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Esposito K, Giugliano F, Di Palo C, et al. Effect of Lifestyle Changes on Erectile Dysfunction in Obese Men: A Randomized Controlled Trial. JAMA. 2004;291(24):2978–2984. doi:10.1001/jama.291.24.2978
Author Affiliations: Center for Obesity Management (Drs Esposito and Di Palo), Division of Metabolic Diseases (Drs D. Giugliano and Marfella), Departments of Urology (Drs F. Giugliano and D'Armiento), and Plastic and Reconstructive Surgery (Drs G. Giugliano and D'Andrea), and Center of Excellence in Cardiology (Drs Esposito, Marfella, and D. Giugliano), Second University of Naples, Naples, Italy.
Context Healthy lifestyle factors are associated with maintenance of erectile
function in men.
Objective To determine the effect of weight loss and increased physical activity
on erectile and endothelial functions in obese men.
Design, Setting, and Patients Randomized, single-blind trial of 110 obese men (body mass index ≥30)
aged 35 to 55 years, without diabetes, hypertension, or hyperlipidemia, who
had erectile dysfunction that was determined by having a score of 21 or less
on the International Index of Erectile Function (IIEF). The study was conducted
from October 2000 to October 2003 at a university hospital in Italy.
Interventions The 55 men randomly assigned to the intervention group received detailed
advice about how to achieve a loss of 10% or more in their total body weight
by reducing caloric intake and increasing their level of physical activity.
Men in the control group (n = 55) were given general information about healthy
food choices and exercise.
Main Outcomes Measures Erectile function score, levels of cholesterol and tryglycerides, circulating
levels of interleukin 6, interleukin 8, and C-reactive protein, and endothelial
function as assessed by vascular responses to L-arginine.
Results After 2 years, body mass index decreased more in the intervention group
(from a mean [SD] of 36.9 [2.5] to 31.2 [2.1]) than in the control group (from
36.4 [2.3] to 35.7 [2.5]) (P<.001), as did serum
concentrations of interleukin 6 (P = .03), and C-reactive
protein (P = .02). The mean (SD) level of physical
activity increased more in the intervention group (from 48  to 195 
min/wk; P<.001) than in the control group (from
51  to 84  min/wk; P<.001). The mean (SD)
IIEF score improved in the intervention group (from 13.9 [4.0] to 17 ; P<.001), but remained stable in the control group (from
13.5 [4.0] to 13.6 [4.1]; P = .89). Seventeen men
in the intervention group and 3 in the control group (P = .001) reported an IIEF score of 22 or higher. In multivariate analyses,
changes in body mass index (P = .02), physical activity
(P = .02), and C-reactive protein (P = .03) were independently associated with changes in IIEF score.
Conclusion Lifestyle changes are associated with improvement in sexual function
in about one third of obese men with erectile dysfunction at baseline.
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