**Author details**

Eileen Harper1 , Shirley Ekvall2,3\*, Valli Ekvall2,3 and Wei Pan3

\*Address all correspondence to: shirley.ekvall@uc.edu

1 Providence Everett Medical Center, Seattle, Washington, USA

2 University Affiliated Cincinnati Center for Developmental Disabilities, Children's Hospital Medical Center, Cincinnati, Ohio, USA

3 University of Cincinnati, Cincinnati, Ohio, USA

### **References**

[1] Child abuse doubles: investigation lags. *Public Health Reports*. 1997; 112:4.

[2] Department of Health and Human Services, Administration for Families Fact Sheet. Washington, D.C.; September 22, 2002.

**4. Conclusion**

**5. Applications**

**Author details**

Eileen Harper1

**References**

conducted to prevent reoccurrence.

332 Pharmacology and Nutritional Intervention in the Treatment of Disease

skills using some of the available resources [45-51].

\*Address all correspondence to: shirley.ekvall@uc.edu

Medical Center, Cincinnati, Ohio, USA

3 University of Cincinnati, Cincinnati, Ohio, USA

1 Providence Everett Medical Center, Seattle, Washington, USA

, Shirley Ekvall2,3\*, Valli Ekvall2,3 and Wei Pan3

Research indicates that abused children may be at nutritional risk upon hospital admission. PA children are especially vulnerable; therefore, awareness of the child's nutritional status by the health care team should be increased. Interdisciplinary cooperation involving physicians, social workers, nurses, and dietitians are needed to provide the best health care for these children. Dietitians should be responsible for employing various nutritional assessment techniques and teamwork with other disciplines. Further studies concerning dietary patterns in the home environment and nutritional knowledge of the caretaker/parent(s) should be

Dietitians/nutritionists should be included as members of a child abuse team. Child abuse/ neglect training materials for medical/health professionals should incorporate nutritional status and provide nutrition education to caretakers/parents through Parents Anonymous Groups and similar therapeutic sessions. Nutritional as well as other environmental toxins, such as lead and mercury, also should be discussed with the families. Cooking sessions with culturally diverse nutrition education materials, nutrition counseling, and teamwork may need to be conducted by dietitians with families who have minimal cooking and/or nutritional

2 University Affiliated Cincinnati Center for Developmental Disabilities, Children's Hospital

[1] Child abuse doubles: investigation lags. *Public Health Reports*. 1997; 112:4.


[18] Lucas, S. Sexton, M., Langenburg, P. The relationship between blood lead levels and nutrition factors in preschool children: a cross-sectional study. *Pediatrics*. 1996; 97:74-78.

[32] Owen, C. The assessment and recording of measurements of growth of children: re‐

The Nutritional Status of Children with Suspected Abuse

http://dx.doi.org/10.5772/57374

335

[33] Lohman, T., Roche, A. Martorell, R. *Anthropmetry standardization reference manual*.

[34] *National Center for Health Statistics: Growth Charts.* Rockville, MD: Health Resources Administration, Monthly Vital Statistics Report. 25(3), Suppl. (HRA), 76-1120.

[35] Bowes and Church. *Food Values of Portions Commonly Used*, 16th ed., Philadelphia, PA:

[36] Sobsey, D., Randall, W. Parrilla, P.K. Gender differences in abused children with and

[37] MacMillan, H.L., Fleming, J.E., Trocme, N, Boyle, M.H., Wong, M., Racine, Y.A., Beardslee, W.R., Offord, D.R. Prevalence of child physical and sexual abuse in the

[38] Ebbin, A.J., Gollub, M.H., Stein, A.M., Wilson, M.G. Battered child syndrome at Los

[40] Wehner, F. Schieffer, M.C., Wehner, H.D., Percentile charts to determine the duration of child abuse by chronic malnutrition. *Forensic Sci Int.* 1999; 105(3):191-194.

[41] Rao, N,K,, Begum, S., Benkataramana,V., Gangadharappa, N. Nutritional neglect and physical abuse in children of alcoholics. *Indian J Pediatr.* 2001; 68(9):843-845.

[42] Bonet Alcaina, M., Martinez Roig, A, Pujals Ferrer, J.M., Vall combelles, O. Kwashior‐ kor as a symptom of abuse and neglect in Barcelona. *An Esp Pediatr*. 2001; 54(4):

[43] Glotzer, D.E., Weitzman, M. Commonly asked questions about childhood lead poi‐

[44] Hutchinson, J., Langlykke, K. *Adolescent Maltreatment: Youth as Victims of Abuse and Neglect* (Maternal and Child Health Technical Information Bulletin), Arlington, VA:

[45] Huber, A., Ekvall,S. Lead Toxicity and Pica. In Ekvall, S.W., Ekvall, V.K.eds. *Pediatric Nutrition in Chronic Diseases and Developmental Disorders*. 2nd edition, New York, Ox‐

[46] Stevens, F., Ekvall, S. *Empowering Children with Good Nutrition and Early Interven‐ tion :Focusing on Culturally Diverse Children with Special Health Care Needs.* Maternal

and Child Health Manual 4, Cincinnati, University of Cincinnati, 2002.

National Center for Education in Maternal and Child Health; 1998.

Angeles County General Hospital. *Am J Dis Child*. 1969; 118:660-667.

[39] Elmer, E. *Children in Jeopardy*. Pittsburgh: University of Pittsburgh Press; 1974.

port of a small conference. *Pediatrics*. 1973; 51:461-466.

JB Lippincott Co.; 1994 (incorporated into computer values).

without disabilities. *Child Abuse Negl.* 1997; 21:707-720.

community. *JAMA.* 1997; 278:131-135.

soning. *Pediatr Ann*. 1995;24(12):631-639.

ford University Press, 2005; 168-170.

405-408.

Champaign, IL: Herman Kinetics Books; 1988.


[32] Owen, C. The assessment and recording of measurements of growth of children: re‐ port of a small conference. *Pediatrics*. 1973; 51:461-466.

[18] Lucas, S. Sexton, M., Langenburg, P. The relationship between blood lead levels and nutrition factors in preschool children: a cross-sectional study. *Pediatrics*. 1996;

[19] Mahaffey, K.R., Garthside, P.S., Glueck, C.J. Blood lead and dietary calcium in 2926 1-through 11 year-old black and white children: The second national health and nu‐

[20] Schanne, F.A., Gupta, R.K., Rosen, J.F. lead inhibits 1, 25 dihydrovitamin D-3 regula‐ tion of calcium metabolis, in osteoblastic osteosarcoma cells (ROS 17/2.8). *Biochem Bi‐*

[21] Long, G.J., Pounds, J.G., Rosen, J.F. Lead intoxication alters basal and parathyroid hormone-regulated cellular calcium homoeostasis in rat osteosarcoma (ROS 17/2.8)

[22] Long, G.J., Rosen, J.F. Lead perturbs epidermal growth factor (EGF) modulation of intracellular calcium metabolism and collagen synthesis in clonal rat osteoblastic

[23] Bogden, J.D., Gertner, S.B., Christakos, S. Kemp, F.W., Yang, Z., Katz, S.R. Dietary calcium modified concentrations of lead and other metals and renal calbindin in rats.

[24] Mahaffey, K.R. Nutrition and lead: Strategies for public health. *Environ Health Per‐*

[25] Lanphear, B.P., Hornung, R., Ho, M., Howard, C.R., Eberle, S., Knauf, B.S. Environ‐

[26] Hammand, T.A., Sexton, M., Langenberg, P. Relationship between blood lead and di‐

[27] Flaherty, E., Weiss, H. Medical evaluation of abused and neglected children. *Am J Dis*

[28] Mushal, P. Cronenti, A.F. Lead and nutrition: biologic interactions of lead with nu‐

[29] Ziegler, E.E., Edward, B.B., Jensen, R.I., Mahaffey, K.R., Fomon, S.J. Absorption and

[30] Itoh, R., Suyama, Y. Sodium excretion in relation to calcium and hydroxyproline ex‐ cretion in a healthy Japanese population. *Am J Clin Nutr.* 1996; 63:735-740.

[31] Ekvall, S.W., Ekvall V.K., Nehring, W., Walberg-Wolfe, J.Nutritional Assessment, All Ages and Levels,In: Ekvall, S. W., Ekvall, V.K.eds. *Pediatric Nutrition in Chronic Dis‐*

ed. New York: Oxford University Press;

mental lead exposure during early childhood. *J Pediatr.* 2002; 140:40-47.

etary iron intake in preschool children. *Ann Epidemiol*. 1996; 6(1):30-33.

trition examination survey,. *Pediatrics*. 1986; 78:257-262.

(ROS 17/2.8) cells. *Toxicol Appl Pharmacol.* 1992; 114:63-70.

*ophys Acta*. 1992; 1180:187-194.

334 Pharmacology and Nutritional Intervention in the Treatment of Disease

*J Nutr*. 1992; 122:1351-1360.

*spect*. 1995;103(S6):191-196.

*Child.* 1990; 144:330-334.

2005:50-80.

trients. *Nutr Today*. 1996; 31:12-18.

*eases and Developmental Disabilities*. 2nd

retention of lead by infants. *Pediatr Res*. 1978; 12:29-34.

cells. *Calcif Tissue Int*. 1992; 50:451-458.

97:74-78.


[47] Rokusek, C, Jarka, E., Hanley, B., Earle-Hahn, J. Community Based Services and Re‐ sources. In *Pediatric Nutrition in Chronic Diseases and Developmental Disorders*. 2nd edi‐ tion, New York, Oxford University Press, 2005, 63-69.

**Chapter 17**

**Copper Deficiency a New Reason of Androgenetic**

Androgenetic alopecia is the common type of hair loss in men and women since puberty. Typically, AA is the complex result of an androgen-dependent process and this process is located to androgen receptor (AR) areas (frontal and vertex zone). Number of androgen receptors is genetic transmission. The polymorphism involving the CAG triple repeat expan‐ sion of the AR protein has been revealed in men with AA. This male pattern hair loss may represents from influence of minimal androgen excess basing on genetically sensitive hair

Dihydrotestosterone (DHT) is derived from circulating testosterone (T) inhibits cell prolifer‐ ation in the dermal papilla and local production of vascular endothelial growth factor [1]. As a result, the DHT-dependent process leads to the miniaturization of sensitive hair follicles and progressive thinning the scalp hair. It is known that the follicular dermal papilla controls hair growth. Steroid hormones, including androgens, estrogens and glucocorticoids may influence

More recent studies have focused on androgen-regulated hair growth. But, studies of action of other steroids in the hair follicle have been relatively limited. There are two estrogen receptors (ERα and ERβ) which bind to 17β-estradiol. The effects of estrogens seem complex whereby estrogen prolongs the anagen phase of the hair follicle and stimulates hair shaft elongation [2]. ERβ expression was found in outer root shaft and epithelial matrix. In contrast, ERα and AR were expressed in dermal papilla [3].Therefore, the ratio of ERα to ERβ in dermal papilla cells is extremely important. Estrogen also modifies androgen metabolism. The local production of estrogens from androgen precursors has been converted by the aromatase cytochrome P 450 enzyme complex. It is now clear there is aromatase expression in the dermal papilla and the outer root sheath. The activity of aromatase is higher in women in occipital

> © 2014 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**Alopecia?**

Margarita G. Skalnaya

http://dx.doi.org/10.5772/58416

**1. Introduction**

on timing of hair cycle [2].

papilla.

Additional information is available at the end of the chapter

