Comparing the effects of meal replacements with reduced-fat diet on weight, sexual and endothelial function, testosterone and quality of life in obese Asian men

Obesity and sexual desire: a systematic review and meta-analysis

BACKGROUND

Impaired sexual functioning is one of the consequences of obesity with hormonal disorders involving testosterone.

AIM

To explore the link between obesity and sexual desire, to assess how changes in body weight affect sexual desire, and to examine the role of testosterone in these changes in obese and overweight men.

METHODS

The systematic review was conducted in PubMed. Studies involving obese/overweight men that reported different libido levels or changes after weight loss interventions were included. Meta-analysis and meta-regression were performed.

RESULTS

The search identified 2259 studies, of which 28 met the eligibility criteria. Most studies focused on weight-loss interventions (n = 21, 77%), with 13 studies investigating the effect of bariatric surgeries. Testosterone levels were reported in 14 studies. The studies encompassed a total population of 18 653 people, including 10 356 obese and overweight men. Of the 28 identified studies, 15 indicated a potential association between BMI, waist circumference, and sexual desire. Effect size meta-analysis (calculated using data from four studies presenting results before and after bariatric surgery) suggests that an increase in the International Index of Erectile Function sexual desire domain was very strongly associated with changes in a patients' weight resulting from bariatric surgery (d = 1.22, 95% CI 0.41-2.03, P = 0.003). The meta-analysis of four studies, presenting results before and after diet intervention, showed a strong impact of weight loss on an increase of the Sexual Desire Inventory (SDI), (d = 1.16, 95% CI 0.44-1.88, P = 0.002) The meta-regression revealed a significant association between the level of sexual desire on the SDI and the magnitude of BMI changes before and after dieting interventions (R2 = 77.97%; P = 0.002). The meta-analysis of plasma total testosterone levels from studies that present results before and after selected diets showed a strong impact of diet on the increase in testosterone levels after interventions (d = 1.39 95% CI 0.86-1.92; P < 0.001). There was a significant impact of the level of plasma total testosterone on the variance of sexual desire in the SDI questionnaire (R2 = 5.33%; P < 0.001).

LIMITATIONS OF EVIDENCE

A lack of studies that focus on sexual desire in obesity, the heterogeneity of the included population, the variability in the used questionnaires and reported statistics.

CONCLUSIONS

A potential association between sexual desire and body weight exists. Weight loss interventions, including dietary changes and bariatric surgery, significantly increased both sexual desire and plasma total testosterone levels. Additionally, variations in plasma total testosterone levels had a significant effect on the variability of sexual desire in obese men.

Association between improved erectile function and dietary patterns: a systematic review and meta-analysis

ABSTRACT

Erectile dysfunction (ED) is prevalent among men, but its relationship with dietary habits is uncertain. The aim of our study was to assess whether dietary patterns enhance erectile function by reviewing the literature published before August 1, 2022, via PubMed, Web of Science, and EMBASE databases. The data compiled included author details; publication dates, countries, treatments, patient numbers, ages, follow-ups, and clinical trial outcomes, such as ED cases, odds ratios (ORs), confidence intervals (CIs), and International Index of Erectile Function-5 (IIEF-5) scores with means and standard deviations. An analysis of 14 studies with 27 389 participants revealed that plant-based diets (OR = 0.71, 95% CI: 0.66-0.75; P < 0.00001), low-fat diets (OR = 0.27, 95% CI: 0.13-0.53; P = 0.0002), and alternative diets such as intermittent fasting and organic diets (OR = 0.54, 95% CI: 0.36-0.80; P = 0.002) significantly reduced ED risk. High-protein low-fat diets (hazard ratio [HR] = 1.38, 95% CI: 1.12-1.64; P < 0.00001) and high-carb low-fat diets (HR = 0.79, 95% CI: 0.55-1.04; P < 0.00001) improved IIEF-5 scores. Combined diet and exercise interventions decreased the likelihood of ED (OR = 0.49, 95% CI: 0.28-0.85; P = 0.01) and increased the IIEF-5 score (OR = 3.40, 95% CI: 1.69-5.11; P < 0.0001). Diets abundant in fruits and vegetables (OR = 0.97, 95% CI: 0.96-0.98; P < 0.00001) and nuts (OR = 0.54, 95% CI: 0.37-0.80; P = 0.002) were also correlated with lower ED risk. Our meta-analysis underscores a strong dietary-ED association, suggesting that low-fat/Mediterranean diets rich in produce and nuts could benefit ED management.

Summary of the clinical practice manual for late-onset hypogonadism

Testosterone plays an important role in maintaining both physical and mental function. Age-related testosterone depletion contributes to the development of angina, arteriosclerosis, obesity, metabolic syndrome, dementia, frailty, and a range of other conditions. A condition involving age-related testosterone depletion and the associated clinical symptoms is defined as late-onset hypogonadism (LOH). LOH is treated by testosterone replacement therapy. Indications for testosterone replacement therapy are determined by evaluating symptoms and signs.

Gaps in the management of diabetes in Asia: A need for improved awareness and strategies in men's sexual health

Sexual dysfunction, which is defined as 'difficulty during any stage of the sexual encounter that prevents or impairs the individual or couple from enjoying sexual activity', is globally prevalent in males with prediabetes and diabetes. It is an early harbinger of cardiovascular diseases and has a profound impact on one's physical, mental, and social health. Among patients with either prediabetes or diabetes, the most common male sexual dysfunctions are hypogonadism, erectile dysfunction, and premature ejaculation. In Asia, although sexual health is an important factor of men's health, it is rarely discussed freely in real-life practice. Addressing sexual health in Asian males has always been challenging with multiple barriers at the levels of patients and health care providers. Therefore, the assessment and management of sexual dysfunction in routine clinical practice should involve a holistic approach with effective patient-provider communication. In this review, we discuss the epidemiology, pathophysiology, and the management of hypogonadism, erectile dysfunction, and premature ejaculation among males with either prediabetes or diabetes (type 1 and type 2), as well as the evidence gaps across Asia.

Eating behaviors and health-related quality of life: A scoping review

Discrepancies between total life expectancy and healthy life expectancy are in part due to unhealthy lifestyles, in which diet plays an important role. Despite this knowledge, observational studies and randomized trials have yet to show consistent improvements in health and well-being, also known as health-related quality of life (HRQoL), given the variety of elements that conform a healthy diet aside from its content. As such, we aimed to describe the evidence and common topics concerning the effects of modifiable eating behaviors and HRQoL in patients with non-communicable diseases (NCD). This scoping review of six electronic databases included 174 reports (69 % were experimental studies, 10 % longitudinal studies, and 21 % cross-sectional studies). Using VOSviewer, a bibliometric tool with text mining functionalities, we identified relevant aspects of dietary assessments and interventions. Commonly observed topics in experimental studies were those related to diet quality (micro- and macronutrients, food items, and dietary patterns). In contrast, less was found regarding eating schedules, eating locations, culturally accepted food items, and the role of food insecurity in HRQoL. Disregarding these aspects of diets may be limiting the full potential of nutrition as a key element of health and well-being in order to ensure lengthy and fulfilling lives.

Worth the wait? Preconception weight reduction in women and men with obesity and infertility: a narrative review

Short and long-term weight reduction interventions are considered in the preconception period for women and men with obesity and infertility as obesity is associated with poorer reproductive outcomes. Short-term weight loss achieved with diet, exercise, and medications does not improve per cycle conception or live birth rates in women undergoing ovulation induction, intrauterine insemination, or in vitro fertilization (IVF), but may increase the rate of natural conception. Long-term weight loss achieved through surgical interventions may increase spontaneous conceptions, particularly among women with polycystic ovary syndrome, and may increase the live birth rate from IVF, though these findings are limited by recent evidence. There is a clear need for additional treatment options and well-designed weight loss intervention trials that address the heterogeneous causes of obesity among women and men with infertility and include fertility outcomes and perinatal morbidity as outcome measures.

Effectiveness of restricted diet with a plate in patients with type 2 diabetes: A randomized controlled trial

BACKGROUND

In view of the complexity of dietary and nutritional education for most patients with type 2 diabetes mellitus (T2DM), a simplified approach called the "restricted diet with a plate" or "plate model" is recommended.

PURPOSE

To evaluate whether the plate model can effectively improve glycemic control and cardiovascular risk markers in type 2 diabetes mellitus (T2DM), while reducing the time devoted to education and avoiding weight gain.

METHODS

The study was a randomized, multicenter, controlled study, conducted between October 2018 and October 2019, among patients with T2DM living in Nanjing. The study included 419 participants who were randomly divided into a plate group and a counting group. The plate model included three components: a low-literacy, color leaflet containing the explanation and composition of the plate model, health education, and medical visits. Patients in the counting group received health education, group medical visits, and a paper booklet containing traditional carbohydrate counting education. Primary outcomes were glycemic control and weight.

RESULTS

Participants in the plate model reduced HbA_1c by 0.7% in the first three months, and reduced to a greater extent at six months (1.44%), but this was not sustained, and HbA_1c increased slightly over the following six months. Fasting plasma glucose (FPG) and 2-h postprandial glucose (2hPG) values were significantly reduced at the endpoint in the plate model (9.25 ± 1.72% vs. 7.44 ± 0.88%, P = 0.008; 12.07 ± 2.94 vs. 8.35 ± 1.99%; P = 0.004); however, the 2hPG values decreased most significantly. Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly in the plate group, which occurred at six months and lasted for 12 months. In the first three months, the average weight loss in the plate group was 1.2 kg/month (95% CI 0.92-1.48), and in the fourth to twelfth months, the average weight gain was 0.21 kg/month (95% CI 0.08-0.34). There was significant difference in education time between the groups (17.3 ± 4.42 vs. 38.6 ± 12.63; P < 0.001).

CONCLUSIONS

The plate model is at least as effective as the counting model over the short term for glycemic control and perhaps even better for weight and lipid control. Plate model has the potential to improve education of those with low health literacy by reducing reading demands.

Diet, herbs and erectile function: A good friendship!

Plants and plant materials have been used for thousands of years to treat and control erectile dysfunction in men. This practice has spanned many cultures and traditions around the world, with the therapeutic effects of many plants attributed to their phytochemical constituents. This review explains how polyphenols (including phenolic acids, flavonoids, terpenoids, carotenoids, alkaloids and polyunsaturated fatty acids) in plants and plant food products interact with key enzymes (phosphodiesterase-5 [PDE-5], angiotensin-converting enzyme [ACE], acetylcholinesterase [AChE], adenosine deaminase [ADA] and arginase) associated with erectile dysfunction. By modulating or altering the activity of these physiologically important enzymes, various bioactive compounds from plants or plant products can synergistically or additively provide tremendous protection against male erectile problems.

Comparative effectiveness of a low-calorie diet combined with acupuncture, cognitive behavioral therapy, meal replacements, or exercise for obesity over different intervention periods: A systematic review and network meta-analysis

OBJECTIVE

The aim of this study was to evaluate the comparative effectiveness of a low-calorie diet (LCD) combined with acupuncture, cognitive behavioral therapy (CBT), meal replacements (MR), and exercise on weight loss.

METHODS

The electronic databases MEDLINE, EMBASE, CENTRAL, CNKI, RISS, and KISS were searched systematically. Randomized controlled trials (RCTs) that directly compared the effect of a low-calorie diet (LCD)-combined acupuncture, CBT, and exercise and an MR-based diet on weight loss with LCD-alone for adults with simple obesity (body mass index [BMI] > 25) published before August 2021 were included in the study. Two investigators extracted and coded the data using a template. Any disagreements between investigators were resolved through discussion. Changes in BMI or weight were transformed to Hedges' g values with a 95% CI, and network meta-analyses using a Bayesian random-effects model were conducted.

RESULTS

A total of thirty-two trials involving 3,364 patients were finally included in the study. The effect sizes of four interventions were medium, in the order of acupuncture (Hedges' g = 0.48, 95% CI = 0.25 - 0.71), CBT (Hedges' g = 0.42, 95% CI = 0.20 - 0.63), MR (Hedges' g = 0.32, 95% CI = 0.19 - 0.45), and exercise (Hedges' g = 0.27, 95% CI = 0.06 - 0.46).In terms of intervention period, acupuncture was effective in the short period (≤ 12 weeks, Hedges' g = 0.39, 95% CI = 0.12 - 0.67) and the long period (>12 weeks, Hedges' g = 0.89, 95% CI = 0.37 - 1.40), whereas CBT (Hedges' g = 0.51, 95% CI = 0.26 - 0.76) and exercise (Hedges' g = 0.37, 95% CI = 0.12 - 0.59) were effective only in the long period. MR was effective only in the short period (Hedges' g = 0.35, 95% CI = 0.18 - 0.53).

CONCLUSIONS

This study suggests that acupuncture, CBT, MR, and exercise for simple obesity show a medium effect size, and their effectiveness differs according to the intervention period.

Effect of weight loss on erectile function in men with overweight or obesity: A meta-analysis of randomised controlled trials

Obesity and overweight are independent risk factors of erectile dysfunction (ED). It is controversial whether weight loss can improve erectile function. We thereby performed this meta-analysis to clarify the therapeutic effect of weight loss on erectile function in overweight or obese men. Literature search was conducted on databases including Cochrane Library, Embase, Web of Science and PubMed to obtain all relevant English articles published before March 1, 2021. The primary outcome was final International Index of Erectile Function (IIEF) score or change in IIEF score. The secondary outcome was final body weight and body mass index (BMI) or change in body weight and BMI. After screening, 5 studies with 619 participants were enrolled in our meta-analysis. Our result showed that the mean difference in body weight between weight loss group and control group was -18.07 kg with p < .01, and the mean difference in BMI was -9.6 kg/m² with p < .01. The mean difference of IIEF between weight loss group and control group was 1.99 with p < .01. This meta-analysis showed that weight loss could improve erectile function in overweight or obese men. Losing weight could serve as an adjuvant therapy for ED.

The Effect of Meal Replacement on Weight Loss According to Calorie-Restriction Type and Proportion of Energy Intake: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Portion control is a useful component of weight reduction interventions and meal replacement (MR) plans represent a promising strategy for portion control. Research performed with pooled data on the effect of MR plans according to various characteristics of MR interventions remains scarce.

OBJECTIVE

Our aim was to assess the effects of MR-based diets compared with food-based diets on weight loss, according to calorie-restriction types and energy intake proportions from MR.

METHODS

Electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Embase, and Research Information Sharing Service) were searched for randomized controlled trials on weight loss results of MR-based calorie-restricted diets compared with food-based calorie-restricted diets from January 2000 to May 2020. Standardized mean differences (Hedges' g) from all study outcomes were calculated using a random-effects model. Heterogeneity was quantified by Q test and I². Publication bias was assessed using a funnel plot and a trim and fill method. Both interventions (MR and control) were separated into very-low-energy diets and low-energy diets (LEDs). A meta-analysis of variance was conducted by dividing patient-related factors and treatment-related factors into subgroups. In multivariable meta-regressions, background variables were selected first, after which main independent variables were included.

RESULTS

Twenty-two studies involving 24 interventions and 1,982 patients who were overweight or obese were included. The effect size in which MR-based LED was compared with food-based LED for weight loss was small, favoring MR (Hedges' g = 0.261; 95% CI 0.156 to 0.365; I² = 21.9; 95% CI 0.0 to 53.6). Diets including ≥60% of total daily energy intake from MR had a medium effect size favoring MR with regard to weight loss among the groups (Hedges' g = 0.545; 95% CI 0.260 to 0.830; I² = 42.7; 95% CI 0.0 to 80.8).

CONCLUSIONS

The effect of MR-based LED on weight loss was superior to the effect of food-based LED, and receiving ≥60% of total daily energy intake from MR had the greatest effect on weight loss.

Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men's Health?

Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men who are apparently risk factor free. In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. Several parameters that derive from good clinical assessment of subjects with ED have proven to be valuable predictors of MACE. These include family history of cardiometabolic events, alcohol abuse, fatherhood, decreased partner’s sexual interest, severe impairment in erection during intercourse or during masturbation, impaired fasting glucose, increased triglycerides, obesity even without metabolic complications, decreased penile blood flows or impaired response to an intra-cavernosal injection test. Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function.

Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study

IMPORTANCE

Erectile dysfunction, especially in younger men, is an early sign of cardiovascular disease and may decrease quality of life. Men may be motivated to adopt a healthy dietary pattern if it lowers their risk of erectile dysfunction.

OBJECTIVE

To assess the association between adherence to a diet quality index based on healthy dietary patterns and erectile dysfunction in men.

DESIGN, SETTING, AND PARTICIPANTS

This population-based prospective cohort study included men from the Health Professionals Follow-up Study with follow-up from January 1, 1998, through January 1, 2014. Participants included US male health professionals aged 40 to 75 years at enrollment. Men with erectile dysfunction or a diagnosis of myocardial infarction, diabetes, stroke, or genitourinary cancer at baseline were excluded. Analyses were completed in February 2020.

EXPOSURES

A food frequency questionnaire was used to determine nutrient and food intake every 4 years.

MAIN OUTCOMES AND MEASURES

Diet quality was assessed by Mediterranean Diet score and the Alternative Healthy Eating Index 2010 score, with higher scores indicating healthier diet. Dietary index scores were cumulatively updated from 1986 until men developed erectile dysfunction, cardiovascular disease, died, or were lost to follow-up. Incident erectile dysfunction was assessed with questionnaires in 2000, 2004, 2008, and 2012. Hazard ratios (HRs) by prespecified categories or quintiles of dietary index scores were estimated using Cox proportional hazards regression analyses stratified by age.

RESULTS

Among 21 469 men included in analysis, mean (SD) age at baseline was 62 (8.4) years. During a mean (SD) follow-up of 10.8 (5.4) years and 232 522 person-years, there were 968 incident erectile dysfunction cases among men younger than 60 years, 3703 cases among men aged 60 to less than 70 years, and 4793 cases among men aged 70 years or older. Men younger than 60 years and in the highest category of the Mediterranean Diet score had the lowest relative risk of incident erectile dysfunction compared with men in the lowest category (HR, 0.78; 95% CI, 0.66-0.92). Higher Mediterranean diet scores were also inversely associated with incident erectile dysfunction among older men (age 60 to <70 years: HR, 0.82; 95% CI, 0.76-0.89; age ≥70 years: HR, 0.93; 95% CI, 0.86-1.00). Men scoring in the highest quintile of the Alternative Healthy Eating Index 2010 also had a lower risk of incident erectile dysfunction, particularly among men age younger than 60 years (quintile 5 vs quintile 1: HR, 0.78; 95% CI, 0.63-0.97).

CONCLUSIONS AND RELEVANCE

This cohort study found that adherence to healthy dietary patterns was associated with a lower risk for erectile dysfunction, suggesting that a healthy dietary pattern may play a role in maintaining erectile health.

The causes of adverse changes of testosterone levels in men

INTRODUCTION

As men age, progressive testosterone deficiency syndrome becomes an increasingly common problem. However, the decreased testosterone levels are not only the result of advanced age.

AREAS COVERED

PubMed search of published data on testosterone, nutritional deficiency, stress, sleep, and obesity. Many factors impact the male HPG axis (the hypothalamic-pituitary-adrenal), including body weight, calorific and nutritional value of a diet, the amount and quality of sleep, as well as the level of stress. In the case of persons of healthy weight, a below-average calorific value of a diet may decrease the levels of testosterone in men. On the other hand, the same caloric deficiency in obese persons may result in a neutral or positive impact on testosterone levels.

EXPERT OPINION

Many factors, including external, environmental and internal factors, influence testosterone levels. Undoubtedly, nutritional deficiency, and particularly of such nutrients as zinc, magnesium, vitamin D, together with low polyphenols intake, affects the HPG axis. The levels of mental and oxidative stress can also adversely impact the axis. Hence, a diagnosis of the cause of disturbance in testosterone levels depends on many factors and requires a broad range of research, as well as a change of patients' lifestyle.

Increasing hypothalamic nucleobindin 2 levels and decreasing hypothalamic inflammation in obese male mice via diet and exercise alleviate obesity-associated hypogonadism

To explore the role of nesfatin-1 in regulating male reproductive function during energy balance variation, we employed an obese mouse model which was first induced by a high-fat diet (HFD) and followed by interventions of a normal diet (ND) and/or moderate exercise, and then serum reproductive hormones of male mice, hypothalamic nucleobindin 2 (NUCB2)/nesfatin-1, inflammatory factors, and gonadotropin-releasing hormone (GnRH) levels were tested. Our findings showed that both serum nesfatin-1, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) levels and hypothalamic NUCB2/nesfatin-1 and Gnrh mRNA levels were reduced, whereas, the mRNA and protein levels of hypothalamic tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, inhibitor kappa B kinase β (IKKβ), and nuclear factor (NF)-κB were increased in obese male mice. Diet, exercise, and diet combined with exercise interventions reversed the decreases in serum nesfatin-1, FSH, LH, and T levels; increased hypothalamic NUCB2/nesfatin-1 and Gnrh mRNA levels; and reduced hypothalamic TNF-α, IL-1β, IKKβ, and NF-κB levels. These changes were accompanied by reduced adiposity, and these effects were more obvious in the diet combined with exercise group. Overall, our findings suggested that the hypogonadotropic hypogonadism associated with obesity may be induced by reduced hypothalamic NUCB2/nesfatin-1 levels, which attenuated the stimulatory effect on GnRH directly or indirectly by suppressing its anti-inflammatory effect in the brain. Diet and/or exercise interventions were able to alleviate the hypogonadotropic hypogonadism associated with obesity, potentially by increasing hypothalamic NUCB2/nesfatin-1 levels.

Adherence to Mediterranean diet and prostate cancer risk in Sicily: population-based case-control study

Prostate cancer (PCa) is the second most frequently diagnosed cancer and the sixth leading cause of death from cancer worldwide. Countries following a Mediterranean-type dietary pattern, has been reported to have lower PCa incidence and mortality compared with other European regions. A population-based case-control study has been conducted from January 2015 to December 2016 in a single institution of the municipality of Catania, southern Italy. A total of 118 PCa and 238 population-based controls were collected. Controls had significantly higher adherence to the Mediterranean diet, which was evident for several subgroups (including age groups, overweight and obese men, current smokers, alcohol intake, low and medium physical activity levels). PCa cases were found to consume lower amount of vegetables (223 g/d vs. 261 g/d; p = 0.001), legumes (34.26 g/d vs. 53.55 g/d; p = 0.003), and fish (47.75 g/d vs. 58.3 g/d) than controls; other differences emerged were related to alcohol intake (12.37 g/d vs 5.07 g/d; p < 0.01), cereals (254.06 g/d vs.235.94 g/d; p < 0.001), dairy (196 g/d vs. 166 g/d; p < 0.001), and meat consumption (98.09 g/d vs. 70.15 g/d; p < 0.001). However, no statistically significant differences between cases and controls were found regarding fruit, legumes, and olive oil consumption. The Mediterranean diet score was inversely associated with lower likelihood of having PCa in a linear manner (odds ratio [OR]: 0.86 [95% CI 0.77-0.96]). Specifically, individuals in the highest group of adherence had 78% less likelihood of have PCa and 14% less likelihood for each point increase of the score. The model adjusted for total polyphenol intake showed still a significant inverse association between adherence to the Mediterranean diet and PCa, but the relation was no more linear and not significant for one-point increase of the score (OR: 0.88 [95% CI 0.77-1.01]). In our cohorts of Italian men, we observed that high adherence to the Mediterranean diet was inversely associated with likelihood of having PCa cancer.

Structured lifestyle intervention based on a trans-cultural diabetes-specific nutrition algorithm (tDNA) in individuals with type 2 diabetes: a randomized controlled trial

OBJECTIVE

Trans-cultural diabetes nutrition algorithm (tDNA) was created by international task force and culturally customized for Malaysian population. This study was designed to evaluate its effectiveness versus usual diabetes care in primary care settings.

RESEARCH DESIGN AND METHODS

We randomized 230 patients with overweight/obesity, type 2 diabetes, and glycated hemoglobin (A1c) 7%-11% to receive usual care (UC) or UC with tDNA for 6 months. The tDNA intervention consisted of structured low-calorie meal plan, diabetes-specific meal replacements, and increased physical activity. Participants were counseled either through motivational interviewing (tDNA-MI) or conventional counseling (tDNA-CC). The UC group received standard dietary and exercise advice through conventional counseling. All patients were followed for another 6 months after intervention.

RESULTS

At 6 months, A1c decreased significantly in tDNA-MI (-1.1±0.1%, p<0.001) and tDNA-CC (-0.5±0.1%, p=0.001) but not in UC (-0.2±0.1%, p=NS). Body weight decreased significantly in tDNA-MI (-6.9±1.3 kg, p<0.001) and tDNA-CC (-5.3±1.2 kg, p<0.001) but not in UC (-0.8±0.5 kg, p=NS). tDNA-MI patients had significantly lower fasting plasma glucose (tDNA-MI: -1.1±0.3 mmol/L, p<0.001; tDNA-CC: -0.6±0.3 mmol/L, p=NS; UC: 0.1±0.3 mmol/L, p=NS) and systolic blood pressure (tDNA-MI: -9±2 mm Hg, p<0.001; tDNA-CC: -9±2 mm Hg, p=0.001; UC: -1±2 mm Hg, p=NS). At 1 year, tDNA-MI patients maintained significant reduction in A1c (tDNA-MI: -0.5±0.2%, p=0.006 vs tDNA-CC: 0.1±0.2%, p=NS and UC: 0.02±0.01%, p=NS) and significant weight loss (tDNA-MI: -5.8±1.3 kg, p<0.001 vs tDNA-CC: -3.3±1.2 kg, p=NS and UC: 0.5±0.6 kg, p=NS).

CONCLUSIONS

Structured lifestyle intervention through culturally adapted nutrition algorithm and motivational interviewing significantly improved diabetes control and body weight in primary care setting.

Long-Term Effects of a Randomised Controlled Trial Comparing High Protein or High Carbohydrate Weight Loss Diets on Testosterone, SHBG, Erectile and Urinary Function in Overweight and Obese Men

Introduction

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.

Aim

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.

Methods

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.

Results

Total testosterone, sex hormone binding globulin and free testosterone increased (P<0.001) and the total IIEF increased (P = 0.017) with no differences between diets (P≥0.244). Increases in testosterone (P = 0.037) and sex hormone binding globulin (P<0.001) and improvements in the total IIEF (P = 0.041) occurred from weeks 0–12 with a further increase in testosterone from week 12–52 (P = 0.002). Increases in free testosterone occurred from week 12–52 (p = 0.002). The IIEF erectile functon domain, lower urinary tract symptoms and sexual desire did not change in either group (P≥0.126).

Conclusions

In overweight and obese men, weight loss with both high protein and carbohydrate diets improve testosterone, sex hormone binding globulin and overall sexual function.

Trial Registration

Anzctr.org.au ACTRN12606000002583

Relationship among diet habit and lower urinary tract symptoms and sexual function in outpatient-based males with LUTS/BPH: a multiregional and cross-sectional study in China

OBJECTIVES

This study assessed the effect of diet habits on lower urinary tract symptoms (LUTS) and sexual function in Chinese men with LUTS/benign prostatic hypertrophy (LUTS/BPH).

SETTING

Multicentre study conducted between July 2013 and December 2013 in 11 hospitals in 3 geographic regions in China.

PARTICIPANTS

Overall, participants with LUTS/BPH accounted for 61.4% (2584/4208) of the respondents, whose data were processed in the following statistical analysis.

PRIMARY AND SECONDARY OUTCOME MEASURES

LUTS and sexual function were assessed based on the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function 5 (IIEF-5) score. Prostate volume (PV) was determined by ultrasound.

RESULTS

A total of 4208 participants met the inclusion criteria. The average age of the whole participants was 65.8±7.7 years. Overall, participants with LUTS/BPH accounted for 61.4% (2584/4208) of the respondents, whose data were processed in the following statistical analysis. Generally, prostate enlargement was greatest in south China. LUTS and male sexual dysfunction (MSD) were most severe in northwest China. Based on multivariable analysis, PV enlarged as the age (p<0.001), body mass index (BMI; p<0.001) and vegetable intake (p<0.001) increased. Age (p<0.001) and BMI (p<0.05) independently increased the IPSS. A higher level of education (p<0.001) and more frequent meat, fish and egg intake (p<0.05) decreased the IPSS. Age (p<0.001), BMI (p<0.001), low education level (p<0.05), vegetable intake (p=0.001), and milk and dairy product intake (p=0.001) decreased the IIEF-5 score.

CONCLUSIONS

In addition to factors including age, obesity and level of education, dietary habits and geographic difference might also play an important role in the variation of PV, LUTS and MSD for Chinese men with LUTS/BPH.

Caloric Restriction as a Strategy to Improve Vascular Dysfunction in Metabolic Disorders

Caloric restriction (CR) has proved to be the most effective and reproducible dietary intervention to increase healthy lifespan and aging. A reduction in cardiovascular disease (CVD) risk in obese subjects can be already achieved by a moderate and sustainable weight loss. Since pharmacological approaches for body weight reduction have, at present, a poor long-term efficacy, CR is of great interest in the prevention and/or reduction of CVD associated with obesity. Other dietary strategies changing specific macronutrients, such as altering carbohydrates, protein content or diet glycemic index have been also shown to decrease the progression of CVD in obese patients. In this review, we will focus on the positive effects and possible mechanisms of action of these strategies on vascular dysfunction.

Lifestyle and lower urinary tract symptoms: what is the correlation in men?

PURPOSE OF REVIEW

The primary purpose of this review is to provide an overview of the current evidence linking lifestyle factors and lower urinary tract symptoms (LUTS), and their relevance in men. An extensive literature search from January 2013 to August 2014 was conducted, reviewed, and summarized in conjunction with key prior evidence.

RECENT FINDINGS

The main findings from this review include 1) epidemiological data repeatedly show a favorable relationship between a healthy eating habits and regular physical activity level and a lower risk for LUTS or progression of LUTS, 2) certain specific nutrients or dietary factors may contribute to the link between diet and LUTS because of their anti-inflammatory potential, and 3) very little research has been conducted to test the epidemiological findings in randomized controlled trials.

SUMMARY

Rigorously designed clinical trials are needed to confirm the association between lifestyle factors and LUTS and the effect of lifestyle modification on the development or progression of LUTS. Nevertheless, a healthy lifestyle is known to closely relate with chronic diseases such as cardiovascular disease and diabetes. Thus, promoting a healthy lifestyle with good quality diet and regular physical activity is beneficial not only for potentially improving or reducing LUTS but also for cardiovascular and overall health. Clinicians are encouraged to include healthy lifestyle counseling in their routine care for patients with LUTS.