Healthy diet protective against ED?

Adherence to healthy dietary patterns is associated with a reduced risk of erectile dysfunction (ED) particularly among younger men (ie, <60 years), a study has shown, suggesting that a healthy diet may play a role in maintaining erectile function.

“[M]en with the greatest adherence to a Mediterranean diet (MD) or AHEI*-2010 dietary pattern were least likely to develop ED … These dietary patterns emphasize the consumption of vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fats, as well as avoidance of red and processed meats,” said the researchers.

“ED is associated with reduced sexual intimacy and health-related quality of life, as well as psychological distress for both the affected men and their sexual partners … [Moreover,] ED is associated with future cardiovascular disease (CVD) and may represent an opportunity to identify and modify shared risk factors,” they added.

Modifiable risk factors for ED and CVD include obesity, hypertension, hyperlipidaemia, diabetes, metabolic syndrome, smoking, and sedentary behaviour. [Arch Intern Med 2006;166:207-212; J Urol 2000;163:460-463] Lifestyle interventions, such as adhering to healthy diets, are recommended for reducing CVD risk, but it is unclear whether such benefit may extend to ED risk. [Circulation 2014;129(25 suppl 2):S76-S99; N Engl J Med 2018;378:e34; Cochrane Database Syst Rev 2019;3:CD009825]

The study included 21,469 men (mean age at baseline 62 years) from the Health Professionals Follow-up Study. Diet quality was assessed by MD score (MDS) and AHEI-2010 score, with higher scores indicating healthier diet. Incident** ED was evaluated using a food frequency questionnaire to determine food and nutrient intake every 4 years. [JAMA Network Open 2020;3:e2021701]

During a mean follow-up of 10.8 years, the number of incident ED cases were 968, 3,703, and 4,793 among men aged <60, 60 to <70, and ≥70 years, respectively.

Compared with men in the lowest MDS category (score 0–3), men in the highest category (score 6–9) were less likely to develop ED regardless of age group (hazard ratio [HR], 0.78; p_trend<0.002 [<60 years], HR, 0.82; p_trend<0.001 [60 to <70 years], and HR, 0.93; p_trend=0.04 [≥70 years]). The inverse association was greatest among younger men (p_interaction=0.003).

Similarly, compared with men in the lowest quintile (Q1) of the AHEI-2010 score, men in the highest quintile (Q5) were less likely to develop incident ED regardless of age group (HR, 0.78; p_trend=0.007, HR, 0.78; p_trend<0.001, and HR, 0.89; p_trend=0.03, respectively), with the greatest inverse association among younger men (p_interaction=0.0004).

“[The] inverse association between healthy dietary patterns … and risk of developing ED in men … suggest that men who are concerned about ED risk should be counselled regarding the potential contribution of their dietary practices,” said the researchers. “Men may be motivated to adopt a healthy dietary pattern if it lowers their risk of ED.”

The results also reinforce evidence reflecting the role of multimodal lifestyle interventions with caloric restriction in improving erectile function in men with ED and significant CV risk factors. [J Diabetes Complications 2016;30:1519-1524; PLoS One 2016;11:e0161297; Int J Impot Res 2014;26:61-66] “However, it is difficult to disentangle the independent effect of a healthy dietary pattern from these multimodal intervention studies because obesity and sedentary behaviour are associated with increased risk of ED,” they stressed.

As such, further randomized studies are warranted to ascertain the potential of dietary interventions in preventing or reversing ED. “[Pending such trials,] our findings support counselling men with low adherence to healthy dietary patterns that they are at higher risk of developing ED compared with men who adhere to healthy dietary patterns,” they concluded.