Erectile dysfunction is characterised by the inability to maintain erection. Normal erections during sleep and in the early morning suggest a psychogenic cause, while loss of these erections may signify underlying disease, often cardiovascular in origin. Other causes leading to erectile dysfunction are diabetes mellitus (causing neuropathy) or hypogonadism (decreased testosterone levels due to disease affecting the testicles or the pituitary gland).
Erectile dysfunction is known to decrease the quality of life in men, and may affect as many as 30 million men in the United States alone, according to the new study. In a previous study, moderate-to-severe erectile dysfunction was reported by 12 percent of men below the age of 59; 22 percent of men aged 60 to 69 years; and 30 percent of 69 years and older.
Katherine Esposito, M.D., of the Center for Obesity Management, Second University of Naples, Italy, and colleagues conducted a study to determine if lifestyle changes designed to obtain a sustained and long-term reduction in body weight and an increase in physical activity would improve erectile function and endothelial (cells lining the inside of blood vessels) function in obese men.
The randomized trial included 110 obese men (body mass index 30 or greater) aged 35 to 55 years, without diabetes, hypertension, or hyperlipidemia, who had erectile dysfunction that was determined by having a score of 21 or less on the International Index of Erectile Function (IIEF). The study was conducted from October 2000 to October 2003 at a university hospital in Italy.
The 55 men randomly assigned to the intervention group received detailed advice about how to achieve a loss of 10 percent or more in their total body weight by reducing caloric intake and increasing their level of physical activity. Men in the control group (n = 55) were given general information about healthy food choices and exercise.
The researchers found that after 2 years, weight and body mass index decreased significantly more in the intervention group than in the control group. The average level of physical activity increased more in the intervention group (from 48 to 195 min/wk) than in the control group (from 51 to 84 min/wk). The average IIEF score improved in the intervention group (from 13.9 to 17), but remained stable in the control group (from 13.5 to 13.6). Seventeen men in the intervention group and 3 in the control group reported an IIEF score of 22 or higher. In multivariate analyses, reductions in body mass index and increases in physical activity were independently associated with changes in IIEF score.
Our data demonstrate that lifestyle changes, including a reduced calorie diet and increased exercise, improve erectile function in obese men and resulted in about one-third of men with erectile dysfunction regaining sexual function after treatment. This improvement was associated with amelioration of both endothelial function and markers of systemic vascular inflammation. Interventions focused on modifiable health behaviors may represent a safe strategy to improve erectile function and reduce cardiovascular risk in obese patients, the authors conclude.
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