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Abstract

Introduction In this current perspective we analyzed the role of Mediterranean diet (MedDiet) in sexual function and particularly in erectile dysfunction (ED), according to the latest scientific evidence. Material and methods We conducted a systematic search of relevant full-length papers identified during the time period from 1 January 2010 to the present. Results Published studies showed that adherence to a MedDiet contributes to preventing ED through an improved lipid and glucose metabolism, increased antioxidant defenses, and increased arginine levels which could raise nitric oxide activity. Conclusions Our findings suggest that the encouragement of a healthy lifestyle, such as MedDiet promotion, could be an attractive dietary approach to prevent ED and preserve sexual function.
185
Central European Journal of Urology
ANDROLOGY
Mediterranean diet and erecle dysfuncon: a current
perspecve
Simona Di Francesco, Raaele Lanfranco Tenaglia
G. D'Annunzio University of Chie-Pescara, Department of Medical and Oral Sciences and Biotechnologies, Chie, Italy
Arcle history
Submied: March 29, 2017
Accepted: April 18, 2017
Published online: June 11,
2017
Introducon In this current perspecve we analyzed the role of Mediterranean diet (MedDiet) in sexual func-
on and parcularly in erecle dysfuncon (ED), according to the latest scienc evidence.
Material and methods We conducted a systemac search of relevant full-length papers idened during
the me period from 1 January 2010 to the present.
Results Published studies showed that adherence to a MedDiet contributes to prevenng ED through
an improved lipid and glucose metabolism, increased anoxidant defenses, and increased arginine levels
which could raise nitric oxide acvity.
Conclusions Our ndings suggest that the encouragement of a healthy lifestyle, such as MedDiet promo-
on, could be an aracve dietary approach to prevent ED and preserve sexual funcon.
Corresponding author
Simona Di Francesco
Department of Medicine
and Aging Science
‘G. d’Annunzio’ University
Chie 66100, Italy
31, Via dei Vesni
phone: +39 333 406 5464
docveronica@gmail.com
Key Words: Mediterranean diet ‹› sexual funcon ‹› erecle dysfuncon ‹› nitric oxide
Cent European J Urol. 2017; 70: 185-187 doi: 10.5173/ceju.2017.1356
INTRODUCTION
Erectile dysfunction (ED) is dened as "the persistent
or recurrent inability to achieve and maintain a pe-
nile erection of sufcient rigidity to permit satisfac-
tory sexual activity during a time period of at least
3 months" [1]. It may have endocrine, neurogenic or
psychogenic causes, however, the most common ori-
gin is vascular, related to reduced penile blood supply.
It has been shown that a Mediterranean diet (MedDi-
et) inuences cardiovascular disease risk factors such
as metabolic syndrome, hypertension, obesity, and in-
sulin resistance [2–5]. These elements are recognized
as precocious indicators of microvascular disease and
markers of signicantly increased risk of erectile dys-
function (ED).
In this current perspective we will summarize and
update, according to the latest scientic evidence, the
current role of a MedDiet in sexual function and par-
ticularly in ED in men.
MATERIAL AND METHODS
In this perspective study we critically analyzed the
recent literature evaluating the complex relationship
between a MedDiet and ED. Papers were identied
by Medline, Scopus, Life Science during a time period
from 1 January 2010 to the present. Clinical trials
were identied using the following keywords: Medi-
terranean Diet, sexual function, Erectile Dysfunc-
tion, Nitric Oxide.
Articles were excluded if the study (a) was not in Eng-
lish, (b) had inappropriate design, (c) did not evaluate
a reciprocal relation of MedDiet and ED (e) was pre-
sented only as meeting abstracts.
RESULTS
We have identied 4 clinical trials, from 2010 to the
present, on the association between MedDiet and its
components with ED (Table 1).
Citaon: Di Francesco S, Tenaglia RL. Mediterranean diet and erecle dysfuncon: a current perspecve. Cent European J Urol. 2017; 70: 185-187.
S H O R T C O M M U N I C A T I O N
Central European Journal of Urology
186
Clinical trials showed that a MedDiet and lifestyle
choices inuence sexual function in men [5–9]. In
particular, a MedDiet with high use of virgin olive oil,
vegetables, fruits, moderate wine intake, whole grains,
nuts, bres and sh was associated with lower risk
and severity of ED, mainly in type 2 Diabetes Mellitus,
with the highest observance to the MedDiet [5, 6, 7].
Newly the MEDITA trial (MEditerranean DIet and
Type 2 diAbetes), a prospective randomized trial,
showed that MedDiet in diabetic patients delayed the
deterioration of sexual activity and positively inu-
enced the inammatory components [5]. Moreover,
current studies demonstrated that MedDiet, with
a respect to higher lower consumption of nuts and veg-
etables, was associated with a reduced risk of ED [8, 9].
MedDiet benets on erectile function might be relat-
ed to an improved lipid and glucose metabolism, in-
creased antioxidant defenses, and increased arginine
levels which could raise nitric oxide activity and thus
improve erectile function [8, 10, 11].
Nitric oxide (NO) is generated endogenously from ar-
ginine by nitric oxide synthase (NOS) and alternative-
ly from nitrate by xanthine oxidase (XOX). NO acts
as a potent opposing modulator on vasoconstriction
and is implicated in the balance between vasodilation
and vasoconstriction in the endothelium. Decreased
NO in vascular ED is determined by decreased NOS
activity or by the inactivation of NO [12].
Table 1. Summary of Clinical Trials evaluang the relaonship between mediterranean Diet and its components with erecle
dysfuncon
Study Paent populaon Design Primary endpoint Results
MЀDITA trial (MEditerranean
DIet and Type 2 diAbetes) [5, 7]
106 male
diabec paents
Single center,
randomized,
controlled trial
Changes of IIEF aer a total fol-
low-up of 8.1 years in MedDiet
(n = 54) or a low-fat diet
(n = 52, control group).
Reducon in IIEF was signicantly
greater in the low-fat group
compared to MedDiet (p = 0.024).
CAPRI (CAmpanian post-PrandIal
hyperglycemia group) [6]
555 male
diabec paents Large observaonal study
Prevalence and severity of ED
according to MedDiet adherence
by terle of MedDiet score.
ED prevalence and severity in the
highest terle of adherence
to MedDiet were signicantly
lower than in those with low
adherence (p 0.01).
Ramirez et al. [9]
440 male
non diabec
paents
mulcentre,
observaonal,
cross-seconal study
Prevalence of ED in a MedDiet
cohort (No ED 254 paents, mild
ED 109 paents, moderate
severe ED 77 paents)
Consumpons of Nuts
and vegetables were inversely
related to ED
Wang et al. [8] 1466 male
diabec paents
Canadian Community
Health Survey (CCHS)
Associaon between
fruit/vegetable consumpon
and ED among Canadian men
with diabetes.
The consumpon of fruits
and vegetables were inversely
associated with ED.
Moreover, the recent PREDIMED (PREvencion con
Dieta MEDiterranea) study, a large scale random-
ized multicenter controlled clinical trial on primary
prevention of cardiovascular disease, showed that
a MedDiet, particularly supplemented with extra-
virgin olive oil, increased plasma antioxidant capac-
ity (extracellular superoxide dismutase and cata-
lase) and reduced XOX activity [13]. Furthermore,
in a substudy of PREDIMED, the authors suggest-
ed that in a MedDiet, virgin olive oil mainly affects
NO bioavailability [14]. Tomatoes, a key component
of the Mediterranean diet, are rich in vitamin C, ca-
rotenoids (lycopene) and polyphenols (rutin), and
also contribute to prevent vascular dysfunction in ED
by exhibiting anti-inammatory properties, improv-
ing NO availability, and normalizing aortic vasocon-
striction[15].
CONCLUSIONS
The encouragement of a healthy lifestyle, such as
MedDiet promotion, particularly Mediterranean diet
vs a low-fat diet, could be an attractive dietary ap-
proach to prevent ED and preserve sexual function
in men.
CONfLICTS Of INTEREST
The authors declare no conicts of interest.
1. Bella AJ, Lee JC, Carrier S, et al.
2015 CUA Pracce guidelines
for erecle dysfuncon. Can Urol
Assoc J. 2015; 9: 23-29.
2. Basu J, Sharma S. Erecle
dysfuncon heralds onset
of cardiovascular disease.
Praconer. 2016; 260: 21-23.
3. Garcia M, Bihuniak JD, Shook J, et al. The
Eect of the Tradional Mediterranean-
Style Diet on Metabolic Risk Factors: A
Meta-Analysis. Nutrients. 2016; 8: 168.
References
187
Central European Journal of Urology
4. Esposito, K, Maiorino, MI, Bellastella, G,
et al. Mediterranean diet for type 2
diabetes: Cardiometabolic benets.
Endocrine. 2017; 56: 27-32.
5. Maiorino MI, Bellastella G, Chiodini P, et al.
Primary Prevenon of Sexual Dysfuncon
With Mediterranean Diet in Type 2
Diabetes: The MÈDITA Randomized Trial.
Diabetes Care. 2016; 39: 143-144.
6. Giugliano F, Maiorino MI, Bellastella G,
et al. Adherence to Mediterranean
diet and erecle dysfuncon in men
with type 2 diabetes. J Sex Med. 2010;
7: 1911-1917.
7. Maiorino MI, Bellastella G, Caputo M,
et al. Eects of Mediterranean diet
on sexual funcon in people with newly
diagnosed type 2 diabetes: The MÈDITA
trial. J Diabetes Complicaons. 2016; 30:
1519-1524.
8. Wang F, Dai S, Wang M, et al. Erecle
dysfuncon and fruit/vegetable
consumpon among diabec Canadian
men. Urology. 2013; 82: 1330-1335.
9. Ramírez R, Pedro-Botet J, García M,
et al. Xarxa de Unitats de Lípids
i Arteriosclerosi (XULA) Invesgators
Group. Erecle dysfuncon
and cardiovascular risk factors
in a Mediterranean diet cohort.
Intern Med J. 2016; 46: 52-56.
10. Estruch R, Ros E, Salas-Salvadó J, et al.
PREDIMED Study Invesgators. Primary
prevenon of cardiovascular disease
with a Mediterranean diet. N Engl J Med.
2013; 368: 1279-1290.
11. Urpi-Sarda M, Casas R, Chiva-Blanch G,
et al. Virgin olive oil and nuts as
key foods of the Mediterranean
diet eects on inammatory
biomakers related to atherosclerosis.
Pharmacol Res. 2012; 65: 577-583.
12. Yek-Anacak G, Sorrenno R, Linder AE,
et al. Gas what: NO is not the only answer
to sexual funcon. Br J Pharmacol. 2015;
172: 1434-1454.
13. Sureda A, Bibiloni MD , Martorell M,
et al. PREDIMED Study Invesgators.
Mediterranean diets supplemented with
virgin olive oil and nuts enhance plasmac
anoxidant capabilies and decrease
xanthine oxidase acvity in people with
metabolic syndrome: The PREDIMED study.
Mol Nutr Food Res. 2016; 60: 2654-2664.
14. Storniolo CE, Casillas R, Bulló M, et al.
A Mediterranean diet supplemented with
extra virgin olive oil or nuts improves
endothelial markers involved in blood
pressure control in hypertensive women.
Eur J Nutr. 2017; 56: 89-97.
15. Rodriguez-Rodriguez R, Jiménez-Altayó F,
Alsina L, et al. Mediterranean tomato-
based sofrito protects against vascular
alteraons in obese Zucker rats by
preserving NO bioavailability. Mol Nutr
Food Res. 2017 Mar 20. doi: 10.1002/
mnfr.201601010. [Epub ahead of print]
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... According to data recently published, adherence to MedStyle improve sexual performances in the elderly (52). In fact, recent advancements about this topic demonstrated that different molecules deriving from different Mediterranean foods are efficacious in counteract the erectile dysfunction, especially those obtained from citrus, peppers, ginseng and tomatoes (52). ...
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Aims: To assess the long-term effect of Mediterranean diet, as compared with low-fat diet, on sexual function in patients with newly diagnosed type 2 diabetes. Methods: In a randomized clinical trial, with a total follow-up of 8.1years, 215 men and women with newly diagnosed type 2 diabetes were assigned to Mediterranean diet (n=108) or a low-fat diet (n=107). The primary outcome measures were changes of erectile function (IIEF) in diabetic men and of female sexual function (FSFI) in diabetic women. Results: There was no difference in baseline sexual function in men (n=54 vs 52) or women (n=54 vs 55) randomized to Mediterranean diet or low-fat diet, respectively (P=0.287, P=0.815). Over the entire follow-up, the changes of the primary outcomes were significantly lower in the Mediterranean diet group compared with the low-fat group: IIEF and FSFI showed a significantly lesser decrease (1.22 and 1.18, respectively, P=0.024 and 0.019) with the Mediterranean diet. Baseline C-reactive protein levels predicted erectile dysfunction in men but not female sexual dysfunction in women. Conclusions: Among persons with newly diagnosed type 2 diabetes, a Mediterranean diet reduced the deterioration of sexual function over time in both sexes.
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Background: Erectile dysfunction (ED) affects more than 100 million men worldwide, with a wide variability in prevalence. An overall association of cardiovascular risk factors, lifestyle and diet in the context of ED in a Mediterranean population is lacking. Aims: To assess ED prevalence and associated factors in a Mediterranean cohort of non-diabetic patients with cardiovascular risk factors. Methods: Observational, cross-sectional study of patients aged over 40 treated at cardiovascular risk units in Catalonia. Anthropometric data, risk factors, lifestyle and diet habits were recorded. ED was assessed using the International Index of Erectile Function. Results: 440 patients included, 186 (42.3%) with ED (24.8% mild, 6.8% moderate and 10.7% severe). ED presence and severity were associated with age, obesity, waist circumference, hypertension, antihypertensive treatment and ischemic disease. Patients with ED were more frequently smokers, sedentary and consumed more alcohol. In multivariate analysis, consumption of nuts (> twice a week) (OR 0.41 [95% CI 0.25 to 0.67] and vegetables (≥ once a day) (OR 0.47 [95% CI 0.28 - 0,77]), were inversely related to ED. Obesity (as BMI ≥ 30 kg/m(2) ) (OR 2.49 [95% CI 1.48 -4.17]), ischemic disease (OR 2.30 [95% CI 1.22 to 4.33], alcohol consumption (alcohol-units a day) (OR 1.14 [95% CI 1.04 to 1.26], and age (year) (OR = 1.07 [95% CI 1.04-1.10] were directly related to ED. Conclusions: ED is a common disorder in patients treated in lipid units in Catalonia for cardiovascular risk factors. This condition is associated with age, obesity, ischemic disease and unhealthy lifestyle habits.
Article
Erectile dysfunction (ED) is the preferred clinical term describing the persistent or recurrent inability to achieve and maintain a penile erection of sufficient rigidity to permit satisfactory sexual activity for at least 3 months. • The initial diagnosis and treatment of ED is most commonly performed in Canada by primary care physicians (PCPs). • PCPs, urologists, internists, psychiatrists, and other treating healthcare professionals should be encouraged to initiate an open dialogue of sexual issues to identify men with ED who may not otherwise volunteer their sexual concerns. • Frequently a careful history, physical exam, serum glucose or hemoglobin A1C, lipid profile and optional hormonal testing facilitate the diagnosis of ED and effective therapy. Patient history can differentiate ED from other male sexual dysfunctions, including ejaculatory disorders (premature ejaculation and other abnormalities), hypogonadism, disorders of orgasm, and Peyronie’s disease. • Organic (physical) causes of ED are present in most men, but situational or psychosocial contributing factors often play a contributory role. Addressing these issues may enhance treatment efficacy. • Underlying risk factors associated with ED are common to cardiovascular disease in general, and should be identified during evaluation as they may represent the initial clinical sign of generalized endothelial disease (vascular insufficiency). Evaluation of family history, nicotine use, blood pressure, lipid profile, and glucose is required or should be documented if previously performed. Active management of identified cardiac risk factors should be instituted (i.e., smoking cessation, blood pressure treatment). • Once reversible causes of ED are ruled out, a trial of oral medication is recommended as first-line therapy, based on treatment efficacy, side effect profile, and minimal invasiveness. Specialized testing and referral are generally reserved for cases where oral first-line treatments fail or are not appropriate, of if greater insight into the etiology is desired by the patient/physician. • Second-line therapies, although more invasive than oral agents, are generally well-tolerated and effective. • Surgery remains an important option for men refractory to medical management, offering effective and durable ED treatment outcomes.