Correlation analysis of metabolically healthy obesity and erectile dysfunction: a cross-sectional study based on the NHANES database (2001–2004)

Objective To explore the relationship between metabolically healthy obesity (MHO) and erectile dysfunction (ED).Methods Using National Health and Nutrition Examination Survey (NHANES) data from 2001 to 2004, 974 participants were classified into ED and non-ED groups. MHO diagnosis combined BMI-based obesity assessment with metabolic status evaluation per National Cholesterol Education Program–Adult Treatment Panel III (ATP III) criteria. Weighted univariate and multivariate logistic regression models assessed the association between obesity subtypes and ED. Subgroup analyzes examined association stability across populations. Two-sample Mendelian randomization (MR) evaluated causal relationships between individual metabolic syndrome criteria and ED occurrence.Results In the optimized model, MHO was not associated with significantly increased ED risk compared to non-obese individuals. Metabolically abnormal obesity was associated with a 13% higher ED risk versus non-obese individuals (OR = 1.13, 95% CI: 1.02–1.25, p = 0.019). Subgroup analyzes showed no significant effect modification across subgroups (p > 0.05). Combined BMI and metabolic indicators demonstrated stronger predictive ability for ED than BMI alone, with waist circumference showing the strongest individual correlation (p = 0.001).Conclusion MHO does not confer elevated ED risk. Metabolically abnormal obesity is associated with a 14% increased ED risk compared to non-obese individuals.