Influence of maternal stature, pregnancy age, and infant birth weight on growth during childhood in Yucatan, Mexico: a test of the intergenerational effects hypothesis

In developing nations, obesity has increased dramatically in the last decade, but a high prevalence of stunting still coexists. The intergenerational influences hypothesis (IIH) is one explanation for this. We test the IIH regarding variation in maternal stature, mother's age at pregnancy, and infant birth weight in relation to risk for overweight and stunting in 206 Maya children (4-6 years old) from Mérida, Yucatan, Mexico. The Maya children are compared with growth references (Frisancho 2008: Anthropometric Standards: An Interactive Nutritional Reference of Body Size and Body Composition for Children and Adults. Ann Arbor, MI: The University of Michigan Press. 335 pp) for height, weight, and body mass index (BMI). Almost 70% of the mothers are shorter than 150 cm. Mothers' height and child's birth weight predict overweight. Children with a mother shorter than 150 cm are less than half as likely (OR = 0.44) to be overweight compared to children whose mothers are equal to or taller than 150 cm. Children with birth weights below 3,000 g are only a third as likely to be overweight (OR = 0.28) than their peers within the range of normal birth weight (3,000-3,500 g). Sex of the child, mother's height, and birth weight predict stunting. Girls are only 40% as likely as boys to be stunted. Children with a mother below 150 cm are 3.6 times more likely of being stunted. Children with birth weights below 3000 g are over 3 times more likely to be stunted relative to children with birth weights within the normal range. Mother's age at pregnancy is not a predictor of overweight or stunting. Our findings conform the IIH and with similar studies of populations undergoing nutritional/epidemiological transitions from traditional to globalized lifestyles.

Associação entre o estado nutricional antropométrico e a situação sócio-econômica de adolescentes em Niterói, Rio de Janeiro, Brasil

Investigou-se a relação entre o estado nutricional e a situação sócio-econômica familiar de adolescentes moradores de Niterói, Rio de Janeiro, Brasil. Os dados de 523 adolescentes, pertencentes a uma amostra probabilística de 1.734 domicílios, foram coletados entre janeiro e dezembro de 2003 e representam os 71.922 jovens residentes em Niterói. As análises incluíram a estimação de intervalos de confiança de razões de prevalência e testes de distribuições proporcionais e de independência entre classes de estado nutricional e classes de renda familiar per capita e as faixas de número de moradores do domicílio. Foi encontrada uma associação positiva significativa entre baixo peso/magreza e o número de moradores do domicílio (sexo masculino: p < 0,05; sexo feminino: p < 0,001). O número de moradores do domicílio encontra-se diretamente associado ao baixo peso/magreza em adolescentes. Foi evidenciada uma tendência positiva de aumento na proporção de adolescentes com sobrepeso/obesidade segundo os quintos de renda familiar per capita.

The role of advocacy and interpretation services in the delivery of quality healthcare to diverse minority communities in London, United Kingdom

Inequalities in access to appropriate and acceptable healthcare contributes to a pattern of poorer health status, reduced life expectancy and greater dissatisfaction with healthcare amongst people from Black and minority ethnic communities (BME). Language acts as a further barrier to access. The development of bilingual advocacy fuses two key functions--interpretation and advocacy--to ensure that people from BME communities are able to have their healthcare needs met appropriately. This paper explores the development of bilingual advocacy in East London, which has a highly diverse population speaking over 100 different languages. It considers the development of the bilingual advocacy services by an NHS University Hospital Trust, the local experience of these services and the factors that have influenced their development. We employed the Delphi method amongst the four authors to examine the advocate-, service- or client-related challenges that face advocacy services; and the threats of these challenges to Trust-based advocacy and their implications to the service, client and advocate. Advocate-related challenges included status, esteem and remuneration of bilingual advocates in relation to other health professionals, as well as skills development, career progression, gender, capacity building and potential research contributions. Service-related challenges included work load, case mix, administration, commissioning processes/arrangements; entrepreneurial aspects of advocacy services; and mechanisms/potentials for cost recovery. Client-related challenges included continuity of advocacy; language requirements and advocacy needs of clients; and ways in which mobile populations influence planning and delivery of advocacy services for inner city hospitals. The paper concludes with identifying the implications for future development of bilingual advocacy services and the implications for their workforce.

Persistence of nucleic acid markers of health-relevant organisms in seawater microcosms: implications for their use in assessing risk in recreational waters

In the last decade, the use of culture-independent methods for detecting indicator organisms and pathogens in recreational waters has increased and has led to heightened interest in their use for routine water quality monitoring. However, a thorough understanding of the persistence of genetic markers in environmental waters is lacking. In the present study, we evaluate the persistence of enterococci, enterovirus, and human-specific Bacteroidales in seawater microcosms. Two microcosms consisted of seawater seeded with human sewage. Two additional seawater microcosms were seeded with naked Enterococcus faecium DNA and poliovirus RNA. One of each replicate microcosm was exposed to natural sunlight; the other was kept in complete darkness. In the sewage microcosms, concentrations of enterococci and enterovirus were measured using standard culture-dependent methods as well as QPCR and RT-QPCR respectively. Concentrations of human-specific Bacteroidales were determined with QPCR. In the naked-genome microcosms, enterococci and enterovirus markers were enumerated using QPCR and RT-QPCR, respectively. In the sewage microcosm exposed to sunlight, concentrations of culturable enterococci fell below the detection limit within 5 days, but the QPCR signal persisted until the end of the experiment (day 28). Culturable enterococci did not persist as long as infectious enteroviruses. The ability to culture enteroviruses and enterococci was lost before detection of the genetic markers was lost, but the human-specific Bacteroidales QPCR signal persisted for a similar duration as infectious enteroviruses in the sewage microcosm exposed to sunlight. In the naked-genome microcosms, DNA and RNA from enterococci and enterovirus, respectively, persisted for over 10d and did not vary between the light and dark treatments. These results indicate differential persistence of genetic markers and culturable organisms of public health relevance in an environmental matrix and have important management implications.

The association between high plasma homocysteine levels and lower bone mineral density in Slovak women: the impact of vegetarian diet

BACKGROUND

A long-term vegetarian diet is generally poor in vitamin B group. The lack of vitamin B(12) together with vitamin B(6) and folate deficiency is closely related to homocysteine metabolism. Hyperhomocysteinemia was found to be associated with increased bone turnover markers and increased fracture risk. Thus, hyperhomocysteinemia, vitamin B(12) and folate deficiency may be regarded as novel risk factors for micronutrient deficiency-related osteoporosis.

AIM OF THE STUDY

To assess the possible impact of a vegetarian diet on bone mineral density in cohort of Slovak vegetarian women.

METHODS

Fasting serum glucose, albumin, calcium, phosphorous and creatinine as well as bone markers, serum vitamin B(12), folate and plasma levels of total homocysteine were assessed in two nutritional groups (vegetarians vs. nonvegetarians) of apparently healthy women (age range 20-70 years). Bone mineral density of the femoral neck, trochanter, total femur and lumbar spine was measured in all subjects.

RESULTS

Vegetarians had a significantly lower weight (p < 0.05), higher PTH (p < 0.01) and homocysteine (p < 0.001). Vitamin B(12) was significantly higher in nonvegetarians (p < 0.001). No differences were observed in folate levels. Univariate analysis showed significant association between homocysteine and B(12) (p < 0.01), folate (p < 0.001), creatinine (p < 0.001), total proteins (p < 0.049), age (p < 0.001) and vegetarian food intake (p < 0.001). Vegetarians had a significantly lower TrFBMD (p < 0.05) and ToFBMD (p < 0.05). Age and CTx were significant predictors in all sites of measured BMD and PTH. A strong correlation between homocysteine and FNBMD (r = -0.2009, p < 0.002), TrFBMD (r = -0.1810, p < 0.004) and ToFBMD (r = -0.2225, p < 0.001) was found in all subjects.

CONCLUSION

Homocysteine is one of the predictors of bone mineral density, and hyperhomocysteinemia is associated with lower bone mineral density. In healthy adults, homocysteine levels are dependent on age as well as on nutritional habits. Thus, elderly women on a vegetarian diet seem to be at higher risk of osteoporosis development than nonvegetarian women.

Breast-feeding and overweight in Singapore school children

BACKGROUND

Studies from developed Western countries have shown inconsistent associations between breast-feeding and overweight/obesity in children and adolescents. Few data are available from Asian populations. The purpose of the present study was therefore to evaluate the association between breast-feeding and overweight/obesity in a study of 10-12-year-old children in Singapore.

METHODS

A total of 797 school children (49% girls, 76% Chinese) who participated in the Singapore Cohort Study of the Risk Factors for Myopia (SCORM) were examined. Overweight/obesity (n = 179) was defined as age-sex-specific body mass index (BMI) cut-offs corresponding to BMI of 25 kg/m(2) for overweight and 30 kg/m(2) for obesity at age 18 based on the International Obesity Task Force (IOTF) reference.

RESULTS

The prevalence of overweight/obesity was 22.5%. Overall, breast-feeding was not found to be associated with overweight/obesity. After adjusting for potential confounders, the multivariable odds ratio (95% confidence interval) of overweight/obesity was 1.14 (0.80-1.63) for ever breast-fed compared with never breast-fed, 1.00 (0.57-1.72) for breast-fed for >3 months compared to < or =3 months and 0.79 (0.47-1.34) for exclusive/mostly breast-fed compared to partly breast-fed.

CONCLUSIONS

No significant associations were detected among breast-feeding, its type, and duration with overweight/obesity in this Asian cohort of 10-12-year-old children.

Androgenetic alopecia and insulin resistance in young men

BACKGROUND

Epidemiological studies have associated androgenetic alopecia (AGA) with severe young-age coronary artery disease and hypertension, and linked it to insulin resistance. We carried out a case-control study in age- and weight-matched young males to study the link between AGA and insulin resistance using the homeostasis model assessment of insulin resistance (HOMA-IR) index or metabolic syndrome clinical manifestations.

METHODS

Eighty young males, 18-35 years old, with AGA > or = stage III in the Hamilton-Norwood classification, and 80 weight- and age-matched controls were included. Alopecia, glucose, serum insulin, HOMA-IR index, lipid profile and androgen levels, as well as metabolic syndrome criteria, were evaluated.

RESULTS

The HOMA-IR index was significantly higher in cases than controls. Nonobese cases had a higher mean diastolic blood pressure and a more frequent family history of AGA than nonobese controls. A borderline difference in the HOMA-IR index was found in obese AGA cases vs. obese controls [P = 0.055, 95% confidence interval (CI) 2.36-4.20 vs. 1.75-2.73]. Free testosterone values were significantly higher in controls than cases, regardless of body mass index (BMI). A statistically significant additive effect for obesity plus alopecia was found, with significant trends for insulin, the HOMA-IR index, lipids and free testosterone when BMI and alopecia status were used to classify the participants.

CONCLUSIONS

Our results support the recommendation for assessing insulin resistance and cardiovascular-related features and disorders in all young males with stage III or higher AGA, according to the Hamilton-Norwood classification.

Examination of the source and extended virulence genotypes of Escherichia coli contaminating retail poultry meat

Extraintestinal pathogenic Escherichia coli (ExPEC) are major players in human urinary tract infections, neonatal bacterial meningitis, and sepsis. Recently, it has been suggested that there might be a zoonotic component to these infections. To determine whether the E. coli contaminating retail poultry are possible extraintestinal pathogens, and to ascertain the source of these contaminants, they were assessed for their genetic similarities to E. coli incriminated in colibacillosis (avian pathogenic E. coli [APEC]), E. coli isolated from multiple locations of apparently healthy birds at slaughter, and human ExPEC. It was anticipated that the retail poultry isolates would most closely resemble avian fecal E. coli since only apparently healthy birds are slaughtered, and fecal contamination of carcasses is the presumed source of meat contamination. Surprisingly, this supposition proved incorrect, as the retail poultry isolates exhibited gene profiles more similar to APEC than to fecal isolates. These isolates contained a number of ExPEC-associated genes, including those associated with ColV virulence plasmids, and many belonged to the B2 phylogenetic group, known to be virulent in human hosts. Additionally, E. coli isolated from the crops and gizzards of apparently healthy birds at slaughter also contained a higher proportion of ExPEC-associated genes than did the avian fecal isolates examined. Such similarities suggest that the widely held beliefs about the sources of poultry contamination may need to be reassessed. Also, the presence of ExPEC-like clones on retail poultry meat means that we cannot yet rule out poultry as a source of ExPEC human disease.

Sleep, hunger, satiety, food cravings, and caloric intake in adolescents

BACKGROUND AND PURPOSE

Prevalence of adolescent obesity has increased worldwide. Although diet and exercise patterns are major determinants of weight, recent studies with adults and children have shown that total amount of sleep is inversely associated with body mass index (BMI). The purpose of this study was to examine associations among total sleep time (TST), hunger, satiety, food cravings, and caloric intake in a sample of healthy adolescents. DESIGN-METHODS: Participants were recruited from the community and a local high school. Demographic data such as sleeping habits, pubertal status, food cravings, caloric intake, physical activity, height, and weight were collected between October 2006 and April 2007. Participants also completed a 7-day sleep-hunger-satiety diary. Descriptive and parametric procedures were used for data analyses (alpha=.05).

FINDINGS

The sample (N=85) included 56% females (n=48), 76% African American (n=65) adolescents. Mean age was 15.6+/-1.4 years and mean BMI was 24.3+/-5.4 kg/m(2). Mean reported 7-day cumulative nocturnal sleep was 52.9 (+/-6.0) hours; mean reported cumulative daytime sleep (or napping) was 3.7 (+/-3.4) hours. Multiple regression analyses showed age, gender, and race were associated with feelings of hunger, satiety, total food cravings and caloric intake. A greater total food-cravings score was associated with increased daytime sleep.

CONCLUSIONS

These findings indicate an unexpected association between increased daytime sleep and eating behaviors that potentially lead to obesity. Longitudinal studies using objective measures of sleep, appetite regulation, and caloric intake are needed to better understand relationships between appetite and sleep in adolescents from varying racial and gender groups.

CLINICAL RELEVANCE

By carefully considering adolescent sleep (especially daytime sleep), race, and gender, clinicians and school health nurses in the US and other countries are in a unique position to develop novel approaches to prevent and reduce obesity.

How does the quality of surveys for nutrient intake adequacy assessment compare across Europe? A scoring system to rate the quality of data in such surveys

Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual nutrient intake adequacy (NIA) assessment collected in twenty-eight European countries and the four European Free Trade Association countries; to design and test innovative tools for data quality analysis. The information was obtained using the method described by Blanquer et al. in the present issue. The best-practice criteria were devised to select the most appropriate survey in each country. Then a survey quality scoring system was developed in consultation with experts and tested on these surveys. Weights were allocated according to a variable priority order agreed by consultation. The thirty-two countries yielded twenty-four national surveys (eight countries excluded). Data collection techniques: eleven countries/surveys used personal interviews only; six used combinations of techniques. Dietary assessment methods: two used repeated 24 h recalls only; eleven used combinations. NIA assessment methods: two used probabilistic approach and sd/Z-scores only; eleven used comparison with estimated average requirements/RDA only. Countries were ranked according to the survey quality scoring, but careful interpretation is needed because of incomplete data from some surveys; bearing this in mind, the information quality is high in 37.5 % countries, medium in 50.0 % and low in 12.5 %. Although there is room for improvement and caution should be taken when drawing conclusions and recommendations from these results, the lessons learned and tools developed at this first attempt form the basis for future work within the EURRECA framework for aligning European micronutrient recommendations.

Transmitted drug resistance in nonsubtype B HIV-1 infection

HIV-1 nonsubtype B variants account for the majority of HIV infections worldwide. Drug resistance in individuals who have never undergone antiretroviral therapy can lead to early failure and limited treatment options and, therefore, is an important concern. Evaluation of reported transmitted drug resistance (TDR) is challenging owing to varying definitions and study designs, and is further complicated by HIV-1 subtype diversity. In this article, we discuss the importance of various mutation lists for TDR definition, summarize TDR in nonsubtype B HIV-1 and highlight TDR reporting and interpreting challenges in the context of HIV-1 diversity. When examined carefully, TDR in HIV-1 non-B protease and reverse transcriptase is still relatively low in most regions. Whether it will increase with time and therapy access, as observed in subtype-B-predominant regions, remains to be determined.

The role of leptin, soluble leptin receptor, resistin, and insulin secretory dynamics in the pathogenesis of hypothalamic obesity in children

INTRODUCTION

In this study, we have investigated the role of leptin, soluble leptin receptor(sOb-R), resistin, and insulin secretory dynamics in the development of hypothalamic obesity.

MATERIALS AND METHODS

Children who had hypothalamo-pituitary tumor were divided into two groups. First group included obese-overweight (hypothalamic obese = HOB group, n = 23) and second group included non-obese children (hypothalamic non-obese = HNOB group, n = 16). Exogenously obese-overweight children (OB group, n = 22) were included as controls. Basal and second-hour serum glucose and insulin in oral glucose tolerance test (OGTT), basal serum leptin, sOb-R, resistin levels, and homeostasis model assessment (HOMA) indexes were compared between the groups.

RESULTS

Age, sex, and pubertal status were similar in study groups. Median and interquartile ranges of body mass index (BMI) z scores were similar in HOB and OB groups (2.0 (1.5-2.1) and 2.1 (1.8-2.3), respectively). Serum leptin levels corrected for BMI were highest and total leptin/sOb-R ratios (free leptin index (FLI)) tended to be higher in HOB than HNOB and OB groups, indicating leptin resistance (leptin/BMI, 4.0 (1.6-5.2), 1.5 (0.8-3.1), and 2.5 (1.8-3.5); FLI, 2.0 (0.8-3.5), 0.6 (0.3-1.2), and 1.5 (1-2.3) in HOB, HNOB, and OB groups; respectively). Serum resistin levels were similar in groups (2.6 (1.9-3.1), 2.8 (1.7-3.4), and 3.0 (2.2-3.5) ng/ml in HOB, HNOB, and OB groups, respectively). Basal serum glucose, basal and second-hour insulin levels in OGTT, and HOMA index were higher in OB group than the HOB and HNOB groups, indicating insulin resistance in simple obesity; however, increment of insulin to same glycemic load in OGTT was highest in the HOB group indicating insulin dysregulation (p < 0.05).

CONCLUSION

Hypothalamic obesity seems to be related to both dysregulated afferent (leptin) and efferent (insulin) neural outputs through the autonomic nervous system resulting in energy storage as fat.

Challenges in starting organised screening programmes for cervical cancer in the new member states of the European Union

Following the 2003 Recommendation of the Council of the European Union on cancer screening, equal access to organised cervical cancer screening is supposed to be ensured for all women at risk in all member states. However, the first IARC report on the implementation of the Council Recommendation suggests that a remarkable proportion of women in the new member states are not yet covered with the free Pap tests offered either in organised or opportunistic manners. Cervical cancer incidence and mortality rates in most of these countries are among the highest in Europe. The purpose of this paper is to identify some common challenges and make further proposals in organising and implementing quality-assured cervical cancer screening programmes in these countries. Based on the responses to a corresponding questionnaire, a summary on cervical cancer prevention policies was established for the seven new European Union member states, Czech Republic, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia, and two candidate states, Croatia and Serbia. In most of these countries there are a lot of challenges to overcome before achieving the level of preventive services as seen in Finland and the Netherlands nowadays.

State downsizing as a determinant of infant mortality and achievement of Millennium Development Goal 4

The aim of this study was to evaluate the worldwide effect of state downsizing policies on achievement of U.N. Millennium Development Goal 4 (MDG4) on infant mortality rates. In an ecological retrospective cohort study of 161 countries, from 1978 to 2002, the authors analyzed changes in government consumption (GC) as determining exposure to achievement of MDG4. Descriptive methods and a multiple logistic regression were applied to adjust for changes in gross domestic product, level of democracy, and income inequality. Excess infant mortality in the exposed countries, attributable to reductions in GC, was estimated. Fifty countries were found to have reduced GC, and 111 had increased GC. The gap in infant mortality rate between these groups of countries doubled in the study period. Non-achievement of MDG4 was associated with reductions in GC and increases in income inequality. The excess infant mortality attributable to GC reductions in the exposed countries from 1990 to 2002 was 4,473,348 deaths. The probability of achieving MDG4 seems to be seriously compromised for many countries because of reduced public sector expenditure during the last 25 years of the 20th century, in response to World Bank/International Monetary Fund Washington Consensus policies. This seeming contradiction between the goals of different U.N. branches may be undermining achievement of MDG4 and should be taken into account when developing future global governance policy.

Do users of the intrauterine system (Mirena) have different genital symptoms and vaginal flora than users of the intrauterine contraceptive device?

The copper intrauterine contraceptive device (IUCD) is strongly associated with bacterial vaginosis (BV). Hormonal influences may play a role in the control of vaginal flora. It is unclear whether use of the progesterone-incorporated intrauterine system (IUS; Mirena) is associated with abnormal vaginal flora or genital symptoms. One hundred and seventy-two women were assessed for symptoms and abnormal vaginal flora prior to and at intervals after insertion of either a copper IUCD or an IUS. Women were significantly more likely to have developed an abnormal vaginal discharge 4-6 weeks after insertion of an IUCD compared with an IUS (27% cf. 14%, P = 0.04), although this trend was not significant six months postinsertion. More women with an IUCD developed BV compared with an IUS at 4-6 weeks and six months. However, there were insufficient numbers of women with BV to demonstrate any significant difference between the vaginal flora of the two groups.

Fast-food and sweetened beverage consumption: association with overweight and high waist circumference in adolescents

Objective

Overweight and obesity have increased to epidemic proportions among adolescents and are associated with chronic non-communicable diseases and excess mortality in adulthood. The association of overweight/obesity with poor dietary habits has not been studied in adolescents in middle-income developing countries. The present study aimed to estimate the prevalence of overweight, obesity and high waist circumference (WC) in 15–19-year-old Jamaican adolescents and to investigate the association with fast-food and sweetened beverage consumption.

Design

The study enrolled 1317 (598 male, 719 female) adolescents aged 15–19 years using multistage, nationally representative sampling. Age-specific prevalence calculation used internal Z-score lines connecting with the WHO adult cut-off points. Logistic regression was used to examine the association of overweight or high WC with fast-food and sweetened beverage consumption, adjusting for potential confounders.

Results

The overall prevalence of overweight, obesity and high WC was approximately 15 %, 6 % and 10 %, respectively. Prevalence estimated using internal Z-scores was similar to that using the International Obesity Taskforce cut-off points. Obesity (8·0 % in females, 3·3 % in males) and high WC (16·2 % in females, 1·7 % in males) were significantly more prevalent in females when using internal Z-score cut-offs. High WC was associated with the absence of fruit consumption (P = 0·043) and overweight with high sweetened beverage consumption (P = 0·018).

Conclusion

Overweight occurs frequently among Jamaican 15–19-year-olds and is associated with increased consumption of sweetened beverages. High WC is more prevalent among females and is related to low consumption of fruits and vegetables. Measures to reduce the consumption of sweetened beverages and increase fruit intake may reduce the prevalence of excess body fat among adolescents.

Factors influencing quality of life of people living with HIV in Estonia: a cross-sectional survey

Background

Identification of factors that determine quality of life is important in order to better tailor health and social care services, and thereby improve the functioning and well being of people living with HIV. The estimated number of people living with HIV in eastern Europe and central Asia is 1.6 million. Little is known about the quality of life of people living with HIV in this region. The main purpose of the present study was to identify the factors influencing quality of life in a sample of HIV-infected persons in Estonia.

Methods

A convenient sample of 451 patients attending three infectious diseases clinics for routine HIV clinical care visits was recruited for a cross-sectional survey. The World Health Organization's Quality of Life HIV instrument was used to measure quality of life of the participants and medical data was abstracted from clinical records.

Results

Good overall quality of life was reported by 42.6% (95% CI: 38.0–47.2%) of the study participants (53% men, 60% self-identify as injecting drug users, 82% <30 years of age, 30% with CD4+ T cell count <300 cells/mm³, and 22% on antiretroviral treatment). We identified the following variables as independent predictors of good overall quality of life: being currently employed or studying (AOR: 2.27, 95% CI: 1.18–4.38); and the absence of HIV-related symptoms (AOR: 2.31, 95% CI: 1.24–4.29).

Conclusion

A comprehensive and competent care system, including health care providers and social workers, is required for an effective response. In addition, social interventions should seek to enhance the economic and employment opportunities for people living with HIV in the region.

Food consumption frequency and perceived stress and depressive symptoms among students in three European countries

BACKGROUND

Certain foods might be more frequently eaten under stress or when higher levels of depressive symptoms are experienced. We examined whether poor nutritional habits are associated with stress and depressive symptoms and whether the relationships differ by country and gender in a sample from three European countries collected as part of a Cross National Student Health Survey.

METHODS

A cross-sectional survey was conducted among first-year students in Germany (N = 696), Poland (N = 489) and Bulgaria (N = 654). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale, and a modified Beck Depression Index. Linear regression analyses were conducted for two outcomes, perceived stress and depressive symptoms.

RESULTS

Food consumption frequencies differed by country and gender, as did depressive symptoms and perceived stress. For male students, none of the food consumption groups were associated with perceived stress or depressive symptoms. In females, perceived stress was associated with more frequent consumption of sweets/fast foods and less frequent consumption of fruits/vegetables. Additionally, depressive symptoms were associated with less frequent consumption of fruits/vegetables and meat.

CONCLUSION

Our data show consistent associations between unhealthy food consumption and depressive symptoms and perceived stress among female students from three European countries, but not among male students. This suggests that efforts to reduce depressive symptoms and stress among female students may also lead to the consumption of healthier foods and/or vice-versa.

Comparing public-health research priorities in Europe

BACKGROUND

Despite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges.

METHODS

Public-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe). There was participation of ministries in 18 of 28 (64% response) European countries, from 22 of 39 (56% response) member national associations of the European Public Health Association, and from 80 civil society health organisations (53% of members of the European Public Health Alliance)

RESULTS

Public-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied but well-defined areas for research in relation to national health plans and programmes. National public health associations reported research priorities across most fields of public health, although with some European regional differences. Civil society health organisations prioritised health promotion research nationally, but also health services research internationally. There was less research reported on methods, such as modelling and economic analysis, wider determinants of health, and public-health interventions.

CONCLUSION

Systematic collaboration between stakeholders across European countries would enhance knowledge and promote innovation to address contemporary public-health challenges.

Comparing public-health research priorities in Europe

BACKGROUND

Despite improving trends, countries in Europe continue to face public-health challenges. This study investigated the priorities of stakeholders for research to meet these challenges.

METHODS

Public-health research includes population-level and health-system research, but not clinical or biomedical research. The study drew on data from three surveys undertaken through collaboration in SPHERE (Strengthening Public Health Research in Europe). There was participation of ministries in 18 of 28 (64% response) European countries, from 22 of 39 (56% response) member national associations of the European Public Health Association, and from 80 civil society health organisations (53% of members of the European Public Health Alliance)

RESULTS

Public-health research fields included disease control, health promotion and health services. Ministries of health, rather than ministries of science or education, mostly took responsibility for public-health research: they reported varied but well-defined areas for research in relation to national health plans and programmes. National public health associations reported research priorities across most fields of public health, although with some European regional differences. Civil society health organisations prioritised health promotion research nationally, but also health services research internationally. There was less research reported on methods, such as modelling and economic analysis, wider determinants of health, and public-health interventions.

CONCLUSION

Systematic collaboration between stakeholders across European countries would enhance knowledge and promote innovation to address contemporary public-health challenges.

Long-Term Fish Intake Is Associated With Less Severe Depressive Symptoms Among Elderly Men and Women

Objective: This work aims at exploring the association between fish intake and depressive symptoms, in older adults. Method: During 2005-2007, 1,190 men and women (>65 years) free living in various Greek islands and in Cyprus participated in the study. Depressive symptoms were assessed using the validated Geriatric Depression Scale (GDS), and foods intake through a Food Frequency Questionnaire. Results: Almost 70% of the participants scored above the depressive cutoff (i.e., GDS score > 5), with women having higher values. People classified under the 1st tertile of GDS score (i.e., GDS ≤ 5) were more educated, physically active, and report higher fish consumption. One portion increase of fish consumption per week was associated with 0.58 times (95% confidence interval: 0.45-0.73) lower likelihood of having GDS score above the clinical threshold, after various adjustments were made. Discussion: These findings may assist public health policy makers in better preventing emotional disorders among the elderly by promoting healthier eating habits.

Clinical implications of icaA and icaD genes in coagulase negative staphylococci and Staphylococcus aureus bacteremia in febrile neutropenic pediatric cancer patients

BACKGROUND

Staphylococci are the most frequently isolated organisms from blood cultures of febrile neutropenic (FN) cancer patients. We aimed to define the nature of these isolates by studying the prevalence of icaA and icaD genes in coagulase-negative staphylococci (CoNS) and Staphylococcus aureus isolates in relation to clinical and microbiological features.

PROCEDURE

Fifty-five CoNS and S. aureus isolates from blood cultures of FN pediatric patients receiving chemotherapy were tested for slime production using Congo red agar plate test (CRA test), and for the presence of icaA and icaD genes by PCR.

RESULTS

Of the CoNS isolates, eight were positive for ica genes, and three were slime positive/ica negative. A total of 11 (24.4%) cases of CoNS bacteremia were either ica genes or CRA test positive. There was a concordance between ica genes and CRA test positivity (P < 0.001). S. aureus isolates exhibited icaA and icaD genes more than CoNS isolates (P = 0.03). Vancomycin was significantly more prescribed in episodes of ica-positive cases (P = 0.029).

CONCLUSIONS

The results of the present study support the hypothesis that the ica genes are important virulence markers for clinically significant CoNS isolates, indicating their ability to produce slime. This could be used to assign a group with higher risk FN. On the other hand, absence of these genes may permit, along with other clinical criteria, the consideration of a low-risk FN episode and allow for safe early discharge.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery

BACKGROUND

The prevalence of obesity in developed countries has reached alarming levels, doubling in the United States since 1980. Although obese patients with chronic low back pain are frequently advised to lose weight, the association between these medical conditions remains unproven.

PURPOSE

This study prospectively assessed clinically reported changes in chronic axial low back pain symptoms after weight reduction from bariatric surgery for morbid obesity.

STUDY DESIGN

Prospective longitudinal study.

PATIENT SAMPLE

Fifty-eight consecutive patients with morbid obesity and chronic axial low back pain undergoing bariatric surgery over a period of 6 months. Patients were considered morbidly obese if they were 50% to 100% above their ideal body weight or having a body mass index (BMI) greater than 40.

OUTCOME MEASURES

Visual Analog Scale (VAS) for axial low back pain, Short Form-36 (SF-36) Health Survey, and Oswestry Disability Index (ODI) METHODS: Patients undergoing weight reduction surgery were assessed preoperatively and postoperatively at 12 months with validated clinical measures for axial back pain and disability (VAS, SF-36, and ODI). Bariatric surgery parameters included demographic data, weight, and BMI. Statistical analysis included paired t tests and multiple regression techniques.

RESULTS

Of the initial 58 patients, 38 (65%) completed both preoperative (Pre-Op) and postoperative (Post-Op) questionnaires at 12 months. These 38 subjects included 30 women and 8 men, with an age range of 20 to 68 years (mean 48.4+/-10.1). Overall, these patients showed a decrease in mean weight from 144.52+/-41.21kg Pre-Op to 105.59+/-29.24 Post-Op (p<.0001) and BMI from 52.25+/-12.61kg/m(2) Pre-Op to 38.32+/-9.66 Post-Op (p<.0001). Patients demonstrated a statistically significant mean 44% decrease in axial back pain on the VAS scale (p=.006; 5.2+/-3.35 Pre-Op, to 2.9+/-3.1 Post-Op). Analysis of the SF-36 major components revealed that patients experienced significant increases in mean physical health by 58% (p<.0001; 44.5+/-20.09 to 70.24+/-26.84) and in median mental health by 6% (p=.03; 70+/-7.14 to 73.39+/-11.78). Patients also showed statistically significant 24% decrease in Post-Op ODI score for physical disability (p=.05) from 26.75+/-16.56 Pre-Op to 20.35+/-18.71 Post-Op (p=.05).

CONCLUSION

This study suggests that the substantial weight reduction after bariatric surgery may be associated with moderate reductions in preexisting back pain at early-follow-up. This effect did not appear to be the result only of an overall improvement in well-being associated with weight loss. However, larger randomized controlled clinical studies with longer-term follow-up are needed to definitively determine a causal relationship.

Androgens and hair loss

PURPOSE OF REVIEW

Androgenetic alopecia (AGA) or male pattern hair loss is a very common condition that has a significant psychosocial impact for patients. Many advances in the pathogenesis and treatment of AGA have been discovered recently. We discuss the pathogenesis and treatment of AGA.

RECENT FINDINGS

Wide genome analysis showed an association of AGA and chromosome 20pll in addition to androgen-receptor gene. Also, a locus on chromosome 3q26 was found to have a linkage with AGA. Dutasteride has been shown to be more effective than finasteride in the treatment of AGA but is not yet a recommended therapy. In an in-vitro study, a new topical liposomal finasteride formulation showed more than five-fold higher deposition of drug in skin than the corresponding plain drug solution.

SUMMARY

These recent developments in the field of AGA hold some promise and may play a role in the future management.

Vulnerability to drug-related infections and co-infections among injecting drug users in Budapest, Hungary

BACKGROUND

Drug-related infectious diseases are among the major health consequences of drug use, and any existing drug-related infection may predispose injecting drug users (IDUs) to other infections.

METHODS

We assessed among IDUs in Budapest, Hungary the prevalence of and vulnerability to selected drug-related infections and co-infections. The sample consisted of 186 participants recruited between October 2005 and December 2006.

RESULTS

We found 0% HIV, 37% HCV, 24% HAV, and 14% past HBV infection. Infections with Herpes 1 or 2, tuberculosis, Chlamydia, syphilis, and gonorrhoea were 79%, 12%, 7%, 4%, and 0%, respectively. Co-infection with HAV/HCV was 12%, HBV/HCV 9%, HAV/HBV 7%, and HAV/HBV/HCV 4%. Those over age 30, the ethnic Roma, and the homeless were more likely to have any hepatitis and a higher number of drug-related infections. Amphetamine injectors were more likely to have a higher number of drug-related infections and those who travelled within Hungary were more likely to have any STI. However, those who worked at least part time and those who were in treatment were less likely to have drug-related infections.

CONCLUSIONS

These results highlight the need of interventions in Hungary to reach and focus on marginalized (Roma or homeless) IDUs and address not only injecting and sex risk, but also hygienic living and injecting conditions. Furthermore, structural interventions to increase social integration (working or being in treatment) may improve welfare and decrease drug use and infection risk tied to drug use/injection among disadvantaged, marginalized, mostly minority populations.

Short-term association between air pollution and emergency room admissions for chronic obstructive pulmonary disease in Nis, Serbia

The present study assesses the short-term association between black smoke (BS) and sulphur dioxide (SO2) levels in urban air and the daily number of emergency room admissions for chronic obstructive pulmonary disease (COPD) in Nis, Serbia. Generalised linear models extending Poisson regression were fitted controlling for time trend, seasonal variations, days of the week, temperature, relative humidity, air pressure, precipitation, rainfall, snowfall, overcast, and wind velocity. The emergency room admissions for all ages for COPD were significantly associated with previous-day level of BS and lag 0-2 (1,60% and 2,26% increase per 10 microg/m3, respectively). After controlling for SO2, single lagged (lag 1 and lag 2) as well as mean lagged values of BS (up to lag 0-3) were significantly associated with COPD emergencies. No effect was found for SO2, even after controlling for black smoke. The present findings support the conclusion that current levels of ambient BS may have an effect on the respiratory health of susceptible persons.

The effects of family history and personal experiences of illness on the inclination to change health-related behaviour

The aim of the present study was to examine how a personal experience of illness and a family history of cardiovascular disease (CVD), adjusted for sex, level of education and nationality, affect risk behaviour. Participants were 1,011 and 1,043, 50-year-old men and women from Sweden and Poland, respectively, who were recruited from a primary health care screening programme. Family history, personal experience of illness and risk behaviour (smoking and exercise habits, BMI level) were self-reported. The results showed that smoking behaviour was affected by a personal experience of illness but not by a family history of CVD. No effects of these variables were found on the remaining risk-related variables tested in this study. These results suggest that individuals with a personal experience of illness may be more inclined to change smoking behaviour than the average person. Smoking prevention strategies may therefore benefit from targeting this group in particular.

Selected aspects of tobacco control in Croatia

This paper seeks to outline the challenges of tobacco consumption control in the transitional economy of Croatia. It focuses on issues of taxation, high unemployment, and smuggling while attempting to meet European Union (EU) accession requirements for tobacco control legislation that reduces smoking consumption. The issue of tobacco control is not a simple one and requires a multi-pronged approach. While Croatia has made good progress in adopting legislation, it needs to strengthen its efforts both in terms of enforcement and increased taxation of cigarettes.

Gestational diabetes: the need for a common ground

Gestational diabetes mellitus is a substantial and growing health concern in many parts of the world. Certain populations are especially vulnerable to developing this condition because of genetic, social, and environmental factors. Gestational diabetes has serious, long-term consequences for both baby and mother, including a predisposition to obesity, metabolic syndrome, and diabetes later in life. Early detection and intervention can greatly improve outcomes for women with this condition and their babies. Unfortunately, screening and diagnostic tests are not uniform worldwide, which could lead not only to underdiagnosis but also undermanagement of the illness. Here, we report the controversies surrounding the causes, screening, diagnosis, management, and prevention of gestational diabetes, and give specific recommendations for research studies to address the major issues of this medical condition.

Dietary and other lifestyle characteristics of Cypriot school children: results from the nationwide CYKIDS study

BACKGROUND

Dietary and lifestyle behaviors at young ages have been associated with the development of various chronic diseases. Schools are regarded as an excellent setting for lifestyle modification; there is a lack, however, of published dietary data in Cypriot school children. Thus, the objective of this work was to describe lifestyle characteristics of a representative segment of Cypriot school children and provide implications for school health education.

METHODS

The CYKIDS (Cyprus Kids Study) is a national, cross-sectional study conducted among 1140 school children (10.7 +/- 0.98 years). Sampling was stratified and multistage in 24 primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire and three supplementary questionnaires, assessing dietary patterns and behaviors. Adherence to the Mediterranean diet was evaluated by the KIDMED index (Mediterranean Diet Quality Index for children and adolescents). Physical activity was assessed by a 32-item, semi-quantitative questionnaire.

RESULTS

Analysis revealed that 6.7% of the children were classified as high adherers, whereas 37% as low adherers to the Mediterranean diet. About 20% of boys and 25% of girls reported "not having breakfast on most days of the week", while more than 80% of the children reported having meals with the family at least 5 times/week. Some food-related behaviors, such as intake of breakfast, were associated with socio-demographic factors, mostly with gender and the geomorphological characteristics of the living milieu. With respect to physical activity, boys reported higher levels compared to girls, however, one fourth of children did not report any kind of physical activity.

CONCLUSION

A large percentage of Cypriot school children have a diet of low quality and inadequate physical activity. Public health policy makers should urgently focus their attention to primary school children and design school health education programs that target the areas that need attention in order to reduce the future burden of metabolic disorders and chronic diseases.

Factors Associated with the Prevalence of Diabetes Mellitus Among Elderly Men and Women Living in Mediterranean Islands: The MEDIS Study

BACKGROUND

The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and psychological characteristics and the presence of diabetes mellitus, among elderly individuals without known cardiovascular disease.

METHODS

During 2005-2007, 1190 elderly (aged 65 to 100 years) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were enrolled. Socio-demographic, clinical and lifestyle factors were assessed using standard procedures. Diabetes mellitus was defined as fasting blood glucose >125 mg/dl or use of special medication.

RESULTS

21% of males and 23% of females had diabetes. Only 70% of diabetic participants were on a special diet and 76% were receiving pharmaceutical treatment. Diabetic individuals had higher prevalence of hypertension (80% vs. 64%, p < 0.001) and hypercholesterolemia (63% vs. 51%, p < 0.001) and reported lower physical activity status (p < 0.001), compared with non-diabetic participants. After adjusting for various confounders, hypertension and hypercholesterolemia were associated with a 144% (95% CI, 1.37-4.35) and 83% (95% CI, 1.13-2.94) higher likelihood of having diabetes, while moderate and vigorous exercise correlated with a 82% (95% CI, 0.09-0.81) and 67% (95% CI, 0.11-0.97) lower likelihood of diabetes.

CONCLUSIONS

A considerable proportion of our elderly sample had diabetes and other metabolic disorders, almost 25% of which were untreated. Promotion of physical activities, even in the elderly, may contribute to reducing their burden of diabetes and provide them with a better quality of living.

Plant foods and plant-based diets: protective against childhood obesity?

The objective of this article is to review the epidemiologic literature examining the role of plant foods and plant-based diets in the prevention of childhood obesity. Available data suggest a protective effect of ready-to-eat cereal on risk of obesity, although prospective studies are still needed. Studies on fruit and vegetables; grains other than cereal; high-protein foods, including beans, legumes, and soy; fiber; and plant-based dietary patterns are inconsistent or generally null. The evidence base is limited, and most studies are fraught with methodologic limitations, including cross-sectional design, inadequate adjustment for potential confounders, and lack of consideration of reporting errors, stage of growth, and genetic influences. Well-designed prospective studies are needed. The lack of evidence showing an association between plant-based diets and childhood obesity does not mean that such diets should not be encouraged. Plant foods are highlighted in the Dietary Guidelines for Americans, and children do not meet the current recommendations for most plant foods. Although the advice to consume a plant-based, low-energy-dense diet is sound, ethical questions arise concerning the relatively high price of these diets in the United States and the way in which such diets are perceived in other parts of the world. Reducing the burden of childhood obesity, eliminating health disparities, and preventing the further spread of the disease around the globe will require not only policy interventions to ensure that plant foods are affordable and accessible to children of all income levels but also awareness of sociocultural norms that affect consumption.

Obesity and cardiovascular disease: from pathophysiology to risk stratification

Obesity is associated with numerous co-morbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension and others. As obesity is considered to be a major risk factor for atherosclerosis, understanding of the underlying mechanisms leading to obesity and linking obesity with atherogenesis is necessary, for the development of therapeutic strategies against atherosclerosis. The pathophysiology of CVD linked to obesity is an area of intensive research. In this review we examine the role of obesity on CVD, and we focus on specific mechanisms of major importance in atherogenesis, such as the role of adipokines, insulin resistance, endothelial function and cardiac structure with emphasis on the effects of obesity on vascular endothelium and atherosclerosis. We then proceed from the pathophysiology of obesity to clinical practice, and we discuss clinical studies linking obesity with subclinical or overt CVD. We highlight that obesity is an easily assessed cardiovascular risk factor in the clinical setting and strategies to promote optimal body weight should be encouraged.

An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults

Despite the recent increase in the number of HIV infections in Central and Eastern Europe, patterns of sexual behavior have not been extensively researched, particularly among young people. The aim of the present study was to provide a comprehensive assessment of HIV/AIDS-related vulnerability and sexual risk-taking among young adults in Croatia. Data were collected in 2005 using a nationally representative, multi-stage stratified probability sample (n = 1,093) of women and men aged 18-24 years. The focus in this article was on predictors of sexual risk-taking measured by a composite risky sexual behaviors scale. Using hierarchical regression models, we analyzed gendered effects of community, family, peer group, and individual level factors. For both men and women, peer pressure, sensation seeking, personal risk-assessment, behavioral intention, condom use at first sexual intercourse, and sexual victimization were significant predictors of sexual risk-taking behaviors. A number of predictors were gender-specific: sexual assertiveness and condom self-efficacy for women and parental monitoring, traditional morality, HIV knowledge, and talking about sex with partner for men. Documenting substantial prevalence of potentially risky sexual behaviors among young people in Croatia, the findings call for prevention and intervention efforts that should focus on individual capacity building for responsible sexual behavior.

Correlates of any condom use among Russian narcology patients reporting recent unprotected sex

The purpose of this study was to assess whether HIV/sexually transmitted infection (STI) risk factors: risky sex (multiple sex partners and sex trade involvement), past HIV or STI diagnosis and substance use (at risk drinking and injection drug use) are associated with the outcome any condom use in the past 6 months among Russian narcology hospital patients. Participants (N = 178) included only those who reported unprotected sex in the past 6 months and were aged 18-55 years and 76% male. Any condom use in the past 6 months was reported by 55% of the sample. History of STIs was reported by 43% of participants; 15% were HIV-infected. Regression analyses adjusted for demographics demonstrated that those reporting multiple sex partners (OR(adj) = 4.2, 95% CI = 2.0-8.7) and sex trade involvement (OR(adj) = 2.4, 95% CI = 1.1-5.1) in the past 6 months had significantly higher odds of reporting any condom use in this same timeframe. HIV/STI and substance use were not associated with increased odds of condom use.

Increased body mass and depressive symptomatology are associated with hypercholesterolemia, among elderly individuals; results from the MEDIS study

BACKGROUND

Hypercholesterolemia is one of the most important factors causing cardiovascular disease (CVD). The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and depression status and the presence of hypercholesterolemia, among elderly individuals without known CVD.

METHODS

During 2005-2007, 1190 elderly (aged 65 to 100 years) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were enrolled. Socio-demographic, clinical and lifestyle factors were assessed through standard procedures. Symptoms of depression were evaluated using the short-form of the Geriatric Depression Scale (GDS, range 0-15). Dietary habits were assessed through a semi-quantitative food frequency questionnaire. Hypercholesterolemia was defined as total serum cholesterol > 200 mg/dL or use of lipids lowering medication.

RESULTS

44.6% of males and 61.9% of females had hypercholesterolemia (p < 0.001). Only, 63% of hypercholesterolemic participants were under special diet or pharmaceutical treatment. Hypercholisterolemic individuals had higher prevalence of obesity (43% vs. 25%), hypertension (76% vs. 57%) and diabetes (25% vs. 17%) compared with normal participants (p < 0.001). Furthermore, hypercholisterolemic participants showed higher depression levels (p = 0.002). After adjusting for various confounders, GDS score and BMI correlated with 13% (95%CI 0.98-1.30) and 14% (95%CI 0.99-1.31) higher likelihood of having hypercholesterolemia.

CONCLUSION

A considerable proportion of our elderly sample had hypercholesterolemia, while 1/3 of them were untreated. Furthermore, presence of hypercholesterolemia was correlated with depressive symptomatology and increased BMI.

Androgenic alopecia and insulin resistance: are they really related?

BACKGROUND

Androgenic alopecia is known to be androgen-dependent. Insulin is found in hair follicles and may play a role in the regulation of androgen metabolism and the hair-growth cycle.

OBJECTIVES

To compare the insulin resistance between people with androgenic alopecia and a control group.

METHODS

A case-control study was conducted with 97 cases in the patient and 87 in the control group. Serum fasting insulin level, fasting blood glucose, serum total cholesterol, triglyceride and high-density lipoprotein (HDL) were all measured in both groups.

RESULTS

There was no difference in serum fasting insulin level, fasting blood glucose, serum total cholesterol, triglyceride, HDL and insulin resistance between the two groups (P > 0.05).

CONCLUSION

Despite previous reports suggesting a link, our study found no significant relationship between insulin resistance and androgenic alopecia. Further studies are warranted.