Effect of obesity and metabolic health on urolithiasis: A nationwide population-based study

Abstract

Purpose To investigate the risk of symptomatic urolithiasis requiring surgical treatment according to obesity and metabolic health status using a nationwide dataset of the Korean population. Materials and Methods Of the 5,300,646 persons who underwent health examinations between the year 2009 and 2016, within one year after the health examination, 35,137 patients who underwent surgical treatment for urolithiasis were enrolled. Participants were classified as “obese” or “non-obese” using a body mass index (BMI) cutoff of 25 kg/m 2 . People who developed ≥1 metabolic disease component in the index year were considered “metabolically unhealthy”, while those with none were considered “metabolically healthy”. Results Out of 34,330 participants excluding 843 missing, 16,509 (48.1%), 4,320 (12.6%), 6,456 (18.8%), and 7,045 (20.5%) subjects were classified into the metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) group, respectively. Mean BMI was 22.1±1.9 kg/m 2 , 22.9±1.6 kg/m 2 , 26.9±1.8 kg/m 2 , and 27.9±2.4 kg/m 2 respectively. After adjusting the age and sex, the subjects in the MUNO group had an HR (95% CI) of 1.192 (1.120–1.268), those in the MHO group, 1.242 (1.183–1.305), and those in the MUO group, 1.341 (1.278–1.407) for either extracorporeal shockwave lithotripsy or surgery, compared to those in the MHNO group. Conclusions Metabolically healthy, obese individuals have a higher risk of developing symptomatic urolithiasis than non-obese, unhealthy, but have a lower risk than obese, unhealthy. It suggests that metabolic health and obesity have collaborative effects, independently affecting the development of symptomatic urinary stone diseases.

The Efficacy and Safety of Radiation-Free Retrograde Intrarenal Surgery: A Prospective Multicenter-Based, Randomized, Controlled Trial

“…[18][19][20][21] In addition, patients with urinary stones may require repeat CT scans and stone-related treatments, such as extracorporeal shock wave lithotripsy, RIRS, and percutaneous nephrolithotomy. 22,23 Therefore, efforts to reduce patients' radiation exposure are necessary.…”

Nephrolithiasis: A Red Flag for Cardiovascular Risk

“…Metabolically healthy obese subjects (about one-tenth of all the obese people) are at lower risk of developing symptomatic nephrolithiasis than unhealthy obese people, according to a study performed on a nationwide dataset of the Korean population [ 59 ]. This supports the idea that the association between obesity and nephrolithiasis is driven by insulin resistance.…”

Visceral adipose tissue and nephrolithiasis risk: Evidence from National Health and Nutrition Examination Survey and Mendelian randomization analysis

“…The VAT, referring to the fat located within the abdominal cavity and surrounding organs, has been increasingly linked to various health conditions, including nephrolithiasis [6][7][8][9] . Nevertheless, the majority of studies on the association between obesity and nephrolithiasis have utilized less representative samples 10 . Additionally, the dose-response relationship between VAT and nephrolithiasis remains unclear.…”