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Association between homocysteine, vitamin B 12 , folic acid and erectile dysfunction: a cross-sectional study in China
  1. Yang Chen1,2,3,
  2. Jie Li2,4,
  3. Tianyu Li1,2,3,
  4. Jianxiong Long2,5,
  5. Jinling Liao2,
  6. Gong-Hong Wei6,
  7. Zengnan Mo1,2,3,
  8. Jiwen Cheng1,2,3
  1. 1 Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
  2. 2 Center for Genomicand Personalized Medicine, Guangxi Medical University, Nanning, China
  3. 3 Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
  4. 4 Department of Reproduction, The Guangxi Zhuang Autonomous Region Family Planning Research Center, Nanning, China
  5. 5 School of Public Health, Guangxi Medical University, Nanning, China
  6. 6 Faculty of Biochemistry and Molecular Medicine, University of Oulu, Oulu, Finland
  1. Correspondence to Dr Jiwen Cheng; chengjiwen1977{at}


Objectives Erectile dysfunction (ED) affects up to 53.4% of men aged 30–80 years. In this study, we aimed to examine the association between homocysteine (HCY), vitamin B12 (B12), folic acid (FA) and ED.

Design Cross-sectional study.

Setting Guangxi, China.

Participants A total of 1381 participants who completed questionnaires were included, between September 2009 and December 2009.

Measures ED was evaluated by the International Index of Erectile Function scores. Also, the values of HCY, B12 and FA were acquired. Then, regression and between-group analyses were performed.

Results No association between FA and ED was found. Significant correlations between HCY and ED were found—the relationships between these two parameters were most notable in men aged over 60 years and in men living alone (bachelors or bachelorhood). B12 levels were higher in men with ED (718.53±234.37 pg/mL vs 688.74±229.68, p=0.015). Using multinomial logistic regression analyses, B12 levels were related to mild ED (multivariate adjusted analysis: OR 1.620, 95% CI 1.141 to 2.300, p=0.007), especially among men aged 40–49 years (OR 2.907, 95% CI 1.402 to 6.026, p=0.004).

Conclusions We report, for the first time, a relationship between B12 levels and ED. We also found specific cohorts of men for whom the relationship between HCY levels and ED is most prominent. Further studies are required to elucidate the mechanisms underlying these relationships—these may ultimately result in new therapies for ED.

  • erectile dysfunction
  • homocysteine
  • Vitamin B12
  • folic acid

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  • YC and JL contributed equally.

  • Contributors YC, JieL, ZM and JC participated in participants’ collection, field investigation, design, writing and modification of all the paper. YC and JieL took part in the statistical analysis. ZM and JC provided important advice for this paper. TL, JiaL, JinL and G-HW provide efforts in the processes of modification.

  • Funding This study was funded by National Natural Science Foundation of China (81770759, 81370857), and Innovation Project of Guangxi Graduate Education (YCBZ2017037) .

  • Competing interests None declared.

  • Ethics approval This study was approved by the Medical Ethics Committee of Guangxi Medical University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data for this study are available in the supplementary materials. Further questions could be sent to ZM ( and JC (