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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.
Central European Journal of Urology
Mediterranean diet and erecle dysfuncon: a current
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,
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
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
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.
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.
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.
Central European Journal of Urology
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
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,
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
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-
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.
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.
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:
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]
... Indeed, it allows affirming physical functions, preventing anxiety, maintaining strong sense of identity and, obviously, gaining self-confidence (51). These aspects become particularly relevant when we consider that aging is characterized by physiological, psychosocial, behavioural and pathological changes, that can all affect sexual functioning, and it's difficult to disentangle their individual effects (52). Elderly people, as well as everybody else, may experience sexual dysfunction due to fear, boredom, fatigue, grief, low sexual desire or physical disability. ...
... 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). ...
... 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). Same authors are recently demonstrated that polyphenolic fractions deriving from Citrus Bergamia, commonly known by the name of Bergamot, a citrus fruit that grows on the Mediterranean coast of Calabria, are efficacious in counteracting erectile dysfunctions generally occurring in patients affected by type 2 diabetes (53), while another study described all positive effects due capsaicin contained in peppers and Panax ginseng in a similar category of patients (54). ...
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The World elderly population is expected to double before 2050. Unhealthy habits and unhealthy lifestyles are commonly associated with age-related diseases or their worsening. Modification in daily lifestyle and diet may help preventing age-related diseases onset and efficiently affecting their evolution, thus promoting the Healthy Aging process, concept recently coined to describe the disease-free aging process. This review highlights the role of nutrition science in promoting healthy aging. Since the Mediterranean Model demonstrated to be a useful style in supporting healthy aging, promotion of this correct lifestyle by health policies seems to be the best approach to achieve this target.
... Erectile function can improve after consuming a Mediterranean dietary pattern rich in plant-based foods, olive oil, nuts, and fish [58]. It is particularly interesting to examine studies on the effect of nuts, since some plant-based dietary patterns encourage nuts, while others avoid them. ...
... Similarly, a prospective study enrolling 555 type 2 diabetic patients with type 2 diabetes randomly assigned to either a Mediterranean or high-fat diet have both shown that adherence to the Mediterranean diet has been shown to decrease the risk of ED, particularly in men with type 2 diabetes [40,41]. This effect may be due to the anti-inflammatory, metabolic and cardiogenic benefits of the Mediterranean diet [42][43][44]. This has been confirmed in type-2 diabetic rats (induced by a high-fat diet) who have higher oxidative stress levels in penile but not the systemic vasculature [45]. ...
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Objective Benign prostatic hyperplasia (BPH) and erectile dysfunction (ED) are common conditions that increase in the aging population. Several environmental factors have been linked to the development and progression of BPH and ED. Several studies have shown potential direct and indirect influences of several micronutrients and macronutrients on the risk of developing these conditions. We reviewed the available published literature of the effect of diet on BPH and ED. Methods A comprehensive search was performed to identify studies that evaluated how diet affected males with BPH and ED. Searches were run on July 5th, 2018 in the following databases: Ovid MEDLINE®; Ovid EMBASE; and The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL). There were no language restrictions, publication date restrictions, or article type restrictions on the search strategy. Results We retrieved a total of 1670 results across all databases. After removing any duplicated results, 2 independent reviewers screened a total of 1325 citations. A total of 35 articles were selected for inclusion in this review. Diet is an important factor affecting the risk of development of BPH and ED. Several studies have shown the effect of dietary interventions for BPH and ED. Discussion A better understanding diet and its relative effects on the development, treatment and prevention of these diseases are an important area of further research for the given aging male population.
Purpose: To investigate the association between the plant-based content of diet and erectile dysfunction in men from the National Health and Nutrition Examination Survey (NHANES). Methods: We collected de-identified information from the NHANES database on demographics, comorbidities, diet, and erectile dysfunction (ED). Exclusion criteria were age <20 or >70 years, incomplete plant-based diet index information, history of prostate cancer, or other missing information. Using the food frequency questionnaire, an overall plant-based diet index (PDI) and healthful plant-based diet index (hPDI) were developed. A higher score on the PDI and hPDI is indicative of greater consumption of plant-based foods. Results: A total of 2549 men were analyzed, of those 1085 (42.6%) have good erectile function and 1464 (57.4%) have some degree of ED [usually have erections 521 (20.4%), sometimes have erection 690 (27.1%), or never have erections 253 (9.9%)]. The median age and BMI were 54 [41 – 64] years and 28.8 [25.5 - 32.6] kg/m², respectively. The median PDI and hPDI were 50 [46 – 54] and 50 [45 – 56], respectively. In multivariable adjusted logistic regression analysis, hPDI was negatively associated with ED (OR = 0.98, 95% CI: 0.96 - 0.99; p = 0.001). There was no association between PDI and ED. Conclusion: In a well characterized national database, we showed that a healthful plant-based diet is associated with less chance of having erectile dysfunction. Whether interventions with a plant-based diet will improve erectile function remains to be studied.
Erectile dysfunction (ED) is a common condition that affects a large percentage of men and can have a significant impact on the patient’s quality of life. In addition to nonmodifiable risk factors, such as age, genetics, hormones, and inflammatory responses, Several modifiable risk factors have been associated with ED, including diet, exercise, tobacco use, and alcohol consumption. Despite this modifiable component in the pathophysiology of ED, research into diet and lifestyle interventions for this condition has been fairly limited. This chapter will focus on the modifiable aspects of ED, including dietary components, such as dietary fats, sodium, red meat, vegetables, fruit, and nuts.
This book has reviewed the literature surrounding the impacts of diet and nutritional supplementation on the pathogenesis and treatment of benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). Given the strong overlap between cardiovascular risk factors and metabolic syndrome with BPH and ED, many of the lifestyle recommendations (especially diet and exercise) to ameliorate cardiovascular risk factors have also shown to be beneficial for managing the symptoms of BPH and ED. Herbal supplements have generally shown no benefit for either condition when compared to placebo in randomized trials and should be used with caution due to the lack of industrial regulation. Given the strong association between cardiovascular risk factors and BPH/ED, patients presenting with either condition should be screened for cardiovascular risk factors, if necessary, counseled about ways to manage their risk factors, and referred to a specialist where appropriate.
Vasculogenic erectile dysfunction has been aptly called the “canary in the coal mine” for cardiovascular disease as it almost always precedes other manifestations of atherosclerotic cardiovascular disease, including myocardial infarction and stroke. It is common, associated with the presence of modifiable cardiovascular risk factors, and impacted by diet and lifestyle choices. This concise review provides an update on the use of dietary and other lifestyle interventions to improve vasculogenic erectile dysfunction and atherosclerotic cardiovascular disease.
Objectives Prior studies of erectile dysfunction (ED) tend to narrowly focus on relationships with specific comorbidities, rather than evaluating a more comprehensive array of risk factors and assessing naturalistic patterns among them. This study identifies natural clusters of male characteristics from a general population sample per country, quantifies ED dynamics in these profiles, and compares profiles across US, Italy, Brazil, and China samples. Methods National Health and Wellness Survey 2015 and 2016 patient‐reported data on men aged 40‐70 years (US n=15,652; Italy n=2,521; Brazil n=2,822; China n=5,553) were analyzed. Hierarchical agglomerative clustering identified clusters where predictors included demographics, health characteristics/behaviors, ED risk factors, and provider visits in the past six months. Multinomial logistic regression assessed the independent utility of variables in predicting cluster membership, compared with the healthiest control cluster per country. Results Different natural clusters were found across countries, with four clusters for the US, Italy, and China and three clusters for Brazil. Age, income, employment, health behaviors, and ED risk factors predicted different cluster membership across countries. In the US, Italy, and Brazil, younger clusters were predicted by ED, unhealthy behaviors, and ED risk factors. Unique cluster profiles were identified in China, with ED and ED risk factors (aside from hypertension) not predicting cluster membership, while socio‐demographics and health behaviors were strongly predictive. Conclusions Natural cluster profiles revealed notable ED rates among adult males of age 40‐70 in four different countries. Clusters were mainly predicted by unhealthy behaviors, ED risk factors, and ED, regardless of level or presence of positive health characteristics and behaviors. This analysis identified meaningful subgroups of men with heightened ED risk factors, which can help healthcare providers to better recognize specific populations with the greatest need for intervention. This article is protected by copyright. All rights reserved.
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Erectile dysfunction (ED) is common with aging. Formerly ED treatment was offered mainly by urologists, but the approval and widespread use of phosphodiesterase inhibitors has enabled primary care clinicians to provide targeted ED treatment. Although large, multicenter clinical trials have shown efficacy and safety with these drugs, they are ineffective in 30–35% of men, may cause sideeffects, and do not improve the underlying pathology. A thorough understanding of erectile physiology and causes of ED and a comprehensive treatment plan addressing all contributing factors may be more effective than pharmaceutical management and may improve aspects of psychological and physical health beyond erectile problems.
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Erectile dysfunction (ED) was once assumed to be a psychological condition but has now been shown to share risk factors with cardiovascular disease including age, diabetes mellitus, smoking, hypertension and hypercholesterolaemia, suggesting an underlying vascular pathology. Evidence reveals that there is a potential link between ED and subsequent development of coronary artery disease. ED itself may also increase cardiovascular risk. The relative risk of developing coronary artery disease within ten years, in patients with moderate to severe ED, has been calculated as 14% in men aged 30-39 years and may be as high as 27% in those aged 60-69. The association appears greater when younger men presenting with ED are considered. The severity of ED has also been linked with the severity of coronary artery disease The proposed pathological mechanisms are based on a theory of endothelial dysfunction which eventually leads to atherosclerosis. This occurs first in more vulnerable narrow diameter vessels such as the cavernosal arteries. The artery size hypothesis may explain why ED occurs before manifestation of coronary artery disease. There is likely to be a delay between presentation with ED and clinical presentation with coronary artery disease. In one study, ED was found to present 39 months prior to coronary symptoms. This provides GPs with a valuable window of opportunity for risk assessment, subsequent primary prevention and early referral to a cardiologist.
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Dietary patterns influence various cardiometabolic risk factors, including body weight, lipoprotein concentrations, and function, blood pressure, glucose–insulin homeostasis, oxidative stress, inflammation, and endothelial health. The Mediterranean diet can be described as a dietary pattern characterized by the high consumption of plant-based foods, olive oil as the main source of fat, low-to-moderate consumption of fish, dairy products and poultry, low consumption of red and processed meat, and low-to-moderate consumption of wine with meals. The American Diabetes Association and the American Heart Association recommend Mediterranean diet for improving glycemic control and cardiovascular risk factors in type 2 diabetes. Prospective studies show that higher adherence to the Mediterranean diet is associated with a 20–23 % reduced risk of developing type 2 diabetes, while the results of randomized controlled trials show that Mediterranean diet reduces glycosylated hemoglobin levels by 0.30–0.47 %, and is also associated with a 28–30 % reduced risk for cardiovascular events. The mechanisms by which Mediterranean diet produces its cardiometabolic benefits in type 2 diabetes are, for the most, anti-inflammatory and antioxidative: increased consumption of high-quality foods may cool down the activation of the innate immune system, by reducing the production of proinflammatory cytokines while increasing that of anti-inflammatory cytokines. This may favor the generation of an anti-inflammatory milieu, which in turn may improve insulin sensitivity in the peripheral tissues and endothelial function at the vascular level and ultimately act as a barrier to the metabolic syndrome, type 2 diabetes and development of atherosclerosis.
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Type 2 diabetes has been associated with sexual dysfunction in men and women (1). Erectile dysfunction (ED) is a marker of significantly increased risk of cardiovascular disease and all-cause mortality in men with diabetes and the general population; however, no data support a clear role for female sexual dysfunction (FSD) as a predictor of future cardiovascular events in women with diabetes. There is some evidence from clinical trials that sexual dysfunction is amenable to amelioration with interventions based on diet and lifestyle modification in men and women (2). Using the data of the MEditerranean DIet and Type 2 diAbetes (MEDITA) randomized trial (3), we investigated the long-term effect of Mediterranean diet on 1 ) incident ED and FSD in people with type 2 diabetes and 2 ) combined incidence of sexual dysfunction (men or women) with worsening of sexual function in those participants with sexual dysfunction at baseline. Participants in the two-arm, single-center MEDITA trial were randomly assigned to a Mediterranean diet ( n = 108) or a low-fat …
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The Mediterranean-style diet (MedSD) has gained attention for its positive effects on health outcomes, including metabolic risk factors. However, it is unknown as to which components of MedSD interventions are most beneficial in reducing risk. The objective of this meta-analysis was to obtain effect sizes for metabolic risk factors and explain the variability across the current literature based on study design, sample, and diet characteristics. Six electronic databases were searched from inception until 9 February 2016. Data from 29 studies (N = 4133) were included. There were significant effects in favor of the MedSD for waist circumference, triglycerides, blood glucose, systolic blood pressure, and diastolic blood pressure (d+ = -0.54; d+ = -0.46; d+ = -0.50; d+ = -0.72; d+ = -0.94, respectively). The MedSD was significantly beneficial when the intervention was longer in duration, was conducted in Europe, used a behavioral technique, and was conducted using small groups. The traditional MedSD had significant beneficial effects on five of the six metabolic risk factors. Results from this study provide support for population specific dietary guideline for metabolic risk reduction.
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Purpose: Serum nitric oxide (NO) reduction and increased endothelin-1 (ET-1) play a pivotal role in endothelial dysfunction and hypertension. Considering that traditional Mediterranean diet (TMD) reduces blood pressure (BP), the aim of this study was to analyze whether TMD induced changes on endothelial physiology elements such as NO, ET-1 and ET-1 receptors which are involved in BP control. Methods: Non-smoking women with moderate hypertension were submitted for 1 year to interventions promoting adherence to the TMD, one supplemented with extra virgin olive oil (EVOO) and the other with nuts versus a control low-fat diet (30 participants/group). BP, NO, ET-1 and related gene expression as well as oxidative stress biomarkers were measured. Results: Serum NO and systolic BP (SBP) or diastolic BP (DBP) were negatively associated at baseline, as well as between NO and ET-1. Our findings also showed a DBP reduction with both interventions. A negative correlation was observed between changes in NO metabolites concentration and SBP or DBP after the intervention with TMD + EVOO (p = 0.033 and p = 0.044, respectively). SBP reduction was related to an impairment of serum ET-1 concentrations after the intervention with TMD + nuts (p = 0.008). We also observed changes in eNOS, caveolin 2 and ET-1 receptors gene expression which are related to NO metabolites levels and BP. Conclusions: The changes in NO and ET-1 as well as ET-1 receptors gene expression explain, at least partially, the effect of EVOO or nuts on lowering BP among hypertensive women.
Scope: This study assessed plasmatic antioxidant capabilities and xanthine oxidase activity in metabolic syndrome (MetS) patients after 5 years intervention with Mediterranean Diet (MeDiet) supplemented with extra-virgin olive oil (MeDiet+EVOO) or with nuts or with low-fat diet (the PREDIMED study). Methods and results: 75 participants were randomly selected. Daily energy and nutrient intake were assessed with a validated 137-item food frequency questionnaire, and adherence to the MeDiet was assessed using a 14-item questionnaire. Catalase, superoxide dismutase, myeloperoxidase, xanthine oxidase activities and protein levels, and protein carbonyl derivatives, nitrotyrosine, nitrite and nitrate levels were determined in overnight fasting venous blood samples. The plasma activity and protein levels of superoxide dismutase and catalase were significantly higher and xanthine oxidase activity lower in MeDiet+EVOO and MeDiet+nuts than in the control group. Participants in both MeDiet groups showed higher plasma nitrate levels than in the control group. Adherence to the MeDiet showed a positive correlation with superoxide dismutase and catalase plasma antioxidant activities. Conclusion: A MeDiet enriched with either virgin olive oil or nuts enhances the plasma antioxidant capabilities and decreases xanthine oxidase activity in patients with the metabolic syndrome but we did not observe changes in myeloperoxidase or markers of oxidative damage. This article is protected by copyright. All rights reserved.
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.
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.
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.