Sina Bazmi ^1* Matin Sepehrinia ² Hossein Pourmontaseri ¹ Hadi Bazyar ^3* Farhad Vahid ^4* Mojtaba Farjam ² Azizallah Dehghan ^2* James Hebert ⁵ Reza Homayounfar ^6* Negin Shakouri ^2*

• ¹ Fasa University of Medical Sciences, Fasa, Fars, Iran
• ² Noncommunicable Diseases Research Centre, Fasa University of Medical Sciences, Fasa, Iran
• ³ Department of Public Health, Sirjan School of Medical Sciences, Sirjan, Iran
• ⁴ Luxembourg Institute of Health, Luxembourg, Luxembourg
• ⁵ Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
• ⁶ Faculty of Nutrition Sciences and Food Industry, Shahid Beheshti University of Medical Sciences, Shahid, Tehran, Iran

Background: Androgenic alopecia (AGA), the most prevalent hair loss type, causes major psychological distress and reduced quality of life. A definite and safe cure/prevention for this condition is still lacking. The role of oxidative stress and inflammation in AGA pathogenesis prompted us to investigate the association between dietary antioxidant index (DAI) and energy-adjusted dietary inflammatory index (E-DII) with AGA.The investigation was designed based on data from 10,138 participants from the Fasa Adult Cohort Study (FACS). DAI and energy-adjusted DII (E-DII) were calculated utilizing a validated 125item food frequency questionnaire (FFQ). A physician diagnosed AGA. Logistic regression models were utilized to evaluate the association of DAI and E-DII with AGA.Results: After exclusion, 9,647 participants (44.0% men, mean age:48.6±9.5 years) consisting of 7,348 participants with AGA entered the analyses. Higher DAI was associated with 10% lower AGA odds, while higher E-DII showed 4% higher AGA odds after adjusting for various confounding variables.However, significant associations were found only among women, and adjusting for metabolic syndrome (MetS) made the E-DII-AGA association insignificant.Antioxidant-rich diets protect against AGA, while pro-inflammatory diets increase the risk, likely through developing MetS. Patient nutrition is frequently overlooked in clinical practice, yet it plays a crucial role, especially for women genetically predisposed to androgenetic alopecia. Dietary changes, such as reducing pro-inflammatory foods (like trans and saturated fats) and increasing antiinflammatory options (fruits and vegetables), can help prevent hair loss and mitigate its psychological impacts, ultimately lowering future treatment costs.