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      Lifestyle modifications and erectile dysfunction: what can be expected?

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          Abstract

          Erectile dysfunction (ED) is a common medical disorder whose prevalence is increasing worldwide. Modifiable risk factors for ED include smoking, lack of physical activity, wrong diets, overweight or obesity, metabolic syndrome, and excessive alcohol consumption. Quite interestingly, all these metabolic conditions are strongly associated with a pro-inflammatory state that results in endothelial dysfunction by decreasing the availability of nitric oxide (NO), which is the driving force of the blood genital flow. Lifestyle and nutrition have been recognized as central factors influencing both vascular NO production, testosterone levels, and erectile function. Moreover, it has also been suggested that lifestyle habits that decrease low-grade clinical inflammation may have a role in the improvement of erectile function. In clinical trials, lifestyle modifications were effective in ameliorating ED or restoring absent ED in people with obesity or metabolic syndrome. Therefore, promotion of healthful lifestyles would yield great benefits in reducing the burden of sexual dysfunction. Efforts, in order to implement educative strategies for healthy lifestyle, should be addressed.

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          Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study.

          H Feldman, B I Goldstein, D G Hatzichristou … (1993)
          We provide current, normative data on the prevalence of impotence, and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study. The Massachusetts Male Aging Study was a community based, random sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston, Massachusetts. Blood samples, physiological measures, socio-demographic variables, psychological indexes, and information on health status, medications, smoking and lifestyle were collected by trained interviewers in the subject's home. A self-administered sexual activity questionnaire was used to characterize erectile potency. The combined prevalence of minimal, moderate and complete impotence was 52%. The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70 years. Subject age was the variable most strongly associated with impotence. After adjustment for age, a higher probability of impotence was directly correlated with heart disease, hypertension, diabetes, associated medications, and indexes of anger and depression, and inversely correlated with serum dehydroepiandrosterone, high density lipoprotein cholesterol and an index of dominant personality. Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension. We conclude that impotence is a major health concern in light of the high prevalence, is strongly associated with age, has multiple determinants, including some risk factors for vascular disease, and may be due partly to modifiable para-aging phenomena.
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            Sexual function in men older than 50 years of age: results from the health professionals follow-up study.

            Constance Bacon, Murray Mittleman, Ichiro Kawachi … (2003)
            Although many studies have provided data on erectile dysfunction in specific settings, few studies have been large enough to precisely examine age-specific prevalence and correlates. To describe the association between age and several aspects of sexual functioning in men older than 50 years of age. Cross-sectional analysis of data from a prospective cohort study. U.S. health professionals. 31 742 men, age 53 to 90 years. Questionnaires mailed in 2000 asked about sexual function, physical activity, body weight, smoking, marital status, medical conditions, and medications. Previous biennial questionnaires since 1986 asked about date of birth, alcohol intake, and other health information. When men with prostate cancer were excluded, the age-standardized prevalence of erectile dysfunction in the previous 3 months was 33%. Many aspects of sexual function (including overall function, desire, orgasm, and overall ability) decreased sharply by decade after 50 years of age. Physical activity was associated with lower risk for erectile dysfunction (multivariable relative risk, 0.7 [95% CI, 0.6 to 0.7] for >32.6 metabolic equivalent hours of exercise per week vs. 0 to 2.7 metabolic equivalent hours of exercise per week), and obesity was associated with higher risk (relative risk, 1.3 [CI, 1.2 to 1.4] for body mass index >28.7 kg/m2 vs. <23.2 kg/m2). Smoking, alcohol consumption, and television viewing time were also associated with increased prevalence of erectile dysfunction. Men who had no chronic medical conditions and engaged in healthy behaviors had the lowest prevalence. Several modifiable health behaviors were associated with maintenance of good erectile function, even after comorbid conditions were considered. Lifestyle factors most strongly associated with erectile dysfunction were physical activity and leanness.
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              Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis.

              Edoardo Mannucci, Enrico Facchiano, Giulia Rastrelli … (2013)
              Few randomized clinical studies have evaluated the impact of diet and physical activity on testosterone levels in obese men with conflicting results. Conversely, studies on bariatric surgery in men generally have shown an increase in testosterone levels. The aim of this study is to perform a systematic review and meta-analysis of available trials on the effect of body weight loss on sex hormones levels. Meta-analysis. An extensive Medline search was performed including the following words: 'testosterone', 'diet', 'weight loss', 'bariatric surgery', and 'males'. The search was restricted to data from January 1, 1969 up to August 31, 2012. Out of 266 retrieved articles, 24 were included in the study. Of the latter, 22 evaluated the effect of diet or bariatric surgery, whereas two compared diet and bariatric surgery. Overall, both a low-calorie diet and bariatric surgery are associated with a significant (P<0.0001) increase in plasma sex hormone-binding globulin-bound and -unbound testosterone levels (total testosterone (TT)), with bariatric surgery being more effective in comparison with the low-calorie diet (TT increase: 8.73 (6.51-10.95) vs 2.87 (1.68-4.07) for bariatric surgery and the low-calorie diet, respectively; both P<0.0001 vs baseline). Androgen rise is greater in those patients who lose more weight as well as in younger, non-diabetic subjects with a greater degree of obesity. Body weight loss is also associated with a decrease in estradiol and an increase in gonadotropins levels. Multiple regression analysis shows that the degree of body weight loss is the best determinant of TT rise (B=2.50±0.98, P=0.029). These data show that weight loss is associated with an increase in both bound and unbound testosterone levels. The normalization of sex hormones induced by body weight loss is a possible mechanism contributing to the beneficial effects of surgery in morbid obesity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian J Androl
                Journal ID (iso-abbrev): Asian J. Androl
                Journal ID (publisher-id): AJA
                Title: Asian Journal of Andrology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1008-682X
                ISSN (Electronic): 1745-7262
                Publication date (Print): Jan-Feb 2015
                Publication date (Electronic): 09 September 2014
                Volume: 17
                Issue: 1
                Pages: 5-10
                Affiliations
                [1 ]Department of Medical, Surgical, Neurological, Metabolic and Geriatric Science, Second University of Naples, Piazza L. Miraglia n° 2, Italy
                [2 ]Department of Clinical and Experimental Medicine, Second University of Naples, via Pansini n° 5, Naples, Italy
                Author notes
                Correspondence: Prof. K Esposito ( katherine.esposito@ 123456unina2.it )
                Article
                Publisher ID: AJA-17-5
                DOI: 10.4103/1008-682X.137687
                PMC ID: 4291878
                PubMed ID: 25248655
                SO-VID: 14cb007f-1288-4d04-b5f5-a004dcd0a322
                Copyright © Copyright: © Asian Journal of Andrology
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 05 May 2014
                Date revision received : 27 June 2014
                Date accepted : 14 July 2014
                Categories
                Subject: Invited Review

                Keywords: erectile dysfunction,lifestyle changes,physical activity,mediterranean diet
                Data availability:
                Keywords: erectile dysfunction, lifestyle changes, physical activity, mediterranean diet

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