How to cite this article:Corona G, Rastrelli G, Filippi S, Vignozzi L, Mannucci E, Maggi M.
Nutrition Reviews, Australian researchers performed a comprehensive meta-analysis looking at the effect of garlic on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides.
During ablation, either heat (thermal) or cryoenergy (freeze) is delivered through a catheter to destroy the abnormal pathways. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Hypogonadism, ED, metabolic syndrome and obesity: a pathological link supporting cardiovascular diseases. Relationship of anterior and posterior subcutaneous abdominal fat to insulin sensitivity in nondiabetic men. Contributions of total body fat, abdominal subcutaneous adipose tissue compartments, and visceral adipose tissue to the metabolic complications of obesity. Efficacy of lifestyle education to prevent type 2 diabetes: a meta-analysis of randomized controlled trials.
Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. Correlates for erectile and ejaculatory dysfunction in older Dutch men: a community-based study.
Assessment of sexual health in aging men in Europe: development and validation of the European Male Ageing Study sexual function questionnaire.
Abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index.
Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review.
Following the common association between testosterone deficiency and diabetes mellitus, can testosterone be regarded as a new therapy for diabetes?
A comparison of NCEP-ATPIII and IDF metabolic syndrome definitions with relation to metabolic syndrome-associated sexual dysfunction. Their findings suggest garlic to be effective in reducing total serum cholesterol and low-density lipoprotein cholesterol in individuals with elevated total cholesterol levels.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. Interdum adipiscing gravida odio porttitor sem non mi integer non faucibus ornare mi ut ante amet placerat aliquet.
Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
Age-related changes in general and sexual health in middle-aged and older men: results from the European Male Ageing Study (EMAS).
Impaired quality of life and sexual function in overweight and obese men: the European Male Ageing Study. How it affects your period After taking the emergency contraceptive pill, most women will have a normal period at the expected time.
Tell your healthcare provider if you have any of these symptoms of a liver problem while taking aspirin and extended release dipyridamole capsules: loss of appetite pale colored stool stomach area (abdomen) pain yellowing of your skin or whites of your eyes dark urine itching Call your healthcare provider right away if you have any. Volutpat eu sed ante lacinia sapien lorem accumsan varius montes viverra nibh in adipiscing blandit tempus accumsan. You can give yourself an insulin injection using a needle and syringe, a cartridge system, or pre-filled pen systems.
Older African American women live alone at about the same percentage as most other women (slightly over 40 but are less likely to live with a spouse (24).
Vestibulum ante ipsum primis in faucibus lorem ipsum dolor sit amet nullam adipiscing eu felis. Obesity causes concern because it constitutes a worldwide, major health problem and is a risk factor for major adverse cardiovascular events (MACE), type 2 diabetes mellitus, certain types of cancer, sleep apnea, osteoarthritis and most of all, excess mortality.
Less than 10 of both men and women live with non-relatives, but the rate is slightly higher than among other groups (Administration on Aging, 2000). Antiretroviral treatment (ART) in Swaziland According to UNAIDS 2013 estimates, Swaziland has around 92,200 people on antiretroviral treatment, representing a treatment coverage of 49. Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study.
Therefore, although there is a correlation between BMI and fat mass, individuals with expanded lean mass (e.g.
In fact, BMI does not take into account the accumulation of visceral fat that characterizes the most morbigenous form of obesity: abdominal or central obesity. Alternative measures that reflect abdominal adiposity, such as waist circumference (WC), waist-hip ratio and waist-height ratio, have been suggested as being superior to BMI in predicting cardiovascular disease (CVD) risk.

This is based largely on the rationale that increased visceral adipose tissue (VAT) is associated with a range of metabolic abnormalities, including decreased glucose tolerance, reduced insulin sensitivity and adverse lipid profiles, which are all risk factors for type 2 diabetes mellitus and CVD. OECD projections indicate that overweight rates will increase by a further 5% within 10 years. The Gallus study also indicated that the BMI trend over calendar years was rather stable in men and even decreasing in women.
In contrast, Italy detected one of the highest rates in the OECD of childhood obesity, because one in three children are overweight. Women with poor education in Italy are three times more likely to be overweight than more educated women. Essentially the frontline treatment is a recommendation to eat less, exercise more and adopt a healthier lifestyle.
In fact, several studies have demonstrated that, in individuals at risk, intensive lifestyle intervention, along with nutritional counseling and physical activity, is able to reduce weight and insulin resistance, preventing the progression of obesity to other diseases, such as overt diabetes.
Eating is more pleasant than abstaining from food, unless some other form of reward is provided.
We strongly believe that promising a better sex life to obese subjects will help them in overcoming barriers to lifestyle change, improving adherence to diet and physical exercise, at least in male individuals. Unsatisfying sexual activity, because of impotence, represents, in fact, a meaningful, straightforward motivation for consulting healthcare professionals, who, in turn, should take advantage of the opportunity to encourage obese patients to treat, besides erectile dysfunction (ED), the underlying unfavorable condition; thus not only restoring erectile function, but also overall health. In fact, having obesity at study entry was a significant predictor of incident ED at follow-up in both US and European populations. The association between decreased TT and accumulation of visceral fat is well-known and has been extensively described in recent reviews, also by our group.
In this analysis, even after the adjustment for smoking habit, other significant, waist-independent modulators of ED risk were age and BDI score. These results suggest that, in the general population from Florence, the accumulation of visceral fat has a detrimental effect on erectile function, independently from other organic or even psychological risk factors.To further verify this hypothesis, we analyzed the association between WC and ED in a population from the same geographical area, but complaining of sexual dysfunction, and therefore consulting our Andrology Clinic (University of Florence, Florence, Italy), a cohort extensively described in previous studies. The associations retained significance in an ordinal logistic model, even after adjusting for TT, smoking habit and age [Figure 2]. In a similar ordinal model, we also explored possible associations between increasing WC and other aspects of male sexuality, such as reduced spontaneous erection, hypoactive sexual desire and premature ejaculation, measured as previously reported. The age-TT-smoking habit correlation coefficients for the indicated observations are also reported in a , b and d .
Note that WC was considered as a continuous variable in all the analyses.Click here to viewThe contribution of organic, marital or psychological factors to obesity-associated ED in subjects complaining of sexual dysfunction was analyzed using SIEDY Scales.
SIEDY is a multidomain, structured interview able to quantify in three separate scales the relevance of body, couple and mind disturbances in the pathogenesis of ED.
In the old- and middle-aged subjects, an increased WC significantly contributed to the organic component of ED, while relational factors did not play any significant role. A mild, but significant, contribution of psychological disturbances were apparent in older individuals, but not in the youngest ones.
Present data confirm the previous finding [23] that the psychological disturbances related to obesity do not seem to play a major role in the pathogenesis of obesity-related ED.Based on those data, hypogonadism appears to be a concurrent factor, but not the only alteration underlying obesity-associated ED. In a randomized, single-blind trial of 110 obese men-without known CV risk factors, but with ED-erectile function was greatly improved by strict dietary and physical activity recommendations for 2 years. Improvement in IIEF score was paralleled by a statistical decrease in inflammatory markers. In fact, it is well-known that T increases as a function of lifestyle modifications and weight loss.
Although WC is an accepted proxy of visceral obesity, often used for epidemiological studies, it does not represent a true measure of visceral fat content in the abdomen. We recently described two experimental, nongenomic protocols to increase visceral adiposity in a rodent, the rabbit, which shows the unique advantage of a mechanism of penile erection very similar to that of humans. Interestingly, we previously showed that with both experimental protocols there was an impairment in erectile response, as demonstrated by a decreased acetylcholine (Ach)-induced relaxation of phenylephrine precontracted corpora cavernosa (CC) strips [Figure 3]a.
NO is produced as the enzymatic byproduct of molecular oxygen and L-arginine, under the control of nitric oxide synthase. We also investigated which genes expressed by VAT were more closely associated with an impaired Ach-induced relaxation in CC, by analyzing its association with a library of almost 50 genes involved in different steps of VAT metabolism. Similar results were obtained when maximal responsiveness to Ach in CC was analyzed (not shown).
These data, taken together, imply that visceral fat accumulation has a detrimental effect on the erectile process, apparently not explained by any of the known (measured) metabolic or hormonal VAT-associated abnormalities in the peripheral blood or within VAT homogenates. Therefore, how visceral fat could signal to the penile microcirculation, impairing Ach-mediated relaxation, is still unknown. The first is that some factors (or a syndromic constellation of factors) not taken into consideration in our analysis are mediating the association between VAT and ED, the second one is that we omitted from the analysis some other important elements, such as, for instance, the liver, that, reasonably, can act as a bridge between visceral fat accumulation and the erectile process. It is widely accepted that visceral obesity is characterized by a state of a low-grade, chronic inflammation that might involve not only visceral fat but also other tissues that directly communicate with VAT, such as the liver.

In a recent study on the aforementioned population of ED subjects, we demonstrated the superiority of flaccid penile acceleration, over other penile color Doppler ultrasound parameters, in predicting MACE. It is important to note that in the general population, the majority of CV events occur in subjects who would be classified as 'lower risk' when using conventional parameters. Interestingly, in the Olmsted study, a population-based survey on more than 2200 men where sexual function was assessed biennially from 1996 to 2004, ED had relatively little impact on the development of incident cardiac events in the oldest men, but it resulted in a nearly 50-fold increase in the 10-year incidence of heart disease in men aged 40-49 years. In 2010 Guo et al.[83] provided the first meta-analysis investigating the relationship between ED and CVD. From seven cohort studies they found an HR of 1.47 for CVD events in ED subjects compared to healthy individuals.
In addition, the same authors showed that the risk conferred by ED on CV events was of a magnitude similar to that of the risk conferred by events with established risk predictors, such as hypertension and dyslipidemia. In particular, the higher CV risk in younger patients and in those with low-intermediate baseline CV risk compared to ED patients with high CV risk is particularly important.
However, the impact of obesity in ED subjects on the risk of incident CVD has been endorsed only by few studies, [3],[86] and the role of central obesity has never been explored. We now originally report associations between WC and potential CV risk factors in a large series of subjects seeking medical care for ED at our unit (see above). We confirmed that also different WC grades, as previously reported for BMI classes, [3],[23] are associated with an increasing severity of hyperglycemia, insulin resistance and the prevalence of diabetes mellitus [Figure 4]a-c as well as dyslipidemia [Figure 4]d-f.
Similarly, pulse pressure, mean blood pressure and prevalence of hypertension were all closely related to WC increment [Figure 5]a-c. The age-adjusted correlation coefficients for the indicated observations are also reported in each panel. However, in a Cox regression model, after adjusting for lifestyle and Chronic Disease Score confounders, only a severe WC increment (>102 cm) still maintained an independent, significant association with MACE [Figure 6]b. However, the association between ED and increased WC is apparently independent from obesity-associated comorbidities and hypogonadism.
In fact, in two distinct cohorts from Florence, Italy, reflecting a general and a symptomatic (ED) population, the association between ED and central obesity was confirmed even after adjusting for total T and known obesity-associated comorbidities and was more dependent on organic than psychological and relational problems.
In fact, the strong association between visceral adiposity and impaired Ach-induced relaxation in CC was not explained by any metabolic or hormonal alteration considered, even when gene expression in VAT was examined as a function of Ach responsiveness within the penis. Hence, the organic factor (s) linking visceral fat accumulation and impaired erectile function deserves further studies.
This point is relevant because an increased WC in ED subjects categorizes individuals at high CV risk, especially in the youngest ones. Few studies have addressed the effect of lifestyle changes on obesity-associated ED, but all report that decreasing weight and increasing physical exercise result in improved erectile function and reverse hypogonadism. Identifying young, obese, ED individuals as those at 'residual risk' of incident vascular events might open up new possibilities of lifestyle or pharmacotherapeutic or even bariatric interventions. The 'residual risk' of incident vascular events or the progression of established vascular damage might be eventually slowed or even halted by some form of current, evidence-based, recommended care.
However, it is difficult to communicate and to convince young obese people that lifestyle changes are needed for modifying their risk profile.
We previously developed the concept that 'impotent patients are lucky'; [7] we now want to extend it to obesity-associated ED. Unsatisfying sexual activity, because of impotence, represents a meaningful, straightforward motivation for consulting healthcare professionals, who can screen for the presence of unfavorable associated conditions, such as obesity. The presence of ED in an obese subject might help healthcare professionals in convincing them to initiate a virtuous cycle, where the correction of sexual dysfunction will be the reward for an improved lifestyle for the obese, ED individual and a lower risk of MACE will be the ultimate goal for both the obese subject and the entire community. Clinicians are often led to classify young subjects with ED as 'psychogenic', and therefore treat them with symptomatic medicaments, underestimating the important aspects of their general health, even those that could be specifically corrected, such as obesity. The data presented in this review should prompt physicians to reclassify obese ED subjects as 'high-risk' individuals, even if they are young, or better, because they are young.
Obesity in childhood is dramatically increasing, even in a 'virtuous', Mediterranean-diet based country like Italy.
Tomorrow we will face a large wave of obesity in young people and very likely, of associated impotence.
We now claim that, also for obese individuals, being impotent could be recomputed as a resource, [7] rather than a further sanitary complication. Eating less, exercising more and adopting a healthier lifestyle will be easier if it is associated with a restored, satisfactory sex life! A combination of lifestyle changes, phosphodiesterase type 5 inhibitors and T supplementation must be considered as a new armamentarium in obesity. GC and MM conceived of the study, participated in its design and coordination, performed the statistical analysis and helped to draft the manuscript.

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