Association between serum albumin levels and erectile dysfunction in American Adults: A cross-sectional study from NHANES 2001–2004

BACKGROUND: The aim of this study is to investigate the association between Serum Albumin Levels (ALB) and erectile dysfunction (ED) within the U.S. general population. METHODS: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2001-2004 cycles. Serum albumin was analyzed both as a continuous variable and categorized into quartiles. Erectile dysfunction (ED) was assessed via self-reported questionnaires. The association between serum albumin and erectile dysfunction was evaluated using weighted logistic regression models across four models: (1) Crude model (unadjusted); (2) Model 1: Adjusted for age, race, poverty-to-income ratio (PIR), marital status, education level, and body mass index (BMI); (3) Model 2: Adjusted for factors in Model 1 plus physical activity, smoking status, drinking status, and Healthy Eating Index (HEI-2015); (4) Model 3: Adjusted for factors in Model 2 plus remaining potential covariates. A generalized additive model (GAM) was employed to examine non-linear associations, followed by subgroup analyses and interaction tests. RESULTS: A total of 2925 participants were included in the study, of which 747 were diagnosed with ED. After adjusting for all covariates, a significant negative association was found between ALB and ED (OR: 0.53, 95% CI: 0.29-0.97, P = 0.04). Higher ALB quartiles were significantly correlated with a decreased risk of ED [Q4 vs. Q1: OR: 0.56 (0.35-0.90), P = 0.02; P for trend = 0.03]. The GAM and smoothed curve fit indicated a linear relationship between ALB and the risk of ED. Stratified and interaction tests further substantiated the inverse relationship between ALB and ED prevalence. CONCLUSIONS: This study revealed an inverse association between ALB and ED. Therefore, it is important for clinicians to recognize the assessment of ALB in patients.