{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T03:54:01Z","timestamp":1783137241027,"version":"3.54.6"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Erectile dysfunction (ED) is a prevalent condition closely associated with systemic inflammation and metabolic disorders. The red cell distribution width to albumin ratio (RAR) is an emerging inflammatory marker; however, its relationship with ED remains poorly understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study conducted a cross-sectional analysis of data from 3,950 participants in the National Health and Nutrition Examination Survey (NHANES) 2001\u20132004 cycle to evaluate the association between RAR and ED risk. A Multivariable logistic regression model was employed to assess the relationship between RAR and ED, while a generalized additive model (GAM) and dose-response analysis were utilized to explore potential nonlinear associations. Subgroup analyses were performed to investigate interactions with demographic and lifestyle factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the study population, 1,157 individuals reported a history of ED. The prevalence of ED was significantly higher in individuals aged 50 years and older (86.78%) and was associated with increased rates of hypertension, diabetes mellitus, and cardiovascular disease (<jats:italic>P<\/jats:italic> &amp;lt; 0.001). A J-shaped relationship was identified between RAR and ED risk. Specifically, the risk of ED significantly increased below the RAR threshold of 3.42 (OR = 3.01, 95% CI: 2.08\u20134.36, <jats:italic>P<\/jats:italic> &amp;lt; 0.001), while the risk plateaued at higher RAR values. Subgroup analyses revealed significant interactions with ethnicity (P = 0.018) and moderate-intensity physical activity (<jats:italic>P<\/jats:italic> = 0.004). Non-Hispanic whites (OR = 2.85) and individuals engaging in moderate-intensity activity (OR = 3.83) exhibited a heightened risk of ED. No significant interactions were observed for other variables, including age and BMI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results demonstrated that RAR was independently associated with ED risk, exhibiting a J-shaped relationship. There was a significant increase in risk below RAR = 3.42, with saturation occurring after exceeding this threshold.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1545272","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T07:57:54Z","timestamp":1742889474000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["J-Shaped relationship between the red cell distribution width to albumin ratio and erectile dysfunction: a cross-sectional study from NHANES 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