Moderate-to-severe atopic dermatitis and lifestyle factors in the Dutch general population

Background: Studies on the association between atopic dermatitis (AD) severity and lifestyle factors among adults have not been conducted in the Netherlands yet.

Objectives: To explore the association between moderate-to-severe AD and lifestyle factors among adults in the Dutch general population.

Methods: We conducted this cross-sectional study within the Lifelines Cohort Study by sending a digital AD questionnaire to 135,950 adults in 2020. We extracted data on lifestyle factors from baseline, collected between 2006 and 2013. We analysed the association between AD, moderate-to-severe AD and lifestyle factors using binary logistic regression and linear regression models.

Results: We included 56,896 subjects (mean age 55.8 years, 39.7% males). The lifetime prevalence of self-reported physician-diagnosed AD was 9.1%. The point prevalence of AD was 3.3%, and the point prevalence of moderate-to-severe AD was 2.3%. We identified associations of moderate-to-severe AD with a smoking pack years of >15, an alcohol consumption of >2 drinks per day, chronic stress, class I obesity, and shorter and longer sleep duration. Moreover, we found dose-response associations with increased smoking pack years and level of chronic stress. We observed no associations with abdominal obesity, physical activity, diet quality, and a vegetarian/vegan diet.

Conclusions: We found associations between moderate-to-severe AD and some modifiable lifestyle factors. Our findings indicate that more screening and counselling for lifestyle factors particularly smoking, alcohol use, stress, obesity, and sleep disturbances, appears warranted in patients with moderate-to-severe AD. Further longitudinal studies are required to better characterize the direction of these associations, and develop strategies for prevention.