D S Lopez1, W Wulaningsih2,3, K K Tsilidis4,5, J Baillargeon6, S B Williams7, R Urban8, S Rohrmann9. 1. Deparment of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA. davlopez@utmb.edu. 2. Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK. 3. MRC Unit for Lifelong Health and Ageing, University College London, London, UK. 4. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. 5. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. 6. Deparment of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA. 7. Deparment of Surgery, Division of Urology, University of Texas Medical Branch, Galveston, TX, USA. 8. Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. 9. Division of Chronic Disease Epidemiology; Epidemiology, Biostatistics and Preventive Institute (EBPI), University of Zurich, Zurich, Switzerland.
Abstract
PURPOSE: Testosterone (T) plays an important role in men's health and its deficiency is linked with poorer health. However, the role of nutritional and lifestyle factors in T regulation and production remains unclear. The objectives are to comprehensively test the cross-sectional associations of nutritional and lifestyle factors with T deficiency and to validate the associations in the NHANES survey. METHODS: We performed weighted multivariable logistic regression analysis to examine the association of 173 nutritional and lifestyle factors with T deficiency (total testosterone ≤ 3.5 ng/mL) in NHANES III as the discovery set (mean age 41). We controlled for multiple comparisons with a false discovery rate (FDR) < 5% and replicated in NHANES 1999-2004 (mean age 44). RESULTS: We identified seven nutritional factors as being inversely associated with T deficiency in NHANES 1999-2004, namely dietary intake of vitamin A, protein, saturated fatty acids, monounsaturated fatty acids, total fats, saturated fatty acid 16:0, and phosphorus. In a multivariable model, only vitamin A intake remained significantly associated with T deficiency (OR 0.97, 95% CI 0.94-0.99). Principal component analysis suggested that the two principal components, (1) dietary fats, protein, and phosphorous and (2) total vitamin A, may be associated with T deficiency. CONCLUSION: Our systematic evaluation provided new insight into the modifiable factors that could play a role in the regulation of T production. This study has the potential to contribute to the current body of literature which seeks to formulate a clinical definition of T deficiency after taking into account nutritional and lifestyle factors.
PURPOSE: Testosterone (T) plays an important role in men's health and its deficiency is linked with poorer health. However, the role of nutritional and lifestyle factors in T regulation and production remains unclear. The objectives are to comprehensively test the cross-sectional associations of nutritional and lifestyle factors with T deficiency and to validate the associations in the NHANES survey. METHODS: We performed weighted multivariable logistic regression analysis to examine the association of 173 nutritional and lifestyle factors with T deficiency (total testosterone ≤ 3.5 ng/mL) in NHANES III as the discovery set (mean age 41). We controlled for multiple comparisons with a false discovery rate (FDR) < 5% and replicated in NHANES 1999-2004 (mean age 44). RESULTS: We identified seven nutritional factors as being inversely associated with T deficiency in NHANES 1999-2004, namely dietary intake of vitamin A, protein, saturated fatty acids, monounsaturated fatty acids, total fats, saturated fatty acid 16:0, and phosphorus. In a multivariable model, only vitamin A intake remained significantly associated with T deficiency (OR 0.97, 95% CI 0.94-0.99). Principal component analysis suggested that the two principal components, (1) dietary fats, protein, and phosphorous and (2) total vitamin A, may be associated with T deficiency. CONCLUSION: Our systematic evaluation provided new insight into the modifiable factors that could play a role in the regulation of T production. This study has the potential to contribute to the current body of literature which seeks to formulate a clinical definition of T deficiency after taking into account nutritional and lifestyle factors.
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