Inflammation factors mediate association of muscle mass and erectile dysfunction: NHANES 2001-2004

Erectile dysfunction (ED) constitutes a global male health issue. Current evidence indicates that low muscle mass may exacerbate insulin resistance and vascular endothelial damage via inflammatory cascades, both of which are established determinants of ED. The relationship between muscle distribution and its effect on ED remains unclear.

This study aimed to examine the association between muscle mass and ED prevalence and evaluate potential mediation by inflammatory biomarkers.

The study analyzed data from 2217 participants in the National Health and Nutrition Examination Survey (NHANES). Appendicular lean mass (ALM) is the total lean mass of the limbs. The Appendicular Skeletal Mass Index (ASMI) is calculated as ALM divided by height in meters squared. The association between ASMI and ED prevalence was evaluated through weighted logistic regression and subgroup analyses. Mediation analyses were conducted to examine the potential mediating roles of inflammatory markers in the relationship between ASMI and ED prevalence.

Compared with the non-ED group, patients with ED exhibited significantly lower ASMI; Monocytes mediated the association between ASMI, vigorous activity, and ED.

Patients diagnosed with ED exhibited significantly lower ALM compared to those in the non-ED group (25.27 ± 4.87 kg vs 27.35 ± 4.52 kg, P < .001). Participants in the highest ASMI tertile (Q3) had a 39.6% lower ED risk compared with those in Q1 (OR = 0.606, 95% CI, 0.396-0.925, P = .033). Restricted cubic spline analysis showed that there was a nonlinear relationship between ASMI and ED in the fully adjusted model 3 (P = .047). Except for drinking status, no statistically significant interactions were observed in any subgroup (P > .05). Vigorous activity showed a significant negative correlation with ED prevalence (OR = 0.604, 95% CI, 0.418-0.873, P = .013). Monocytes mediated 1.76% and 2.01% of the association between ASMI, vigorous activity, and ED, respectively.

Early screening for sarcopenia and ED, followed by resistance training and anti-inflammatory interventions, may provide a comprehensive approach to protecting muscle mass and erectile health.

Studies utilizing nationally representative databases to investigate the association between muscle mass and ED remain insufficiently explored, a gap that this research aims to fill. The diagnosis of ED relied on participant self-report via questionnaire, which may lead to underreporting or misclassification bias due to psychological factors.

Current research suggests that increased muscle mass is associated with a reduced risk of ED, and that systemic inflammation mediates this relationship to some extent.