Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 3979  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 64  |  Issue : 1  |  Page : 23-27
The association of metabolic syndrome and insulin resistance in early-onset androgenetic alopecia in males: A case–control study


Department of Dermatology, Venereology and Leprosy, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India

Date of Web Publication7-Jan-2019

Correspondence Address:
Dr. Mukunda Ranga Swaroop
No. 108, First Floor, MIG, KHB Colony, 2nd Stage, 6th Cross, Basaveshwaranagar, Bengaluru -560 079, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_724_16

Rights and Permissions

   Abstract 


Background: Men with premature androgenetic alopecia (AGA) are found to be susceptible to cardiovascular diseases, metabolic syndrome (MS), diabetes mellitus and hypertension, and also premature baldness can have a definite negative impact on self-image and self-esteem in these patients. The aim of this study was to assess the strength of association between MS and/or insulin resistance (IR) in males with early-onset AGA. Methods: A total of 50 male patients with premature AGA and equal number of age-matched controls were enrolled in the study. Anthropometric measures, blood pressure, fasting glucose, fasting insulin, high-density lipoprotein cholesterol, and triglycerides were measured for all the participants. Association of IR and MS was evaluated. Results: Most common grade of hair loss was Grade IIIa (32%) of Hamilton–Norwood Scale of hair loss. Five out of 50 cases (10%) and 2 out of 50 controls (4%) had shown association with IR and the difference between the groups was statistically insignificant (P =0.23). Fifteen out of 50 cases (30%) and 4 out of 50 controls had shown association with MS and the difference between the groups was statistically significant (P =0.005). Conclusion: Male patients with early-onset AGA were not associated with IR. MS was associated with male patients with early-onset AGA. The results observed in our study may raise awareness in susceptible individuals that lifestyle changes in early life can reduce the risk of coronary heart diseases in the long term.


Keywords: Androgenetic alopecia, insulin resistance, metabolic syndrome


How to cite this article:
Swaroop MR, Kumar B M, Sathyanarayana B D, Yogesh D, Raghavendra J C, Kumari P. The association of metabolic syndrome and insulin resistance in early-onset androgenetic alopecia in males: A case–control study. Indian J Dermatol 2019;64:23-7

How to cite this URL:
Swaroop MR, Kumar B M, Sathyanarayana B D, Yogesh D, Raghavendra J C, Kumari P. The association of metabolic syndrome and insulin resistance in early-onset androgenetic alopecia in males: A case–control study. Indian J Dermatol [serial online] 2019 [cited 2019 Mar 26];64:23-7. Available from: http://www.e-ijd.org/text.asp?2019/64/1/23/249547





   Introduction Top


Androgenetic alopecia (AGA), the most common nonscarring alopecia, is an androgen-induced disorder characterized by hair loss in genetically predisposed men and women. In AGA, androgens induce miniaturization of hair follicles, especially in the frontotemporal area and vertex of the scalp in men; over the crown in women.[1]

AGA in male developing before 30 year of age with at least Grade III of Hamilton–Norwood classification is termed as early-onset or premature AGA. Men with premature AGA are found to be susceptible to cardiovascular diseases, metabolic syndrome (MS), diabetes mellitus, hypertension, and also premature baldness can have a definite negative impact on the self-image and self-esteem in these patients.[2] In spite of the emerging evidences for the association between premature AGA and MS, it is highly inconsistent, with very few studies being reported in Indian population. Since the pathophysiological link between MS, insulin resistance (IR), and premature AGA is not yet fully understood, we conducted the present study to evaluate their association.


   Methods Top


This study was conducted in the Outpatient Department of Dermatology, Venereology and Leprosy, Adichunchanagiri Institute of Medical Sciences, B G Nagara, during December 2014–May 2016. This was a case–control study. Fifty male patients aged between 18 and 30 years with early-onset AGA were enrolled in the study as cases and equal number of age-matched males who presented to outpatient department were enrolled in the study as control.

Approval was obtained from the Institutional Ethics Committee and informed consent was taken from each participant before enrolling them in the study. Those who presented with AGA after 30 years of age, had cardiovascular disease or glucose metabolism disorder, presented with other patterns of nonscarring alopecia (such as alopecia areata, telogen effluvium, and anagen effluvium), were taking androgen or antiandrogen therapy, insulin treatment, and glucocorticoid treatment within the previous 6 months were excluded from the study.

Clinical history

A detailed history of the patients as per the prepared questionnaire was taken with emphasis on history of hair fall, onset, duration, any associated symptoms (itching, pain in scalp, and scaling of the scalp), and history of exacerbating factors if any. Family history of hair loss was also taken.

Clinical examination

Elaborate general, physical, and systemic examinations were carried out and recorded. Complete examination of scalp was done with emphasis on pattern and severity of hair loss. Hair loss was graded according to Hamilton–Norwood Scale.[1]

Anthropometric and blood pressure measurement

Height

It was measured against a vertical board with attached metric rule and by bringing a horizontal headboard in contact with the uppermost point on the head. it was recorded in barefoot, full erect position with deep inspiration.

Weight

It was recorded without footwear and with light clothes on Indian Standards Institute certified weighing machine to the nearest of 100 g.

Body mass index

It was calculated as weight in kg/height in m2 (kilogram/square meter). In adults, overweight is defined as body mass index (BMI) between 25 and 29.9 and obese is defined as BMI ≥30.

Waist circumference

It was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest, using a stretch-resistant tape that provides a constant 100 g tension.

Blood pressure measurement

Blood pressure (BP) was recorded with sphygmomanometer on the right arm in a sitting position after 20 min rest. The mean value for systolic and diastolic BP was calculated from average of three readings.

Systolic BP ≥130 mm of Hg and diastolic BP ≥85 mm of Hg were taken as cutoff points for hypertension.

Investigations

Blood samples were collected from all enrolled participants after 12-h fast and the following investigations were performed.

  1. Fasting serum insulin level
  2. Fasting blood sugar level (FBS)
  3. Triglycerides (TGs)
  4. High-density lipoprotein (HDL).


Diagnosis of metabolic syndrome

Diagnosis of MS was done based on the National Cholesterol Education Programme (NCEP) Adult Treatment Panel III by the presence of three or more of the following criteria:[3]

  1. Waist circumference (WC) ≥102 cm in male
  2. TGs value ≥ 150 mg/dl
  3. HDL > 40 mg/dl
  4. FBS ≥ 110 mg/dl
  5. BP ≥ 130/85 mmHg.


Diagnosis of insulin resistance

Diagnosis of IR was done using the homeostasis model assessment of IR (HOMA-IR) according to the following formula:

IR = (Fasting insulin level [μIU/mL] × fasting glucose level [mmol/L]/22.5)

A value above 2.7 is considered to indicate IR.[3]

For measurement of fasting insulin level, microplate chemiluminescent assay using the instrument Alpha prime light was used. Normal values ranged from 2.6 to 24.9 μIU/mL.

Serum lipid profile: HDL and TGs measurements were performed using standard enzymatic techniques. HDL <40 mg % and TGs >150 mg % were considered as raised.

Venous plasma glucose was measured by glucose oxidase method. Fasting blood glucose 110 mg% or more was considered as raised.

Statistical analysis

The statistical software, SPSS 15.0 (IBM SPSS for windows, South Wacker Drive, Chicago) was used. Data entry was done in Microsoft Excel. P < 0.05 was considered to be statistically significant.


   Results Top


The patient group consisted of 50 male patients in the age group between 18 and 30 years and the same number of age- and gender-matched patients were taken as control. In the present study, majority of patients with early-onset AGA were in the age group of 18–24 years (68%). The mean age of patients with early-onset AGA was 25.12±2.344 years and that of participants in the control group was 24.18±2.663 years (P =0.94). Majority of the patients had insidious onset of hair loss (58%). Thirty-one percent among the cases and 14% of the controls had family history of baldness (P =0.001). On scalp examination, 23 (46%) patients were classified as Stage III, 12 (24%) as Stage IV, 10 (20%) as Stage V, and 5 (10%) as Stage VI based on Hamilton–Norwood scale of hair loss.

The groups were compared in terms of height, weight, BMI, WC, systolic and diastolic BP, HDL, TGs, and FBS. The difference between the groups with respect to weight, BMI, WC, HDL, TGs, and FBS were statistically significant (P < 0.05). However, the difference between the groups in respect to height, systolic and diastolic BP was not significant (P>0.05) [Table 1].
Table 1: Distribution of demographic and laboratory parameters of the two groups in the study

Click here to view


The fasting insulin levels were 4.21±2.285 μIU/mL in the cases and 3.32±1.341 μIU/mL in the control group. The values in the cases were higher than in controls and the difference between the two groups was statistically significant (P =0.020).

When the patients were grouped according to the HOMA-IR > 2.7 cutoff value and IR was compared, 5 out of 50 (10%) patients in the early AGA group were found to have IR, whereas only 2 out of 50 (4%) in the control group were found to have IR. The difference between the groups was statistically not significant (P =0.23).

When the stages of hair loss in patients with early-onset AGA were compared with regard to IR, the difference was statistically not significant (P =0.185) [Table 2].
Table 2: Comparison of androgenetic alopecia stages with respect to insulin resistance

Click here to view


When the groups were compared in respect to MS frequency, 15 (30%) patients in early AGA group and 4 (8%) participants in control group were found to have MS and the difference between the groups was statistically significant (P =0.005) [Table 3].
Table 3: Comparison of the groups in respect to metabolic syndrome

Click here to view



   Discussion Top


AGA in males developing before 30 year of age with at least Grade III of Hamilton–Norwood classification is termed as early-onset or premature AGA. In the present study, 50 cases and 50 age- and gender-matched controls were recruited in the study. In our study, the most common age group was between 22 and 24 years.

In the present study out of 50 cases with early-onset AGA, 31 (62%) patients had family history of hair loss. Out of the 50 controls, 14 (28%) patients had a family history of hair loss. The difference between the groups was statistically significant (P =0.001). Our results were in concordance with a study by Arias-Santiago et al.[5]

Evaluation of insulin resistance in studied groups

IR plays a major role in the pathophysiology of MS and hyperinsulinemia is an independent risk factor for coronary artery disease (CAD), wherein it accelerates the development of atherosclerosis and prevents the resorption of atherosclerotic plaque.[3] Association between IR and early-onset AGA have been reported and hyperinsulinemia plays a pathogenic role in local androgen production and miniaturization of hair follicles.[6]

In our study, when the groups were assessed in respect to their fasting insulin levels, men with AGA were found to have higher level (4.21±2.28) than those in the control group, the difference was statistically significant (P =0.020). However, when the groups were compared in respect to IR based on the HOMA-IR, only 5 cases out of 50 patients with early-onset AGA and 2 among control group had IR, the difference between the groups was not statistically significant (P =0.23).

The studies done by Acibucu et al.,[3] Matilainen et al.,[7] Pengsalae et al.,[8] and Gonzalez-Gonzalez et al.[9] showed a significant relationship between IR and early-onset AGA.

Evaluation of metabolic syndrome

The NCEP ATP III mentions MS as a major cardiovascular risk factor. Individuals with MS are at an increased risk of coronary arterial calcification. The presence of MS has been associated with a three-fold increase of risk for CADs and five-fold increase for cardiovascular mortality.[3]

The groups were compared in terms of height, weight, BMI, WC, systolic and diastolic BP, TGs, HDL, and FBS.

In the present study, there were significant differences between the cases and controls regarding body weight and WC (P < 0.05). Similar results were reported in a study done by Bakry et al.[6]

Abdominal fat tissue is associated with serious metabolic disorders such as IR, hyperinsulinemia, hypertension, increased TG, glucose intolerance, and diabetes mellitus.[3]

In the present study, there was significant difference between the cases and controls in respect to BMI (P < 0.05). Similar observations were reported in studies done by Bakry et al.[6] and Matilainen et al.[7] However, Arias-Santiago et al.[5] found that BMI did not differ between AGA cases and normal controls.

In the present study, there was no significant difference between cases and controls regarding the mean values of systolic and diastolic BP. Contrary to our results, Bakry et al.,[4] Hirsso et al.,[10] Matilainen et al.,[7] and Arias-Santiago et al.[5] found significant differences between cases and controls regarding systolic and diastolic BP.

In the present study, the difference between the groups in respect to the mean value of FBS was statistically significant which was in concordance with studies done by Bakry et al.,[4] Nabaie et al.,[11] and Acibucu et al.[3]

In the present study, mean value of HDL-C and TGs were found to be significantly higher in cases than in controls. In a similar study done by Bakry OA et al., the mean value of TGs was significantly higher in cases, whereas the mean value of HDL-C was significantly lower in cases than in controls. Contrary to our results, Guzzo et al.[12] found no difference in the mean values of HDL-C and TGs between cases and controls.

In the present study, MS was significantly associated with early-onset AGA group when compared with control group (P =0.005). Similar results were observed by Acibucu et al.[3] and Bakry et al.[4]


   Conclusion Top


In the present study, MS was significantly associated with early-onset AGA. Early-onset AGA patients should be closely followed up long term, particularly for cardiovascular disorders. The observations in the present study may raise awareness in susceptible individuals that lifestyle changes (weight control, exercise diet with a low glycemic index) in early life may reduce the risk of coronary heart diseases.

Limitation

Prospective studies with large sample sizes may be required to conclusively define any association between early-onset AGA and MS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Wadhwa SL, Khopkar U, Nischal KC. Hair and scalp disorders. In: Valia RG, Valia RA, editors. IADVL Textbook of Dermatology. 3rd ed. Mumbai: Bhalani Publishing House; 2008. p. 887-9.  Back to cited text no. 1
    
2.
Narad S, Pande S, Gupta M, Chari S. Hormonal profile in Indian men with premature androgenetic alopecia. Int J Trichol 2013;5:69-72.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Acibucu F, Kayatas M, Candan F. The association of insulin resistance and metabolic syndrome in early androgenetic alopecia. Singapore Med J 2010;51:931-6.  Back to cited text no. 3
    
4.
Chakrabarty S, Hariharan R, Gowda D, Suresh H. Association of premature androgenetic alopecia and metabolic syndrome in a young Indian population. Int J Trichol 2014;6:50-3.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Arias-Santiago S, Gutiérrez-Salmerón MT, Castellote-Caballero L, Buendía-Eisman A, Naranjo-Sintes R. Male androgenetic alopecia and cardiovascular risk factors: A case-control study. Actas Dermosifiliogr 2010;101:248-56.  Back to cited text no. 5
    
6.
Bakry OA, Shoeib MA, El Shafiee MK, Hassan A. Androgenetic alopecia, metabolic syndrome, and insulin resistance: Is there any association? A case-control study. Indian Dermatol Online J 2014;5:276-81.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Matilainen V, Koskela P, Keinänen-Kiukaanniemi S. Early androgenetic alopecia as a marker of insulin resistance. Lancet 2000;356:1165-6.  Back to cited text no. 7
    
8.
Pengsalae N, Tanglertsampan C, Phichawong T, Lee S. Association of early-onset androgenetic alopecia and metabolic syndrome in Thai men: A case-control study. J Med Assoc Thai 2013;96:947-51.  Back to cited text no. 8
    
9.
González-González JG, Mancillas-Adame LG, Fernández-Reyes M, Gómez-Flores M, Lavalle-González FJ, Ocampo-Candiani J, et al. Androgenetic alopecia and insulin resistance in young men. Clin Endocrinol (Oxf) 2009;71:494-9.  Back to cited text no. 9
    
10.
Hirsso P, Laakso M, Matilainen V, Hiltunen L, Rajala U, Jokelainen J, et al. Association of insulin resistance linked diseases and hair loss in elderly men. Finnish population-based study. Cent Eur J Public Health 2006;14:78-81.  Back to cited text no. 10
    
11.
Nabaie L, Kavand S, Robati RM, Sarrafi-Rad N, Kavand S, Shahgholi L, et al. Androgenic alopecia and insulin resistance: Are they really related? Clin Exp Dermatol 2009;34:694-7.  Back to cited text no. 11
    
12.
Guzzo CA, Margolis DJ, Johnson J. Lipid profiles, alopecia, and coronary disease: Any relationship? Dermatol Surg 1996;22:481.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (309 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed422    
    Printed1    
    Emailed0    
    PDF Downloaded44    
    Comments [Add]    

Recommend this journal