Non-alcoholic fatty liver disease is associated with a higher risk of erectile dysfunction than alcoholic fatty liver disease.

Objective: In this study, we examine the prevalence and risk of erectile dysfunction (ED) by conducting a comparative analysis between cohorts with alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD). Methods: This retrospective cohort study used the TriNetX database, including anonymized electronic health records from about 190 million patients globally. The study enrolled men aged ≥20 years diagnosed with AFLD or NAFLD between 2011 and 2019. Patients with liver cirrhosis or malignancy were excluded. Propensity score matching controlled for demographics and comorbidities. The primary outcome, incidence of ED, was analyzed at 1, 3 and 5 years using risk ratios (RR), odds ratios (OR) and hazard ratio (HR), ensuring balanced comparisons. Results: There were 9,066 AFLD and 431,064 NAFLD patients were enrolled before propensity score matching. Finally, following matching, 9,066 patients from each group were included for analysis. Within 1 year, NAFLD patients showed higher ED risk (2.394%) compared to AFLD patients (1.836%), with RR of 1.284 (1.052, 1.567), OR of 1.291 (1.054, 1.582) and HR of 1.263 (1.033, 1.544). At 3 years, NAFLD outcomes remained higher (5.228 vs. 4.169%), RR of 1.254 (1.099, 1.431), OR of 1.268 (1.104, 1.456) and HR of 1.221 (1.066, 1.397). By 5 years, NAFLD continued exhibiting greater risks (6.806 vs. 5.824%), RR of 1.169 (1.044, 1.308), OR of 1.181 (1.047, 1.331) and HR of 1.125 (1.002, 1.264). These findings demonstrate consistently elevated clinical risk in NAFLD patients vs. AFLD, highlighting the necessity of careful NAFLD monitoring. Conclusion: NAFLD demonstrates a significantly greater association with ED than AFLD. Clinicians should maintain heightened vigilance for ED when managing patients with NAFLD, particularly during the initial year following diagnosis.