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Mediterranean diet: fresh herbs and fresh vegetables decrease the risk of Androgenetic Alopecia in males

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Abstract

It is well established that Androgenetic Alopecia (AGA) occurs in genetically predisposed individuals but little is known of its non-genetic risk factors. The aim of the study was to investigate the role of the Mediterranean diet in determining the risk of AGA. A hospital-based case-control study was conducted in the outpatient clinics of the hospital “Istituto Dermopatico dell’Immacolata, Rome, Italy”. We included 104 males and 108 controls not affected by AGA. Controls were frequency matched to cases. Information on socio-demographic characteristics, medical history, smoking and diet were collected for all patients. Logistic regression was used to estimate odds ratio and 95% confidence intervals. After controlling for age, education, body mass index and family history of AGA, protective effects for AGA were found for high consumption (≥ 3 times weekly) of raw vegetables (OR 0.43; 95% CI 0.21–0.89) and high consumption of fresh herbs (3 or more regularly) (OR 0.44; 95% CI 0.22–0.87). We suggest that some foods of the Mediterranean diet, say fresh herbs and salad, may reduce the risk of AGA onset.
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Archives of Dermatological Research (2018) 310:71–76
https://doi.org/10.1007/s00403-017-1799-z
ORIGINAL PAPER
Mediterranean diet: fresh herbs andfresh vegetables decrease therisk
ofAndrogenetic Alopecia inmales
CristinaFortes1· S.Mastroeni1· T.Mannooranparampil1· D.Abeni1· A.Panebianco2
Received: 3 October 2017 / Revised: 20 November 2017 / Accepted: 21 November 2017 / Published online: 27 November 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Abstract
It is well established that Androgenetic Alopecia (AGA) occurs in genetically predisposed individuals but little is known of
its non-genetic risk factors. The aim of the study was to investigate the role of the Mediterranean diet in determining the risk
of AGA. A hospital-based case-control study was conducted in the outpatient clinics of the hospital “Istituto Dermopatico
dell’Immacolata, Rome, Italy”. We included 104 males and 108 controls not affected by AGA. Controls were frequency
matched to cases. Information on socio-demographic characteristics, medical history, smoking and diet were collected for
all patients. Logistic regression was used to estimate odds ratio and 95% confidence intervals. After controlling for age,
education, body mass index and family history of AGA, protective effects for AGA were found for high consumption (≥ 3
times weekly) of raw vegetables (OR 0.43; 95% CI 0.21–0.89) and high consumption of fresh herbs (3 or more regularly)
(OR 0.44; 95% CI 0.22–0.87). We suggest that some foods of the Mediterranean diet, say fresh herbs and salad, may reduce
the risk of AGA onset.
Keywords Androgenetic Alopecia· Diet· Risk factors· Case control
Introduction
Male baldness or Androgenetic Alopecia (AGA) is a der-
matological condition characterized by a severe shrinking
of hair follicles and in the worst case complete hair loss.
The prevalence of AGA is race-dependant and varies from
14 to 50%. The presence of androgen dihydrotestosterone
and genetic factors are suggested to play an important role
in the development of AGA. Genome-wide association stud-
ies indicate that genetic variants at the level, or close to the
androgen receptor gene and in locus at 20p11 are associ-
ated with an increased risk of AGA [19]. However, single
nucleotide polymorphisms (SNPs) found to be associated
with AGA; so far, are characterized by an apparent reduced
penetrance into the phenotype suggesting a role of other fac-
tors in the aetiology of AGA, including lifestyle factors [3,
21, 26]. Diet could contribute to the aetiology of AGA since
hair function, and appearance have been reported to depend
on adequate and balanced nutritional intake [9]. Moreover,
epidemiological studies show that AGA is associated with
an increased risk of many chronic diseases including cancer
[4, 24, 27], in particular, prostate cancer, suggesting com-
mon individual and behavioural risk factors. In fact, the
5α-reductase is an important enzyme in the steroid metabo-
lism and it is involved in the pathogenesis of both AGA and
prostate cancer [10, 13]. Polyphenol compounds which are
present in the Mediterranean diet have been suggested as
inhibitors of the 5α-reductase enzyme and the Mediterra-
nean diet is very rich in those [11]. It has been suggested that
normal growth and function of the prostate are linked to the
reduction of testosterone to DHT by 5α-reductase and that
high levels of DHT are involved in the pathogenesis prostate
cancer [10]. It is interesting to note that AGA does not occur
in men with a genetic deficiency of the type 2 5α-reductase
enzyme [13].
The Mediterranean diet has an important role in modulat-
ing cancer risk [8, 20]. In view of the link between prostate
cancer and AGA [27] and the protective effect of the Medi-
terranean diet for the prevention of prostate cancer [20],
* Cristina Fortes
c.fortes@idi.it
1 Epidemiology Unit, Istituto Dermopatico dell’Immacolata
(IDI-IRCCS-FLMM), Via dei Monti di Creta, 104,
00167Rome, Italy
2 Medical Direction, Istituto Dermopatico dell’Immacolata
(IDI-IRCCS-FLMM), Rome, Italy
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... However, interpretation of the results from both studies was impacted by a lack of detail provided in the smoking history and age of AGA diagnosis [18,19]. Questionnaire results from a hospital-based, controlled study reported no statistical difference in the frequency of subjects with or without AGA who were current smokers of <10 cigarettes per day (n = 214 M) (p = 0.13) [20]. The study results are limited by the younger age of subjects with AGA (28.5 years) compared to controls (38.9 years), which may limit the generalizability of the results [20]. ...
... Questionnaire results from a hospital-based, controlled study reported no statistical difference in the frequency of subjects with or without AGA who were current smokers of <10 cigarettes per day (n = 214 M) (p = 0.13) [20]. The study results are limited by the younger age of subjects with AGA (28.5 years) compared to controls (38.9 years), which may limit the generalizability of the results [20]. In a case-controlled study including 256 subjects with AGA and 256 agematched controls, no significant difference in cigarette smoking status was reported between subjects with or without AGA (p = 0.550). ...
... Severe presentations of AGA were observed in subjects who smoked a larger quantity of cigarettes per day [8,[10][11][12][13]. Several studies reported no association between smoking and alopecia [17][18][19][20][21][22][23][24][25][26][27]. Among these, a cross-sectional retrospective study reported a higher prevalence of scarring alopecia, severe FFA, in subjects with no previous tobacco exposure [24]. ...
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... In this regard, there is an increasing interest in nonhormonal factors that play a role in AGA pathogenesis and their relationship with hormonal status [6]. In particular, micronutrients (trace elements, vitamins, and essential amino acids), a number of which have shown a positive effect on the growth and strengthening of hair roots capture the attention of researchers [7][8][9][10][11]. ...
... The regular use of food supplements, a topical L-carnitine tartrate, zinc, niacin, branched chain amino acids, and biotin treatment, led to a decrease in the rate of hair loss and an increase in the anagen/telogen ratio in individuals with AGA [12]. These data are also supported by studies that demonstrated that the Mediterranean diet-fresh herbs and vegetables-reduces the risk of AGA development in men [6], including due to the effect on low-grade inflammation observed in alopecia [13]. Deficiency of micronutrients, such as iron, selenium, zinc, folic acid (FA), and vitamins A, B, C, D, can be a modifiable risk factor associated with the AGA development, prevention, and treatment [14]. ...
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Androgenetic alopecia (AGA) is the most common variant of male pattern baldness in which occurrence and development of multiple genetic, hormonal, and metabolic factors are involved. We aimed to estimate plasma element content (Mg, Ca, Zn, Cu, Se, Fe), vitamin status (B12, D, E, and folic acid) in patients with AGA using direct colorimetric tests or atomic absorption spectrometry, and the influence of these parameters in the formation of various hair loss patterns. The study included 50 patients with I–IV stages of AGA divided into two groups with normal and high levels of dihydrotestosterone compared with 25 healthy individuals. The presence of two patterns of pathological hair loss in the androgen-dependent (parietal) and androgen-independent (occipital) areas of the scalp was confirmed. It was shown that all patients with AGA have a deficiency of elements (Zn, Cu, Mg, Se) and vitamins (B12, E, D, folic acid). However, the hair loss rate was not due to their content. А positive interrelation between quantitative trichogram parameters in the occipital region and iron metabolism in pairs “hair density vs Fe” and “hair diameter vs ferritin” was shown. In turn, in the parietal region, an inverse correlation of hair diameter with plasma Cu level was found, the most pronouncing in patients with high levels of dihydrotestosterone. The obtained results indicate the importance of multiple micronutrient deficiencies in the AGA occurrence accompanied by the existence of two different hair loss patterns, differently related to the content of certain trace elements and androgens in the blood.
... In addition, it has been reported that epigallocatechin-3-gallate, the main component of tea polyphenols, can reduce the risk of androgenetic alopecia by inhibiting 5α-reductase, which increases hair growth in humans [96]. Essential fatty acids (linolenic, linoleic, oleic, myristoleic, palmitoleic, and stearic acids) found in olive oil, which has an important place in the MD, have inhibitory effects on 5α-reductase (5AR) that provide hair regrowth [4,18,97]. It has been reported that hair loss and depigmentation are seen in hair and eyebrows in people affected by linoleic acid and alpha-linolenic acid deficiency [83]. ...
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... The rumored association of western diet and AGA prompted consideration of the Mediterranean diet to ameliorate the effects. A statistical analysis of dietary habits and degree of AGA progression demonstrated a protective effect of fresh herbs and raw vegetables (Fortes et al., 2018). In such cases protective affects might be partly mediated by improved glycemic control and lower cholesterol (Tzima et al., 2007). ...
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... Here, we provide an overview of the currently available literature devoted to alternative natural dietary treatments for HL (Figure 1). Among others, a recent work paid attention to Mediterranean diet supporting the hypothesis that some fresh herbs and salad, rich in phytochemicals such as carotenoids and polyphenols, may reduce the risk of AGA [16]. In the present review, we started for a query for "alopecia" OR "hair loss" AND "Rosmarinum officinalis L." (and other 6 botanicals) in ARTICLE (Title/Abstract/Keyword) in PUBMED and Web of Sciences database. ...
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Chapter
Genetic factors, androgens, and follicular micro-inflammation play key roles in causing “androgenic” hair loss (see Chaps. 11 and 14, Vol. 1) In order to affect the course and progression of AGA through diet or lifestyle, the only parameter in AGA that could be “manipulated” is the hormonal one, which includes several sub-components:Only the production and transfer steps could be modified through dietary and lifestyle changes, either towards a favorable decrease or an—unwanted—increase in overall androgen availability. The consumption of androgen-containing foods could exacerbate FPHL in some women, but it is unlikely that men would experience any detrimental effects because of high endogenous androgen levels. In the following sections, those lifestyle factors that could impact the course of AGA/FPHL, either by affecting androgen metabolism or by directly influencing the hair follicle physiology, will be examined.
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Background Association of androgenetic alopecia (AGA) with increased incidence of hypertension, a strong risk factor for coronary artery disease, has been suggested. However, there are no data on arterial stiffness measures of asymptomatic young adults with AGA.Objective In this study, we aimed to investigate the association of the AGA with arterial stiffness assessed by cardio-ankle vascular index (CAVI), in asymptomatic young men.MethodsA total of 162 asymptomatic men aged between 18 and 45 years were consecutively enrolled to the study. Subjects were considered to have AGA if they have ≥3 grade vertex alopecia according to Hamilton–Norwood scale. Arterial stiffness was assessed by CAVI and defined as abnormal if CAVI is ≥8.ResultsFrequency of abnormal CAVI was higher in patients with AGA (29.3% vs. 10.0%, P = 0.003). Subjects with AGA had higher mean CAVI than subjects without AGA (7.56 ± 0.93 vs. 7.15 ± 0.79, P = 0.004). Binary logistic regression analysis demonstrated that presence of AGA (OR, 5.6; 95% CI, 1.7–20.0, P = 0.006), age (OR, 1.1; 95% CI, 1.0–1.2, P = 0.03) and diastolic blood pressure (OR, 1.1; 95% CI, 1.0–1.3, P = 0.005) were independently associated with abnormal CAVI.Conclusion We concluded that, AGA might be an indicator of arterial stiffness in asymptomatic young adults.
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Low-grade inflammation is characterised by raised concentrations of inflammatory markers in the absence of any overt symptoms and is recognized as a risk factor for a number of chronic diseases including cancer, cardiovascular, cerebrovascular and neurodegenerative diseases. Many studies suggest that low-grade inflammation is mitigated by health-promoting behaviours such as healthy eating patterns, physical activity, body weight maintenance and tobacco cessation. To date, large-scale studies were mainly focused on circulating markers and little evidence is available on cellular biomarkers. The MOLI-SANI study is a prospective cohort study that has recruited 24,325 men and women aged ≥35 from the general population of the Molise Region, a Southern Italian area, with the purpose of investigating genetic and environmental risk/protection factors for cardiovascular and cerebrovascular disease and cancer. Within this cohort, a composite score of low-grade inflammation based on the use of plasmatic (C-reactive protein) and cellular (leukocyte and platelet counts and granulocyte/lymphocyte ratio) biomarkers has been proposed and validated. This score accounts for all possible synergistic effects of such inflammatory markers, thus overcoming any potential bias linked to the multi-collinearity of these variables. Of notice, the MOLI-SANI study was the first to address the relationship between the traditional Mediterranean diet and platelet and leucocyte counts as emerging cellular biomarker of low-grade inflammation. The present review paper will discuss the main findings derived from the MOLI-SANI study on the association of low-grade inflammation with a Mediterranean eating pattern, with a particular emphasis on the associated dietary polyphenols. This article is protected by copyright. All rights reserved.
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The aim of this research study was to meta-analyze the effects of adherence to Mediterranean Diet (MD) on overall cancer risk, and different cancer types. Literature search was performed using the electronic databases MEDLINE, SCOPUS, and EMBASE until 10th January 2014. Inclusion criteria were: cohort or case-control studies. Study specific risk ratios (RR) were pooled using a random effect model by the Cochrane software package Review Manager 5.2. 21 cohort studies including 1,368,736 subjects, and 12 case-control studies with 62,725 subjects met the objectives and were enclosed for meta-analyses. The highest adherence to MD category resulted in a significantly risk reduction for overall cancer mortality/incidence [cohort; RR: 0.90, 95% CI 0.86 to 0.95, p < 0.0001; I2=55%], colorectal [cohort/case control; RR: 0.86, 95% CI 0.80 to 0.93, p < 0.0001; I2=62%], prostate [cohort/case control; RR: 0.96, 95% CI 0.92 to 0.99, p = 0.03; I2=0%], and aerodigestive cancer [cohort/case-control studies; RR: 0.44, 95% CI 0.26 to 0.77, p = 0.003; I2=83%]. Non-significant changes could be observed for breast cancer, and gastric cancer, and pancreatic cancer. The Egger regression tests provided limited evidence of substantial publication bias. High adherence to a Mediterranean diet is associated with a significant reduction in the risk of overall cancer mortality (10%), colorectal cancer (14%), prostate cancer (4%), and aerodigestive cancer (56%). © 2014 Wiley Periodicals, Inc.
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Androgenetic alopecia (AGA) is the most common type of hair loss, and is characterized by the transformation of terminal scalp hair into vellus hair. The epidemiology of AGA is not fully understood. A strong genetic basis has long been identified, although little is known of its nongenetic causes. To evaluate the association of AGA with a number of environmental factors, including smoking, drinking and sleeping habit. In total, 3114 Korean individuals with AGA who attended any one of 17 dermatology clinics in 6 cities in South Korea between March 2011 and February 2012 were enrolled in the study. Epidemiologic a data were collected using a standard questionnaire. No association was seen between eating or sleeping habits and severity of hair loss. However, drinking and smoking were associated with the severity of AGA in male patients. We also found that patients of both genders with a family history had more advanced types of hair loss, and the age of onset of AGA in male patients with a family history was earlier than that in male patients without a family history. Although the evidence for an environmental influence on AGA remains very weak, we did find an association between hair loss severity and certain environmental factors, such as smoking and drinking. Family history with more severe hair loss and an earlier age of onset.
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Obesity is a risk factor for multiple health problems, but its association with androgenetic alopecia (AGA) remains controversial. We sought to determine the association between body mass index (BMI) and alopecia severity in men with AGA and early-onset AGA. A cross-sectional study was conducted. The medical charts and photographs of men with a clinical diagnosis of AGA were reviewed. In all, 189 men were enrolled with a mean age of 30.8 years. In male-pattern AGA (n = 142), men with severe alopecia (grade V-VII) had higher BMI than those with mild to moderate alopecia (grade I-IV) (25.1 vs 22.8 kg/m(2), P = .01). After multivariate adjustments, the risk for severe alopecia was higher in the overweight or obese (BMI ≥24 kg/m(2)) subjects with male-pattern AGA (odds ratio 3.52, P < .01). In early-onset male-pattern AGA (n = 46), the risk for having severe alopecia was also higher in the overweight or obese subjects (odds ratio 4.97, P = .03). Parameters used to evaluate obesity were limited because of the retrospective nature of the study. Higher BMI was significantly associated with greater severity of hair loss in men with male-pattern AGA, especially in those with early-onset AGA.