ArticleInternational urology and nephrology2026
Associations between diet quality and testosterone: evidence from mixture and mediation analysis.
Article in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile higher diet quality is associated with improved testosterone levels, prior population-based evidence relied on binary testosterone deficiency outcomes. The continuous dose-response relationship, component-specific contributions and adiposity-mediated mechanisms linking diet quality to testosterone remain unclear.
objectiveTo examine the association between overall diet quality and serum testosterone in adult men, identify key dietary components and evaluate adiposity-mediated pathways.
methodsThis cross-sectional study included 5434 adult males from the National Health and Nutrition Examination Survey (2011-2016). Diet quality was assessed using Healthy Eating Index-2020 (HEI-2020) from 24-h dietary recalls. Testosterone was quantified by liquid chromatography-tandem mass spectrometry. Associations were evaluated using multivariable linear regression, restricted cubic spline analysis, mixture models (weighted quantile sum, quantile g-computation and Bayesian kernel machine regression) and mediation analysis.
resultsHigher HEI-2020 scores were significantly associated with increased log-transformed total testosterone (β per 10-point increase = 0.015; 95% CI: 0.002-0.028; P = 0.028), demonstrating a significant positive linear dose-response relationship. Mixture analyses assigned highest relative weights to sodium and dairy components. The effects were potentially mediated through body mass index and waist circumference.
conclusionsHigher overall diet quality exhibits a positive linear association with elevated serum testosterone in adult men. In exploratory mixture and mediation analyses, sodium, dairy and adiposity were identified as possible contributors.
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