Eating disorder, dietary pattern, and nutritional behavior among patients with acne vulgaris: A case-control study

Acne vulgaris is a common inflammatory skin condition in adolescence and early adulthood. Although multiple factors contribute to acne, the role of diet remains debated. This study examined associations between acne and nutrition-related variables in young adults.

We conducted an unmatched case-control study among adults aged 18-25 years in Hebron. Cases were recruited by convenience sampling from dermatology clinics, and controls were recruited voluntarily from the community (universities/social media). Data included sociodemographics, medical history, self-reported BMI, screening for eating-disorder risk (SCOFF), adherence to a Mediterranean diet, and an acne-related food frequency questionnaire. Although 200 cases and 100 controls were initially targeted, the final analyzed sample comprised 199 cases and 101 controls (N = 300) due to missing responses in key dietary questionnaire items required for analysis.

Compared with controls, cases had a higher proportion of females (76.9% versus 59.4%) and more non-normal BMI (36.7% versus 19.8%). In adjusted analysis, acne was associated with female sex in this clinic versus community sampling frame (aOR 2.66, 95% CI 1.50-4.72), overweight BMI (aOR 2.72, 95% CI 1.29-5.75), and intake of other white cereal products ⩾21/week versus 0-1/week (aOR 3.39, 95% CI 1.02-11.25); salty snacks were not independently associated. Among cases, 68.8% had mild acne, 21.1% moderate, and 10.1% severe/very severe. In the severity model, age was associated with moderate/severe acne (aOR 1.23 per year, 95% CI 1.00-1.50), while diet variables were not significant.

In this unmatched case-control sample, acne was independently associated with overweight BMI and high intake of other white cereal products, while salty snack intake did not remain significant after adjustment. The observed association with female sex should be interpreted cautiously because different recruitment sources for cases and controls may introduce selection bias and reflect healthcare-seeking or participation differences rather than a population risk effect. Findings should be interpreted as associations that may be influenced by sampling and self-reporting biases. Prospective and interventional studies are needed to clarify whether dietary factors independently contribute to acne risk and severity.