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Review
. 2021 Jun;9(3):100356.
doi: 10.1016/j.esxm.2021.100356. Epub 2021 May 26.

Serum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis

Yuyang Zhang  1 , Wei Zhang  1 , Yutian Dai  2 , Hui Jiang  3 , Xiansheng Zhang  4
Affiliations
Review

Serum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis

Yuyang Zhang et al. Sex Med. 2021 Jun.

Abstract

Introduction: The association between folic acid (FA) and erectile dysfunction (ED) was contradictory in the published original articles, and no meta-analysis was conducted to pool these data.

Aim: To verify the role of FA in the pathology of ED and explore the treatment efficacy of FA for ED patients.

Methods: An extensive search was performed on PubMed, Cochrane Library, and Web of Science to obtain all relevant studies published up to October 31, 2020. Studies comparing the serum FA level between ED patients and healthy controls, or comparing the score of the IIEF-5, or IIEF before and after folic acid therapy alone or combination in ED patient were eligible for our meta-analysis. The Newcastle-Ottawa Scales (NOS) was used to qualify included studies.

Main outcome measures: The standardized mean differences (SMD) and their corresponding 95% confidence intervals (95% CIs) were calculated to pool our data.

Results: Nine studies were eligible for our meta-analysis to verify the association between FA and ED, and to explore the treatment efficacy of FA for ED patients. The pooled SMD of the FA level difference between ED patients and healthy subjects was -0.94 (95% CI: -1.59, -0.30, P = .004). Moreover, the level of folic acid in healthy subjects, Mild ED patients, Moderate ED patients and Severe ED patients was 11.847 (95%CI = 9.671, 14.022), 9.496 (95%CI = 8.425, 10.567), 6.597 (95%CI = 5.187, 8.007) and 5.623 (95%CI = 3.535, 7.711) respectively. The SMD of changes in score of IIEF-5 was 1.89 with 95%CI (1.60, 2.17) after FA administration in ED patients. Our analysis also showed that combination therapy of FA plus tadalafil changed the score of IIEF with 0.90 (95%CI = 0.44, 1.36) comparing to combination of placebo plus tadalafil.

Conclusion: This novel meta-analysis demonstrated that FA was an independent risk factor for ED and FA supplement may have potentially positive effects in the treatment of ED patients. Zhang Y, Zhang W, Dai Y, et al. Serum Folic Acid and Erectile Dysfunction: A Systematic Review and Meta-Analysis. Sex Med 2021;9:100356.

Keywords: Erectile Dysfunction; Folic Acid; Meta-Analysis.

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Figures

Figure 1
Figure 1
Flowchart of the studies selected for the meta-analysis.
Figure 2
Figure 2
Forest plot for the level of folic acid between ED patients and healthy subjects.
Figure 3
Figure 3
Sensitivity analysis of the selected studies for level of folic acid between ED patients and healthy subjects.
Figure 4
Figure 4
Forest plot for the level of folic acid between Mild ED, Moderate ED, Severe ED and Healthy subjects.
Figure 51
Figure 5.1
Synthesized results of the level of folic acid in healthy subjects.
Figure 52
Figure 5.2
Synthesized results of the level of folic acid in Mild ED patients.
Figure 53
Figure 5.3
Synthesized results of the level of folic acid in Moderate ED patients.
Figure 54
Figure 5.4
Synthesized results of the level of folic acid in Severe ED patients.
Figure 6
Figure 6
Forest plot for the IIEF-5 before and after folic acid administration.
Figure 7
Figure 7
Forest plot for the IIEF between folic acid combining tadalafil and placebo combining tadalafil.
See this image and copyright information in PMC

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