Corona_EU Urology 18/03/2010 10:38 Page 75
Obesity and Erectile Dysfunction
Figure 2: Associations Between Obesity and Several Metabolic and Cardiovascular Parameters (n=2,652) (A–E), and
Phobic Anxiety Symptoms (MHQ-P Score) as a Function of Obesity Class (n=2,652) (F)
A B C
100
52 2.2
Adj. r=0.111
Adj. r=0.250
p<0.0001
p<0.001
95 50 2.2
90
48
2.1
85
46 2.1
Adj. r=0.199
80
HDL (mg/dl)
p<0.0001
Hypertension (%) 44 (triglycerides) (mg/dl)
10
2.0
75
Log
42 2.0
70
D
1.6
E
80
F
6.5
Adj. r=0.195
Adj. r=0.229 Adj. r=0.072
p<0.0001
70
p<0.0001
p<0.001
1.4 60
6.0
50
5.5
1.2 40
QP score
Glycaemia (gl/dl)
30
H
M
5.0
1.0
T
ype 2 diabetes (%)
20
10
4.5
0
<25 25–29.9 30–34.9 ≥35 <25 25–29.9 30–34.9 ≥35 <25 25–29.9 30–34.9 ≥35
BMI (kg/m
2
) BMI (kg/m
2
) BMI (kg/m
2
)
Data in panels B–D and F are expressed as means (95% confidence interval); data in panels A and E data are expressed as percentages. Inset indicators represent age-adjusted data.
BMI = body mass index; HDL = high-density lipoprotein; MHQ-P = Multidimensional Health Questionnaire–Phobic Anxiety.
human penile cells.
24
If insulin resistance and hyperglicaemia play an Weight reduction and increased physical activity have been shown
important role in sustaining complications of essential hypertension, to improve glycaemic control and cardiovascular risk factors
it is important to target weight reduction, particularly in obese associated with insulin resistance in obese individuals with type 2
hypertensive subjects with ED. Figures 2B–D show that both diabetes. Since 1977, four hallmark multisite clinical trials have
dyslipidaemia and hyperglycaemia were closely related to increased been conducted in the US, UK and Finland. These studies confirm
BMI. Accordingly, the fraction of obese patients having type 2 diabetes that improved glycaemic and hypertensive control of patients
was increased four-fold in extremely obese subjects (BMI ≥35; see through lifestyle interventions can have positive effects on
Figure 2E), but rose dramatically in the lower obesity classes associated complications and longitudinal outcomes.
28
A fifth
compared with the normal-weight band. robust and well-controlled study is currently being conducted in
multiple sites in the US.
28
As previously stated, obesity is the most common cause of insulin
resistance in humans. It leads to the failure of insulin to stimulate Lifestyle interventions represent the main approach to tackling the
glucose uptake and suppress hepatic gluconeogenesis, constituting a diabesity epidemic, even in subjects with ED. Esposito et al.
29
major risk factor for type 2 diabetes. The recently adopted term analysed the effect of two-year detailed advice about how to
‘diabesity’
25
reflects the burden of escalating rates of both obesity and reduce bodyweight, improve quality of diet and increase physical
diabetes in developed and developing countries over the past two activity on erectile function in obese subjects with ED or at
decades. Both conditions are now recognised as sharing significant increased risk of ED. They found that it is possible to achieve an
components underlying their pathophysiologies. improvement in erectile function in obese men by means of non-
pharmacological intervention. There was a strong correlation
It is estimated that type 2 diabetes currently accounts for 5.2% of all between the successscore and restoration of erectile function.
29
deaths worldwide.
26
The number of people with diabetes is expected
to double from 175 million in 2000 to 353 million in 2030.
27
The largest A Mediterranean diet based on olive oil as the major fat source and
increase is expected to occur in developing countries, with 305 including more fish, legumes, vegetables and fruits has been
million individuals likely to have type 2 diabetes by 2030.
27
The strong recommended as an extremely successful and conservative way to
association between type 2 diabetes and excess bodyweight treat obesity since the time of Greco-Roman writers.
30
A large body
emphasises the importance of weight control interventions at a of evidence has demonstrated that greater adherence to a
population level as a cornerstone strategy to curb the diabesity Mediterranean diet is associated with a significant improvement in
epidemic. In fact, given the large burden imposed by obesity on the health status, as well as a significant reduction in overall and
welfare of society, it is imperative to develop new methods that can cardiovascular disease mortality.
31
Hence, in line with these data,
decrease its prevalence and reverse its detrimental physiological the protective role of a Mediterranean diet on erectile function is
alterations leading towards type 2 diabetes. not surprising.
32
EUROPEAN UROLOGICAL REVIEW 75
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