ORIGINAL RESEARCH article
Front. Med.
Sec. Hepatobiliary Diseases
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1625498
Non-alcoholic fatty liver disease is associated with a higher risk of erectile dysfunction than alcoholic fatty liver disease
Provisionally accepted
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
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Objective: In this study, we examine the prevalence and risk of erectile dysfunction (ED) by conducting a comparative analysis between cohorts with alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). Methods: This retrospective cohort study used the TriNetX database, including anonymized electronic health records from about 190 million patients globally. The study enrolled men aged ≥20 years diagnosed with AFLD or NAFLD between 2011 and 2019. Patients with liver cirrhosis or malignancy were excluded. Propensity score matching controlled for demographics and comorbidities. The primary outcome, incidence of ED, was analyzed at 1, 3 and 5 years using risk ratios (RR), odds ratios (OR) and hazard ratio (HR), ensuring balanced comparisons. Results: There were 9,066 AFLD and 431,064 NAFLD patients were enrolled before propensity score matching. Finally, following matching, 9,066 patients from each group were included for analysis. Within one year, NAFLD patients showed higher ED risk (2.394%) compared to AFLD patients (1.836%), with RR of 1.284 (1.052, 1.567), OR of 1.291 (1.054, 1.582) and HR of 1.263 (1.033, 1.544). At three years, NAFLD outcomes remained higher (5.228% vs. 4.169%), RR of 1.254 (1.099, 1.431), OR of 1.268 (1.104, 1.456) and HR of 1.221 (1.066, 1.397). By five years, NAFLD continued exhibiting greater risks (6.806% vs. 5.824%), RR of 1.169 (1.044, 1.308), OR of 1.181 (1.047, 1.331) and HR of 1.125 (1.002, 1.264). These findings demonstrate consistently elevated clinical risk in NAFLD patients versus AFLD, highlighting the necessity of careful NAFLD monitoring. Conclusion: NAFLD demonstrates a significantly greater association with ED than AFLD. Clinicians should maintain heightened vigilance for ED when managing patients with NAFLD, particularly during the initial year following diagnosis.
Keywords: Non-alcoholic fatty liver disease, Alcoholic fatty liver disease, Erectile Dysfunction, TriNetX, Fatty Liver
Received: 09 May 2025; Accepted: 17 Oct 2025.
Copyright: © 2025 Chan, Su, Lee and Hsu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chao-Yu Hsu, hsuchaoyu66@yahoo.com
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