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Several modifiable lifestyle factors were associated with moderate to severe atopic dermatitis in a cohort of patients from the Netherlands, including smoking, alcohol consumption and stress.

According to the results of a study published in Clinical and experimental dermatology.

AD, whose prevalence is estimated at 7.1% in adults in the general European population and at 9.3% in the Netherlands, has a considerable impact on health-related quality of life, especially among adults. patients with severe disease.

Several lifestyle factors have been considered potentially correlated with the severity of Alzheimer’s disease, such as smoking, obesity, and alcohol consumption, but the researchers noted that the existing literature on this topic is limited.

“Understanding how the association with modifiable lifestyle factors varies with AD severity can help monitor patients with moderate to severe AD in daily practice and develop treatment and prevention strategies,” wrote writes the authors of the study. “So far, no studies on the association between moderate to severe AD and lifestyle factors in adults have been conducted in the Netherlands.”

Seeking to further explore the association between moderate to severe AD and lifestyle factors, they conducted a cross-sectional study of adults from the Dutch general population who were enrolled in the Lifelines Cohort Study in 2020.

A total of 135,950 adults received a digital AD questionnaire, of which 56,896 subjects (mean age, 55.8 years; 39.7% male) were included in the analysis. Participants provided data on basic lifestyle factors, collected between 2006 and 2013, including smoking, alcohol consumption, stress, obesity, physical activity, diet and sleep duration.

“Based on lifetime self-reported and physician-diagnosed Alzheimer’s disease, subjects were categorized as Alzheimer’s disease and non-Alzheimer’s disease. Point prevalence was determined as the proportion of subjects with physician-diagnosed Alzheimer’s disease who had eczema within the past week,” the authors explained. “With respect to disease severity, subjects with current eczema completed the patient-centered measurement of eczema.”

In the study cohort, the lifetime prevalence of self-reported and physician-diagnosed AD was 9.1%, the point prevalence of AD was 3.3%, and the point prevalence of AD moderate to severe was 2.3%.

After adjusting for age and gender, moderate to severe AD was positively associated with a pack of cigarettes older than 15 years, alcohol consumption of more than 2 drinks/day, class I obesity (mass index body weight, 30-34.9 kg/m2), and shorter sleep duration less than or equal to 7 hours/day.

Additionally, dose-response associations with increased number of years spent smoking and chronic stress level have been identified in people with moderate to severe AD. No association with abdominal obesity, physical activity, diet quality and vegetarian/vegan diet was observed.

“Our results indicate that further screening and counseling for lifestyle factors, particularly smoking, alcohol consumption, stress, obesity and sleep disturbances, appear warranted in patients with Moderate to severe AD,” the study authors concluded.

“Further longitudinal studies are needed to better characterize the direction of these associations and develop prevention strategies.”


Zhang J, Loman L, Oldhoff JM, Schuttelaar MLA. Moderate to severe atopic dermatitis and lifestyle factors in the Dutch general population. Clin Exp Dermatol. Published online April 5, 2022. doi:10.1111/ced.15212