Article

The Association Between Popular Diets and Serum Testosterone Among Men in the United States

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Abstract

Objective: To examine the relationship between low-fat, Mediterranean, and low-carbohydrate diets and serum testosterone (T) level using a large, nationally-representative patient sample. Methods: The National Health and Nutrition Examination Survey (NHANES) database was queried from 1999-2000, 2003-2004 and 2011-2012. Men 18-80 years who completed the two-day dietary history and underwent serum T testing were included. Diets were categorized as low-fat, Mediterranean, low-carbohydrate, or non-restrictive. Multivariable modeling was used to determine the relationship between diet and serum T. Results: Among 3128 men who met inclusion criteria, 457 (14.6%) met criteria for a low-fat diet, 764 (24.4%) a Mediterranean diet, and only 2 (<0.1%) a low-carbohydrate diet, which was removed from further analysis. Mean serum T was 435.5 ± 6.7 ng/dL. Mean T was lower among men with low-fat (410.8±8.1 vs. 443.5±7.3, p=0.005) and Mediterranean diets (412.9±9.1 vs. 443.5±7.3, p=0.002). Multivariable analysis controlling for age, body mass index, activity level, diabetes, comorbidities, and prostate cancer showed men with non-restrictive diets had higher serum T compared to those adhering to a low-fat diet (ß -57.2, 95% confidence interval [CI] -105.6 - -8.8, p<0.05). Conclusion: Men adhering to low-fat diets had lower serum T levels, even when controlling for comorbidities, age, BMI and activity levels. As differences in serum T between diets were modest, the avoidance of fat-restrictive diets should be weighed against the potential benefits on an individual patient basis.

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... Dietary patterns have received increasing attention in the field of disease prevention because they account for the complexity of nutrient and food interactions within diets that may contribute to alterations in metabolism [24]. Overall, the associations between healthy diets and T and SHBG levels have been inconsistent [25] and only a few studies have evaluated associations with the dietary patterns we examined [13,[26][27][28]. Among these studies, two recent cross-sectional studies from NHANES found conflicting results, one reporting [26] that men adhering to a low-fat diet or a Mediterranean diet (n = 1221) had lower serum testosterone levels, while the second [27] did not find a significant association between HEI and testosterone and SHBG levels. ...
... Overall, the associations between healthy diets and T and SHBG levels have been inconsistent [25] and only a few studies have evaluated associations with the dietary patterns we examined [13,[26][27][28]. Among these studies, two recent cross-sectional studies from NHANES found conflicting results, one reporting [26] that men adhering to a low-fat diet or a Mediterranean diet (n = 1221) had lower serum testosterone levels, while the second [27] did not find a significant association between HEI and testosterone and SHBG levels. Another study of 336 men [13] reported that increased adherence to the Prudent diet pattern was associated with higher levels of T after adjusting for sexual abstinence, age, smoking, past diseases, and alcohol consumption. ...
... This finding may suggest that although a more prudent diet is associated with lower T levels in obese men, the overall benefits of a prudent diet on health outcomes are positive. This suggestion was also recently presented in another cross-sectional study in NHANES [26] which found that men adhering to a low-fat diet had lower serum T levels. ...
Article
PurposeThe association of dietary patterns with testosterone (T) and sex hormone binding globulin (SHBG) levels remains unclear. We investigated the associations of dietary patterns with T and SHBG levels to determine whether these associations vary by obesity status.MethodsA cross-sectional analysis was conducted in 1376 middle-aged (≥ 40 years old) men of the Health Professionals Follow-up Study. Prudent (rich in whole grains and dietary fiber) and Western (rich in red meat and refined grains) diet scores were identified using principal component analysis. The Alternate Healthy Eating Index 2010 (AHEI-2010) score, a measure of overall diet quality, was defined based on foods and nutrients predictive of chronic disease risk.ResultsWe identified a weak inverse association between AHEI-2010 and T levels (Ptrend = 0.07), but no associations with other dietary patterns. Null associations were observed between diet scores and SHBG. Obesity status appeared to modify the associations for the Prudent diet and AHEI-2010 with both T and SHBG (Pinteraction ≤ 0.05). T levels were lower (Q1 vs. Q4, 4.23 vs. 3.38) and SHBG higher (Q1 vs. Q4, 48.6 vs. 64.3) with adherence to a more prudent diet among obese men (Ptrends ≤ 0.05).Conclusion We observed a weak inverse association between AHEI-2010 and T levels. Null associations were identified for SHBG. Obesity status seemed to modulate associations of T and SHBG levels with diet scores, especially the AHEI-2010 and prudent diets. However, this research question warrants further investigation in prospective studies.
... Cross-sectional studies on the association between fat intake and T have produced conflicting results [18][19][20][21][22], possibly due to unmeasured confounding variables. However, the largest of these studies found that men adhering to a low-fat (LF) vs non-restricted diet had significantly lower serum TT (-32.7 ng/dL) [18]. ...
... Cross-sectional studies on the association between fat intake and T have produced conflicting results [18][19][20][21][22], possibly due to unmeasured confounding variables. However, the largest of these studies found that men adhering to a low-fat (LF) vs non-restricted diet had significantly lower serum TT (-32.7 ng/dL) [18]. General reviews on diet and sex hormones have only briefly covered the topic of dietary fat and T [23][24][25][26]. ...
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Background: Higher endogenous testosterone levels are associated with reduced chronic disease risk and mortality. Since the mid-20th century, there have been significant changes in dietary patterns, and men's testosterone levels have declined in western countries. Cross-sectional studies show inconsistent associations between fat intake and testosterone in men. Methods: Studies eligible for inclusion were intervention studies, with minimal confounding variables, comparing the effect of low-fat vs high-fat diets on men's sex hormones. 9 databases were searched from their inception to October 2020, yielding 6 eligible studies, with a total of 206 participants. Random effects meta-analyses were performed using Cochrane's Review Manager software. Cochrane's risk of bias tool was used for quality assessment. Results: There were significant decreases in sex hormones on low-fat vs high-fat diets. Standardised mean differences with 95% confidence intervals (CI) for outcomes were: total testosterone [-0.38 (95% CI -0.75 to -0.01) P = 0.04]; free testosterone [-0.37 (95% CI -0.63 to -0.11) P = 0.005]; urinary testosterone [-0.38 (CI 95% -0.66 to -0.09) P = 0.009], and dihydrotestosterone [-0.3 (CI 95% -0.56 to -0.03) P = 0.03]. There were no significant differences for luteinising hormone or sex hormone binding globulin. Subgroup analysis for total testosterone, European and American men, showed a stronger effect [-0.52 (95% CI -0.75 to -0.3) P < 0.001]. Conclusions: Low-fat diets appear to decrease testosterone levels in men, but further randomised controlled trials are needed to confirm this effect. Men with European ancestry may experience a greater decrease in testosterone, in response to a low-fat diet.
... It is clear that the incidence and progression of PCa is multifactorial but currently a strong theoretical rationale supports the adoption of the MD in reducing the onset of PCa. 49,55 According to Fantus et al. 56 men who adhered to a MD had lower serum testosterone in a large, nationally representative patient sample. 56 This observation is very interesting given that clinical evidence implicates testosterone in the aetiology of PCa. ...
... 49,55 According to Fantus et al. 56 men who adhered to a MD had lower serum testosterone in a large, nationally representative patient sample. 56 This observation is very interesting given that clinical evidence implicates testosterone in the aetiology of PCa. Several authors have already reported the association of lower serum testosterone concentrations with high-grade PCa and a higher stage at presentation. ...
... Cross-sectional studies on the association between fat intake and T have produced conflicting results [18][19][20][21][22], possibly due to unmeasured confounding variables. However, the largest of these studies found that men adhering to a low-fat (LF) vs non-restricted diet had significantly lower serum TT (-32.7 ng/dL) [18]. ...
... Cross-sectional studies on the association between fat intake and T have produced conflicting results [18][19][20][21][22], possibly due to unmeasured confounding variables. However, the largest of these studies found that men adhering to a low-fat (LF) vs non-restricted diet had significantly lower serum TT (-32.7 ng/dL) [18]. General reviews on diet and sex hormones have only briefly covered the topic of dietary fat and T [23][24][25][26]. ...
Article
Background: Higher endogenous testosterone levels are associated with reduced chronic disease risk and mortality. Since the mid-20th century, there have been significant changes in dietary patterns, and men’s testosterone levels have declined in western countries. Cross-sectional studies show inconsistent associations between fat intake and testosterone in men. Methods: Studies eligible for inclusion were intervention studies, with minimal confounding variables, comparing the effect of low-fat vs high-fat diets on men’s sex hormones. 9 databases were searched from their inception to October 2020, yielding 6 eligible studies, with a total of 206 participants. Random effects meta-analyses were performed using Cochrane’s Review Manager software. Cochrane’s risk of bias tool was used for quality assessment. Results: There were significant decreases in sex hormones on low-fat vs high-fat diets. Standardised mean differences with 95% confidence intervals (CI) for outcomes were: total testosterone [-0.38 (95% CI -0.75 to -0.01) P = 0.04]; free testosterone [-0.37 (95% CI -0.63 to -0.11) P = 0.005]; urinary testosterone [-0.38 (CI 95% -0.66 to -0.09) P = 0.009]; and dihydrotestosterone [-0.3 (CI 95% -0.56 to -0.03) P = 0.03]. There were no significant differences for luteinising hormone or sex hormone binding globulin. Subgroup analysis for total testosterone, European and North American men, showed a stronger effect [-0.52 (95% CI -0.75 to -0.3) P < 0.001]. Conclusions: Low-fat diets appear to decrease testosterone levels in men, but further randomised controlled trials are needed to confirm this effect. Men with European ancestry may experience a greater decrease in testosterone, in response to a low-fat diet.
... Combined, these findings are supported by a recent study showing that 760 men participating in a National Health and Nutrition Examination Survey (NHANES), who adhered to a Mediterranean-style dietary pattern typically characterised by high intakes of fruits, vegetables, whole grains and fish and a low intake of meat [16,19,35], with 40% of calories from fat (approximately 85 g) and high in antioxidants, possessed significantly lower mean serum testosterone levels compared to men consuming an ad libitum diet (14.3 nmol/L c.f 15.4 nmol/L, respectively). These effects were maintained after controlling confounders of age, BMI, physical activity, comorbidities, diabetes and prostate cancer [36]. Our findings may have implications for the popular Mediterranean dietary pattern which promotes the consumption of 58-67 g of fat each day [31], the majority of which is 'healthy' fat. ...
... As such, the Mediterranean diet is unlikely to have a positive benefit for androgen production. Finally, it is interesting to note that the NHANES database also showed that men adhering to a very low fat diet, similar to that recommended by the American Heart Association (31% of energy from total fat (60-80 g/day)), were also more likely to be hypogonadal than men who consumed an ad libitum diet [36]. As such, it appears that too much and too little dietary fat can negatively impact on testicular function. ...
Article
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Hypogonadal obese men find it difficult to lose weight. We investigated whether the modification of macronutrient intake can alter testosterone levels independently of the body mass index. Fasted overweight or obese fertile men were asked to consume meals of polyunsaturated fats (PUFA), monounsaturated fats (MUFA), refined carbohydrates (CHO, orange juice, OJ), whey and egg albumin and mixed meals of PUFA and CHO, PUFA and egg albumin, and CHO and egg albumin. Blood was collected at fasting, then hourly for 5 h and analysed to determine the levels of testosterone and other hormones. We found PUFA and MUFA or a mixed meal of PUFA and CHO significantly reduced serum testosterone production to a similar degree over a 5 h period. PUFA decreased serum testosterone levels by 3.2 nmol/L after 1 h compared to baseline (p = 0.023), with this suppression remaining significant up to 5 h postprandially (2.1 nmol/L; p = 0.012). The net overall testosterone levels were reduced by approximately 10 nmol/L × h by PUFA, MUFA and PUFA combined with CHO. CHO alone had little effect on testosterone levels, whereas egg albumin was able to increase them (7.4 cf 2.0 nmol/L × h). Therefore, for men wishing to optimize their testosterone levels, it may be wise to avoid a high fat intake, drink liquids such as water or OJ or even consider fasting. ANZCTR, Australia; ACTRN12617001034325.
... In addition, we will also discuss the role of low energy availability, a growing condition in the athletic population, and its effect on testosterone concentrations. While other reviews have previously discussed the effect of nutrition on testosterone status [13][14][15][16], most of these papers have examined the role of single nutrient (macro/micro) or food/food groups. To the best of our knowledge, this review is the first to focus on the nutrient influence on circulating testosterone concentrations. ...
Article
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Elevations in the circulating concentration of androgens are thought to have a positive effect on the anabolic processes leading to improved athletic performance. Anabolic-androgenic steroids have often been used by competitive athletes to augment this effect. Although there has been concerted effort on examining how manipulating training variables (e.g., intensity and volume of training) can influence the androgen response to exercise, there has been much less effort directed at understanding how changes in both macronutrient and micronutrient intake can impact the androgen response. Thus, the focus of this review is to examine the effect that manipulating energy and nutrient intake has on circulating concentrations of testosterone and what the potential mechanism is governing these changes.
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Objectives There are sex differences in distribution of fat and in the prevalence of overweight and obesity. We therefore sought to explore sex differences in the prevalence of adiposity-metabolic health phenotypes, in anthropometric and cardio-metabolic parameters, and in the relationship between body mass index (BMI) categories and metabolic health.Methods We conducted a cross-sectional study carried out between January 2018 and June 2019, of a nationally representative sample of the Maltese Caucasian population aged 41 ± 5 years. Metabolic health was defined as presence of ≤ 1 parameter of the metabolic syndrome as defined by the National Cholesterol Education Program-Adult Treatment Panel III criteria.ResultsMales exhibited the unhealthy metabolic phenotype more frequently than women (41.3% vs 27.8%). In total, 10.3% of normal weight men and 6.3% of normal weight women were metabolically unhealthy. Males had a higher median BMI, but a lower proportion of males exhibited an abnormally high waist circumference as compared with females. A significant difference in sex distribution was noted for each body composition phenotype.Conclusion In a contemporary sample of middle-aged individuals, males were more metabolically unhealthy and more insulin resistant than their female counterparts in spite of exhibiting an abnormal waist circumference less frequently and having similar waist index. This suggests that the currently used cut-offs for normal waist circumference should be revised downwards in men. Since even normal weight men were more often metabolically unhealthy than normal weight women, BMI cut-offs may also need to be lowered in men.
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The article highlights the modern problems of nutrition for junior athletes. The authors outline the role of the nutritional plan as an integral part of sports training, as well as a factor in the healthy growth and development of a young athlete. They describe the features of the nutritional status of athletes. The article notes the need for educational programs in the field of balanced nutrition, the use of nutritional supplements and sports products among junior athletes.
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Objective: Serum testosterone concentrations are affected by factors unrelated to hypothalamo-pituitary-testicular axis pathology. We evaluated the impact of sociodemographic, lifestyle and medical factors, on serum testosterone and sex hormone-binding globulin (SHBG) in men aged 40-69 years. Design: Cross-sectional analysis of 208,677 community-dwelling men from the UK Biobank. Measurements We analysed associations of different factors with serum testosterone and SHBG (immunoassays) and calculated free testosterone (cFT), using smoothed centile plots, linear mixed models, and effect size estimates. Results: Median (interquartile range) for serum testosterone was 11.6 (9.4-14.1) nmol/L, SHBG 36.9 (27.9-48.1) nmol/L, and cFT 213 (178-255) pmol/L. Age and BMI were inversely associated with testosterone and cFT, while SHBG was associated with age, and inversely with BMI (all P<0.001). Living with a partner, (South) Asian ethnicity, never or previous smoker, and some medical conditions, were associated with lower testosterone. Poultry or fish eater, and higher physical activity, were associated with higher testosterone (all P<0.001). Testosterone was lower by ~0.5 nmol/L across ages, ~1.5 nmol/L for BMI 30 vs 25 kg/m2 , ~2 nmol/L for (South) Asian ethnicity, living with partner, college/university qualifications, low red meat eater, insufficient physical activity, and 0.3-1.0 nmol/L with cardiovascular disease or diabetes. Different combinations of these factors varied serum testosterone by ~4 nmol/L, SHBG by ~30 nmol/L, and cFT by ~60 pmol/L. Conclusions: The identified modifiable risk factors support lifestyle-based interventions in men with low testosterone concentrations. Considering sociodemographic, lifestyle and medical factors facilitates more personalised interpretation of testosterone testing results with respect to existing reference ranges.
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