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. 2025 Mar 18:13:1543668.
doi: 10.3389/fpubh.2025.1543668. eCollection 2025.

Associations between metabolic syndrome and erectile dysfunction: evidence from the NHANES 2001-2004

Wei Wang #  1   2 , Shuai Zhao #  3 , Ran Zhou #  2   4 , Pei-Ze Yu #  2   4 , Si-Yuan Pan  2   4 , Peng-Fei Huan  2 , Zhen-Duo Shi  2 , Ying Liu  5 , Xiao Hu  5 , Jing-Ru Lu  6 , Conghui Han  1
Affiliations

Associations between metabolic syndrome and erectile dysfunction: evidence from the NHANES 2001-2004

Wei Wang et al. Front Public Health. .

Abstract

Background and objectives: Erectile dysfunction is a common clinical condition that seriously affects the quality of life and mental health of men and their partners. Metabolic syndrome (MetS) is the most important public health problem threatening men's health worldwide, and its current prevalence continues to grow. This study examines the relationship between metabolic syndrome and erectile dysfunction (ED).

Method: We conducted a cross-sectional study with data were sourced from NHANES 2001-2004. In this study, the relationship between METS-VF and ED was analyzed using multivariate logistic regression, followed by subgroup analyses to identify sensitive populations. Comparative logistic regression of the Receiver Operating Characteristic (ROC) curve assessed the diagnostic capability of METS-VF against the classical obesity index for ED. Creating Predictive Histograms for ED Patients and assess the net benefit of the model through Decision Curve Analysis (DCA).

Results: The study enrolled 1,374 participants, of whom 545 self-reported ED history. There was a significant positive association between metabolic syndrome and erectile dysfunction (ED). The risk of ED in people with metabolic syndrome was 2.32 times higher than that in people without metabolic syndrome (dominance ratio = 2.32, 95% confidence interval: 1.83-2.96, p < 0.001). Subgroup analysis highlighted a stronger correlation in participants aged 50-85 years, hypertensive individuals, and those with large belly circumference. A histogram model including three variables: metabolic syndrome, age and smoking status was constructed to predict the probability of ED occurrence. And decision curve analysis (DCA) was used to assess the net benefit of its nomogram model at different high-risk thresholds. The high clinical utility of the model under different thresholds was illustrated.

Conclusion: The risk of ED in people with metabolic syndrome was 2.32 times higher than that in people without metabolic syndrome. Furthermore, this observed positive correlation emphasizes the need for increased vigilance in patients with advanced age, smoking, and MetS.

Keywords: NHANES; cross-sectional study; erectile dysfunction; metabolic syndrome; prevalence.

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Conflict of interest statement

Shuai Zhao was employed by China RongTong Medical Healthcare Group Co. Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of participant selection.
Figure 2
Figure 2
ROC curve for erectile dysfunction.
Figure 3
Figure 3
Multifactor logistic regression model.
Figure 4
Figure 4
Predictive modelling.
Figure 5
Figure 5
DCA evaluates the net benefit of the nomogram model across different high-risk thresholds.
See this image and copyright information in PMC

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