Min Kyung Park

The Role of Micronutrients in Alopecia Areata: A Review

Alopecia areata (AA) is a common, non-scarring form of hair loss caused by immune-mediated attack of the hair follicle. As with other immune-mediated diseases, a complex interplay between environment and genetics is thought to lead to the development of AA. Deficiency of micronutrients such as vitamins and minerals may represent a modifiable risk factor associated with development of AA. Given the role of these micronutrients in normal hair follicle development and in immune cell function, a growing number of investigations have sought to determine whether serum levels of these nutrients might differ in AA patients, and whether supplementation of these nutrients might represent a therapeutic option for AA. While current treatment often relies on invasive steroid injections or immunomodulating agents with potentially harmful side effects, therapy by micronutrient supplementation, whether as a primary modality or as adjunctive treatment, could offer a promising low-risk alternative. However, our review highlights a need for further research in this area, given that the current body of literature largely consists of small case–control studies and case reports, which preclude any definite conclusions for a role of micronutrients in AA. In this comprehensive review of the current literature, we found that serum vitamin D, zinc, and folate levels tend to be lower in patients with AA as compared to controls. Evidence is conflicting or insufficient to suggest differences in levels of iron, vitamin B12, copper, magnesium, or selenium. A small number of studies suggest that vitamin A levels may modify the disease. Though understanding of the role for micronutrients in AA is growing, definitive clinical recommendations such as routine serum level testing or therapeutic supplementation call for additional studies in larger populations and with a prospective design.

Consumption of polyunsaturated fatty acids and risk of incident psoriasis and psoriatic arthritis from the Nurses' Health Study II.

DEAR EDITOR, Fish are rich in marine omega-3 fatty acids (FA) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). As marine omega-3 FAs have anti-inflammatory and immunomodulatory properties, their potential use as a dietary adjunct in the treatment of psoriasis has been explored. Fish-oil supplements have shown potentially protective effects on progression of psoriasis in small-scale (n = 9–145) clinical studies. However, fish oil’s benefit for psoriasis has been difficult to confirm because of the lack of baseline measures of dietary and nutritional status. To our knowledge, no prospective data are available on the association between dietary intake of omega-3 FAs and risk of psoriasis and psoriatic arthritis (PsA). Therefore, we examined the association between consumption of polyunsaturated FAs and risk of incident psoriasis in the Nurses’ Health Study II (NHS II). Since 1989, NHS II participants have biennially completed a self-administered questionnaire regarding their personal medical history and lifestyle factors. Food-frequency questionnaires (FFQ) for dietary intake in the previous year have also been completed every 4 years since 1991. Participants were asked how often they had consumed a given unit or one portion size of each food item in the FFQ, on average, during the previous year, with nine frequency responses ranging from ‘almost never’ to ‘six or more per day’. Nutrient intakes of participants were calculated by multiplying the consumption frequency of each food item with a nutrient database prepared for specified amount of the food item. The nutrient database was based on the Harvard University Food Composition Database derived from U.S. Department of Agriculture sources and supplemented with information from manufacturers. Dietary supplement intake was also considered in the calculation of each nutrient. Nutrient intake was adjusted with total energy intake by the residual method. Previous studies have demonstrated reasonable levels of reproducibility and validity of the FFQ for ranking individuals by consumption of nutrients and foods. The FA intake measured by the FFQ has also been validated in the Nurses’ Health Study, showing moderate-tostrong correlations between dietary intakes and plasma biomarkers. Personal history of clinician-diagnosed psoriasis and the time period of diagnosis were assessed in the 2005 questionnaire (before 1991, 1991–94, 1995–98, 1999–2002 or 2003–05). Participants with self-reported psoriasis were mailed to complete the Psoriasis Screening Tool (PST) questionnaire and Psoriatic Arthritis Screening and Evaluation questionnaire (PASE). The validity of the PST has been evaluated with 99% sensitivity and 94% specificity for psoriasis screening. The PASE also distinguished patients with PsA from those without with high sensitivity (70–82%) and specificity (73–80%). The age-standardized baseline characteristics of participants in 1991 were examined according to quintiles of marine omega-3 FA consumption. The intakes of EPA, DHA, marine omega-3 FAs (sum of EPA and DHA), linoleic acid, arachidonic acid, omega-6 FAs (sum of linoleic acid and arachidonic acid) and omega-6/omega-3 FA ratio were

Fat Intake and Risk of Skin Cancer in U.S. Adults

Background: Fat intake has been associated with certain cancers, including colorectal, breast, and prostate cancers. However, literature on dietary fat and skin cancer has been limited. Methods: We examined the association between fat intake and risk of skin cancer including cutaneous malignant melanoma, squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) within two prospective studies: the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). Dietary information on total, saturated, monounsaturated, polyunsaturated, omega-6, and omega-3 fat and cholesterol was repeatedly assessed generally every 4 years. Incident cases were identified by self-report. Diagnosis on melanoma and SCC was confirmed by pathologic records. Results: A total of 794 melanoma, 2,223 SCC, and 17,556 BCC in the NHS (1984–2012) and 736 melanoma, 1,756 SCC, and 13,092 BCC in the HPFS (1986–2012) were documented. Higher polyunsaturated fat intake was associated with risk of SCC [pooled HR for highest vs. lowest quintiles, 1.16; 95% confidence interval (CI), 1.05–1.28; Ptrend=0.001] and BCC (pooled HR, 1.06; 95% CI, 1.01–1.11; Ptrend=0.01). Higher omega-6 fat intake was associated with risks of SCC, BCC, and melanoma. Omega-3 fat intake was associated with risk of BCC, but not with SCC or melanoma. No other fats were associated with melanoma risk. The associations were similar in women and men and by other skin cancer risk factors. Conclusions: Polyunsaturated fat intake was modestly associated with skin cancer risk. Impact: Further studies are needed to confirm our findings and to identify relevant biological mechanisms. Cancer Epidemiol Biomarkers Prev; 27(7); 776–82. ©2018 AACR.