Calorie restriction and/or weight loss may also influence symptom severity in psoriasis. In obese patients with moderate-to-severe plaque psoriasis, weight loss was shown to improve the therapeutic response to cyclosporine. In mice, four weeks of calorie restriction (by 33% of energy intake) led to a decrease of 45% in the epidermal cell proliferation rate. Likewise, symptoms of inflammatory diseases such as rheumatoid arthritis have been shown to be improved through fasting or low-energy diets. Associations have also been recognized between psoriasis and an increased incidence of metabolic syndrome (visceral obesity, diabetes or insulin resistance, hypertension, and dyslipidemia). Although the link between psoriasis and individual components of metabolic syndrome is not completely elucidated, visceral fat, which releases pro-inflammatory cytokines, appears to play a role in both metabolic syndrome and psoriasis.