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Pecora G, Sciarra F, Gangitano E, Venneri MA. How Food Choices Impact on Male Fertility. Curr Nutr Rep 2023; 12:864-876. [PMID: 37861951 PMCID: PMC10766669 DOI: 10.1007/s13668-023-00503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Increasing evidence on the significance of nutrition in reproduction is emerging from both animal and human studies, suggesting an association between nutrition and male fertility. Here, we have highlighted the impact of the various food groups on reproductive hormones and on spermatogenesis, and the effects of classical and latest dietary patterns such as Mediterranean diet, Western diet, intermittent fasting, ketogenic diet, and vegan/vegetarian diet on male fertility. RECENT FINDINGS Nutrients are the precursors of molecules involved in various body's reactions; therefore, their balance is essential to ensure the correct regulation of different systems including the endocrine system. Hormones are strongly influenced by the nutritional status of the individual, and their alteration can lead to dysfunctions or diseases like infertility. In addition, nutrients affect sperm production and spermatogenesis, controlling sexual development, and maintaining secondary sexual characteristics and behaviors. The consumption of fruit, vegetables, fish, processed meats, dairy products, sugars, alcohol, and caffeine importantly impact on male fertility. Among dietary patterns, the Mediterranean diet and the Western diet are most strongly associated with the quality of semen. Nutrients, dietary patterns, and hormonal levels have an impact on male infertility. Therefore, understanding how these factors interact with each other is important for strategies to improve male fertility.
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Affiliation(s)
- Giulia Pecora
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 329, 00161, Rome, Italy
| | - Francesca Sciarra
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 329, 00161, Rome, Italy
| | - Elena Gangitano
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 329, 00161, Rome, Italy
| | - Mary Anna Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 329, 00161, Rome, Italy.
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Zhao JQ, Wang XB, Leng X, Wei YF, Huang DH, Lv JL, Du Q, Guo RH, Pan BC, Wu QJ, Zhao YH. Dietary fat and fatty acid consumptions and the odds of asthenozoospermia: a case-control study in China. Hum Reprod Open 2023; 2023:hoad030. [PMID: 37547665 PMCID: PMC10403433 DOI: 10.1093/hropen/hoad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/09/2023] [Indexed: 08/08/2023] Open
Abstract
STUDY QUESTION Are dietary fat and fatty acid (FA) intakes related to the odds of asthenozoospermia? SUMMARY ANSWER Plant-based fat consumption was associated with decreased asthenozoospermia odds, while the consumption of animal-based monounsaturated fatty acid (MUFA) was positively related to asthenozoospermia odds. WHAT IS KNOWN ALREADY Dietary fat and FA are significant ingredients of a daily diet, which have been demonstrated to be correlated to the reproductive health of men. However, to date, evidence on fat and FA associations with the odds of asthenozoospermia is unclear. STUDY DESIGN SIZE DURATION The hospital-based case-control study was performed in an infertility clinic from June 2020 to December 2020. Briefly, 549 asthenozoospermia cases and 581 controls with normozoospermia were available for final analyses. PARTICIPANTS/MATERIALS SETTING METHODS We collected dietary data through a verified food frequency questionnaire of 110 food items. Asthenozoospermia cases were ascertained according to the World Health Organization guidelines. To investigate the correlations of dietary fat and FA consumptions with the odds of asthenozoospermia, we calculated the odds ratios (ORs) and corresponding 95% CIs through unconditional logistic regression models. MAIN RESULTS AND THE ROLE OF CHANCE Relative to the lowest tertile of consumption, the highest tertile of plant-based fat intake was inversely correlated to the odds of asthenozoospermia (OR = 0.68, 95% CI = 0.50-0.91), with a significant dose-response relation (OR = 0.85, 95% CI = 0.75-0.97, per standard deviation increment). Inversely, animal-based MUFA intake (OR = 1.49, 95% CI = 1.04-2.14) was significantly correlated to increased odds of asthenozoospermia, and an evident dose-response relation was also detected (OR = 1.24, 95% CI = 1.05-1.45, per standard deviation increment). Subgroup analyses showed similar patterns of associations to those of the primary results. Moreover, we observed significant interactions on both multiplicative and additive scales between animal-based MUFA and cigarette smoking. LIMITATIONS REASONS FOR CAUTION Selection bias and recall bias were unavoidable in any of the observational studies. As we failed to obtain the information of trans-fatty acid (TFA) consumption, the relation of TFA intake and asthenozoospermia odds was unclear. WIDER IMPLICATIONS OF THE FINDINGS This study indicated that different sources of fat and FAs might exert different effects on the etiology of asthenozoospermia, and cigarette smoking could exacerbate the adverse effect of high animal-based MUFA intake on asthenozoospermia. Our findings provide novel evidence pertaining to the fields of prevention of asthenozoospermia through decreasing animal-derived fat and FA consumptions and smoking cessation. STUDY FUNDING/COMPETING INTERESTS This work was supported by the JieBangGuaShuai Project of Liaoning Province, Natural Science Foundation of Liaoning Province, Clinical Research Cultivation Project of Shengjing Hospital, and Outstanding Scientific Fund of Shengjing Hospital. All authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | | | - Xu Leng
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yi-Fan Wei
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dong-Hui Huang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jia-Le Lv
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiang Du
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ren-Hao Guo
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bo-Chen Pan
- Correspondence address. Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615; E-mail: (B.-C.P.); Department of Clinical Epidemiology, Clinical Research Center, Department of Obstetrics and Gynecology, NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615-13652; E-mail: (Q.-J.W.); Department of Clinical Epidemiology, Clinical Research Center, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615-13652; E-mail: (Y.-H.Z.)
| | - Qi-Jun Wu
- Correspondence address. Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615; E-mail: (B.-C.P.); Department of Clinical Epidemiology, Clinical Research Center, Department of Obstetrics and Gynecology, NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615-13652; E-mail: (Q.-J.W.); Department of Clinical Epidemiology, Clinical Research Center, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615-13652; E-mail: (Y.-H.Z.)
| | - Yu-Hong Zhao
- Correspondence address. Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615; E-mail: (B.-C.P.); Department of Clinical Epidemiology, Clinical Research Center, Department of Obstetrics and Gynecology, NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615-13652; E-mail: (Q.-J.W.); Department of Clinical Epidemiology, Clinical Research Center, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, China. Tel: +86-24-96615-13652; E-mail: (Y.-H.Z.)
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Zhao JQ, Lv JL, Wang XB, Wei YF, Guo RH, Leng X, Du Q, Huang DH, Wu QJ, Pan BC, Zhao YH. Phytochemical consumption and the risk of teratozoospermia: findings from a hospital-based case-control study in China. Hum Reprod Open 2023; 2023:hoad025. [PMID: 37346245 PMCID: PMC10279649 DOI: 10.1093/hropen/hoad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/06/2023] [Indexed: 06/23/2023] Open
Abstract
STUDY QUESTION Are dietary phytochemicals associated with the risk of teratozoospermia? SUMMARY ANSWER Dietary intake of carotene, including total carotene, α-carotene, β-carotene as well as retinol equivalent, and lutein + zeaxanthin, were inversely correlated with the risk of teratozoospermia. WHAT IS KNOWN ALREADY Phytochemicals are natural plant derived bioactive compounds, which have been reported to be potentially associated with male reproductive health. To date, no study has investigated the association between phytochemical intake and the risk of teratozoospermia. STUDY DESIGN SIZE DURATION This hospital-based case-control study, which included 146 newly diagnosed teratozoospermia cases and 581 controls with normozoospermia from infertile couples, was conducted in a hospital-based infertility clinic in China, from June 2020 to December 2020. PARTICIPANTS/MATERIALS SETTING METHODS Dietary information was collected using a validated semi-quantitative 110-item food frequency questionnaire. Unconditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between phytochemical (i.e. phytosterol, carotene, flavonoid, isoflavone, anthocyanidin, lutein + zeaxanthin, and resveratrol) intake and the risk of teratozoospermia. MAIN RESULTS AND THE ROLE OF CHANCE We observed a decreased risk of teratozoospermia for the highest compared with the lowest tertile consumption of total carotene (OR = 0.40, 95% CI = 0.21-0.77), α-carotene (OR = 0.53, 95% CI = 0.30-0.93), β-carotene (OR = 0.47, 95% CI = 0.25-0.88), retinol equivalent (OR = 0.47, 95% CI = 0.24-0.90), and lutein + zeaxanthin (OR = 0.35, 95% CI = 0.19-0.66), with all of the associations showing evident linear trends (all P trend <0.05). In addition, significant dose-response associations were observed between campestanol and α-carotene consumption and the risk of teratozoospermia. Moreover, there was a significant multiplicative interaction between BMI and lutein + zeaxanthin intake (P interaction <0.05). LIMITATIONS REASONS FOR CAUTION The cases and controls were not a random sample of the entire target population, which could lead to admission rate bias. Nevertheless, the controls were enrolled from the same infertility clinic, which could reduce the bias caused by selection and increase the comparability. Furthermore, our study only included a Chinese population, therefore caution is required regarding generalization of our findings to other populations. WIDER IMPLICATIONS OF THE FINDINGS Dietary phytochemicals, namely carotene, lutein, and zeaxanthin, might exert a positive effect on teratozoospermia. These phytochemicals are common in the daily diet and dietary supplements, and thus may provide a preventive intervention for teratozoospermia. STUDY FUNDING/COMPETING INTERESTS This study was funded by Natural Science Foundation of Liaoning Province (No. 2022-MS-219 to X.B.W.), Outstanding Scientific Fund of Shengjing Hospital (No. M1150 to Q.J.W.), Clinical Research Cultivation Project of Shengjing Hospital (No. M0071 to B.C.P.), and JieBangGuaShuai Project of Liaoning Province (No. 2021JH1/1040050 to Y.H.Z.). All authors declared that there was no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
| | | | - Xiao-Bin Wang
- Correspondence address. Center for Reproductive Medicine, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615; E-mail: (X.-B.W.); Department of Clinical Epidemiology, Clinical Research Center, Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Department of Obstetrics and Gynecology, NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615-13652; E-mail: (Q.-J.W.); Department of Clinical Epidemiology, Clinical Research Center, Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615; E-mail: (Y.-H.Z.)
| | - Yi-Fan Wei
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ren-Hao Guo
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Leng
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiang Du
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dong-Hui Huang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Correspondence address. Center for Reproductive Medicine, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615; E-mail: (X.-B.W.); Department of Clinical Epidemiology, Clinical Research Center, Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Department of Obstetrics and Gynecology, NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615-13652; E-mail: (Q.-J.W.); Department of Clinical Epidemiology, Clinical Research Center, Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615; E-mail: (Y.-H.Z.)
| | - Bo-Chen Pan
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu-Hong Zhao
- Correspondence address. Center for Reproductive Medicine, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615; E-mail: (X.-B.W.); Department of Clinical Epidemiology, Clinical Research Center, Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Department of Obstetrics and Gynecology, NHC Key Laboratory of Advanced Reproductive Medicine and Fertility (China Medical University), Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615-13652; E-mail: (Q.-J.W.); Department of Clinical Epidemiology, Clinical Research Center, Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Shenyang, Liaoning 110004, P. R. China. Tel: +86-24-96615; E-mail: (Y.-H.Z.)
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Lv JL, Wu QJ, Wang XB, Du Q, Liu FH, Guo RH, Leng X, Pan BC, Zhao YH. Intake of ultra-processed foods and asthenozoospermia odds: A hospital-based case-control study. Front Nutr 2022; 9:941745. [PMID: 36337657 PMCID: PMC9630735 DOI: 10.3389/fnut.2022.941745] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background The intake of ultra-processed foods (UPFs) has increased rapidly in recent years. Evidence has suggested that UPFs has adverse effects on several health outcomes. This study aimed to first evaluate the association between the intake of UPFs and asthenozoospermia odds. Methods A hospital-based case-control study including 549 cases and 581 controls was performed in the infertility clinics of Shengjing Hospital of China Medical University from June 2020 to December 2020. Dietary intake was assessed using a validated food frequency questionnaire. Food items were categorized by the NOVA classification system based on the degree of processing. Semen parameters were analyzed according to the World Health Organization guidelines. Results The highest tertile of UPFs intake (% of total energy intake) was positively associated with the odds of asthenozoospermia (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.12, 2.10; P for trend < 0.05), compared with the lowest tertile. Similar patterns were also found in subgroup analyses among participants with age ≥32 years (OR = 1.58; 95% CI: 1.04, 2.40), BMI ≥ 24 kg/m2 (OR = 1.52; 95% CI: 1.04, 2.22), ever cigarette smoking (OR = 1.78; 95% CI: 1.14, 2.79), and ever alcohol drinking (OR = 1.65; 95% CI: 1.01, 2.72), and in sensitivity analyses by using absolute amount (g/day) to calculate the intake of UPFs. Conclusion Higher consumption of UPFs was positively associated with the odds of asthenozoospermia. More studies are needed to confirm our findings.
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Affiliation(s)
- Jia-Le Lv
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Bin Wang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiang Du
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang-Hua Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ren-Hao Guo
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Leng
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bo-Chen Pan
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Bo-Chen Pan
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Shengjing Hospital of China Medical University, Shenyang, China
- Yu-Hong Zhao
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Liu YS, Zhang YX, Wang XB, Wu QJ, Liu FH, Pan BC, Zhao YH. Associations between Meat and Vegetable Intake, Cooking Methods, and Asthenozoospermia: A Hospital-Based Case–Control Study in China. Nutrients 2022; 14:nu14091956. [PMID: 35565922 PMCID: PMC9104795 DOI: 10.3390/nu14091956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The role of meat and vegetable intake in the development of asthenozoospermia has been controversial, and the role of cooking methods for meat and vegetables in the association has yet to be determined. The present study aimed to illuminate the relationship between the consumption and cooking methods of meat and vegetables and the risk of asthenozoospermia. Methods: In this hospital-based case–control study, we enrolled 552 patients with asthenozoospermia and 585 healthy controls. Dietary information was assessed using a validated self-administered food frequency questionnaire. Asthenozoospermia was diagnosed according to the fifth edition of the WHO laboratory manual for the examination and processing of human semen. Results: Participants in the highest tertile of total meat and unprocessed meat intake had a 44% and 39% lower risk of asthenozoospermia than those in the lowest tertile (OR = 0.56, 95% CI: 0.37, 0.87 and OR = 0.61, 95% CI: 0.40, 0.93), respectively. Participants with the highest processed meat consumption showed higher risk (OR = 1.44, 95% CI: 1.01, 2.06). Raw vegetable consumption was negatively associated with the risk of asthenozoospermia (OR = 0.67, 95% CI: 0.45, 0.98). The stir-frying cooking method for meat was associated with increased risk of asthenozoospermia (OR = 1.58, 95% CI: 1.02, 2.46). Conclusions: Intake of total meat, unprocessed meat, and raw vegetable may reduce asthenozoospermia risk, while higher consumption of processed meat may increase the risk. Cooking methods may play a role in these associations. These findings need to be confirmed in large and prospective cohort studies.
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Affiliation(s)
- Ya-Shu Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China; (Y.-S.L.); (Q.-J.W.); (F.-H.L.)
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yi-Xiao Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang 110004, China;
| | - Xiao-Bin Wang
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China;
| | - Qi-Jun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China; (Y.-S.L.); (Q.-J.W.); (F.-H.L.)
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Fang-Hua Liu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China; (Y.-S.L.); (Q.-J.W.); (F.-H.L.)
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Bo-Chen Pan
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, China;
- Correspondence: (B.-C.P.); (Y.-H.Z.); Tel.: +86-24-96615 (B.-C.P. & Y.-H.Z.)
| | - Yu-Hong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang 110004, China; (Y.-S.L.); (Q.-J.W.); (F.-H.L.)
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang 110004, China
- Correspondence: (B.-C.P.); (Y.-H.Z.); Tel.: +86-24-96615 (B.-C.P. & Y.-H.Z.)
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