Systematic Review and Meta-analysis of the Association Between Metabolic Syndrome and Androgenetic Alopecia
Keywords:alopecia, androgens, metabolic syndrome, systematic review, meta-analysis
The association of androgenetic alopecia with metabolic syndrome has been investigated in several studies, with conflicting results. We conducted a meta-analysis to quantitatively evaluate the risk grade of metabolic syndrome and the metabolic profile in patients with androgenetic alopecia compared with controls. In total, 19 articles (2,531 participants) satisfied the inclusion criteria. The pooled odds ratio for the prevalence rate of metabolic syndrome between the group with androgenetic alopecia and controls was 3.46 (95% CI 2.38–5.05; p < 0.001). Female sex, early onset, and African ethnicity were associated with an increased risk of metabolic syndrome. Furthermore, patients with androgenetic alopecia had significantly poorer metabolic profiles, such as body mass index, waist circumference, fasting glucose, blood lipids, and blood pressure. It is important for physicians to screen metabolism-related indicators in patients with androgenetic alopecia. More rigorously designed studies and larger sample sizes are required in future studies.
Kelly Y, Blanco A, Tosti A. Androgenetic alopecia: an update of treatment options. Drugs 2016; 76: 1349-1364.
https://doi.org/10.1007/s40265-016-0629-5 DOI: https://doi.org/10.1007/s40265-016-0629-5
Otberg N, Finner AM, Shapiro J. Androgenetic alopecia. Endocrinol Metab Clin North Am 2007; 36: 379-398.
https://doi.org/10.1016/j.ecl.2007.03.004 DOI: https://doi.org/10.1016/j.ecl.2007.03.004
Piérard-Franchimont C, Piérard GE. Teloptosis, a turning point in hair shedding biorhythms. Dermatology 2001; 203: 115-117.
https://doi.org/10.1159/000051723 DOI: https://doi.org/10.1159/000051723
Hu Y, Zhu Y, Lian N, Chen M, Bartke A, Yuan R. Metabolic syndrome and skin diseases. Front Endocrinol 2019; 10: 788.
https://doi.org/10.3389/fendo.2019.00788 DOI: https://doi.org/10.3389/fendo.2019.00788
Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120: 1640-1645.
https://doi.org/10.1161/CIRCULATIONAHA.109.192644 DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.192644
Mumcuoglu C, Ekmekci TR, Ucak S. The investigation of insulin resistance and metabolic syndrome in male patients with early-onset androgenetic alopecia. Eur J Dermatol 2011; 21: 79-82.
https://doi.org/10.1684/ejd.2010.1193 DOI: https://doi.org/10.1684/ejd.2010.1193
Swaroop MR, Kumar BM, Sathyanarayana BD, Yogesh D, Raghavendra JC, 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: 23-27.
https://doi.org/10.4103/ijd.IJD_724_16 DOI: https://doi.org/10.4103/ijd.IJD_724_16
Ozbas Gok S, Akin Belli A, Dervis E. Is there really relationship between androgenetic alopecia and metabolic syndrome? Dermatol Res Pract 2015; 2015: 980310.
https://doi.org/10.1155/2015/980310 DOI: https://doi.org/10.1155/2015/980310
Wu D-x, Wu L-f, Yang Z-x. [Association between androgenetic alopecia and metabolic syndrome: a meta-analysis]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2014; 43: 597-601 (in Chinese).
Caro-Chang LAM, Gervasio MKR, Yap-Silva C. Androgenetic alopecia and its association with metabolic syndrome: a systematic review and meta-analysis. Acta Medica Philippina 2019; 53: 122-131.
https://doi.org/10.47895/amp.v53i2.175 DOI: https://doi.org/10.47895/amp.v53i2.175
Trieu N, Eslick GD. Alopecia and its association with coronary heart disease and cardiovascular risk factors: a meta-analysis. Int J Cardiol 2014; 176: 687-695.
https://doi.org/10.1016/j.ijcard.2014.07.079 DOI: https://doi.org/10.1016/j.ijcard.2014.07.079
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603-605.
https://doi.org/10.1007/s10654-010-9491-z DOI: https://doi.org/10.1007/s10654-010-9491-z
Huedo-Medina TB, Sánchez-Meca J, Marín-Martínez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 2006; 11: 193-206.
https://doi.org/10.1037/1082-989X.11.2.193 DOI: https://doi.org/10.1037/1082-989X.11.2.193
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560.
https://doi.org/10.1136/bmj.327.7414.557 DOI: https://doi.org/10.1136/bmj.327.7414.557
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629-634.
https://doi.org/10.1136/bmj.315.7109.629 DOI: https://doi.org/10.1136/bmj.315.7109.629
Acibucu F, Kayatas M, Candan F. The association of insulin resistance and metabolic syndrome in early androgenetic alopecia. Singapore Med J 2010; 51: 931-936.
Alam M, Amin SS, Adil M, Mohtashim M, Mushtaq S, Priya A. Prevalence of metabolic syndrome and its components in early onset androgenetic alopecia: a case control study from a north Indian tertiary care hospital. Turkiye Klinikleri Dermatoloji 2018; 28: 87-92.
https://doi.org/10.5336/dermato.2018-63562 DOI: https://doi.org/10.5336/dermato.2018-63562
Arias-Santiago S, Gutiérrez-Salmerón MT, Castellote-Caballero L, Buendía-Eisman A, Naranjo-Sintes R. Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study. J Am Acad Dermatol 2010; 63: 420-429.
https://doi.org/10.1016/j.jaad.2009.10.018 DOI: https://doi.org/10.1016/j.jaad.2009.10.018
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: 276-281.
https://doi.org/10.4103/2229-5178.137776 DOI: https://doi.org/10.4103/2229-5178.137776
Banger HS, Malhotra SK, Singh S, Mahajan M. Is early onset androgenic alopecia a marker of metabolic syndrome and carotid artery atherosclerosis in young Indian male patients? Int J Trichol 2015; 7: 141-147.
https://doi.org/10.4103/0974-7753.171566 DOI: https://doi.org/10.4103/0974-7753.171566
Behrangi E, Azizian Z, Ardestani FS, Najafi Z, Vakili SH. Association of androgenic alopecia with metabolic syndrome. Ann Med Health Sci Res 2018; 8: 91-93.
Chakrabarty S, Hariharan R, Gowda D, Suresh H. Association of premature androgenetic alopecia and metabolic syndrome in a young Indian population. Int J Trichology 2014; 6: 50-53.
https://doi.org/10.4103/0974-7753.138586 DOI: https://doi.org/10.4103/0974-7753.138586
Dharam Kumar KC, Kishan Kumar YH, Neladimmanahally V. Association of androgenetic alopecia with metabolic syndrome: a case-control study on 100 patients in a tertiary care hospital in south India. Indian J Endocrinol Metab 2018; 22: 196-199.
https://doi.org/10.4103/ijem.IJEM_650_17 DOI: https://doi.org/10.4103/ijem.IJEM_650_17
El Sayed MH, Abdallah MA, Aly DG, Khater NH. Association of metabolic syndrome with female pattern hair loss in women: a case-control study. Int J Dermatol 2016; 55: 1131-1137.
https://doi.org/10.1111/ijd.13303 DOI: https://doi.org/10.1111/ijd.13303
Ertas R, Orscelik O, Kartal D, Dogan A, Ertas SK, Aydogdu EG, et al. Androgenetic alopecia as an indicator of metabolic syndrome and cardiovascular risk. Blood Press 2016; 25: 141-148.
https://doi.org/10.3109/08037051.2015.1111021 DOI: https://doi.org/10.3109/08037051.2015.1111021
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: 494-499.
https://doi.org/10.1111/j.1365-2265.2008.03508.x DOI: https://doi.org/10.1111/j.1365-2265.2008.03508.x
Mustafa AI, Abel Halim WAE, Eman F, Doaa EH. Metabolic syndrome in androgenetic alopecia patients; is serum regulated on activation, normal T-cell expressed and secreted the missing link? J Cosmet Dermatol 2021; 20: 2270-2276.
https://doi.org/10.1111/jocd.13802 DOI: https://doi.org/10.1111/jocd.13802
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: 947-951.
Sheikh FZ, Butt G, Hafeez R, Maqsood A, Altaf F, Hussain I. Association of early-onset androgenetic alopecia and metabolic syndrome. J Coll Physicians Surg Pak 2021; 31: 123-127.
https://doi.org/10.29271/jcpsp.2021.02.123 DOI: https://doi.org/10.29271/jcpsp.2021.02.123
Taheri AR, Afkhamizadeh M, Sabourirad S, Hassani O, Ghanizadeh S. The association of androgenetic alopecia with metabolic syndrome: a case control study on Iranian population. Iran J Dermatol 2019; 22: 129-132.
Vayá A, Sarnago A, Ricart JM, López V, Martínez-Triguero ML, Laiz B. Inflammatory markers and Lp(a) levels as cardiovascular risk factors in androgenetic alopecia. Clin Hemorheol Microcirculat 2015; 61: 471-477.
https://doi.org/10.3233/CH-141913 DOI: https://doi.org/10.3233/CH-141913
DeBoer MD. Assessing and managing the metabolic syndrome in children and adolescents. Nutrients 2019; 11.
https://doi.org/10.3390/nu11081788 DOI: https://doi.org/10.3390/nu11081788
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 2735-2752.
https://doi.org/10.1161/CIRCULATIONAHA.105.169404 DOI: https://doi.org/10.1161/CIRCULATIONAHA.105.169404
Cotton SG, Nixon JM, Carpenter RG, Evans DW. Factors discriminating men with coronary heart disease from healthy controls. Br Heart J 1972; 34: 458-464.
https://doi.org/10.1136/hrt.34.5.458 DOI: https://doi.org/10.1136/hrt.34.5.458
Lie C, Liew CF, Oon HH. Alopecia and the metabolic syndrome. Clin Dermatol 2018; 36: 54-61.
https://doi.org/10.1016/j.clindermatol.2017.09.009 DOI: https://doi.org/10.1016/j.clindermatol.2017.09.009
Hamada K, Randall VA. Inhibitory autocrine factors produced by the mesenchyme-derived hair follicle dermal papilla may be a key to male pattern baldness. Br J Dermatol 2006; 154: 609-618.
https://doi.org/10.1111/j.1365-2133.2006.07144.x DOI: https://doi.org/10.1111/j.1365-2133.2006.07144.x
Fujimoto R, Morimoto I, Morita E, Sugimoto H, Ito Y, Eto S. Androgen receptors, 5 alpha-reductase activity and androgen-dependent proliferation of vascular smooth muscle cells. J Steroid Biochem Mol Biol 1994; 50: 169-174.
https://doi.org/10.1016/0960-0760(94)90025-6 DOI: https://doi.org/10.1016/0960-0760(94)90025-6
Yaribeygi H, Farrokhi FR, Butler AE, Sahebkar A. Insulin resistance: review of the underlying molecular mechanisms. J Cell Physiol 2019; 234: 8152-8161.
https://doi.org/10.1002/jcp.27603 DOI: https://doi.org/10.1002/jcp.27603
De Sousa SMC, Norman RJ. Metabolic syndrome, diet and exercise. Best Pract Res Clin Obstet Gynaecol 2016; 37: 140-151.
https://doi.org/10.1016/j.bpobgyn.2016.01.006 DOI: https://doi.org/10.1016/j.bpobgyn.2016.01.006
Cannarella R, La Vignera S, Condorelli RA, Calogero AE. Glycolipid and hormonal profiles in young men with early-onset androgenetic alopecia: a meta-analysis. Sci Rep 2017; 7: 7801.
https://doi.org/10.1038/s41598-017-08528-3 DOI: https://doi.org/10.1038/s41598-017-08528-3
How to Cite
Copyright (c) 2021 Yueqi Qiu, Xingyu Zhou, Siqi Fu, Shuaihantian Luo, Yaping Li
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.