabolic syndrome in psoriasis, and to present the differentiated prevention algorithm we have developed. Materials and Methods. A narrative review considered publications from 2015–2026 identified in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, eLibrary and Google Scholar. Sources included systematic and narrative reviews, meta-analyses, interventional and observational studies, Mendelian randomisation studies and clinical guidelines, together with the authors’ previously published research. Results. The association between psoriasis and metabolic disturbances is bidirectional; shared mechanisms include systemic inflammation, insulin resistance, adipokine imbalance and endothelial dysfunction. Mendelian randomisation studies support a causal effect of higher body mass index on psoriasis risk. In a meta-analysis of six randomised trials, weight reduction through diet or physical activity was associated with a mean PASI reduction of 2.59 points relative to controls. Based on the review and the authors’ research, an algorithm is proposed for patients with psoriasis and body mass index above 28 kg/m². A preliminary integral screening index defines three categories for the proposed intensity of preventive care; immunological and genetic assessments are considered research components. Conclusions. The proposed algorithm organises preventive measures and directions for further research into personalised care in psoriasis. Its ability to predict metabolic syndrome, clinical effectiveness and the value of additional assessments require prospective evaluation in an independent cohort.

Background and Objectives: Psoriasis is a chronic immune-mediated inflammatory disease frequently accompanied by obesity and cardiometabolic disturbances. This study evaluated metabolic, inflammatory, and genetic correlates of overweight/obesity in ethnic Kazakh patients with psoriasis and explored potential multilocus genetic interactions. Materials and Methods: This study included 150 patients with clinically confirmed psoriasis, comprising 75 patients with overweight/obesity and 75 non-overweight/obese individuals frequency-matched by age and sex; because group sizes were fixed by design rather than sampled in proportion to prevalence, the reported odds ratios reflect within-sample associations rather than population-level risk estimates. Clinical, anthropometric, biochemical, inflammatory, and genetic data were collected using standardized protocols. Multivariable logistic regression was used to assess clinical, metabolic, and inflammatory correlates of overweight/obesity. Associations between three candidate polymorphisms, rs1558902 in FTO, rs696574 in CALCRL, and rs10968110 in ZTV, were evaluated. Results: In the multivariable model adjusted for age and sex, higher triglyceride levels (adjusted OR 4.73, 95% CI 1.36–18.57), higher HbA1c (adjusted OR 1.71, 95% CI 1.09–2.91), and lower HDL-C levels (adjusted OR 0.36, 95% CI 0.18–0.66) were independently associated with overweight/obesity. In genetic analyses, rs10968110 in ZTV showed significant associations with overweight/obesity in genotype, additive trend, allelic, and dominant models, while the recessive model was not significant. The FTO rs1558902 variant was also significantly associated with overweight/obesity, with the strongest support observed under additive, allelic, and dominant assumptions. In contrast, rs696574 in CALCRL was not significantly associated with overweight/obesity. Exploratory MDR analysis identified rs10968110 as the most stable single-locus model, whereas higher-order models showed only limited additional discriminatory value and lower cross-validation consistency. Conclusions: Among ethnic Kazakh patients with psoriasis, overweight/obesity was associated with an adverse cardiometabolic profile characterized by elevated triglycerides, higher HbA1c, and reduced HDL-C. Candidate genetic findings suggest that ZTV rs10968110 and FTO rs1558902 may be associated with overweight/obesity susceptibility, although these results should be considered exploratory pending validation in larger independent cohorts. These findings support integrated cardiometabolic assessment in psoriasis care and further investigation of genetic susceptibility to obesity in this population.