title: Dietary flavonoid intake and incidence of erectile dysfunction.
abstract: BACKGROUND
  The predominant etiology for erectile dysfunction (ED) is vascular, but limited data are available on the role of diet. A higher intake of several flavonoids reduces diabetes and cardiovascular disease risk, but no studies have examined associations between flavonoids and erectile function.
  
  
  OBJECTIVE
  This study examined the relation between habitual flavonoid subclass intakes and incidence of ED.
  
  
  METHODS
  We conducted a prospective study among 25,096 men from the Health Professionals Follow-Up Study. Total flavonoid and subclass intakes were calculated from food-frequency questionnaires collected every 4 y. Participants rated their erectile function in 2000 (with historical reporting from 1986) and again in 2004 and 2008.
  
  
  RESULTS
  During 10 y of follow-up, 35.6% reported incident ED. After multivariate adjustment, including classic cardiovascular disease risk factors, several subclasses were associated with reduced ED incidence, specifically flavones (RR = 0.91; 95% CI: 0.85, 0.97; P-trend = 0.006), flavanones (RR = 0.89; 95% CI: 0.83, 0.95; P-trend = 0.0009), and anthocyanins (RR = 0.91; 95% CI: 0.85, 0.98; P-trend = 0.002) comparing extreme intakes. The results remained statistically significant after additional adjustment for a composite dietary intake score. In analyses stratified by age, a higher intake of flavanones, anthocyanins, and flavones was significantly associated with a reduction in risk of ED only in men <70 y old and not older men (11-16% reduction in risk; P-interaction = 0.002, 0.03, and 0.007 for flavones, flavanones, and anthocyanins, respectively). In food-based analysis, higher total intake of fruit, a major source of anthocyanins and flavanones, was associated with a 14% reduction in risk of ED (RR = 0.86; 95% CI: 0.79, 0.92; P = 0.002).
  
  
  CONCLUSIONS
  These data suggest that a higher habitual intake of specific flavonoid-rich foods is associated with reduced ED incidence. Intervention trials are needed to further examine the impact of increasing intakes of commonly consumed flavonoid-rich foods on men's health.
authors.affiliation: Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Departments of.
authors.forename: Aedín
authors.initials: A
authors.lastname: Cassidy
authors.affiliation: Nutrition and.
authors.forename: Mary
authors.initials: M
authors.lastname: Franz
authors.affiliation: Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital; and Harvard Medical School, Boston, MA erimm@hsph.harvard.edu.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
mesh_terms: D000367:Age Factors; D000368:Aged; D000872:Anthocyanins / Q000008:administration & dosage / Q000627:therapeutic use; D015331:Cohort Studies; D004032:Diet; D019587:Dietary Supplements; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000517:prevention & control*; D005247:Feeding Behavior; D044950:Flavanones / Q000008:administration & dosage / Q000627:therapeutic use; D047309:Flavones / Q000008:administration & dosage / Q000627:therapeutic use; D005419:Flavonoids / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005638:Fruit; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000872:Anthocyanins; D044950:Flavanones; D047309:Flavones; D005419:Flavonoids
keywords: anthocyanins; erectile dysfunction; flavanones; flavones; flavonoids