1. Aedín Cassidy2, 
2. Mary Franz3, and
3. Eric B Rimm3–6*

+Author Affiliations

1. 
   
   2Department of Nutrition, Norwich Medical School, University of East Anglia, Norwich, United Kingdom;
2. 
   
   3Departments of Nutrition and
3. 
   
   4Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; and
4. 
   
   5Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital; and
5. 
   
   6Harvard Medical School, Boston, MA

+Author Notes

• ↵1 Supported by research grants CA55075, HL35464, and UM1 CA167552 from the NIH and the Biotechnology and Biological Sciences Research Council, United Kingdom (reference BB/J004545/1); AC is a Royal Society Wolfson Research Merit Award Holder. This is an open access article distributed under the CC-BY license (http://creativecommons.org/licenses/by/3.0/).

1. ↵*To whom correspondence should be addressed. E-mail: erimm@hsph.harvard.edu.

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.

Design: 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.