Body Roundness Index and Prevalent Erectile Dysfunction in Adult Men: A Survey-Weighted Cross-Sectional Analysis of...

Body roundness index (BRI), calculated from height and waist circumference, summarizes abdominal body shape and may capture central adiposity not fully described by body mass index. We examined the association between BRI and prevalent erectile dysfunction (ED) among men aged 20 years or older in the 2001-2004 National Health and Nutrition Examination Survey. ED was defined using a standardized erectile-function question. Primary analyses incorporated NHANES 4-year mobile examination center weights, strata, and primary sampling units, and analyses involving homeostasis model assessment of insulin resistance (HOMA-IR) used 4-year fasting subsample weights. The primary cohort included 3,850 men, of whom 1,024 met the study definition of ED, corresponding to a weighted ED prevalence of 17.8%. After adjustment for demographic, socioeconomic, and behavioral factors, each 1-unit higher BRI was associated with higher odds of ED (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.11-1.24). Men in the highest BRI quartile had higher odds of ED than those in the lowest quartile (OR = 1.74, 95% CI = 1.27-2.38). Spline analysis did not support significant nonlinearity (P = .36). In the fasting subsample, each 1-unit higher BRI was associated with a 32% higher geometric mean HOMA-IR. An exploratory statistical decomposition was used to describe the HOMA-IR-related component of the BRI-ED association. Higher BRI was associated with prevalent ED, supporting the clinical relevance of abdominal body shape in men's cardiometabolic and sexual-health assessment.