Erectile dysfunction and cardiovascular risk factors in a Mediterranean diet cohort

Global prevalence of sexual dysfunction in cardiovascular patients: a systematic review and meta-analysis

BACKGROUND

Sexual dysfunction poses a significant challenge for patients with cardiac conditions. Concerning the prevalence of sexual disorders in cardiovascular patients, several seminal studies conducted in various regions of the world have provided diverse facts and figures pertaining to sexual dysfunction among cardiovascular patients. Therefore, the present study aimed to analyze, summarize, and integrate the findings of seminal studies on the effect of underlying factors and estimate the global rate of sexual disorders in cardiovascular patients.

METHODS

The present systematic review and meta-analysis included studies conducted in 2003-2023. To find the relevant published academic papers, SID, MagIran, PubMed, Scopus, Web of Science (WOS), and Google Scholar databases were searched for keywords using MeSH/Emtree until January 14, 2023. The GRADEpro software was used to evaluate the quality of evidence. The heterogeneity of studies was checked using the I2 index.

RESULTS

An initial number of 2122 studies were found in the first search. Following a precise screening process based on predefined inclusion criteria, a total of 17 studies were deemed suitable for inclusion in the meta-analysis. The global prevalence of sexual disorders in cardiovascular patients was estimated at 62.6% (95% CI: 49.8-73.8%). As the results of the meta-regression showed that as the sample size increased, there was a significant decrease in the overall prevalence of sexual disorders among cardiovascular patients. Additionally, as the study years progressed, both age and JBI score exhibited an upward trend.

CONCLUSION

The present findings showed a high prevalence of sexual disorders among cardiovascular patients. Therefore, it is recommended that experts and health policymakers enhance their focus on effectively preventing and controlling these disorders. Besides the evidence achieved very low certainty, it is important for the treatment team to prioritize the sexual relations of cardiovascular patients and focus on improving their sexual function. This should be seen as an essential aspect of their overall recovery process.

Impact of a Mediterranean diet on prevention and management of urologic diseases

Compared to a Western diet, the Mediterranean diet moves away from red meat and processed foods. Universally regarded as a healthier dietary alternative, the Mediterranean diet has garnered scientific endorsement for its ability to confer an array of compelling benefits. These health benefits encompass not only a lowered incidence of Type 2 diabetes with a reduction in obesity, but also a robust protective effect on cardiovascular health. Extensive literature exists to corroborate these health benefits; however, the impact of a Mediterranean diet on urologic diseases, specifically sexual dysfunction, lower urinary tract symptoms, stone disease, and urologic cancers are not well studied. Understanding how dietary habits may impact these urologic conditions can contribute to improved prevention and treatment strategies.A total of 955 papers from PubMed and Embase were systematically reviewed and screened. After exclusion of disqualified and duplicated studies, 58 studies consisting of randomized controlled trials, cohort studies, cross sectional studies, reviews and other meta-analyses were included in this review. 11 primary studies were related to the impact of a Mediterranean diet on sexual dysfunction, 9 primary studies regarding urinary symptoms, 8 primary studies regarding stone disease, and 9 primary studies regarding urologic cancers. All primary studies included were considered of good quality based on a New-Castle Ottawa scale. The results demonstrate a Mediterranean diet as an effective means to prevent as well as improve erectile dysfunction, nephrolithiasis, lower urinary tract symptoms, and urinary incontinence. The review highlights the need for additional research to study the impact of diet on urologic cancers and other urologic conditions such as premature ejaculation, loss of libido, female sexual dysfunction, and overactive bladder.

Unlocking Potentially Therapeutic Phytochemicals in Capadulla (Doliocarpus dentatus) from Guyana Using Untargeted Mass Spectrometry-Based Metabolomics

Doliocarpus dentatus is thought to have a wide variety of therapeutic phytochemicals that allegedly improve libido and cure impotence. Although a few biomarkers have been identified with potential antinociceptive and cytotoxic properties, an untargeted mass spectrometry-based metabolomics approach has never been undertaken to identify therapeutic biofingerprints for conditions, such as erectile dysfunction, in men. This study executes a preliminary phytochemical screening of the woody vine of two ecotypes of D. dentatus with renowned differences in therapeutic potential for erectile dysfunction. Liquid chromatography-mass spectrometry-based metabolomics was used to screen for flavonoids, terpenoids, and other chemical classes found to contrast between red and white ecotypes. Among the metabolite chemodiversity found in the ecotype screens, using a combination of GNPS, MS-DIAL, and SIRIUS, approximately 847 compounds were annotated at levels 2 to 4, with the majority of compounds falling under lipid and lipid-like molecules, benzenoids and phenylpropanoids, and polyketides, indicative of the contributions of the flavonoid, shikimic acid, and terpenoid biosynthesis pathways. Despite the extensive annotation, we report on 138 tentative compound identifications of potentially therapeutic compounds, with 55 selected compounds at a level-2 annotation, and 22 statistically significant therapeutic biomarkers, the majority of which were polyphenols. Epicatechin methyl gallate, catechin gallate, and proanthocyanidin A2 had the greatest significant differences and were also relatively abundant among the red and white ecotypes. These putatively identified compounds reportedly act as antioxidants, neutralizing damaging free radicals, and lowering cell oxidative stress, thus aiding in potentially preventing cellular damage and promoting overall well-being, especially for treating erectile dysfunction (ED).

Should Men Eat More Plants? A Systematic Review of the Literature on the Effect of Plant-Forward Diets on Men's Health

OBJECTIVE

To perform a systematic review of the literature on plant-based and plant-forward diets and the prevention/treatment of the following common men's health conditions: prostate cancer (PCa), erectile dysfunction (ED), and benign prostatic hyperplasia (BPH).

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system criteria were utilized to search PubMed and Medline databases for the following search terms: "Diet (Mesh)" OR "Diet Therapy (Mesh)" AND "Prostatic Hyperplasia (Mesh)" OR "Prostatic Neoplasm (Mesh)" OR "Erectile Dysfunction (Mesh)." Articles in English published from 1989 to 2022 using human participants were analyzed, data summarized, and assessed for bias.

RESULTS

Studies reporting on plant-based or vegetable-forward diets (Mediterranean) as an intervention were included. Cohort and cross-sectional studies using food frequency questionnaires or diet classification indices to quantify plant-based food intake patterns were included in the study. Ultimately, 12 PCa articles, 4 BPH articles, 6 ED articles, and 2 articles related to both BPH and ED were reviewed. Overall, the literature suggests plant-forward diets confer a protective effect on the men's health conditions reviewed.

CONCLUSIONS

Evaluation of the literature on the impact of plant-forward diets on urologic conditions includes a heterogenous range of dietary patterns and study designs. The greatest amount of research has evaluated the application of plant-forward diets for PCa. While there is currently a lack of high-quality evidence for the use of plant-forward diets as prevention and/or treatment for PCa, ED, or BPH, reported outcomes suggest a consistent small beneficial impact alongside well-established benefits for common chronic conditions.

Effects of diet and antihyperglycemic drugs on erectile dysfunction: A systematic review

BACKGROUND

Erectile dysfunction is recognized as one of the complications of diabetes mellitus. To date, a wide gap of knowledge is present on the efficacy of pharmacological treatments of diabetes mellitus on erectile function, acting not only through metabolic control. Similarly, the effects of different diet regimens on erectile dysfunction are still debated.

OBJECTIVES

We aimed to explore the effects of diet and antihyperglycemic drugs, considering both old and novel therapeutic approaches, on erectile function.

MATERIALS/METHODS

We performed a systematic review, following the PRISMA guidelines. The research was conducted on studies reporting erectile dysfunction assessment in subjects with diabetes and the relationship with diet and antihyperglycemic drugs.

RESULTS

The Mediterranean diet was effective in most studies for the protection of erectile function. Furthermore, antihyperglycemic drugs seem to show an overall protective role on erectile function.

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 inhibitors, and sodium-glucose cotransporter-2 inhibitors.

COVID-19 and hypopituitarism

Besides the pulmonary manifestations caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with coronavirus disease 2019 (COVID-19). Patients with pituitary diseases or the pituitary gland itself may also be involved in COVID-19 clinical presentation and/or severity, causing pituitary apoplexy.Moreover, hypopituitarism is frequently burdened by several metabolic complications, including arterial hypertension, hyperglycemia, obesity and vertebral fractures, which have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2.This review will discuss hypopituitarism as a condition that might have a bidirectional relationship with COVID-19 due to the frequent presence of metabolic comorbidities, to the direct or indirect pituitary damage or being per se a potential risk factor for COVID-19. Finally, we will address the current recommendations for the clinical management of vaccines in patients with hypopituitarism and adrenal insufficiency.

Beneficial Effects of the Very-Low-Calorie Ketogenic Diet on the Symptoms of Male Accessory Gland Inflammation

Introduction. Obesity exposes individuals to the risk of chronic inflammation of the prostate gland. Aim and design of the study. A longitudinal clinical study was conducted on selected overweight/obese patients with male accessory gland inflammation (MAGI) to evaluate the effects of body weight loss on their urogenital symptoms. Materials and methods. One hundred patients were selected and assigned to two groups undergoing two different nutritional programs. The first group (n = 50) started a Mediterranean diet (MedDiet) and the second (n = 50) a very-low-calorie ketogenic diet (VLCKD). Before and after three months on the diet, each patient was evaluated for body weight, waist circumference, and MAGI symptoms. The MAGI was assessed using the Structured Interview about MAGI (SI-MAGI), a questionnaire previously designed to assess the symptoms of MAGI. The questionnaire explores four domains, including urinary symptoms, ejaculatory pain or discomfort, sexual dysfunction, and impaired quality of life. Finally, in the two groups, the frequency of an α-blocker used to treat urinary tract symptoms was also evaluated. Results. Patients on MedDiet experienced significant amelioration in urinary symptoms and quality of life. Patients under VLCKD reported not only significant improvement of the same parameters, but also in ejaculatory pain/discomfort and sexual dysfunction. Finally, the percentage of patients on VLCKD taking the α-blocker decreased significantly. Moreover, patients under VLCKD showed a greater loss of body weight than those following the MedDiet. Discussion. The results of this study support the effectiveness of VLCKD in improving the symptoms of patients with MAGI. This improvement involved all of the domains of the SI-MAGI questionnaire and became manifest in a relatively short time. We suggest that a ketogenic nutritional approach can be used in overweight/obese patients with MAGI.

Erectile Dysfunction in Individuals with Type 1 Diabetes is Associated with Long-term Metabolic Control and Diabetic Complications: A Cross-Sectional Study

Background  Erectile dysfunction (ED) affects approximately 38% of individuals with type 1 diabetes (T1DM). Skin autofluorescence (AF) reflects skin advanced glycation end product (AGE) deposits and is a marker of long-term glycemia control. Objective  The study investigates the relationship between ED and diabetes control in patients with T1DM. Methods  Adult patients with T1DM visiting the Diabetology Department were cross-sectionally investigated. Medical history, anthropometric features, and laboratory findings were collected. All individuals filled the International Index of Erectile Function (IIEF-5). IIEF-5 total score < 22 represented the presence of ED. AF was measured on the volar aspect of the forearm using AGE Reader. Insulin resistance (IR) was assessed by the estimated glucose disposal rate. Descriptive statistics and multivariate logistic regression analyses were performed. The adjusted covariates were general risk factors of ED. Results  Of a total of n  = 70 patients, n  = 30 (42.9%) suffered from ED. The presence of ED was associated with higher glycated hemoglobin level (OR, 95% CI; 1.62, 1.02-2.60; p  = 0.043), presence of at least one diabetic complication (3.49, 1.10-11.03; p  = 0.03), and skin AF (9.20, 1.60-52.94; p  = 0.01), but not with IR (0.78, 0.57-2.60; p  = 0.12). Skin AF values ≥ 2.2 indicates presence of ED with a sensitivity of 70.0% and a specificity of 77.5%. Area under the curve was equal to 0.72 (95% CI: 0.60-0.85). Conclusions  The presence of ED in individuals with T1DM is associated with HbA1c, the presence of at least one diabetic complication, and skin AF.

Mediterranean diet in type 2 diabetes: An updated overview of pharmacological activities of cardiometabolic and reproductive outcomes

Mediterranean diet represents an optimal "way of living" to pursue in order to preserve health and well-being. A large body of evidence indicates that the Mediterranean diet is effective in preventing diabetes and improving both glycemic control and cardiometabolic health in people with type 2 diabetes. Moreover, in the recent years a growing interest risen on the importance of dietary style choice in both male and female sexual and reproductive health. This review aims at providing an updated overview of the latest available evidence on the effects of Mediterranean diet on cardiovascular, metabolic, and reproductive health in the context of type 2 diabetes.

Erectile Dysfunction in Men on the Rise: Is There a Link with Endocrine Disrupting Chemicals?

Erectile dysfunction (ED) is one of the most prevalent chronic conditions affecting men. ED can arise from disruptions during development, affecting the patterning of erectile tissues in the penis and/or disruptions in adulthood that impact sexual stimuli, neural pathways, molecular changes, and endocrine signalling that are required to drive erection. Sexual stimulation activates the parasympathetic system which causes nerve terminals in the penis to release nitric oxide (NO). As a result, the penile blood vessels dilate, allowing the penis to engorge with blood. This expansion subsequently compresses the veins surrounding the erectile tissue, restricting venous outflow. As a result, the blood pressure localised in the penis increases dramatically to produce a rigid erection, a process known as tumescence. The sympathetic pathway releases noradrenaline (NA) which causes detumescence: the reversion of the penis to the flaccid state. Androgen signalling is critical for erectile function through its role in penis development and in regulating the physiological processes driving erection in the adult. Interestingly, estrogen signalling is also implicated in penis development and potentially in processes which regulate erectile function during adulthood. Given that endocrine signalling has a prominent role in erectile function, it is likely that exposure to endocrine disrupting chemicals (EDCs) is a risk factor for ED, although this is an under-researched field. Thus, our review provides a detailed description of the underlying biology of erectile function with a focus on the role of endocrine signalling, exploring the potential link between EDCs and ED based on animal and human studies.

The association between plant-based diet and erectile dysfunction in Chinese men

Background

Diet, one of the components of lifestyle, has been believed to have associations with erectile dysfunction (ED). However, whether there is an association between plant-based diet and ED is remains to be explored. Thus, we conducted the nested case-control study to investigate the relationship between the plant-based diet and ED in China.

Results

ED group (92 subjeczts) and ED free group (92 subjects) were similar in terms of basic features (P > 0.05), except for lifestyle (P < 0.05). The plant-diet index (PDI) and healthy plant-diet index (hPDI) in the ED group were significantly lower than those in the control group (P < 0.001). Adjusted multivariate analysis indicated that the presence of ED was negatively associated with nitric oxide levels, PDI, and hPDI (all P < 0.05), and was positively related to body mass index, metabolic syndrome, and E-selectin levels. Furthermore, both the PDI and hPDI increased significantly as the International Index of Erectile Function (IIEF-5) scores increased within the ED group (P < 0.05). Multi-model multivariate analysis indicated the robustness of results.

Conclusions

More plant-based diet intake was associated with a reduced presence of ED and less severe ED in China. Committing to plant-based diet can be encouraged for many health benefits and to lower ED burden. Further well-designed studies are warranted to validate our findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12610-021-00129-5.

The association between plant-based diet and erectile function in Chinese young healthy men: A population-based study

The study was designed and conducted to evaluate the plant-based diet status and its association with erectile function (EF) in Chinese young healthy men. From July 2018 to May 2020, 116 objectively proved physically and psychologically healthy men were selected. Clinical questionnaires, detailed physical examinations and blood tests were all assessed. An overall plant-based diet index (PDI) and a healthful plant-based diet index (hPDI) were developed from each participant to measure plant-based diet quantitatively. The EF was measured by both the International Index of Erectile Function-5 (IIEF-5) and the surrogated measures of endothelial function, peripheral levels of nitric oxide (NO) and E-selectin. In subjects, the mean PDI and hPDI were 53.8 ± 8.2 and 54.7 ± 8.9 respectively. Results of multivariate analysis showed that both PDI and hPDI were negatively associated with BMI (all p < .05), but had no relationships with NO, E-selectin, TT levels and IIEF-5 scores (all p > .05). In a subgroup of male population, Chinese young healthy men, the plant-based diet, measured by PDI and hPDI, was not related to erectile function. The population can adhere to plant-based diet to keep healthy without concerns of negative influence on erectile function.

Associations between body mass index, waist circumference and erectile dysfunction: a systematic review and META-analysis

Growing evidence reports that obesity might play a role in erectile dysfunction (ED), but limited knowledge is available. We conducted a meta-analysis to estimate the prevalence of ED in overweight men and men with obesity. We performed a systematic review up to 01/04/2019 to investigate the associations between obesity and ED. Applying a random-effect model, we calculated the prevalence of ED, the odds ratio (OR) for the presence of ED by Body Mass Index (BMI) categories and the mean differences between ED and controls in BMI and Waist Circumference (WC). Among 3409 studies, we included 45 articles with 42,489 men (mean age = 55 years). Taking normal weight men as reference, the prevalence of ED was significantly higher in overweight (OR = 1.31; 95%CI: 1.13-1.51; I² = 72%) and in men with obesity (OR = 1.60; 95%CI: 1.29-1.98; I² = 79%). Adjusting our analyses for potential confounders, the results were confirmed in men with obesity (OR = 1.46; 95%CI: 1.24-1.72; I² = 72%). ED was associated with significant higher values of BMI (MD = 0.769; 95%CI: 0.565-0.973 Kg/m²; I² = 78%) and WC (MD = 5.251 cm; 95%CI: 1.295-9.208; I² = 96%). Considering the high prevalence of ED among men with obesity, clinicians should screen for this clinical condition in this population. Findings from the present study suggest that reducing adiposity is a crucial approach in patients with ED who are affected by obesity.

Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis

BACKGROUND

Erectile dysfunction (ED) is a common problem among men across the world. It is usually multifactorial in origin. Behavioral factors can be related to the development of ED and related to many other chronic diseases. It impacts not only the sexual function but also the psychology and their overall quality of life.

AIM

To determine the association of the behavior factors in relation to ED and to identify the risk and protective factors.

METHOD

A systematic review search based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted. The primary databases PubMed, PlosOne, Oxford Academic, SCOPUS, and Ovid were accessed using specific keyword searches. Quality of articles was assessed by using Newcastle-Ottawa Assessment Scale according to the study design.

OUTCOME

Evaluation of the relationship between behavioral factors and ED.

RESULTS

24 studies were identified from the 5 databases which met the predetermined criteria. Overall, the study population include adult male age between 18 and 80 years. The sample size of the studies ranges from 101 to the largest sample size of 51,329. Smoking, alcohol, and drugs usage are found to be risk factors for ED. Meanwhile, dietary intake, physical activity, and intimacy are the protective factors for ED.

CLINICAL IMPLICATION

The findings from this review may aid clinicians to aim for early detection of ED by screening their risk factors and providing early treatment. This can also be used to promote awareness to the community on the sexual health and factors that can affect their sexual function.

STRENGTH & LIMITATION

This study looks at all types of behavioral factors that may affect ED; however, there was a substantial heterogeneity detected across the selected study factors. Furthermore, the lack of PROSPERO registration is also a limitation in this study.

CONCLUSION

Overall, smoking, dietary intake, alcohol consumption, drugs, and physical activities are modifiable risk factors for ED in men. Therefore, it is crucial to promote healthy lifestyle and empower men to prevent ED and early detection of ED for early treatment. Sivaratnam L, Selimin DS, Abd Ghani SR, et al. Behavior-Related Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med 2021;18:121-143.

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.

Promising role of medicinal plants in the regulation and management of male erectile dysfunction

Male erectile dysfunction (ED) refers to incompetency to reaching and retaining adequate penile tumescence for sexual intercourse. Over 152 million men globally suffer from ED and by 2025, the number of affected individuals is anticipated to be around 322 million. Pharmacological and nonpharmacological therapies such as phosphodiesterase (PDE) inhibitors, alprostadil, penile prosthesis surgery, and hormonal replacement are available for management and recuperation of ED. Nevertheless, such therapies are reported to have adverse effects as well as life-threatening. Accordingly, diversity of medicinal plant species and bioactive active compounds are preferred as therapeutic options because they are natural, abundant, available, low-cost and cause fewer or no side effects. This current review will emphasise the aetiology, risk factors, mechanisms underlying the pathophysiology of ED, treatments of ED as well as their side effects. It also provides medicinal plants that are proven effective in vivo and in vitro for the mitigation and treatment of male ED. This knowledge could be used in the future in drug discovery for the development of more natural drugs with no side effects.

The effect of diet on BPH, LUTS and ED

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.

Association Between Cardiovascular Health and Endothelial Function With Future Erectile Dysfunction: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

The association of Cardiovascular Health (CVH; defined by the American Heart Association by assigning points for health-related behavioral and clinical factors) with endothelial and erectile dysfunction has not been reported, although endothelial and erectile dysfunction have been associated with components of CVH.

METHODS

Data were collected in 1,136 men in the Multi-Ethnic Study of Atherosclerosis at baseline and erectile dysfunction status (measured by survey or medication use) at exam 5. CVH was determined with 7 health metrics. Endothelial function was measured with brachial artery flow-mediated dilation (FMD). Poisson regression was used to determine associations between CVH and erectile dysfunction across categories of CVH (low, moderate, and high).

RESULTS

Age and proportion of Black or Latino participants decreased while proportion of Chinese-American participants increased with higher CVH category. FMD was higher in men without erectile dysfunction and higher in men with high vs. low CVH. Erectile dysfunction prevalence was lower with better CVH; 58% in men with low CVH, 41% with moderate CVH, and 33% with high CVH (P < 0.001). CVH was associated with erectile dysfunction; prevalence ratio = 0.75 (95% confidence interval (CI) = 0.66, 0.84) with moderate CVH and 0.68 (95% CI = 0.49, 0.94) with high CVH (vs. men with low CVH) and 0.93 (95% CI = 0.91, 0.96) for every 1-point higher CVH score in a fully adjusted model, including FMD, age, education, depression score, use of antidepressant or beta-blocker medications, chronic disease, heavy drinking, and race.

CONCLUSION

CVH is associated with future erectile dysfunction, even after adjustment for baseline FMD. Maintaining high CVH may improve quality of life for men.

Sexual health, adherence to Mediterranean diet, body weight, physical activity and mental state: factors correlated to each other

INTRODUCTION

Mediterranean diet has shown a protective role against cardiovascular disease, diabetes, cancer onset, microvascular damage and dementia in many trials. Our purpose is the assessment of a correlation between physical activity, Mediterranean diet, body mass index (BMI), depression and erection disorder (ED).

METHODS

After having signed disclaimer to the study participation, we administered the IIEF 15 questionnaire (International Index of Erectil Function), the Hamilton questionnaire for major depression, the Med-Diet Questionnaire, the Ipaq Questionnaire (International Index of Physical Activity) to 245 patients and calculated the BMI. Only 141 were eligible. We excluded patients with a history of smoking, with obesity from the second grade to rise, anorexia, hyperlipidemia, Induratio Penis Plastica, diabetes, cardiovascular and neurological disease, hypogonadism, prostatitis, diabetes, hypertension, psychiatric diseases and the history of radical prostatectomy and finally age >72 and <50 years or who were taking cholesterol-lowering medication. Patients were divided into two groups: 65 patients without ED and 76 patients with ED.

RESULTS

We found a statistically difference in BMI between the groups. Adherence to Med-Diet showed a significant difference between the two groups at Student t-test and the Chi-square test. The Ipaq test and Hamilton test did not show statistical differences between the two groups neither for Student t-test nor for Chi-square test, but high levels seem to be protective factors.

CONCLUSIONS

Body weight and a healthy diet are protective factors against the ED, more than a sufficient physical activity. Depression has shown only a worsening tendency of the erection.

Mediterranean diet and erectile dysfunction: a current perspective

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.

Prevalence, psychological impact, and risk factors of erectile dysfunction in patients with Peyronie's disease: a retrospective analysis of 309 cases

Peyronie's disease (PD) is a chronic inflammatory disease involving the tunica albuginea of the penis. Erectile dysfunction (ED) is a possible invalidating symptom of PD. The aim of this study was to evaluate the prevalence, psychological impact, and risk factors of ED in patients with PD. The study was conducted by carrying out a retrospective analysis of the clinical records of 309 patients with PD who visited our andrology clinic. All patients underwent the following tests: body mass index, common blood tests and hormone assays, questionnaire for erectile function assessment, dynamic penile color Doppler ultrasonography, imaging of the penis at maximum erection with photographic poses according to Kelâmi, psychosexual impact evaluation with PD Questionnaire (symptom bother score), evaluation of depression symptoms with the Patient Health Questionnaire-9, and evaluation of the intensity of penile pain with the pain intensity numeric rating scale. ED was observed in 37.5% of the cases. We divided the cases into two groups: group A (PD + ED), 116 cases, and group B (PD without ED), 193 cases. After multivariate analysis, we concluded that the following comorbidities are independent risk factors for ED: dyslipidemia, obesity, chronic prostatitis, benign prostatic hyperplasia, and autoimmune diseases. A depressive disorder was observed in 62.4%, and it was more frequent in patients with PD + ED (91.37% versus 45.07% group B). Sexual bother was greater in group A compared with group B (9.7 versus 7.6). Intensities of depressive symptoms and sexual bother were significantly higher compared with cases with no curvature when the bend angle was ≥30°. Our study confirms that an integrated psychological support with medical treatment is needed in patients with PD.