title: Association between adherence to the Mediterranean diet and semen quality parameters in male partners of couples attempting fertility.
abstract: Is adherence to the Mediterranean diet (MedDiet) associated with better semen quality in men of subfertile couples attempting fertility?
  
  
  
  Greater adherence to the MedDiet, as assessed through the validated Mediterranean diet score (MedDietScore), was significantly associated with higher sperm concentration, total sperm count and sperm motility.
  
  
  
  A-posteriori dietary pattern approaches have revealed that dietary patterns characterized by high intakes of fruits, vegetables, whole grains, fish and low intake of meat are associated with better semen quality. Yet, whether adherence to the MedDiet is associated with better semen profile remains largely unexplored.
  
  
  
  This was a cross-sectional study of 225 men from couples attending a fertility clinic in Athens, Greece, recruited between November 2013 and May 2016. The study was designed to evaluate the influence of habitual dietary intake and lifestyle on fertility outcomes.
  
  
  
  Men aged 26-55 years, 51.1% overweight or obese, 20.9% smokers, with complete dietary data were analyzed. Diet was assessed via a food-frequency questionnaire and adherence to the MedDiet was assessed through the MedDietScore (range: 0-55; higher scores indicating greater adherence to MedDiet). Semen quality was evaluated according to World Health Organization 2010 guidelines. Multiple logistic regression analysis was used to evaluate associations between tertiles of the MedDietScore and the likelihood of having abnormal semen parameters, after adjusting for potential confounders.
  
  
  
  Compared to men in the highest tertile of the MedDietScore (≥37, N = 66), a higher percentage of men in the lowest tertile of the score (≤30, N = 76) exhibited below the WHO reference values for sperm concentration (47.4% vs 16.7%, P < 0.001), total sperm count (55.3% vs 22.7%, P < 0.001), total motility (65.8% vs 31.8%, P < 0.001), progressive motility (84.2 vs 62.1%, P = 0.011) and sperm morphology (50.0 vs 28.8%, P = 0.023). In the multivariable adjusted models, men in the lowest tertile of the MedDietScore had ~2.6 times higher likelihood of having abnormal sperm concentration, total sperm count and motility, compared to men in the highest tertile of the score.
  
  
  
  The main limitation of the study stems from its cross-sectional nature, limiting our ability to determine causality.
  
  
  
  The results suggest that greater compliance to the MedDiet may help improve semen quality. Whether this translates into differences in male fertility remains to be elucidated. Our findings are consistent with previous studies showing that dietary patterns with some of the characteristics of the MedDiet, i.e. rich in fruit, vegetables, legumes and whole grains, are associated with better measures of semen quality.
  
  
  
  No funding was obtained. The authors have no competing interests to declare.
  
  
  
  n/a.
authors.affiliation: Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens , Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karayiannis
authors.affiliation: Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens , Greece.
authors.forename: Meropi D
authors.initials: MD
authors.lastname: Kontogianni
authors.affiliation: Embryogenesis Assisted Conception Unit, Athens , Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Mendorou
authors.affiliation: Embryogenesis Assisted Conception Unit, Athens , Greece.
authors.forename: Lygeri
authors.initials: L
authors.lastname: Douka
authors.affiliation: Embryogenesis Assisted Conception Unit, Athens , Greece.
authors.forename: Minas
authors.initials: M
authors.lastname: Mastrominas
authors.affiliation: Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens , Greece nyiannak@hua.gr.
authors.forename: Nikos
authors.initials: N
authors.lastname: Yiannakouris
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean; D006115:Greece; D006801:Humans; D007246:Infertility / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D055101:Semen Analysis; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology*; D013094:Spermatozoa / Q000166:cytology / Q000502:physiology*
keywords: Mediterranean diet; in-vitro fertilization; male fertility; score; semen quality