Association of Lower Urinary Tract Symptoms and the Metabolic Syndrome: Results From the Boston Area Community Health Survey

Abstract

Objectives The objectives of this study were to: 1) investigate the relationship between LUTS as defined by the American Urologic Association Symptom Index (AUA-SI) and the metabolic syndrome (MetS); and 2) determine the relationship between individual symptoms comprising the AUA-SI and MetS. Methods The Boston Area Community Health (BACH) Survey used a two-stage cluster design to recruit a random sample of 2,301 men age 30-79. Analyses were conducted on 1,899 men who provided blood samples. Urologic symptoms comprising the American Urological Association symptom index were included in the analysis. MetS was defined using a modification of the Adult Treatment Panel (ATP) III guidelines. The association between LUTS and MetS was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. Results Increased odds of MetS were observed among men with mild to severe symptoms (AUA-SI 2-35) compared to men with an AUA-SI score of 0 or 1 (multivariate Odds Ratio (OR)=1.68, 95% confidence interval (CI): 1.21, 2.35). A statistically significant association was observed between MetS and voiding symptom score ≥5 (multivariate adjusted OR=1.73, 95%CI: 1.06, 2.80) but not for storage symptom score ≥4 (multivariate adjusted OR=0.94, 95%CI: 0.66, 1.33). Increased odds of MetS were observed even with mild symptoms, primarily for incomplete emptying, intermittency, and nocturia. These associations were observed primarily among younger men (age<60 years) and were null among older men (age≥60 years). Conclusions The observed association between urologic symptoms and MetS provides further evidence of common underlying factors between LUTS and chronic conditions outside the urinary tract.

Impact of Metabolic Syndrome on Benign Prostatic Hyperplasia in Elderly Chinese Men

“…However, there have been conflicting reports about the associations between MetS and LUTS. Several large-scale surveys [30,31] showed that MetS and its components were correlated with LUTS. Out of 2,372 men in the NHANES III study [30], the participants with no components of MetS had 80% decreased odds of having LUTS compared with those with at least three components.…”

“…Out of 2,372 men in the NHANES III study [30], the participants with no components of MetS had 80% decreased odds of having LUTS compared with those with at least three components. In the Boston Area Community Health Survey [31] that examined 1,899 male participants, the data showed that increased risks for MetS were observed in men with mild to severe symptoms compared with men with an American Urological Association symptom index score of 0 or 1. Conversely, in our study, although prostate volume was significantly greater in BPH patients with MetS than in those without, MetS was only related to a longer duration of LUTS, but not associated with maximum urinary flow rate (one of the factors used to estimate the urethral obstruction grade and detrusor contractility grade in men with LUTS) or IPSS value.…”

Are blood vessels a target to treat lower urinary tract dysfunction?

“…Indeed, some studies in which dyslipidemia and/or diabetes had only small if any effects observed tighter associations and/or greater effect sizes when LUTS were compared to presence of the metabolic syndrome (Gupta et al 2006;Rohrmann et al 2005). Associations between intensity of male LUTS and presence of the metabolic syndrome were also observed from the Boston Area Community Health (BACH) Survey (Kupelian et al 2009). In line with these clinical findings, bladder dysfunction has also been reported in rat models of metabolic syndrome (Chung et al 2013;Lee et al 2008).…”

Incontinences et obésité

“…En effet, les relations entre incontinence et obésité ne se résument pas forcément à un simple facteur « mécaniciste » où l'excès de pression intra-abdominale ou intravésicale induite par la surcharge pondérale dépasse les possibilités résistives des appareils sphinctériens urétraux ou anaux [1,2]. L'association de ces troubles est de fait beaucoup plus complexe et procède de mécanismes de régulation plus intimes.De nombreuses études épidémiologiques ont mis en évidence la relation entre syndrome métabolique, intriqué avec l'obésité et troubles urinaires tout particulièrement à type d'incontinence [3][4][5][6][7]. Sur le plan physiopathologique, le rôle de l'hyperglycémie sur les neurones parasympathiques des ganglions pelviens, dont on connaît l'action sur le détrusor et le sphincter urétral, a été souligné.…”

“…De nombreuses études épidémiologiques ont mis en évidence la relation entre syndrome métabolique, intriqué avec l'obésité et troubles urinaires tout particulièrement à type d'incontinence [3][4][5][6][7]. Sur le plan physiopathologique, le rôle de l'hyperglycémie sur les neurones parasympathiques des ganglions pelviens, dont on connaît l'action sur le détrusor et le sphincter urétral, a été souligné.…”