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. 2022 Mar 29;7:95–112. doi: 10.1016/j.jdin.2022.02.012

Table III.

Observational studies on the effect of both glycemic index/glycemic load and dairy on acne

Source; country Study design; no. of participants Participant characteristics Measures Outcome summary Strengths Limitations Quality of evidence
Ismail et al,34 2012; Malaysia Case-control study; 44 patients with acne, 44 controls 18-30 y olds from a dermatology clinic (with acne) and a university campus (control). Interview on the frequency of milk consumption and 3-d food diary. Dermatologist-evaluated acne severity (comprehensive acne severity scale). High glycemic load (175 ± 35 in patients with acne vs 122 ± 28 in controls), milk (OR 3.99 [1.39-11.43]), and ice cream (OR 4.47 [1.77-11.266]) consumption associated with acne. Appropriate sample size. Well-defined case selection and exposure classification. Unrepresentative control selection (university student). 6
Burris et al,35 2014; New York City Cross-sectional study; 248 18-25 y olds from “public locations” in New York. Questionnaire on dietary intake. Self-reported acne severity. Higher GI (51.8 ± 3 vs 48.9 ± 4.6) and daily milk servings (0.7 ± 0.7 vs 0.3 ± 0.5) associated with acne severity. None. Low sample size. Potential recruitment bias. Potential biases in exposure (limited) and outcome classification (self-report). 4
Wolkenstein et al,36 2015; France Cross-sectional study; 1375 patients with acne, 891 control patients 15-24 y olds from a national French database who self-reported acne status. Questionnaire on dietary habits and acne severity. Daily consumption of chocolate and sweets associated with acne (OR 2.38 [1.31-4.31]). Dairy and sugary drink consumption not associated. Appropriate sample size. Generalized exposure classification. Potential recruitment bias. Potential bias in outcome classification (self-report). 7
LaRosa et al,37 2016; United States Case-control study; 120 patients with moderate facial acne, 105 controls 14-19 y olds from dermatology and pediatric clinics. Structured telephone interviews assessing 24-h dietary recall. Dermatologist-evaluated facial acne (global acne assessment scale). Increased servings of low-fat/skim milk (0.61 vs 0.41) in moderate acne cases compared with those in acne-free controls. Glycemic load not associated. Appropriate case and control selection. Well-defined exposure and outcome classification. Low sample size. 6
Çerman et al,38 2016; Turkey Case-control study; 50 patients with acne, 36 controls Participants (mean age: 18.8 y) recruited from a dermatology outpatient clinic. Self-reported dietary intake over 1 wk. GL and GI calculated using a dietary analysis software. Dermatologist-assessed acne severity. GI (47.24 ± 6.6 for patients with acne and 44.52 ± 6.58 for controls) and GL increased in patients with acne. Milk consumption not associated. Well-defined exposure and outcome classification. Low sample size. Low effect size. Unrepresentative control selection (hospital volunteer). 5
Okoro et al,39 2016; Nigeria Cross-sectional study; 464 Secondary school students (mean age: 13.6 y) recruited from 4 sites. Interview on dietary habits and questionnaire on food frequency. Dermatologists evaluated the presence of acne. Daily milk consumption (72.6% cases vs 62.0% controls) and cake (77.8% cases vs 62.3% controls) associated with acne. Well-defined exposure and outcome classification. Low sample size. 8
Suppiah et al,40 2018; Malaysia Case-control study; 57 patients with acne, 57 control patients 14 y or older recruited from a single hospital clinic. Questionnaires on dietary habits. Dermatologist-assessed acne (comprehensive acne severity scale). Milk (OR 2.19 [1.04-4.65]) and chocolate (OR 2.4 [1.08-5.33]) consumption associated with acne. Appropriate sample size. Appropriate case and control selection. Well-defined outcome classification. Limited exposure classification (Y/N format). 5
Aalemi et al,41 2019; Afghanistan Case-control study; 279 patients with acne, 279 controls 10-24 y olds from a single dermatology clinic. Questionnaire on food consumption. Dermatologist-evaluated facial acne (global acne assessment scale). Whole milk (OR 2.36 [1.39-4.01]) and low-fat milk consumption (OR 1.95 [1.10-3.45]) associated with acne severity. Chocolate associated with acne. Appropriate sample size. Appropriate case and control selection. Well-defined outcome and exposure classification. None. 8
Karadağ et al,42 2019; Turkey Case-control study; 3826 patients with acne, 759 controls 12-31 y olds from 26 different clinics. Control subjects had no record of past or present acne. Questionnaire on eating frequency and habits. Dermatologist-evaluated acne severity (global acne assessment scale) Chocolate associated with acne (OR 1.48 [1.24-1.76]). Milk and cheese not associated (OR 1.13 [0.94-1.36]). Appropriate sample size. Multiple institutions. Appropriate case and control selection. Well-defined exposure and outcome classification. None. 9
Akpinar Kara and Ozdemir,43 2020; Turkey Case-control study; 53 patients with acne, 53 controls 13-44 y olds from dermatology, nutrition, and dietetics clinics at a single hospital. Interview on the frequency and quantity of food consumed over 3 d. Dermatologist-evaluated facial acne (global acne assessment scale). Cheese associated with acne (P < .05). No association found with other dairy products. Increased carbohydrates correlated with acne severity (correlation coefficient 0.36; P < .01). Appropriate case and control selection. Well-defined exposure and outcome classification. Low sample size. 7
Dreno et al,44 2020; France, Germany, Italy, Brazil, Canada, and Russia Cross-sectional study; 2826 participants with acne and 3853 control patients. 15-39 y olds recruited from the internet. Questionnaire on personal nutritional habits and the presence of clinically confirmed acne. Dairy (OR 1.21 [1.1-1.35]), whey protein (OR 3.94 [3.29-4.71]), and high-GI food consumption associated with acne. Appropriate sample size. Appropriate case and control selection. Potential recruitment bias. Limited exposure classification (Y/N). Potential bias in outcome classification (self-report). 6
Penso et al,45 2020; France Cross-sectional study; 24,452 Participants (mean age: 57 y); 75% women and 25% men) from the French NutriNet-Santé study. Questionnaire on food intake at baseline and every 6 mo. Self-reported acne presence and severity. Fatty and sugary products (aOR 1.54 [1.09-2.16]), sugary beverages (aOR 1.18; [1.01-1.38]), and milk products (aOR 1.12; [1.00-1.25]) associated with acne. Appropriate sample size. Longitudinal exposure classification. Potential recruitment bias. Potential biases in outcome classification (self-report). Significant demographic differences in comparison groups. 5
Anaba et al,46 2021; Nigeria Case-control study; 56 cases, 56 controls ≥25-y-old women recruited from an outpatient clinic. Questionnaire on dietary frequency and intake. Dermatologist-evaluated acne presence and severity (comprehensive acne severity scale). Milk consumption, cakes, sweets, and starchy foods not associated with acne presence, severity, or frequency. Appropriate case and control selection. Well-defined exposure and outcome classification. Low sample size. Generalizability. 4

aOR, Adjusted odds ratio; GI, glycemic index; GL, glycemic load; OR, odds ratio.