Apolipoprotein B as a Protective Factor Against Atopic Dermatitis: Insights Into Lipid Metabolism From a Large Prospective Cohort of 454,974 Individuals

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition influenced by lipid metabolism. Apolipoprotein B (ApoB), a crucial component of lipid transport, may be linked to AD risk, but this relationship has not been extensively studied in large cohorts. Objectives: To investigate the association between ApoB and the risk of developing AD using data from a large, prospective cohort in the UK Biobank (UKB). Methods: The study analyzed 454,974 participants from the UKB, with ApoB measured via blood biochemistry and nuclear magnetic resonance (NMR) spectroscopy. Cox proportional hazard models were used to evaluate the relationship between ApoB and AD risk, adjusting for demographic, lifestyle, and clinical covariates. Restricted cubic spline (RCS) analysis was employed to assess potential nonlinear relationships. Sensitivity analyses included adjusting for lipid-lowering medication use, comparing apolipoprotein A (ApoA) levels, and repeating analyses with NMR-measured ApoB. Results: Higher ApoB levels were significantly associated with a reduced risk of AD (hazard ratio for continuous ApoB: 0.74, 95% confidence interval: 0.64-0.86, P < 0.001). RCS analysis confirmed a linear inverse relationship between ApoB and AD risk (P for overall <0.001; P for nonlinear: 0.803). Sensitivity analyses reinforced these findings, showing consistent results across different measures and adjustments, with no significant association found between ApoA levels and AD. Conclusions: This study establishes a significant inverse association between ApoB levels and AD risk, underscoring the role of lipid metabolism in AD pathogenesis in the UKB population. ApoB might be a potential biomarker or therapeutic target for AD prevention, meriting further investigation.