JAMA Dermatology

<jats:sec id="ab-doi240016-4"><jats:title>Importance</jats:title><jats:p>The association of diet with atopic dermatitis (AD) remains poorly understood and could help explain heterogeneity in disease course.</jats:p></jats:sec><jats:sec id="ab-doi240016-5"><jats:title>Objective</jats:title><jats:p>To determine the extent to which a higher level of dietary sodium intake, estimated using urine sodium as a biomarker, is associated with AD in a large, population-based cohort.</jats:p></jats:sec><jats:sec id="ab-doi240016-6"><jats:title>Design, Setting, and Participants</jats:title><jats:p>This cross-sectional study of adult participants (aged 37-73 years) from the UK Biobank examined 24-hour urine sodium excretion, which was estimated using a single spot urine sample collected between March 31, 2006, and October 1, 2010, and calculations from the sex-specific International Cooperative Study on Salt, Other Factors, and Blood Pressure equation, incorporating body mass index; age; and urine concentrations of potassium, sodium, and creatinine. The data were analyzed between February 23, 2022, and March 20, 2024.</jats:p></jats:sec><jats:sec id="ab-doi240016-7"><jats:title>Exposure</jats:title><jats:p>The primary exposure was 24-hour urinary sodium excretion.</jats:p></jats:sec><jats:sec id="ab-doi240016-8"><jats:title>Main Outcome and Measure</jats:title><jats:p>The primary outcome was AD or active AD based on diagnostic and prescription codes from linked electronic medical records. Multivariable logistic regression models adjusted for age, sex, race and ethnicity, Townsend Deprivation Index, and education were used to measure the association.</jats:p></jats:sec><jats:sec id="ab-doi240016-9"><jats:title>Results</jats:title><jats:p>The analytic sample comprised 215 832 participants (mean [SD] age, 56.52 [8.06] years; 54.3% female). Mean (SD) estimated 24-hour urine sodium excretion was 3.01 (0.82) g per day, and 10 839 participants (5.0%) had a diagnosis of AD. Multivariable logistic regression revealed that a 1-g increase in estimated 24-hour urine sodium excretion was associated with increased odds of AD (adjusted odds ratio [AOR], 1.11; 95% CI, 1.07-1.14), increased odds of active AD (AOR, 1.16; 95% CI, 1.05-1.28), and increased odds of increasing severity of AD (AOR, 1.11; 95% CI, 1.07-1.15). In a validation cohort of 13 014 participants from the National Health and Nutrition Examination Survey, a 1 g per day higher dietary sodium intake estimated using dietary recall questionnaires was associated with a higher risk of current AD (AOR, 1.22; 95% CI, 1.01-1.47).</jats:p></jats:sec><jats:sec id="ab-doi240016-10"><jats:title>Conclusions and Relevance</jats:title><jats:p>These findings suggest that restriction of dietary sodium intake may be a cost-effective and low-risk intervention for AD.</jats:p></jats:sec>

The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017.

Br J Dermatol

The epidemiology of atopic dermatitis in older adults: a population-based study in the United Kingdom.

PLoS One

Atopic dermatitis across the life course.

Clinical onset of atopic eczema: results from 2 nationally representative British birth cohorts followed through midlife.

J Allergy Clin Immunol

Atopic eczema and major cardiovascular outcomes: a systematic review and meta-analysis of population-based studies.

Sodium in the skin: a summary of the physiology and a scoping review of disease associations.

Clin Exp Dermatol

Atopic dermatitis.

Lancet

The exposome in atopic dermatitis.

Allergy

Qualitative analysis of the impact of atopic dermatitis on caregivers.

Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) phase three.

Thorax

Sodium chloride is an ionic checkpoint for human TH2 cells and shapes the atopic skin microenvironment.

Sci Transl Med

UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.

PLoS Med

Comparison of sociodemographic and health-related characteristics of UK Biobank participants with those of the general population.

Am J Epidemiol

Percentage of ingested sodium excreted in 24-hour urine collections: a systematic review and meta-analysis.

J Clin Hypertens (Greenwich)

Estimated 24-hour urinary sodium excretion and incident cardiovascular disease and mortality among 398 628 individuals in UK Biobank.

Hypertension

Validity of predictive equations for 24-h urinary sodium excretion in adults aged 18-39 y.

Am J Clin Nutr

Estimating 24-hour urinary sodium excretion from casual urinary sodium concentrations in Western populations: the INTERSALT study.

Development and validation of an algorithm to accurately identify atopic eczema patients in primary care electronic health records from the UK.

J Invest Dermatol

Severe and predominantly active atopic eczema in adulthood and long term risk of cardiovascular disease: population based cohort study.

Association between atopic dermatitis, asthma, and serum lipids: a UK Biobank based observational study and Mendelian randomization analysis.

Front Med (Lausanne)

Assessment of a causal relationship between body mass index and atopic dermatitis.

Investigating causal relationships between body mass index and risk of atopic dermatitis: a Mendelian randomization analysis.

Sci Rep

National health and nutrition examination survey: plan and operations, 1999-2010.

Vital Health Stat 1

23Na magnetic resonance imaging-determined tissue sodium in healthy subjects and hypertensive patients.

Skin sodium measured with 23Na MRI at 7.0 T.

NMR Biomed

Novel mechanism for buffering dietary salt in humans: effects of salt loading on skin sodium, vascular endothelial growth factor C, and blood pressure.

Once-daily upadacitinib versus placebo in adolescents and adults with moderate-to-severe atopic dermatitis (Measure Up 1 and Measure Up 2): results from two replicate double-blind, randomised controlled phase 3 trials.

Abrocitinib versus placebo or dupilumab for atopic dermatitis.

N Engl J Med

Two phase 3 trials of dupilumab versus placebo in atopic dermatitis.

Salt reduction to prevent hypertension and cardiovascular disease: JACC state-of-the-art review.

J Am Coll Cardiol

Formulas to estimate dietary sodium intake from spot urine alter sodium-mortality relationship.

Na+ is shifted from the extracellular to the intracellular compartment and is not inactivated by glycosaminoglycans during high salt conditions in rats.

J Physiol

Tissue sodium excess is not hypertonic and reflects extracellular volume expansion.

Nat Commun

Association between atopic dermatitis and hypertension: a systematic review and meta-analysis.

Salt sensitivity of blood pressure: a scientific statement from the American Heart Association.

The role of body mass index in the association between dietary sodium intake and blood pressure: a mediation analysis with NHANES.

Nutr Metab Cardiovasc Dis

The association of diet with atopic dermatitis (AD) remains poorly understood and could help explain heterogeneity in disease course.
To determine the extent to which a higher level of dietary sodium intake, estimated using urine sodium as a biomarker, is associated with AD in a large, population-based cohort.
This cross-sectional study of adult participants (aged 37-73 years) from the UK Biobank examined 24-hour urine sodium excretion, which was estimated using a single spot urine sample collected between March 31, 2006, and October 1, 2010, and calculations from the sex-specific International Cooperative Study on Salt, Other Factors, and Blood Pressure equation, incorporating body mass index; age; and urine concentrations of potassium, sodium, and creatinine. The data were analyzed between February 23, 2022, and March 20, 2024.
The primary exposure was 24-hour urinary sodium excretion.
The primary outcome was AD or active AD based on diagnostic and prescription codes from linked electronic medical records. Multivariable logistic regression models adjusted for age, sex, race and ethnicity, Townsend Deprivation Index, and education were used to measure the association.
The analytic sample comprised 215 832 participants (mean [SD] age, 56.52 [8.06] years; 54.3% female). Mean (SD) estimated 24-hour urine sodium excretion was 3.01 (0.82) g per day, and 10 839 participants (5.0%) had a diagnosis of AD. Multivariable logistic regression revealed that a 1-g increase in estimated 24-hour urine sodium excretion was associated with increased odds of AD (adjusted odds ratio [AOR], 1.11; 95% CI, 1.07-1.14), increased odds of active AD (AOR, 1.16; 95% CI, 1.05-1.28), and increased odds of increasing severity of AD (AOR, 1.11; 95% CI, 1.07-1.15). In a validation cohort of 13 014 participants from the National Health and Nutrition Examination Survey, a 1 g per day higher dietary sodium intake estimated using dietary recall questionnaires was associated with a higher risk of current AD (AOR, 1.22; 95% CI, 1.01-1.47).
These findings suggest that restriction of dietary sodium intake may be a cost-effective and low-risk intervention for AD.

Sodium Intake and Atopic Dermatitis.

Sodium Intake and Atopic Dermatitis

Sodium Intake and Atopic Dermatitis

Clinical Summary

What was studied

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