Association of estimated glucose disposal rate with erectile dysfunction: mediating role of neutrophil-to-lymphocyte ratio.

BACKGROUND: Insulin resistance (IR) has been established as an independent risk factor for erectile dysfunction (ED). OBJECTIVE: This study aimed to investigate the association between the estimated glucose disposal rate (eGDR) - a simple and non-invasive surrogate measure of IR - and the prevalence of ED. DESIGN: This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. The association between ED prevalence and eGDR was assessed using receiver operating characteristic analysis, multivariate logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis. In addition, the mediating role of the neutrophil-to-lymphocyte ratio (NLR) in the eGDR-ED relationship was evaluated through mediation analysis. RESULTS: A total of 3,774 subjects were included, of whom 1,072 (28.4%) had ED. Multivariate logistic regression analysis revealed that eGDR was significantly and inversely associated with the risk of ED (odds ratios = 0.85, 95% confidence intervals [CI]: 0.78, 0.92). Subgroup analyses indicated that this association was more pronounced among individuals with higher educational attainment. RCS regression confirmed a linear inverse relationship. Furthermore, eGDR demonstrated superior discriminative performance for ED (area under the curve [AUC] = 0.705, 95% CI: 0.679, 0.731) compared with traditional IR and obesity indices. Mediation analysis showed that NLR mediated 10.3% (95% CI: 2.3%, 25.2%) of the total association between eGDR and ED. CONCLUSION: This study provides the first evidence of a significant inverse association between eGDR and ED prevalence, with NLR serving as a partial mediator.