Diet and physical activity as risk-reducing factors for hidradenitis suppurativa

Background: Hidradenitis suppurativa (HS) is a multifactorial skin disease, with limited data on the impact of a healthy lifestyle on HS. 
Objective: To investigate the effect of dietary intake and physical activity (PA) on HS. 
Methods: Dietary data were obtained from 167,729 participants of the longitudinal Lifelines Cohort Study using a validated food frequency questionnaire, subsequently translated to the Lifelines Diet Score (LLDS), alternate Mediterranean Diet Score (aMED), and Dutch Dietary Guidelines score (DDG); higher scores reflect healthier lifestyles. Latent dietary clusters were identified through cluster analyses. PA was measured by the Short Questionnaire to Assess Health-enhancing PA score. Multivariable logistic regression analyses were performed between dietary scores/clusters and HS.
Results: HS patients (n=1,004) scored lower on the LLDS [OR=0.98; 95%CI 0.96 to 0.99], aMED [0.93; 0.89 to 0.97] and DDG [0.93; 0.88 to 0.97] versus controls (n=4,436), indicating less adhesion to dietary recommendations. However, no significant association was found for the identified “unhealthy diet” cluster and risk for HS [0.97; 0.86 to 1.46]. In contrast, all PA scores were significantly lower in HS (p≤0.001). 
Limitations: Using self-administered questionnaires and the risk of cohort- and cognition bias. 
Conclusions: A high diet quality and PA might be preventive in HS.