Dietary Sugar and Atopic Dermatitis in a Longitudinal Birth Cohort

Importance: The association of diet with atopic dermatitis (AD) in children is understudied and may present an opportunity to optimize AD management in a cost-effective and low-risk manner. Objective: The aim of this study was to determine the extent to which dietary sugar is associated with AD period prevalence and severity in a longitudinal pediatric cohort. Design, setting, and participants: This was a longitudinal cohort study of children from the Avon Longitudinal Study of Parents and Children with food frequency questionnaire data to estimate dietary carbohydrate and sugar at 1, 3, 5, 7, 10, and 13 years. Exposure: The exposure was dietary sugar as a proportion of total caloric intake. Main outcome and measure: The primary outcome was AD based on a maternal- or self-reported questionnaire that asked about disease activity and severity over the past 12 months. Logistic regression models adjusted for sex, race, maternal delivery age, highest parental education level, social class assessed through parental occupation, body mass index, total caloric intake, and maternal history of AD. Results: The study population included 5372 unique participants, 50% of whom were female, and 20–30% of whom reported AD at any time point. No significant associations were found at ages 1, 3, 5, and 7 years. At age 13 years, logistic regression revealed that a 10% increase in dietary sugar as a proportion of total caloric intake was associated with a 22% (95% confidence interval = 7–40%) increase in odds of AD overall. There was a dose–response relationship with disease severity: there was a 19% (95% confidence interval = 0–42%) increase in the odds of mild AD and 32% (95% confidence interval = 5–86%) increase in the odds of moderate–severe AD. When examining subtypes of dietary sugar, the effect was limited to nonmilk extrinsic sugars. Conclusions and relevance: Given the known health benefits, reduction of nonmilk sugars could be studied as a cost-effective and low-risk intervention for AD in late childhood and early adolescence.