Serum folic acid levels and erectile dysfunction: A meta‐analysis and systematic review

Abstract

The aim of this study was to assess the relationship between serum folic acid (FA) levels and erectile dysfunction (ED) through a meta‐analysis. A research was conducted in MEDLINE via PubMed, Cochrane Library, EMBASE and Web of Science up to 22 November 2020 to identify studies related to FA and ED. Two authors independently screened the literature, evaluated methodological quality and extracted the data. We used RevMan5.3 and STATA 14.0 for meta‐analysis. A total of six studies including 1,842 participants were included, and the results showed that the FA levels in the non‐ED group were significantly higher than those in the ED group (MD = 3.37, 95% CI 1.49–5.52, p = 0.004). Subgroup analysis indicated that with the increase in ED severity, the difference in FA levels between groups was more obvious (MD: 1.99 vs. 4.63 vs. 5.63). The differences in FA levels between groups seem more significant in the younger group (MD = 4.87, 95% CI 2.58–6.89, p < 0.001) than in the older group (MD = 3.15, 95% CI 2.21–4.08, p < 0.001). In conclusion, FA deficiency is closely related to ED, and the degree of FA deficiency may reflect the severity of ED. In addition, the association seems to be more pronounced in the younger group.

Association between folic acid, homocysteine, vitamin B12 and erectile dysfunction—A cross‐sectional study

“…In addition, our study found that differences in FA, vitamin B12 and HCY between groups seemed to be more pronounced in the younger participants (age < 35 yr). Our previous meta‐analysis first proposed that there was such a trend in FA differences between ED patients and the control group, which was well verified in this study (Xu et al., 2021). This may be due to the prevalence of FA and vitamin B12 deficiency among older people, a confounding factor that masks differences between the groups (Mooijaart et al., 2005).…”

“…Yan et al(Yan et al., 2014) first found that the serum folate level of ED patients was lower than that of healthy controls. Subsequent studies and our latest meta‐analysis also verified this difference (Attia et al., 2019; Karabakan et al., 2016; Sansone et al., 2018; Xu et al., 2021). Previous studies have explained the link between low FA levels and ED from the perspective of HCY metabolism, but in fact, only two studies have measured HCY and FA levels at the same time.…”

Correlation between erectile dysfunction and serum B12 levels: a 136‐case cross‐sectional analysis

“…6 In several studies and meta-analyses after Yan et al revealed this correlation, ED patients were shown to have low FA levels. [18][19][20][21] However, only a few studies examined the correlation of vit B12, an important cofactor in HS metabolism, with FA, HS levels, and ED. The first of these studies identified a weak correlation, while a later study revealed a negative correlation between vit B12 levels and HS levels and a correlation between vit B12 deficiency and ED.…”

The Role of Diet in the Pathogenesis of Erectile Dysfunction

“…In another study, ED in diabetic patients treated with the combination of tadalafil and folic acid 5 mg improved significantly as compared with the placebo group [111]. The degree of folic acid deficiency may reflect the severity of ED [112]. It appears to be more commonly seen in younger individuals [112].…”

“…The degree of folic acid deficiency may reflect the severity of ED [112]. It appears to be more commonly seen in younger individuals [112]. This association may be mediated by homocysteine and higher than usual doses of folic acid may be necessary to normalize serum homocysteine levels [113].…”