Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study | Acne | JAMA Dermatology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Degitz  K, Placzek  M, Borelli  C, Plewig  G.  Pathophysiology of acne.   J Dtsch Dermatol Ges. 2007;5(4):316-323. doi:10.1111/j.1610-0387.2007.06274.x PubMedGoogle Scholar
Gollnick  HP, Zouboulis  CC.  Not all acne is acne vulgaris.   Dtsch Arztebl Int. 2014;111(17):301-312.PubMedGoogle Scholar
Hay  RJ, Johns  NE, Williams  HC,  et al.  The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions.   J Invest Dermatol. 2014;134(6):1527-1534. doi:10.1038/jid.2013.446 PubMedGoogle Scholar
Rademaker  M, Garioch  JJ, Simpson  NB.  Acne in schoolchildren: no longer a concern for dermatologists.   BMJ. 1989;298(6682):1217-1219. doi:10.1136/bmj.298.6682.1217 PubMedGoogle Scholar
Kilkenny  M, Merlin  K, Plunkett  A, Marks  R.  The prevalence of common skin conditions in Australian school students: 3; acne vulgaris.   Br J Dermatol. 1998;139(5):840-845. doi:10.1046/j.1365-2133.1998.02510.x PubMedGoogle Scholar
Perkins  AC, Cheng  CE, Hillebrand  GG, Miyamoto  K, Kimball  AB.  Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women.   J Eur Acad Dermatol Venereol. 2011;25(9):1054-1060. doi:10.1111/j.1468-3083.2010.03919.x PubMedGoogle Scholar
Cunliffe  WJ, Gould  DJ.  Prevalence of facial acne vulgaris in late adolescence and in adults.   BMJ. 1979;1(6171):1109-1110. doi:10.1136/bmj.1.6171.1109 PubMedGoogle Scholar
Goulden  V, Stables  GI, Cunliffe  WJ.  Prevalence of facial acne in adults.   J Am Acad Dermatol. 1999;41(4):577-580.PubMedGoogle Scholar
Collier  CN, Harper  JC, Cafardi  JA,  et al.  The prevalence of acne in adults 20 years and older [published correction appears in J Am Acad Dermatol. 2008 May;58(5):874. Cafardi, Jennifer A [added]].   J Am Acad Dermatol. 2008;58(1):56-59. doi:10.1016/j.jaad.2007.06.045PubMedGoogle Scholar
Semedo  D, Ladeiro  F, Ruivo  M,  et al.  Adult acne: prevalence and portrayal in primary healthcare patients, in the Greater Porto Area, Portugal.   Acta Med Port. 2016;29(9):507-513. doi:10.20344/amp.6626 PubMedGoogle Scholar
Tan  JK.  Psychosocial impact of acne vulgaris: evaluating the evidence.   Skin Therapy Lett. 2004;9(7):1-3, 9.PubMedGoogle Scholar
Hull  PR, D’Arcy  C.  Acne, depression, and suicide.   Dermatol Clin. 2005;23(4):665-674. doi:10.1016/j.det.2005.05.008 PubMedGoogle Scholar
Mallon  E, Newton  JN, Klassen  A, Stewart-Brown  SL, Ryan  TJ, Finlay  AY.  The quality of life in acne: a comparison with general medical conditions using generic questionnaires.   Br J Dermatol. 1999;140(4):672-676. doi:10.1046/j.1365-2133.1999.02768.x PubMedGoogle Scholar
Di Landro  A, Cazzaniga  S, Parazzini  F,  et al; GISED Acne Study Group.  Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults.   J Am Acad Dermatol. 2012;67(6):1129-1135. doi:10.1016/j.jaad.2012.02.018 PubMedGoogle Scholar
Navarini  AA, Simpson  MA, Weale  M,  et al; Acne Genetic Study Group.  Genome-wide association study identifies three novel susceptibility loci for severe acne vulgaris.   Nat Commun. 2014;5:4020. doi:10.1038/ncomms5020 PubMedGoogle Scholar
Lefebvre  MA, Pham  DM, Boussouira  B, Bernard  D, Camus  C, Nguyen  QL.  Evaluation of the impact of urban pollution on the quality of skin: a multicentre study in Mexico.   Int J Cosmet Sci. 2015;37(3):329-338. doi:10.1111/ics.12203 PubMedGoogle Scholar
Wolkenstein  P, Misery  L, Amici  JM,  et al.  Smoking and dietary factors associated with moderate-to-severe acne in French adolescents and young adults: results of a survey using a representative sample.   Dermatology. 2015;230(1):34-39. doi:10.1159/000366195 PubMedGoogle Scholar
Krutmann  J, Moyal  D, Liu  W,  et al.  Pollution and acne: is there a link?   Clin Cosmet Investig Dermatol. 2017;10:199-204. doi:10.2147/CCID.S131323 PubMedGoogle Scholar
Stewart  TJ, Bazergy  C.  Hormonal and dietary factors in acne vulgaris versus controls.   Dermatoendocrinol. 2018;10(1):e1442160. doi:10.1080/19381980.2018.1442160 PubMedGoogle Scholar
Tan  JKL, Vasey  K, Fung  KY.  Beliefs and perceptions of patients with acne.   J Am Acad Dermatol. 2001;44(3):439-445. doi:10.1067/mjd.2001.111340 PubMedGoogle Scholar
El-Akawi  Z, Abdel-Latif Nemr  N, Abdul-Razzak  K, Al-Aboosi  M.  Factors believed by Jordanian acne patients to affect their acne condition.   East Mediterr Health J. 2006;12(6):840-846.PubMedGoogle Scholar
Smith  RN, Mann  NJ, Braue  A, Mäkeläinen  H, Varigos  GA.  A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial.   Am J Clin Nutr. 2007;86(1):107-115. doi:10.1093/ajcn/86.1.107 PubMedGoogle Scholar
Ismail  NH, Manaf  ZA, Azizan  NZ.  High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study.   BMC Dermatol. 2012;12:13. doi:10.1186/1471-5945-12-13 PubMedGoogle Scholar
Adebamowo  CA, Spiegelman  D, Danby  FW, Frazier  AL, Willett  WC, Holmes  MD.  High school dietary dairy intake and teenage acne.   J Am Acad Dermatol. 2005;52(2):207-214. doi:10.1016/j.jaad.2004.08.007 PubMedGoogle Scholar
Adebamowo  CA, Spiegelman  D, Berkey  CS,  et al.  Milk consumption and acne in adolescent girls.   Dermatol Online J. 2006;12(4):1.PubMedGoogle Scholar
Adebamowo  CA, Spiegelman  D, Berkey  CS,  et al.  Milk consumption and acne in teenaged boys.   J Am Acad Dermatol. 2008;58(5):787-793. doi:10.1016/j.jaad.2007.08.049 PubMedGoogle Scholar
Juhl  CR, Bergholdt  HKM, Miller  IM, Jemec  GBE, Kanters  JK, Ellervik  C.  Dairy intake and acne vulgaris: a systematic review and meta-analysis of 78,529 children, adolescents, and young adults.   Nutrients. 2018;10(8):E1049. doi:10.3390/nu10081049 PubMedGoogle Scholar
Juhl  CR, Bergholdt  HKM, Miller  IM, Jemec  GBE, Kanters  JK, Ellervik  C.  Lactase persistence, milk intake, and adult acne: a mendelian randomization study of 20,416 Danish adults.   Nutrients. 2018;10(8):1041. doi:10.3390/nu10081041 PubMedGoogle Scholar
Tasli  L, Turgut  S, Kacar  N,  et al.  Insulin-like growth factor-I gene polymorphism in acne vulgaris.   J Eur Acad Dermatol Venereol. 2013;27(2):254-257. doi:10.1111/j.1468-3083.2011.04299.x PubMedGoogle Scholar
Mirdamadi  Y, Thielitz  A, Wiede  A,  et al.  Insulin and insulin-like growth factor-1 can modulate the phosphoinositide-3-kinase/Akt/FoxO1 pathway in SZ95 sebocytes in vitro.   Mol Cell Endocrinol. 2015;415:32-44. doi:10.1016/j.mce.2015.08.001 PubMedGoogle Scholar
Çerman  AA, Aktaş  E, Altunay  İK, Arıcı  JE, Tulunay  A, Ozturk  FY.  Dietary glycemic factors, insulin resistance, and adiponectin levels in acne vulgaris.   J Am Acad Dermatol. 2016;75(1):155-162. doi:10.1016/j.jaad.2016.02.1220 PubMedGoogle Scholar
Rahaman  SMA, De  D, Handa  S,  et al.  Association of insulin-like growth factor (IGF)-1 gene polymorphisms with plasma levels of IGF-1 and acne severity.   J Am Acad Dermatol. 2016;75(4):768-773. doi:10.1016/j.jaad.2016.05.019 PubMedGoogle Scholar
Jung  JY, Kwon  HH, Hong  JS,  et al.  Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial.   Acta Derm Venereol. 2014;94(5):521-525. doi:10.2340/00015555-1802 PubMedGoogle Scholar
Burris  J, Rietkerk  W, Woolf  K.  Relationships of self-reported dietary factors and perceived acne severity in a cohort of New York young adults.   J Acad Nutr Diet. 2014;114(3):384-392. doi:10.1016/j.jand.2013.11.010 PubMedGoogle Scholar
Ulvestad  M, Bjertness  E, Dalgard  F, Halvorsen  JA.  Acne and dairy products in adolescence: results from a Norwegian longitudinal study.   J Eur Acad Dermatol Venereol. 2017;31(3):530-535. doi:10.1111/jdv.13835 PubMedGoogle Scholar
LaRosa  CL, Quach  KA, Koons  K,  et al.  Consumption of dairy in teenagers with and without acne.   J Am Acad Dermatol. 2016;75(2):318-322. doi:10.1016/j.jaad.2016.04.030 PubMedGoogle Scholar
Hercberg  S, Castetbon  K, Czernichow  S,  et al.  The Nutrinet-Santé Study: a web-based prospective study on the relationship between nutrition and health and determinants of dietary patterns and nutritional status.   BMC Public Health. 2010;10:242. doi:10.1186/1471-2458-10-242 PubMedGoogle Scholar
World Medical Association.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.   JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053 PubMedGoogle Scholar
von Elm  E, Altman  DG, Egger  M, Pocock  SJ, Gøtzsche  PC, Vandenbroucke  JP; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.   Lancet. 2007;370(9596):1453-1457. doi:10.1016/S0140-6736(07)61602-X PubMedGoogle Scholar
Touvier  M, Kesse-Guyot  E, Méjean  C,  et al.  Comparison between an interactive web-based self-administered 24 h dietary record and an interview by a dietitian for large-scale epidemiological studies.   Br J Nutr. 2011;105(7):1055-1064. doi:10.1017/S0007114510004617 PubMedGoogle Scholar
Lassale  C, Castetbon  K, Laporte  F,  et al.  Validation of a Web-based, self-administered, non-consecutive-day dietary record tool against urinary biomarkers.   Br J Nutr. 2015;113(6):953-962. doi:10.1017/S0007114515000057 PubMedGoogle Scholar
Lassale  C, Castetbon  K, Laporte  F,  et al.  Correlations between fruit, vegetables, fish, vitamins, and fatty acids estimated by web-based nonconsecutived dietary records and respective biomarkers of nutritional status.   J Acad Nutr Diet. 2016;116(3):427-438.e5. doi:10.1016/j.jand.2015.09.017 PubMedGoogle Scholar
Le Moullec  N, Deheeger  M, Preziosi  P,  et al.  Validation du manuel-photos utilisé pour l’enquête alimentaire de l’étude SU.VI.MAX. Validation of the photography manual of servings used in dietary collection in the SU.VI.MAX study.   Cah Nutr Diét. 1996;31:158-164.Google Scholar
Vergnaud  A-C, Touvier  M, Méjean  C,  et al.  Agreement between web-based and paper versions of a socio-demographic questionnaire in the NutriNet-Santé study.   Int J Public Health. 2011;56(4):407-417. doi:10.1007/s00038-011-0257-5 PubMedGoogle Scholar
Touvier  M, Méjean  C, Kesse-Guyot  E,  et al.  Comparison between web-based and paper versions of a self-administered anthropometric questionnaire.   Eur J Epidemiol. 2010;25(5):287-296. doi:10.1007/s10654-010-9433-9 PubMedGoogle Scholar
Lassale  C, Péneau  S, Touvier  M,  et al.  Validity of web-based self-reported weight and height: results of the Nutrinet-Santé study.   J Med Internet Res. 2013;15(8):e152. doi:10.2196/jmir.2575 PubMedGoogle Scholar
Craig  CL, Marshall  AL, Sjöström  M,  et al.  International physical activity questionnaire: 12-country reliability and validity.   Med Sci Sports Exerc. 2003;35(8):1381-1395. doi:10.1249/01.MSS.0000078924.61453.FB PubMedGoogle Scholar
Spencer  EH, Ferdowsian  HR, Barnard  ND.  Diet and acne: a review of the evidence.   Int J Dermatol. 2009;48(4):339-347. doi:10.1111/j.1365-4632.2009.04002.x PubMedGoogle Scholar
Cordain  L, Lindeberg  S, Hurtado  M, Hill  K, Eaton  SB, Brand-Miller  J.  Acne vulgaris: a disease of Western civilization.   Arch Dermatol. 2002;138(12):1584-1590. doi:10.1001/archderm.138.12.1584 PubMedGoogle Scholar
Millward  DJ, Layman  DK, Tomé  D, Schaafsma  G.  Protein quality assessment: impact of expanding understanding of protein and amino acid needs for optimal health.   Am J Clin Nutr. 2008;87(5):1576S-1581S. doi:10.1093/ajcn/87.5.1576S PubMedGoogle Scholar
Nicklin  P, Bergman  P, Zhang  B,  et al.  Bidirectional transport of amino acids regulates mTOR and autophagy.   Cell. 2009;136(3):521-534. doi:10.1016/j.cell.2008.11.044 PubMedGoogle Scholar
Zhenyukh  O, Civantos  E, Ruiz-Ortega  M,  et al.  High concentration of branched-chain amino acids promotes oxidative stress, inflammation and migration of human peripheral blood mononuclear cells via mTORC1 activation.   Free Radic Biol Med. 2017;104:165-177. doi:10.1016/j.freeradbiomed.2017.01.009 PubMedGoogle Scholar
Aizawa  H, Niimura  M.  Elevated serum insulin-like growth factor-1 (IGF-1) levels in women with postadolescent acne.   J Dermatol. 1995;22(4):249-252. doi:10.1111/j.1346-8138.1995.tb03381.x PubMedGoogle Scholar
Francis  GL, Upton  FM, Ballard  FJ, McNeil  KA, Wallace  JC.  Insulin-like growth factors 1 and 2 in bovine colostrum: sequences and biological activities compared with those of a potent truncated form.   Biochem J. 1988;251(1):95-103. doi:10.1042/bj2510095 PubMedGoogle Scholar
Melnik  B.  Milk consumption: aggravating factor of acne and promoter of chronic diseases of Western societies.   J Dtsch Dermatol Ges. 2009;7(4):364-370. doi:10.1111/j.1610-0387.2009.07019.x PubMedGoogle Scholar
Costa  A, Lage  D, Moisés  TA.  Acne and diet: truth or myth?   An Bras Dermatol. 2010;85(3):346-353. doi:10.1590/S0365-05962010000300008 PubMedGoogle Scholar
Melnik  BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. In: Clemens  RA, Hernell  O, Michaelsen  KF, eds.  Nestlé Nutrition Institute Workshop Series: Pediatric Program. Vol 67. Karger; 2011:131-145. doi:10.1159/000325580
Ben-Amitai  D, Laron  Z.  Effect of insulin-like growth factor-1 deficiency or administration on the occurrence of acne.   J Eur Acad Dermatol Venereol. 2011;25(8):950-954. doi:10.1111/j.1468-3083.2010.03896.x PubMedGoogle Scholar
Guevara-Aguirre  J, Balasubramanian  P, Guevara-Aguirre  M,  et al.  Growth hormone receptor deficiency is associated with a major reduction in pro-aging signaling, cancer, and diabetes in humans.   Sci Transl Med. 2011;3(70):70ra13. doi:10.1126/scitranslmed.3001845 PubMedGoogle Scholar
Berra  B, Rizzo  AM.  Glycemic index, glycemic load: new evidence for a link with acne.   J Am Coll Nutr. 2009;28(suppl):450S-454S. doi:10.1080/07315724.2009.10718111 PubMedGoogle Scholar
Aghasi  M, Golzarand  M, Shab-Bidar  S, Aminianfar  A, Omidian  M, Taheri  F.  Dairy intake and acne development: a meta-analysis of observational studies.   Clin Nutr. 2019;38(3):1067-1075. doi:10.1016/j.clnu.2018.04.015 PubMedGoogle Scholar
Fassier  P, Zelek  L, Lécuyer  L,  et al.  Modifications in dietary and alcohol intakes between before and after cancer diagnosis: results from the prospective population-based NutriNet-Santé cohort.   Int J Cancer. 2017;141(3):457-470. doi:10.1002/ijc.30704 PubMedGoogle Scholar
Andreeva  VA, Deschamps  V, Salanave  B,  et al.  Comparison of dietary intakes between a large online cohort study (Etude NutriNet-Santé) and a nationally representative cross-sectional study (Etude Nationale Nutrition Santé) in France: addressing the issue of generalizability in E-epidemiology.   Am J Epidemiol. 2016;184(9):660-669. doi:10.1093/aje/kww016 PubMedGoogle Scholar
Méjean  C, Si Hassen  W, Gojard  S,  et al.  Social disparities in food preparation behaviours: a DEDIPAC study.   Nutr J. 2017;16(1):62. doi:10.1186/s12937-017-0281-2 PubMedGoogle Scholar
Rosenfield  RL.  What every physician should know about polycystic ovary syndrome.   Dermatol Ther. 2008;21(5):354-361. doi:10.1111/j.1529-8019.2008.00217.x PubMedGoogle Scholar
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    2 Comments for this article
    Request for Comment on Potential Confounders
    Nicolette Gonzales, MD and MPH Candidate | George Washington University: Milken Institute of Public Health
    Confirmation of the association between diet and acne is sought out by many, and with conflicting studies, it becomes murky. Several confounding factors have been controlled for and it appears the participants go through somewhat extensive questionnaires, with the number of uncompensated steps required in participation in this study, what is the impact, if any, of self-selection bias on the study. Also, what, if any, controls have been put in place to mitigate the effect of self-selected participants?
    Mentioned within the study limitations portion of this study is the possibility for incorrect self-diagnosis of acne, would this same phenomenon possibly
    impact any of the 11-question medical history survey questions? It does not appear the administered surveys are available for viewing.
    Next, it seems age at menarche, pregnancy, and menopause are taken into account to assess any hormone-related factors. However, it is not mentioned if whether the participant utilizes an oral or topical hormone-based therapy such as contraceptives. If this was assessed, does use of exogenous hormones also prove to have little influence over acne? Some oral contraceptives, such as Yaz (drospirenone/ethinyl estradiol), have been FDA approved to treat acne. Spirinolactone, a common diretic, can also impact endogenous hormones (Al-Natour, 2017) If any of the female participants were taking such a therapy, was this taken into account as a confounder of acne?
    Along the same vein, and possibly noted within the medical history questionnaire, was there any consideration for any affect oral anti-inflammatories could have on acne, such as any tetracyclines like doxycycline or minocycline (Rosso, 2015). While not always prescribed for acne, it could reduce breakouts if prescribed for other reasons such as infection. Would prescriptions like this be required to be reported for the study?
    Also, would use of any past drugs be reported in the study such as isotretinoin which reportedly “cures” acne in around half of those who take it (Azoulay, Oraichi, Berard, 2007)? A participant who may report positive for past acne but negative for acne currently, could be adhering to a high glycemic diet and not experience breakouts to the degree of their peers due to past adherence to an isotretinoin treatment. There are also topical treatments for acne which did not appear to be reported or described. It is not clear whether participants are to adhere to similar cleansing habits and whether this would have an effect.
    Lastly, in regard to hygiene, was there any consideration for lifestyle differences such as differences in sleep hygiene, picking of lesions, or number of times the participant touches their face. Spreading of Propionibacterium acnes through poor hygiene could contribute to prolonged breakouts and may mask an effectiveness (or ineffectiveness) of the participants diet (Dreno, 2018).

    Al-Natour, S. H. (2017). Acne Vulgaris: Perceptions and Beliefs of Saudi Adolescent Males. Journal of Family & Community Medicine, 24(1), 34.
    Azoulay, L., Oraichi, D., & Bérard, A. (2007). Isotretinoin Therapy and the Incidence of Acne Relapse: A Nested Case–Control Study. British Journal of Dermatology, 157(6), 1240-1248.
    Del Rosso, J. Q. (2015). Oral Doxycycline in The Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-Scored Small Tablet Formulation. The Journal of Clinical and Aesthetic Dermatology, 8(5), 19.
    Dreno, B., Bagatin, E., Blume‐Peytavi, U., Rocha, M., & Gollnick, H. (2018). Female Type of Adult Acne: Physiological
    Dietary intake and risk of acne in adults
    Tomoyuki Kawada, MD | Nippon Medical School
    Penso et al. conducted a cross-sectional study to evaluate the association between dietary behaviors and acne in adults [1]. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of the consumption of fatty and sugary products, sugary beverages, and milk for current acne were 1.54 (1.09-2.16), 1.18 (1.01-1.38), 1.12 (1.00-1.25), respectively. In addition, adjusted OR (95% CI) of an energy-dense dietary pattern for current acne was 1.13 (1.05-1.18). I want to discuss the association with special reference to dairy products and health.

    Samuels et al. conducted a meta-analysis to verify the association of acne vulgaris with depression and anxiety [2].
    Although there are moderating influences by factors such as age, study setting, and geographic region, they found a weak but significant association between them. Regarding the risk of depression, Sun et al. evaluated the associations between different types of milk products and depressive symptoms [3]. Adjusted ORs (95% CIs) of the second and the third higher intakes of skim milk and the third higher intake of milk desserts against the lowest group for depressive symptoms were 0.46 (0.29-0.75), 0.48 (0.27-0.85), and 0.70 (0.55-0.88), respectively. In contrast, adjusted ORs (95% CIs) of the highest, the second higher and the third higher intakes of whole milk against the lowest group for depressive symptoms were 1.55 (1.11-2.16), 1.70 (1.15-2.50), and 1.61 (1.05-2.46), respectively. I think that the content of dairy products should be classified for the risk assessment of acne.

    On this point, Dai et al. conducted a meta-analysis to investigate the association between milk consumption and acne [4]. Although there was a positive association between milk consumption and acne risk, different types of milk products and the amount of consumption presented a different risk of acne.

    Finally, Juhl et al. conducted a meta-analysis to evaluate the association in individuals aged 7⁻30 years, and dairy products, such as milk, yogurt, and cheese, were significantly associated with an increased OR for acne, although there were heterogeneity and publication bias [5]. As aging is closely associated with acne [6], risk assessment of dietary intake for acne should be conducted by considering the potential factors that might affect the risk of acne presentation or severe acne.

    1. Penso L, Touvier M, Deschasaux M, Szabo de Edelenyi F, Hercberg S, Ezzedine K, Sbidian E. Association between adult acne and dietary behaviors: Findings from the NutriNet-Santé Prospective Cohort Study. JAMA Dermatol 2020;156(8):854-862.
    2. Samuels DV, Rosenthal R, Lin R, Chaudhari S, Natsuaki MN. Acne vulgaris and risk of depression and anxiety: A meta-analytic review. J Am Acad Dermatol 2020;83(2):532-541.
    3. Sun J, Wang W, Zhang D. Associations of different types of dairy intakes with depressive symptoms in adults. J Affect Disord 2020;274:326-333.
    4. Dai R, Hua W, Chen W, Xiong L, Li L. The effect of milk consumption on acne: a meta-analysis of observational studies. J Eur Acad Dermatol Venereol 2018;32(12):2244-2253.
    5. Juhl CR, Bergholdt HKM, Miller IM, Jemec GBE, Kanters JK, Ellervik C. Dairy Intake and acne vulgaris: A systematic review and meta-analysis of 78,529 children, adolescents, and young adults. Nutrients 2018;10(8):1049.6.
    6. Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep 2020;10(1):5754.
    Original Investigation
    June 10, 2020

    Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study

    Author Affiliations
    • 1Paris 13 University, Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Conservatoire National Des Arts et Métiers, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Centre, University of Paris, F-93022 Bobigny, France
    • 2Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris-Est University, Paris Est Créteil University, Département Infectieux/Immuno/Vaccin, F-94000 Créteil, France
    • 3Department of Dermatology, Mondor Hospital (Assistance Publique, Hôpitaux de Paris), Paris Est Créteil University, F-94000 Créteil, France
    • 4Clinical Investigation Center 1430, Institut National de la Santé et de la Recherche Médicale, F-94000 Créteil, France
    JAMA Dermatol. 2020;156(8):854-862. doi:10.1001/jamadermatol.2020.1602
    Key Points

    Question  Is dietary behavior associated with acne in adults?

    Findings  In this cross-sectional study of 24 452 participants in the French NutriNet-Santé study, the consumption of fatty and sugary products, sugary beverages, and milk was associated with current acne in adults. This association was noted after adjustment for sociodemographic variables and confounding factors, including daily energy intake, the number of dietary records completed, and depressive symptoms.

    Meaning  These findings suggest that a Western diet (ie, rich in animal products and fatty and sugary foods) is associated with the presence of acne in adults.


    Importance  Acne is a chronic, multifactorial inflammatory disease. The association between consumption of dairy products and fatty and sugary foods and occurrence and progression of acne remains unclear.

    Objective  To assess the association between dietary behavior and current acne in adults.

    Design, Setting, and Participants  A cross-sectional study was performed as part of the NutriNet-Santé study, which is an ongoing observational, web-based cohort study that was launched in France in May 2009. The present study was conducted from November 14, 2018, to July 8, 2019. A total of 24 452 participants completed an online self-questionnaire to categorize their acne status: never acne, past acne, or current acne. Associations between dietary behavior (food intake, nutrient intake, and the dietary pattern derived from a principal component analysis) and current or past acne were studied in multinomial logistic regression models adjusted for potential confounding variables (age, sex, physical activity, smoking status, educational level, daily energy intake, number of dietary records completed, and depressive symptoms).

    Results  The 24 452 participants (mean [SD] age, 57 [14] years; 18 327 women [75%]) completed at least 3 dietary records. Of these, 11 324 individuals (46%) reported past or current acne. After adjustment, there was a significant association between current acne and the consumption of fatty and sugary products (adjusted odds ratio [aOR], 1.54; 95% CI, 1.09-2.16), sugary beverages (aOR, 1.18; 95% CI, 1.01-1.38), and milk (aOR, 1.12; 95% CI, 1.00-1.25). An energy-dense dietary pattern (high consumption of fatty and sugary products) was associated with current acne (aOR, 1.13; 95% CI, 1.05-1.18).

    Conclusions and Relevance  In this study, consumption of milk, sugary beverages, and fatty and sugary products appeared to be associated with current acne in adults. Further large-scale studies are warranted to investigate more closely the associations between diet and adult acne.