Aim: To investigate the effects of adherence to the Mediterranean diet and familial dysmetabolisms on acne development. Methods: A community-based case-control study was carried out in Italy enrolling cases as acneic outpatients of a dermatological ambulatory service and controls as clinically healthy acne-free subjects. Food consumption were evaluated with a validated food-frequency questionnaire, exploring the consumption of pasta, meat, cheese, fish, fruit, vegetables, and olive oil. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean diet scale that incorporated the main characteristics of this diet. A logistic regression analysis estimated the variables who predicted the odds of being case, using those variables that at the univariate analysis yielded a p-value = 6 revealed a protective effect towards acne (crude OR 0.22, 95% CI 0.08-0.64). Logistic regression analysis showed that familial hypercholesterolaemia, diabetes, and hypertension are strong risk factors for acne (AOR 8.79, 95% CI 1.67-46.22; 3.32, 95% CI 1.27-8.63; and 2.73, 95% CI 1.07-6.96, respectively), while the Mediterranean diet represents a protective factor (score >= 6, AOR 0.31, 95% CI 0.11-0.89). Conclusions: The odds for familial dysmetabolisms was higher in cases than in controls, confirming their role in determining or maintaining acne. Moreover, this is the first study demonstrating a protective role of the Mediterranean diet in the pathogenesis of acne
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