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Cited by 108Acne and Rosacea Treatments and EffectsDermatology and Skin DiseasesOvarian function and disorders

Diet and acne: A systematic review

Open access
Meixiong, James, Ricco, Cristina, Vasavda, Chirag, Ho, Byron K.·2022·JAAD International
DOI 10.1016/j.jdin.2022.02.012PMC PMC8971946
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Abstract

Background: Acne vulgaris is a common cutaneous disorder. Diet and metabolism, specifically glycemic content and dairy, influence hormones such as insulin, insulin-like growth factor 1, and androgens, which affect acnegenesis. Objective: To systematically review high-quality evidence regarding the association of dietary glycemic and dairy intake with acnegenesis. Methods: A comprehensive literature search, without timeline restriction, of MEDLINE (completed between October and November 2021) for English-language papers that examined the association between diet and acne was conducted. The evidence quality was assessed using the Ottawa quality assessment scale. Results: The literature search yielded 410 articles, of which 34 articles met the inclusion criteria. The literature on whether dairy product intake is associated with acnegenesis is mixed and may be dependent on sex, ethnicity, and cultural dietary habits. High glycemic index and increased daily glycemic load intake were positively associated with acnegenesis and acne severity, an observation supported by randomized controlled trials. Conclusion: High glycemic index, increased glycemic load, and carbohydrate intake have a modest yet significant proacnegenic effect. Increased dairy consumption may have been proacnegenic in select populations, such as those in which a Western diet is prevalent. The impact of diet on acnegenesis is likely dependent on sex and ethnicity. Further randomized trials are necessary to fully characterize the potential associations.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 34 studies found that high glycemic index/load and carbohydrate intake have a modest but significant proacnegenic effect, while dairy’s association with acne is mixed and may be limited to Western-diet populations. It concludes that further randomized trials, especially on dairy and ethnicity, are needed.

Key findings

  • The search yielded 410 articles, of which 34 met inclusion criteria: 28/34 (82.4%) were observational and 6/34 were interventional controlled trials; no interventional trials relating to dairy and acne were identified.
  • Among 18 observational studies on GI/glycemic load, sweets, and carbohydrate intake, 77% (14/18) reported at least 1 item positively associated with acnegenesis or acne severity; positive studies had an average LOE score of 6.5 vs 5.5 for negative studies. RCTs supported low-GI diets, including total lesion count −22.0 ± 3.5 vs −10.9 ± 2.9 (P = .02), inflammatory lesion count −16.2 ± 2.9 vs −5.6 ± 2.5 (P = .01), and a 10-week trial showing a 70.9% decrease from baseline.
  • Among dairy studies, 70% (16/23) linked at least 1 dairy food item with acnegenesis or acne severity; positive vs negative studies had similar average LOE scores (6.1 vs 6.4). Most negative studies were conducted outside the United States and Europe, leading the authors to conclude that increased dairy intake may exacerbate acne in Western-diet nations but is unlikely to do so among non-Western youths.
  • One negative RCT found no significant association between a low-glycemic-load diet and acne severity, with all intervention and control participants showing acne reduction at 12 weeks.

Methods

  • Systematic review conducted according to PRISMA 2020 guidelines, with a comprehensive MEDLINE search without timeline restriction, completed between October and November 2021, for English-language primary observational and interventional studies of participants with acne that assessed eating habits or dietary interventions and outcomes related to GI, glycemic load, and/or dairy.
  • Two reviewers independently screened titles, abstracts, and full text; data extraction covered study design, participant characteristics, methods/intervention, outcome, and level of evidence. Observational study quality was assessed with the Newcastle-Ottawa scale (maximum 9; 8 for cross-sectional studies), with discrepancies averaged and rounded up.
  • Studies were synthesized by dietary category, and a study was classified as “positive” if at least 1 relevant food item was significantly associated with acne.

Limitations

  • Stated: dietary records and self-reporting are subject to substantial biases; strict dietary adherence in trials is difficult; many studies lacked power analyses and were underpowered for modest effect sizes; RCTs enrolled mostly men while observational studies included mostly women; the review focused on broad dairy and glycemic categories rather than specific foods; chocolate was strictly categorized as “glycemic-related,” an imperfect classification; and classifying a study as positive if a single food item was associated may overestimate associations.
  • Stated: conclusions are limited mostly to teens and young adults; no dairy RCTs were identified, so dairy conclusions rely on observational studies with varied exposure assessment.
  • Evident from the text: included studies were heterogeneous in design, exposure measurement (eg, Y/N questionnaires vs food diaries), population, and geographic setting, limiting comparability; several studies had low sample sizes, recruitment/exposure/outcome biases, or generalizability concerns as noted in the tables.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jdin.2022.02.012

Cites

59 of 59 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

14 of 104 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured

  • Findingown data

    35.7% (10/28) of observational studies exclusively commented on the association between dairy and acne.

    “Overall, 35.7% (10/28) exclusively commented on the association between dairy and acne (Table II),24, 25, 26, 27, 28, 29, 30, 31, 32, 33”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [24] Adebamowo, 2005, High school dietary dairy intake and teenage acne, J Am Acad Dermatol source
    • cites [25] Adebamowo, 2006, Milk consumption and acne in adolescent girls, Dermatol Online J source
    • cites [26] Adebamowo, 2008, Milk consumption and acne in teenaged boys, J Am Acad Dermatol source
    • cites [27] Di Landro, 2012, Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults, J Am Acad Dermatol source
    • cites [28] Pontes, 2013, Incidence of acne vulgaris in young adult users of protein-calorie supplements in the city of Joao Pessoa-PB, An Bras Dermatol source

      The Introduction identifies whey protein as derived from milk, and the Discussion links protein-calorie supplement use with acne. But the study did not exclusively examine dairy: the Results include participants using other protein supplements. The 35.7% (10/28) figure describes the citing paper’s collection of studies, not a finding attributed to this individual study. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [29] Semedo, 2016, Adult acne: prevalence and portrayal in primary healthcare patients, in the Greater Porto Area, Portugal, Acta Med Port source

      The Results section reports an association between milk consumption and acne, so this paper can be cited as a study addressing that association. It did not address dairy exclusively: the Results also examine smoking, and the Conclusion discusses calorie intake, hirsutism, and seborrhoea. The paper does not establish the citing document’s count of 10 out of 28 studies. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [30] Duquia, 2017, Epidemiology of acne vulgaris in 18-year-old male army conscripts in a South Brazilian city, Dermatology source
    • cites [31] Ulvestad, 2017, Acne and dairy products in adolescence: results from a Norwegian longitudinal study, J Eur Acad Dermatol Venereol source
    • cites [32] Heng, 2022, Epidemiological risk factors associated with acne vulgaris presentation, severity, and scarring in a Singapore Chinese population: a cross-sectional study, Dermatology source
    • cites [33] Say, 2021, Modifiable and non-modifiable epidemiological risk factors for acne, acne severity and acne scarring among Malaysian Chinese: a cross-sectional study, BMC Public Health source

      The Methods and Discussion describe a cross-sectional study of familial history, lifestyle, multiple dietary habits, acne severity, and scarring—not a study exclusively about dairy and acne. The paper does examine milk consumption, but its stated scope contradicts its inclusion as a dairy-only study. The 10/28 tally appears to be the citing authors’ own count, not a result reported by this source. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Ingestion of whey or casein is associated with increased levels of IGF-1 and insulin.

    “and the ingestion of either whey or casein, protein dairy components, has been associated with increased levels of IGF-1 and insulin.14, 15, 16, 17”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [14] Dall'Oglio, 2021, Diet and acne: review of the evidence from 2009 to 2020, Int J Dermatol source
    • cites [15] Page, 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews, J Clin Epidemiol source

      The cited paper discusses PRISMA reporting guidance (Box 2, p. 6; Article in Press, p. 9), not the effects of dairy proteins. Searches of our copy for whey, casein, IGF-1, and insulin found no passage addressing the claimed association. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [16] Augustin, 2015, Glycemic index, glycemic load and glycemic response: an International Scientific Consensus Summit from the International Carbohydrate Quality Consortium (ICQC), Nutr Metab Cardiovasc Dis source

      The section “GI as affected by the presence of proteins/amino acids” (p. 16) reports that whey stimulated an insulin response. It does not report increased IGF-1 levels or establish the claimed increase in insulin for casein. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [17] Silva, 2015, A high-glycemic index, low-fiber breakfast affects the postprandial plasma glucose, insulin, and ghrelin responses of patients with type 2 diabetes in a randomized clinical trial, J Nutr source

      The Breakfast test composition section describes meals varied by glycemic index and fiber, and the Abstract reports differences in insulin responses between those meals. Searches for whey, casein, dairy protein, and IGF-1 found no passage linking ingestion of whey or casein to increased IGF-1 or insulin. Our copy therefore does not address the attributed claim. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
  • Premisecitation

    Frequent dairy consumers have higher serum levels of IGF-1 and insulin compared with nondairy consumers.

    “Similarly, frequent dairy consumers have higher serum levels of IGF-1 and insulin compared with nondairy consumers,12,13”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [12] Steiner, 1946, Necropsies on Okinawans; anatomic and pathologic observations, Arch Pathol (Chic)
    • cites [13] Conforti C, Agozzino M, Emendato G, et al. Acne and diet: a review. Preprint. Posted online August 22, 2021. Int J Dermatol. https://doi.org/10.1111/ijd.15862 source

      The “Milk and acne” section (page unavailable) says milk can increase serum IGF-1. It does not report higher serum insulin in dairy consumers or compare frequent dairy consumers with nondairy consumers. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Findingown data

    All interventional trials included examined the effect of GI/glycemic load on acne.

    “All the interventional trials included examined the effect of GI/glycemic load on acne (Table IV).47, 48, 49, 50, 51, 52”
    Quote in the paperNot a substantial claim3 of 6 sources checked
    • cites [47] Smith, 2007, A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial, Am J Clin Nutr source
    • cites [48] Smith, 2007, The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial, J Am Acad Dermatol source
    • cites [49] Smith, 2008, A pilot study to determine the short-term effects of a low glycemic load diet on hormonal markers of acne: a nonrandomized, parallel, controlled feeding trial, Mol Nutr Food Res source
    • cites [50] Reynolds, 2010, Effect of the glycemic index of carbohydrates on acne vulgaris, Nutrients source
    • cites [51] Kwon, 2012, Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: a randomized, controlled trial, Acta Derm Venereol source
    • cites [52] Pavithra, 2019, A randomized controlled trial of topical benzoyl peroxide 2.5% gel with a low glycemic load diet versus topical benzoyl peroxide 2.5% gel with a normal diet in acne (grades 1-3), Indian J Dermatol Venereol Leprol source
  • Premisecitation

    A low-GI diet (GI, 50) decreased acne severity and lesion count (mean decrease: 70.9% of baseline) in a 10-week trial on 32 patients with mild-to-moderate acne compared with a control diet (GI, 70).

    “Similarly, a low-GI diet (GI, 50) decreased acne severity and lesion count (mean decrease: 70.9% of baseline) in a 10-week trial conducted on 32 patients with mild-to-moderate acne compared with a control diet (GI, 70).51”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [51] Kwon, 2012, Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: a randomized, controlled trial, Acta Derm Venereol source

      Methods (p. 1) describe a 10-week trial of 32 patients with mild-to-moderate acne, and Dietary intake (p. 3) reports mean intervention glycaemic indices of about 50 and 70. Acne severity and lesion counts (p. 3) reports improved severity and fewer lesions in the low-glycaemic-load group. But 70.9% was the lesion count remaining relative to baseline, not the mean decrease; the implied decrease was 29.1%. (LLM, conf=0.94)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 14
  • May combine two claims. 45

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The review conducted a comprehensive literature search, without timeline restriction, of MEDLINE according to 2020 PRISMA guidelines.

    “We conducted a comprehensive literature search, without timeline restriction, of the MEDLINE database according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.15”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Page, 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews, J Clin Epidemiol source

  • May combine two claims.

    Premisecitation

    An 8-week trial of a low-GI diet (GI of 51) on 58 adolescent participants failed to demonstrate a significant improvement in facial acne severity compared with a control diet (GI, 61); however, there was a nonsignificant trend toward a greater benefit with the low-GI diet (acne severity score change: low GI −0.65 ± 0.14 vs high GI −0.35 ± 0.15; P = .15).

    “In contrast, an 8-week trial of a low-GI diet (GI of 51) conducted on 58 adolescent participants failed to demonstrate a significant improvement in facial acne severity compared with a control diet (GI, 61); however, there was a nonsignificant trend toward a greater benefit with the low-GI diet (acne severity score change: low GI mean ± SEM, n = 23, −0.65 ± 0.14 vs high GI mean ± SEM, n = 20, −0.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] Penso, 2020, Association between adult acne and dietary behaviors: findings from the NutriNet-Santé Prospective Cohort Study, JAMA Dermatol source

      Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Overall, 82.4% (28/34) of included studies were observational, and 6/34 were interventional controlled trials.

    “Overall, 82.4% (28/34) of the included studies were observational, with the remainder being interventional controlled trials (6/34).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the controlled trials, 5/6 were RCTs and one was nonrandomized.

    “Of the controlled trials, majority (5/6) were RCTs. One trial was nonrandomized.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among observational studies, 42.9% (12/28) were case-control, 14.3% (4/28) were longitudinal cohort, and 42.9% (12/28) were cross-sectional.

    “Among the observational studies, 42.9% (12/28) were case-control studies, 14.3% (4/28) were longitudinal cohort studies, and 42.9% (12/28) were cross-sectional studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In Wolkenstein et al 2015, daily consumption of chocolate and sweets was associated with acne (OR 2.38 [1.31-4.31]); dairy and sugary drink consumption were not associated.

    “Daily consumption of chocolate and sweets associated with acne (OR 2.38 [1.31-4.31]). Dairy and sugary drink consumption not associated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wolkenstein et al,36

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Ulvestad et al 2017, high intake of full-fat dairy was associated with acne (OR 1.56 [1.02-2.39]); total milk intake in girls only was associated with acne (OR 1.80 [1.02-3.16]).

    “High intake of full-fat dairy associated with acne (OR 1.56 [1.02-2.39]). Total milk intake in girls only associated with acne (OR 1.80 [1.02-3.16]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ulvestad et al,31

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Karadağ et al 2019, chocolate was associated with acne (OR 1.48 [1.24-1.76]); milk and cheese were not associated (OR 1.13 [0.94-1.36]).

    “Chocolate associated with acne (OR 1.48 [1.24-1.76]). Milk and cheese not associated (OR 1.13 [0.94-1.36]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Karadağ et al,42

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Koku Aksu et al 2011, frequent sugar intake (aOR 1.3 [1.06-1.82]) and frequent sweet consumption (aOR 1.2 [1.16-1.43]) were associated with acne.

    “Frequent sugar intake (aOR, 1.3 [1.06-1.82]) and frequent sweet consumption (aOR 1.2 [1.16-1.43]) associated with acne.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Koku Aksu et al,21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    High glycemic index and increased daily glycemic load intake are positively associated with acnegenesis and acne severity, supported by randomized controlled trials.

    “High glycemic index and increased daily glycemic load intake were positively associated with acnegenesis and acne severity, an observation supported by randomized controlled trials.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In Çerman et al 2016, GI (47.24 ± 6.6 for patients with acne and 44.52 ± 6.58 for controls) and GL were increased in patients with acne; milk consumption was not associated.

    “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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Çerman et al,38

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Say et al 2021, there was no association between frequency of milk consumption and acne severity; increased milk consumption was associated with a lower risk of scarring.

    “No association between the frequency of milk consumption and acne severity. Increased milk consumption associated with a lower risk of scarring.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Say et al,33

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Adebamowo et al 2008, skim milk was associated with acne (PR 1.19 [1.01-1.40]); total milk, whole milk, 2% milk, and low-fat milk were not associated.

    “Skim milk associated with acne (PR 1.19 [1.01-1.40]). Total milk, whole milk, 2% milk, and low-fat milk not associated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Adebamowo et al,26

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Okoro et al 2016, daily milk consumption (72.6% cases vs 62.0% controls) and cake (77.8% cases vs 62.3% controls) were associated with acne.

    “Daily milk consumption (72.6% cases vs 62.0% controls) and cake (77.8% cases vs 62.3% controls) associated with acne.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Okoro et al,39

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Suppiah et al 2018, milk (OR 2.19 [1.04-4.65]) and chocolate (OR 2.4 [1.08-5.33]) consumption were associated with acne.

    “Milk (OR 2.19 [1.04-4.65]) and chocolate (OR 2.4 [1.08-5.33]) consumption associated with acne.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Suppiah et al,40

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Burris et al 2014, higher GI (51.8 ± 3 vs 48.9 ± 4.6) and daily milk servings (0.7 ± 0.7 vs 0.3 ± 0.5) were associated with 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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Burris et al,35

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Ismail et al 2012, 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 were associated with acne.

    “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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ismail et al,34

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingnone given

    The literature on whether dairy product intake is associated with acnegenesis is mixed and may be dependent on sex, ethnicity, and cultural dietary habits.

    “The literature on whether dairy product intake is associated with acnegenesis is mixed and may be dependent on sex, ethnicity, and cultural dietary habits.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In LaRosa et al 2016, increased servings of low-fat/skim milk (0.61 vs 0.41) were found in moderate acne cases compared with acne-free controls; glycemic load was not associated.

    “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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites LaRosa et al,37

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Aalemi et al 2019, whole milk (OR 2.36 [1.39-4.01]) and low-fat milk consumption (OR 1.95 [1.10-3.45]) were associated with acne severity; chocolate was associated with acne.

    “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.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Aalemi et al,41

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Adebamowo et al 2005, total milk (PR 1.22 [1.03-1.44]), skim milk (PR 1.44 [1.21-1.72]), and cottage cheese (PR 1.63 [1.22-2.20]) consumption were associated with severe acne; whole milk and low-fat milk were not associated.

    “Total milk (PR 1.22 [1.03-1.44]), skim milk (PR 1.44 [1.21-1.72]), and cottage cheese (PR 1.63 [1.22-2.20]) consumption associated with severe acne. Whole milk and low-fat milk not associated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Adebamowo et al,24

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In Dreno et al 2020, dairy (OR 1.21 [1.1-1.35]), whey protein (OR 3.94 [3.29-4.71]), and high-GI food consumption were associated with 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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dreno et al,44

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Overall, 50% (2/4) of studies were conducted in nations with a predominant Western diet (the United States and Europe).

    “Overall, 50% (2/4) of studies were conducted in nations with a predominant Western diet (the United States and Europe).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Despite the majority of participants in the observational studies being women, the RCTs described enrolled mostly men.

    “In addition, despite the majority of the participants in the observational studies being women, the RCTs described enrolled mostly men.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among articles that examined association between dairy and acne, 70% (16/23) linked at least 1 dairy food item with acnegenesis or acne severity and had an average LOE score of 6.1.

    “Among articles that examined the association between dairy and acne, 70% (16/23) linked at least 1 dairy food item with acnegenesis or acne severity and had an average LOE score of 6.1 (Tables II and III).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Studies that linked glycemic content and acne had an average LOE score of 6.5; those that did not find an association had an average LOE score of 5.5.

    “Studies that linked glycemic content and acne had an average LOE score of 6.5 (Tables I and III). Articles that did not find an association had an average LOE score of 5.5 (Tables I and III).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    These studies had a higher assigned strength of evidence (6.5 vs 5.5), and their conclusions were backed by numerous RCTs that demonstrated either significant improvement in acne with the adoption of a low-GI diet or a trend toward significance.

    “These studies had a higher assigned strength of evidence (6.5 vs 5.5), and their conclusions were backed by numerous RCTs that demonstrated either significant improvement in acne with the adoption of a low-GI diet or a trend toward significance (Table I, Table II, Table III, Table IV).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In Penso et al 2020, 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]) were associated with acne.

    “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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Penso et al,45

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among observational studies, 67.9% (19/28) reported participant age for cases and controls as a continuous variable.

    “Among the observational studies, 67.9% (19/28) reported the participant age for the cases and controls as a continuous variable.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In Akpinar Kara and Ozdemir 2020, cheese was associated with acne (P < .05); no association was found with other dairy products; increased carbohydrates correlated with acne severity (correlation coefficient 0.36; P < .01).

    “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).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Akpinar Kara and Ozdemir,43

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data

    Articles that assessed association between dairy and acne included 26,782 cases (36.1% men, 63.9% women, 63.2% from US/Europe) and 25,262 controls (34.3% men, 65.7% women, 83.2% from US/Europe).

    “Articles that assessed the association between dairy and acne included 26,782 cases (36.1% men and 63.9% women, 63.2% from the United States and Europe) and 25,262 controls (34.3% men and 65.7% women, 83.2% from the United States and Europe) (Tables II and III).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In Anaba et al 2021, milk consumption, cakes, sweets, and starchy foods were not associated with acne presence, severity, or frequency.

    “Milk consumption, cakes, sweets, and starchy foods not associated with acne presence, severity, or frequency.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Anaba et al,46

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among the interventional studies, 4 trials were conducted in Australia, one in India, and one in Korea.

    “Among the interventional studies, 4 trials were conducted in Australia. One was conducted in India and the other in Korea.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In Smith et al 2007, a 12-week low-glycemic-load diet decreased total lesion count (−22.0 ± 3.5 for LGL vs −10.9 ± 2.9 for control, P = .02) and inflammatory lesion count (−16.2 ± 2.9 for LGL vs −5.6 ± 2.5 for control, P = .01).

    “LGL diet decreased total lesion count (−22.0 ± 3.5 for LGL vs −10.9 ± 2.9 for control, P = .02) and inflammatory lesion count (−16.2 ± 2.9 for LGL vs −5.6 ± 2.5 for control, P = .01).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Smith et al,47

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In the observational studies, 46.4% (13/28) were conducted in Western countries (the United States, Europe, and Australia), with the remainder in East Asia (17.9%, 5/28), Western Asia (21.4%, 6/28), South America (7.1%, 2/28), and Africa (7.1%, 2/28).

    “In the observational studies, 46.4% (13/28) were conducted in Western countries (the United States, Europe, and Australia), with the remainder being conducted in East Asia (17.9%, 5/28), Western Asia (21.4%,6/28), South America (7.1%, 2/28), and Africa (7.1%, 2/28).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    A majority of the negative studies, including 1 notable study that reported that increased milk consumption decreased the risk of acne scarring, were conducted in countries outside the United States and Europe.

    “Importantly, a majority of the negative studies, including 1 notable study that reported that increased milk consumption decreased the risk of acne scarring,53,54 were conducted in countries outside the United States and Europe.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [53] Danby, 2009, Acne, dairy and cancer: the 5alpha-P link, Dermatoendocrinology source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites [54] Ma, 2001, Milk intake, circulating levels of insulin-like growth factor-I, and risk of colorectal cancer in men, J Natl Cancer Inst source

  • Classified as probably not a substantial claim.

    Findingown data

    Based on search criteria, 6 trials relating GI to acne were identified.

    “Based on our search criteria, 6 trials relating GI to acne were identified.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Observational studies examining GI/glycemic load and acne reported data from 22,671 cases (30.6% men, 69.4% women, 69.6% from US/Europe) and 27,951 controls (39.7% men, 60.3% women, 65.2% from US/Europe).

    “The observational studies examining GI/glycemic load and acne reported data from 22,671 cases (30.6% men and 69.4% women, 69.6% from the United States and Europe) and 27,951 controls (39.7% men and 60.3% women, 65.2% from the United States and Europe) (Tables I and III).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Studies from 18 countries were included in the data extracted.

    “Studies from 18 countries were included in the data extracted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Exogenous ingestion of androgens or growth hormone often causes acne.

    “The exogenous ingestion of either androgens or growth hormone often causes acne.4,5”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Smit, 2018, Outpatient clinic for users of anabolic androgenic steroids: an overview, Neth J Med
    • cites [5] Ben-Amitai, 2011, Effect of insulin-like growth factor-1 deficiency or administration on the occurrence of acne, J Eur Acad Dermatol Venereol source

  • May combine two claims.

    Premisecitation

    Hormones influence both acne development and severity.

    “Consistent with the association between acne and puberty, hormones influence both acne development and severity.3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Thiboutot, 2004, Acne: hormonal concepts and therapy, Clin Dermatol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Patients with Laron syndrome had a lower incidence of acne (1 case of mild acne out of 13 patients).

    “a small cohort study of patients with Laron syndrome, a recessive disease characterized by primary growth hormone insensitivity, found that the patients had a lower incidence of acne (1 case of mild acne out of 13 patients).5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Ben-Amitai, 2011, Effect of insulin-like growth factor-1 deficiency or administration on the occurrence of acne, J Eur Acad Dermatol Venereol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two reviewers independently screened titles, abstracts, and full text to determine inclusion criteria.

    “Two reviewers independently screened the titles, abstracts, and full text to determine whether they met the inclusion criteria detailed in Fig 1.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    High-GI diets (>55) are associated with worse glycemic control, higher postprandial insulin levels, and elevated IGF-1 levels.

    “In multiple clinical trials, high-GI diets (>55) have been associated with worse glycemic control, higher postprandial insulin levels,7,8 and elevated insulin-like growth factor 1 (IGF-1) levels,7”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Ratnam, 1979, Skin diseases in Zambia, Br J Dermatol source
    • cites [8] Bechelli, 1981, Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State, Amazonia, Brazil), Dermatologica source

  • May combine two claims.

    Premisecitation

    Genetically similar Pacific Islanders and South American Indians who adopted a more Westernized lifestyle have much higher incidences of acne; similar trends were observed among Okinawans and Inuit.

    “Interestingly, genetically similar Pacific Islanders and South American Indians who have adopted a more Westernized lifestyle have much higher incidences of acne. Similar trends were observed among other peoples, such as Okinawans and the Inuit, in whom the acne prevalence increased after the adoption of a Western lifestyle.9,12”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Cordain, 2002, Acne vulgaris: a disease of Western civilization, Arch Dermatol source
    • cites [12] Steiner, 1946, Necropsies on Okinawans; anatomic and pathologic observations, Arch Pathol (Chic)

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Discrepancies in quality assessment were discussed between two reviewers, and disagreements were resolved by averaging and rounding up scores.

    “Discrepancies were discussed between 2 reviewers, and in the event of a disagreement, the scores were averaged and rounded up.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The level of evidence for observational studies was independently assessed using the Newcastle-Ottawa quality assessment scale by three reviewers.

    “The LOEs for observational studies were independently assessed using the Newcastle-Ottawa quality assessment scale by J.M., C.R., and B.K.H.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    High glycemic index, increased glycemic load, and carbohydrate intake have a modest yet significant proacnegenic effect.

    “High glycemic index, increased glycemic load, and carbohydrate intake have a modest yet significant proacnegenic effect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Many studies did not include a prior justification of sample size based on power analyses and were underpowered to determine the modest effect sizes that associated diet with acne.

    “Many did not include a prior justification of sample size based on power analyses and, upon a posthoc review, were determined to be underpowered to determine the modest effect sizes that associated diet with acne.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Adebamowo et al found a significant association between skim milk and acne but not between total milk, whole milk, 2% milk, or low-fat milk and acne.

    “One notable example is that Adebamowo et al26 found a significant association between skim milk and acne but not between total milk, whole milk, 2% milk, or low-fat milk and acne.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Adebamowo, 2008, Milk consumption and acne in teenaged boys, J Am Acad Dermatol source

      Checked before — its earlier verdict is held back until a new check runs.

  • May combine two claims.

    Interpretationreasoning

    Increased glycemic intake and high-GI diets promote acnegenesis and exacerbate acne severity, whereas increased dairy intake has been consistently shown to promote acnegenesis only among Western populations.

    “Increased glycemic intake and high-GI diets promote acnegenesis and exacerbate acne severity, whereas increased dairy intake has been consistently shown to promote acnegenesis only among Western populations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Pavithra et al, in their sole negative trial, did not show significant improvement with a low-GI diet, likely in part due to substantial improvement among all participants from baseline because of their participation in the trial and associated counseling.

    “Pavithra et al,52 in their sole negative trial, did not show significant improvement with a low-GI diet, likely in part due to substantial improvement among all participants from baseline because of their participation in the trial and associated counseling.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [52] Pavithra, 2019, A randomized controlled trial of topical benzoyl peroxide 2.5% gel with a low glycemic load diet versus topical benzoyl peroxide 2.5% gel with a normal diet in acne (grades 1-3), Indian J Dermatol Venereol Leprol source

      Checked before — its earlier verdict is held back until a new check runs.

52 of 52

  • The paper relies on this without support.

    Dietary records and self-reporting are subject to substantial biases.

    “Dietary records and self-reporting are subject to substantial biases, and strict dietary adherence in interventional trials is difficult to achieve.”

  • The paper relies on this without support.

    Strict dietary adherence in interventional trials is difficult to achieve.

    “Dietary records and self-reporting are subject to substantial biases, and strict dietary adherence in interventional trials is difficult to achieve.”

  • The paper relies on this without support.

    The observed geographic differences in dairy-acne association are attributable to differences in diet or ethnicity rather than other confounding factors.

    “In contrast, dairy is unlikely to exacerbate acne among youths from non-Western countries.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Full-text exclusions do not yield 34 included articles

    Major

    Of the 113 articles that reached full-text screening, excluding 81 leaves 32, not 34. This affects the reported number of studies included in the review.

    Reported 34 · recomputed 32

  • Smith 2008 trial has conflicting randomization labels

    Minor

    Table IV calls Smith et al (2008) a randomized control trial, while the cited reference identifies it as nonrandomized.

  • Dreno study's stated mean age exceeds its age range

    Minor

    The text gives a mean case age of 55.2 years for Dreno et al, but Table III states that its participants were 15-39 years old. A mean cannot exceed every participant's stated maximum age.

3 of 3

Cites

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Related

Authors
Meixiong, J., Ricco, C., Vasavda, C., & Ho, B. K.
Affiliations
  • Johns Hopkins University (US)
  • Rutgers, The State University of New Jersey (US)
Corresponding author
Ho, Byron K.
ORCID
Venue
JAAD International
Publisher
Elsevier BV
Published
2022-06
Volume
7
Pages
95-112
ISSN
2666-3287 (ISSN-L)
DOI
10.1016/j.jdin.2022.02.012
PMC
PMC8971946
OpenAlex
W4220719225
Semantic Scholar
fd4e5d31f6ce4dfd877aac9aad517e7b079bd7f0
Cited by
108
References
59
Citations by year
2026: 33 · 2025: 34 · 2024: 25 · 2023: 10 · 2022: 6
FWCI
3.24
Type
journal article
Language
en
Open access
Licence
Locations
  • JAAD International (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • National Institutes of Health
  • National Institute of General Medical Sciences (T32 GM136577)
Topics
  • Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
acne, diet, glycemic index, glycemic load, dairy consumption, carbohydrate intake, insulin, insulin-like growth factor I, androgens, acne severity, sex differences, ethnicity, Western diet

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-11-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-11-05.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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