Nonalcoholic Fatty Liver Disease is Associated with Erectile Dysfunction: A Prospective Pilot Study

Abstract

Introduction Nonalcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome (MetS). Although the link between MetS and erectile dysfunction (ED) is well known, clinical studies investigating the association between NAFLD and ED are scant. Aim To evaluate the relationship between NAFLD and ED. Methods Male patients with biopsy-proven NAFLD were prospectively asked to fill the five-item International Index of Erectile Function (IIEF-5) questionnaire. Their clinical and histologic variables were compared with the IEFF scores. Main Outcome Measures IIEF scores; proportions of NAFLD patients who demonstrated ED and/or MetS; association between the severity of histological hepatic damage and ED. Results Forty male patients having an age range of 33 (24–57) and a mean age of 40.13 ± 10.22 years with biopsy-proven NAFLD had a median IIEF-5 score of 16 (9–25) and MetS was present in 23 (57.5%). ED severity distributions as moderate, mild, and no ED were 11 (27.5%), 16 (40%), and 13 (32.5 %), respectively. Histological NAFLD score was significantly higher in patients having ED compared with patients with no ED (5.63 ± 1.39 vs 4.15 ± 1.46; P = .006). MetS diagnosis was significantly more common in patients having ED, compared with those without ED [19 (70.4%) vs 4 (30.8%), respectively, P = .018)]. When patients with and without ED were compared, gamma glutamyl transferase was significantly lower in ED, whereas components of MetS did not correlate with ED. After multivariate analysis, NAFLD score has remained the only significant outcome associated with ED [P = .03; OR (95% CI): 2.38 (1.079–5.238)]. Conclusion The current clinical study demonstrates a significant association between nonalcoholic steatohepatitis and ED for the first time. Our findings suggest liver damage may play role in the pathogenesis of ED in patients with NAFLD. Future studies are needed to expand the underlying common mechanisms responsible for this novel hypothesis.

Erectile dysfunction in cirrhosis is impacted by liver dysfunction, portal hypertension, diabetes and arterial hypertension

“…Hence, it seems that once cirrhosis develops, the prevalence of ED is high irrespective of aetiology and this is also confirmed by our data. To our best knowledge, only 2 studies investigated ED in non‐alcoholic fatty liver disease and found a prevalence of 45% and 67.5% respectively. It was interesting to note that in the latter study metabolic syndrome was present in 57.5% of patients and was diagnosed more common in patients with ED and this is in line with the results presented in our study.…”

Nonalcoholic fatty liver disease in adolescents and young adults: The next frontier in the epidemic

“…Studies demonstrated lower testosterone levels and reduced sperm count and motility in men with HS when compared to healthy controls . An association has been also noted between NASH and erectile dysfunction (ED) in a prospective pilot study of middle‐aged men with biopsy‐proven NAFLD, where NAFLD activity score (NAS) was the only independent predictor of ED …”

“…(48,49) An association has been also noted between NASH and erectile dysfunction (ED) in a prospective pilot study of middle-aged men with biopsy-proven NAFLD, where NAFLD activity score (NAS) was the only independent predictor of ED. (50)…”

The independent association of non‐alcoholic fatty liver disease with lower urinary tract symptoms/benign prostatic hyperplasia and erectile function scores

“…Duman et al. observed the association between NASH and ED, suggesting liver damage in the pathogenesis of ED. A recent Egyptian study reported that 45.8% of patients with NAFLD had ED that was higher than the reported prevalence of ED in the USA, which might indicate that genetic and environmental factors may also have a role .…”