Abstract
Background: The predominant etiology for erectile dysfunction (ED) is vascular, but limited data are available on the role of diet. A higher intake of several flavonoids reduces diabetes and cardiovascular disease risk, but no studies have examined associations between flavonoids and erectile function.Objective: This study examined the relation between habitual flavonoid subclass intakes and incidence of ED.Design: We conducted a prospective study among 25,096 men from the Health Professionals Follow-Up Study. Total flavonoid and subclass intakes were calculated from food-frequency questionnaires collected every 4 y. Participants rated their erectile function in 2000 (with historical reporting from 1986) and again in 2004 and 2008.Results: During 10 y of follow-up, 35.6% reported incident ED. After multivariate adjustment, including classic cardiovascular disease risk factors, several subclasses were associated with reduced ED incidence, specifically flavones (RR = 0.91; 95% CI: 0.85, 0.97; P-trend = 0.006), flavanones (RR = 0.89; 95% CI: 0.83, 0.95; P-trend = 0.0009), and anthocyanins (RR = 0.91; 95% CI: 0.85, 0.98; P-trend = 0.002) comparing extreme intakes. The results remained statistically significant after additional adjustment for a composite dietary intake score. In analyses stratified by age, a higher intake of flavanones, anthocyanins, and flavones was significantly associated with a reduction in risk of ED only in men <70 y old and not older men (11–16% reduction in risk; P-interaction = 0.002, 0.03, and 0.007 for flavones, flavanones, and anthocyanins, respectively). In food-based analysis, higher total intake of fruit, a major source of anthocyanins and flavanones, was associated with a 14% reduction in risk of ED (RR = 0.86; 95% CI: 0.79, 0.92; P = 0.002).Conclusions: These data suggest that a higher habitual intake of specific flavonoid-rich foods is associated with reduced ED incidence. Intervention trials are needed to further examine the impact of increasing intakes of commonly consumed flavonoid-rich foods on men’s health.
Highlights
Erectile dysfunction (ED)7 has considerable impact on the quality of life of middle-aged men and is a significant global health problem with estimates of a 33–52% prevalence [1,2,3]. the origins of erectile dysfunction (ED) were thought to be psychogenic or neuropathic, evidence clearly suggests that the predominant etiology is vascular [4,5,6,7]
After adjusting for potential confounders, including classic cardiovascular disease (CVD) risk factors and a range of lifestyle factors, participants in the highest compared with the lowest quintile of several subclasses of flavonoids had a reduction in the incidence of ED, intakes of flavones (RR = 0.91; 95% CI: 0.85, 0.97; P-trend = 0.006), flavanones (RR = 0.89; 95% CI: 0.83, 0.95; P-trend = 0.0009), and anthocyanins (RR = 0.91; 95% CI: 0.85, 0.98; P-trend = 0.002) (Table 2)
During 10 y of follow-up and after adjustment for a number of potential confounders, including classic CVD risk factors and a range of lifestyle factors, men in the highest compared with the lowest quintile of intakes of flavanones, flavones, and anthocyanins had a 9–11% reduced incidence of ED
Summary
Erectile dysfunction (ED) has considerable impact on the quality of life of middle-aged men and is a significant global health problem with estimates of a 33–52% prevalence [1,2,3]. the origins of ED were thought to be psychogenic or neuropathic, evidence clearly suggests that the predominant etiology is vascular [4,5,6,7]. Lifestyle modifications that target CVD risk factors will have the potential to improve ED, with data from a systematic review of the available 6 randomized controlled trials demonstrating beneficial effects of lifestyle interventions on erectile function after follow-up of 2–24 mo [13] They showed that a healthy diet, increased physical activity, and statin therapy were important components to improve men’s sexual health. The specific role of dietary change was demonstrated in a 2-y Mediterranean diet trial where a diet rich in whole grains, fruit, vegetables, nuts, legumes, and olive oil was associated with an improvement in erectile function in subjects with metabolic syndrome [14] This intervention resulted in an improvement in endothelial function and a decrease in C-reactive protein concentrations, which further highlights the shared underlying mechanisms linking diet, inflammation, vascular function, and ED.
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