Abdominal Obesity and Physical Inactivity Are Associated with Erectile Dysfunction Independent of Body Mass Index

Introduction. Erectile dysfunction (ED) is common among men with an elevated body mass index (BMI). However, a high waist circumference (WC) and low levels of physical activity may predict ED independently of BMI. Aim. We investigated the independent relationships between BMI, WC, and physical activity with ED. Methods. Subjects consisted of 3,941 adult men (age >= 20 years) with no history of prostate cancer from the 2001-2004 National Health and Nutrition Examination Survey. Logistic regression analyses were used to examine the relative odds of ED association with categories of BMI, WC, and physical activity. Main Outcome Measures. Established thresholds were used to divide subjects into three WC and BMI categories. Physical activity level was divided into active (>= 150 min/week), moderately active (30-149 min/week), and inactive (< 30 min/week) categories. A single survey question was used to assess the presence of ED. Results. After control for potential confounders, men with either a high WC or an obese BMI had an approximately 50% higher odds of having ED compared with men with a low WC or a normal BMI, respectively. Further, moderately active or inactive men had an approximately 40-60% greater odds of ED compared with active men. When all three predictors (WC, BMI, and physical activity level) were entered into the same logistic regression model, both a high WC and low physical activity level (moderately active and inactive) were independently associated with a greater odds of ED, whereas BMI level was not. Conclusion. Maintaining a WC level below 102 cm and achieving the recommended amount of moderate-intensity physical activity (>= 150 min/week) is associated with the maintenance of proper erectile function, regardless of BMI level. These findings suggest that the clinical screening for ED risk should include the assessment of WC and physical activity level in addition to BMI. Janiszewski PM, Janssen I, and Ross R. Abdominal obesity and physical inactivity are associated with erectile dysfunction independent of body mass index. J Sex Med 2009;6:1990-1998.