ArticlePublisher preview available

The association of popular diets and erectile function among men in the United States

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

To determine the relationship between popular diets and erectile function we queried the National Health and Nutrition Examination Survey, a cross-sectional dataset, between 2001 and 2004. All men aged 18–85 who answered the prostate and dietary questionnaires were included. Diets were categorized as Mediterranean, low-fat, low-carbohydrate, or nonrestrictive. Multivariable models were created to determine the relationship between erectile function and each diet. Among 4027 men, 649 (16.1%) met criteria for a low-fat diet, 1085 (26.9%) for a Mediterranean diet, and 0 (0%) for a low-carbohydrate diet. 1999 men (49.6%) had some degree of erectile dysfunction. Men with nonrestrictive diets were more likely to endorse normal erectile function compared with those adhering to the Mediterranean or low-fat diets (both p < 0.05) on univariable analysis. Multivariable analysis controlling for age, comorbidities, activity level, and body mass index showed no differences in erectile function among men adhering to a low-fat, Mediterranean diet, or nonrestrictive diet. There was no association between specific diets and erectile function. While additional prospective research is required to corroborate these findings, these data support the notion that individualized diets should be tailored toward goals of weight loss and reduction of comorbidity.
IJIR: Your Sexual Medicine Journal (2021) 33:548555
https://doi.org/10.1038/s41443-020-0313-x
ARTICLE
The association of popular diets and erectile function among men
in the United States
Richard J. Fantus 1,2 Joshua A. Halpern3Cecilia Chang2Mary Kate Keeter3Robert E. Brannigan3
Brian T. Helfand2Nelson E. Bennett3
Received: 20 March 2020 / Revised: 29 April 2020 / Accepted: 19 May 2020 / Published online: 2 June 2020
© The Author(s), under exclusive licence to Springer Nature Limited 2020
Abstract
To determine the relationship between popular diets and erectile function we queried the National Health and Nutrition
Examination Survey, a cross-sectional dataset, between 2001 and 2004. All men aged 1885 who answered the prostate and
dietary questionnaires were included. Diets were categorized as Mediterranean, low-fat, low-carbohydrate, or nonrestrictive.
Multivariable models were created to determine the relationship between erectile function and each diet. Among 4027 men,
649 (16.1%) met criteria for a low-fat diet, 1085 (26.9%) for a Mediterranean diet, and 0 (0%) for a low-carbohydrate diet.
1999 men (49.6%) had some degree of erectile dysfunction. Men with nonrestrictive diets were more likely to endorse
normal erectile function compared with those adhering to the Mediterranean or low-fat diets (both p< 0.05) on univariable
analysis. Multivariable analysis controlling for age, comorbidities, activity level, and body mass index showed no
differences in erectile function among men adhering to a low-fat, Mediterranean diet, or nonrestrictive diet. There was no
association between specic diets and erectile function. While additional prospective research is required to corroborate
these ndings, these data support the notion that individualized diets should be tailored toward goals of weight loss and
reduction of comorbidity.
Introduction
Erectile dysfunction (ED) is a common condition that
affects up to 40% of men by the age of 70, and roughly
30 million men in the United States (US) [1,2]. ED can
have a detrimental impact upon a wide range of psycho-
social domains, interpersonal relationships, and overall
mental health [3]. Furthermore, ED may serve as a har-
binger of serious adverse cardiovascular events [4,5]. The
intimate relationship between cardiovascular morbidity and
ED highlights the overlapping, modiable risk factors
between these two entities: diabetes, hyperlipidemia,
sedentary lifestyle, and smoking [5,6].
The recently published American Urological Association
Guidelines on ED recommend a multifaceted, patient-
tailored treatment approach that includes lifestyle mod-
ication [5]. Lifestyle modication such as smoking ces-
sation has reproducibly shown a decrease in ED [5,7].
However, the effects of diet and exercise are somewhat
unclear. The downstream impact of these interventions such
as weight loss and subsequent reduction of comorbidity
appear to impact erectile function, yet the specic effect of
dietary composition remains unknown [5,811]. Further-
more, many of the studies examining the relationship
between diet and erectile function have been subject to
criticism due to concerns regarding generalizability of
ndingsmany examined very specic populations such as
overweight men, type II diabetics, and men with ischemic
heart disease, and the ndings from these cohorts may not
be applicable to the general population [5,811].
With the increased emphasis on the importance of living
a healthy lifestyle, ~45 million Americans will try a new
*Nelson E. Bennett
Nelson.Bennett@nm.org
1Section of Urology, Department of Surgery, University of Chicago
Medicine, Chicago, IL, USA
2Department of Surgery, NorthShore University Health System,
Chicago, IL, USA
3Department of Urology, Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
Supplementary information The online version of this article (https://
doi.org/10.1038/s41443-020-0313-x) contains supplementary
material, which is available to authorized users.
1234567890();,:
1234567890();,:
Content courtesy of Springer Nature, terms of use apply. Rights reserved
... 29,30 Furthermore, in a crosssectional study of 4027 men ages 18-85 from the National Health and Nutrition Examination Survey, on multivariate analysis, no difference in erectile function was observed among men consuming a Mediterranean diet, a low-fat diet, or a nonrestrictive diet. 31 However, the measure of erectile function used in this study had not been validated and the study is subject to limitations given its cross-sectional design. ...
Article
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.
Article
Full-text available
Background Erectile dysfunction (ED) is one of the most common male sexual disorders, closely associated with both inflammation and lipid dysregulation. Recently, a novel inflammation-lipid composite marker, CRP/HDL, has been proposed to integrate the impact of both pathways on health, yet its relationship with ED remains unexplored. Therefore, our study aimed to investigate the potential association between the CRP/HDL ratio and ED. Methods We utilized data from the NHANES database, known for its comprehensive and high-quality information. A total of 3,633 eligible participants from the 2001-2004 cycles were included. ED was assessed using a single-item questionnaire, while CRP and HDL were measured from blood samples. Multivariable regression analyses were performed to evaluate the association between CRP/HDL and ED after adjusting for potential confounders. Additionally, subgroup and sensitivity analyses were conducted to test the robustness of the results, and the linear trend between CRP/HDL and ED was visualized through smooth curve fitting. Results Among the 3,633 participants, 1,027 had a history of ED. The CRP/HDL ratio was significantly higher in participants with ED compared to those without (10.53 ± 0.69 vs. 7.43 ± 0.35, P<0.001). In the regression analysis, a higher continuous CRP/HDL ratio was significantly associated with increased ED risk even after full adjustment (OR: 1.17, 95% CI: 1.05, 1.30; P = 0.01). Compared to Q1 of the CRP/HDL ratio, participants in Q2, Q3, and Q4 had progressively higher ED risks: Q2 (OR: 1.40, 95% CI: 1.01, 1.95; P = 0.05), Q3 (OR: 1.58, 95% CI: 1.10, 2.27; P = 0.02), and Q4 (OR: 1.85, 95% CI: 1.31, 2.60; P = 0.005), showing a clear linear trend. Subgroup analyses indicated consistent results across various populations with no significant interactions, and sensitivity analysis revealed that the CRP/HDL ratio also increased the risk of severe ED (OR: 1.14, 95% CI: 1.03, 1.26; P = 0.02). Conclusion This is the first study to establish a significant positive association between an elevated CRP/HDL ratio and ED risk, suggesting its potential role in screening for ED risk and guiding timely interventions. However, further large-scale studies are needed to confirm our findings and explore the underlying mechanisms.
Article
Full-text available
Background: Erectile dysfunction (ED) is recognized as one of the complications of diabetes mellitus (DM). To date, a wide gap of knowledge is present on the efficacy of pharmacological treatments of DM on erectile function (EF), acting not only through metabolic control. Similarly, the effects of different diet regimens on ED are still debated. Objectives: we aimed to explore the effects of diet and antihyperglycemic drugs, considering both old and novel therapeutic approaches, on EF. Materials/methods: we performed a systematic review, following the PRISMA guidelines. The research was made on studies reporting ED assessment in subjects with diabetes and the relationship with diet and antihyperglycemic drugs. Results: Mediterranean diet resulted effective in most studies for the protection of EF. Furthermore, antihyperglycemic drugs seem to show overall a protective role on EF. Discussion/conclusion: Although encouraging results are present for all classes of antihyperglycemic drugs, several studies are needed in humans, mainly on acarbose, pioglitazone, dipeptidyl-peptidase-4 (DPP-4) inhibitors, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. This article is protected by copyright. All rights reserved.
Article
Full-text available
Erectile dysfunction is a common condition that affects men over age 40. It is highly related to obesity. The corpus cavernosum is the most important structure involved in erection. The aim of this study was to evaluate the structure of the corpus cavernosum of mice fed with a high energy density diet (HED). At 3 months of age, male C57BL/6 mice were fed with a HED diet (50% lipids) or standard chow (SC) diet (10% lipids) for 14 weeks. Afterwards, the animals were euthanized and the corpus cavernosum was analyzed through stereology. Statistical significance was calculated by the student’s t-test (p < 0.05). The group fed with HED diet showed higher values of body weight, blood pressure and higher rates of cholesterol, triglycerides, and glucose from the second week to the end of the experiment. The HED group showed a significant increase in the connective tissue (15%) and a decrease in smooth muscle fibers (41%). The testosterone concentration in the HED group was 63% lower than in SC animals. Animals fed with a HED presented reduced testosterone serum levels and morphological changes on the corpus cavernosum, which may be related to erectile dysfunction.
Article
Full-text available
Purpose: The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction. Materials & methods: A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 7/29/17) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of erectile dysfunction. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. Results: The American Urological Association has developed an evidence-based guideline on the management of erectile dysfunction. This document is designed to be used in conjunction with the associated treatment algorithm. Conclusions: Using the shared decision-making process as a cornerstone for care, all patients should be informed of all treatment modalities that are not contraindicated, regardless of invasiveness or irreversibility, as potential first-line treatments. For each treatment, the clinician should ensure that the man and his partner have a full understanding of the benefits and risk/burdens associated with that choice.
Article
Full-text available
Obesity is characterized by an excessive increase in body mass, leading to endothelial damage that may favor the development of erectile dysfunction (ED). ED is defined as the inability to achieve or maintain a penile erection long enough to have a sexual intercourse. In this context, different ED models were developed, however the high price of special animals or the long period to establish the disease has limited studies in this field. Therefore, this study proposed to establish and characterize a novel model of ED in rats associated to a hypercaloric diet consumption. Animals were randomly divided into control group (CG), which received a standard diet, and obese group (OG), fed with a hypercaloric diet during 8 weeks. Rat's erectile function was evaluated in vivo and in vitro. Food and caloric intake of OG were reduced compared to CG, due to an increased diet energy efficiency. However, OG presented an increased body mass, inguinal, retroperitoneal and epididymal adipose tissues, as well as body adiposity index at the end of experimental protocol. In erectile function analysis, there was a decrease in the number and the latency of penile erections in OG. Additionally, the contractile reactivity of corpus cavernosum was increased in OG, favoring penile detumescence and related to a reduced nitric oxide bioavailability and an increased in contractile prostaglandins levels as a consequence of endothelial damage. Moreover, the endothelium-relaxation reactivity of corpus cavernosum was attenuated in OG associated to the oxidative stress. Thus, it was provided a model for advances in sexual dysfunction field and drug discovery for ED treatment.
Article
Full-text available
Obesity is associated with reduced testosterone and worsened erectile and sexual function in men. Weight loss improves these outcomes. High protein diets potentially offer anthropometric and metabolic benefits, but their effects on reproductive and sexual outcomes is not known.To examine the long-term effects of weight loss with a higher protein or carbohydrate diet on testosterone, sex hormone binding globulin, erectile dysfunction, lower urinary tract symptoms and sexual desire in overweight and obese men.One-hundred and eighteen overweight or obese men (body mass index 27-40 kg/m2, age 20-65 years) were randomly assigned to an energy restricted higher protein low fat (35% protein, 40% carbohydrate, 25% fat; n = 57) or higher carbohydrate low fat diet (17% protein, 58% carbohydrate, 25% fat, n = 61) diet for 52 weeks (12 weeks weight loss, 40 weeks weight maintenance). Primary outcomes were serum total testosterone, sex hormone binding globulin and calculated free testosterone. Secondary outcomes were erectile function as assessed by the International Index of Erectile Function (IIEF) (total score and erectile function domain), lower urinary tract symptoms and sexual desire.Total testosterone, sex hormone binding globulin and free testosterone increased (P
Article
Full-text available
NHANES is the cornerstone for national nutrition monitoring to inform nutrition and health policy. Nutritional assessment in NHANES is described with a focus on dietary data collection, analysis, and uses in nutrition monitoring. NHANES has been collecting thorough data on diet, nutritional status, and chronic disease in cross-sectional surveys with nationally representative samples since the early 1970s. Continuous data collection began in 1999 with public data release in 2-y cycles on ∼10,000 participants. In 2002, the Continuing Survey of Food Intakes by Individuals and the NHANES dietary component were merged, forming a consolidated dietary data collection known as What We Eat in America; since then, 24-h recalls have been collected on 2 d using the USDA's Automated Multiple-Pass Method. Detailed and targeted food-frequency questionnaires have been collected in some NHANES cycles. Dietary supplement use data have been collected (in detail since 2007) so that total nutrient intakes can be described for the population. The continuous NHANES can adapt its content to address emerging public health needs and reflect federal priorities. Changes in data collection methods are made after expert input and validation/crossover studies. NHANES dietary data are used to describe intake of foods, nutrients, food groups, and dietary patterns by the US population and large sociodemographic groups to plan and evaluate nutrition programs and policies. Usual dietary intake distributions can be estimated after adjusting for day-to-day variation. NHANES remains open and flexible to incorporate improvements while maintaining data quality and providing timely data to track the nation's nutrition and health status. In summary, NHANES collects dietary data in the context of its broad, multipurpose goals; the strengths and limitations of these data are also discussed in this review.
Article
Introduction: Male sexual dysfunctions are more prevalent with aging. With increasing evidence about the impact of various diets on chronic diseases, there is a growing interest in establishing an association between various diets and men's health and sexual dysfunction. Aim: To review the current literature examining diet and dietary patterns and male sexual health. Methods: A thorough literature search of peer-reviewed publications on the association between diet and dietary patterns and male sexual health (erectile dysfunction, hypogonadism, and infertility) was carried using the online PubMed database from 1977 through 2017 with the keywords diet, dietary patterns, erectile dysfunction, male hypogonadism, low testosterone, and male infertility. Main outcome measures: Summary of significant findings on erectile function, androgen levels, and semen analysis parameters in relation to diets or dietary patterns. Results: Thirteen studies on diet and erectile dysfunction and 15 studies on diet and testosterone levels were reviewed, including observational studies and randomized controlled trials. Thirteen studies analyzing the relation between diet and semen analysis parameters were reviewed but consisted of only cross-sectional and case-control studies. Conclusion: Evidence exists demonstrating the association between various diets and men's sexual health. Erectile dysfunction appears to lessen in men adhering to the Mediterranean diet. Obese and overweight men who lose weight through low-fat, low-calorie diets seem to have improvements in their erectile function and testosterone levels. Furthermore, a Western diet is associated with lower semen quality. Future prospective and randomized controlled trials are necessary to establish the benefit of diet and dietary patterns on men's sexual health. La J, Roberts NH, Yafi FA. Diet and Men's Sexual Health. Sex Med Rev 2017;X:XXX-XXX.
Article
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.
Conference Paper
Well-designed and well-conducted clinical studies represent gold standard approaches for generating medical evidence. However, elderly populations are systematically underrepresented in studies across major chronic medical conditions, which has hampered the generalizability (external validity) of studies to the real-world patient population. It is the norm that intervention studies often require a homogeneous cohort to test their hypotheses; therefore older adults with co-medications and comorbidities are often excluded. The purpose of this study is to assess the gap between clinical studies on comorbidities and prevalence in elderly populations derived from the National Health and Nutrition Examination Survey (NHANES) and the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) dataset. A comorbidity gap between them was observed and reported in this work.
Article
Cigarette smoking is a leading cause of preventable morbidity and mortality in the United States. Although public policies have resulted in a decreased number of new smokers, smoking rates remain stubbornly high in certain demographics with 20% of all American middle-aged men smoking. In addition to the well-established harmful effects of smoking (i.e. coronary artery disease and lung cancer), the past three decades have led to a compendium of evidence being compiled into the development of a relationship between cigarette smoking and erectile dysfunction. The main physiologic mechanism that appears to be affected includes the nitric oxide signal transduction pathway. This review details the recent literature linking cigarette smoking to erectile dysfunction, epidemiological associations, dose dependency and the effects of smoking cessation on improving erectile quality.