Varicocoele among 1 300 000 Israeli adolescent males: time trends and association with body mass index

Abstract

SUMMARYScarce data are available on epidemiology of varicocoele, the most common surgically correctable cause of male infertility. The objectives of this study were to evaluate the association between body mass index (BMI) and varicocoele and to assess trends in prevalence over time. We conducted a nationwide population-based long-term (1967-2010) study among 1 323 061 Israeli adolescent males using data from mandatory medical examination. BMI was grouped into underweight, normal weight, overweight and obese categories by percentiles adjusted for age in months and by further classification to five categories within normal weight. Univariable and multivariable logistic regression models were constructed, adjusting for possible confounders. Varicocoele prevalence (N = 47 398) increased during the study period from 1.6% for the 1950-1954 birth cohort to 4.6% for the 1990-1993 birth cohort, with the steepest rise in the normal weight group. Varicocoele unadjusted rates were highest (4.1%) among underweight and lowest (1.6%) among obese. In a multivariable model, adjusted for birth cohort, height, age and socio-demographic factors, we found a decreased risk for varicocoele in the overweight group [odds ratio (OR) = 0.51, 95% confidence interval (CI): 0.49, 0.54] and the obese group (OR = 0.34, 95% CI: 0.32, 0.37), compared with the normal weight group. Within the normal weight group, a monotonic inverse association between BMI percentile and varicocoele was observed, most notable among 75-84.9 percentile compared to 25-49.9 percentile (OR = 0.65, 95% CI: 0.63, 0.68). In conclusion, varicocoele is common among adolescents in Israel, and its prevalence had increased in recent decades, providing clues to direct further andrological research on the role of modern lifestyle and environment in the aetiology of varicocoele. BMI, across percentiles, was found to be monotonically inversely associated with varicocoele, thus directing research and clinical efforts.

Prevalence of varicocoele and its association with body mass index among 39,559 rural men in eastern China: a population‐based cross‐sectional study

“…These findings are consistent with the results of a recent largest nationwide population-based epidemiological study of 1.3 million Israeli men, which was conducted by Rais et al (2013). The current population-based cross-sectional study found that varicocoele was common in Chinese rural men aged 21-49 years, with a prevalence of 4.83%.…”

“…Previous studies have assessed the association between varicocoele and other factors such as age, height, body mass index (BMI), lifestyle habits and occupation (Delaney et al, 2004;Handel et al, 2006;May et al, 2006;Nielsen et al, 2006;Prabakaran et al, 2006;Tsao et al, 2009;Chen & Huang, 2010;Bae et al, 2014;Shafi et al, 2014). Some studies suggested that BMI was inversely associated with the prevalence of varicocoele (Handel et al, 2006;May et al, 2006;Nielsen et al, 2006;Prabakaran et al, 2006;Tsao et al, 2009;Chen & Huang, 2010;Baek et al, 2011;Gokce et al, 2013;Rais et al, 2013), whereas other studies found no such relationship (Oster, 1971;Delaney et al, 2004;Bae et al, 2014;Shafi et al, 2014). Some studies suggested that BMI was inversely associated with the prevalence of varicocoele (Handel et al, 2006;May et al, 2006;Nielsen et al, 2006;Prabakaran et al, 2006;Tsao et al, 2009;Chen & Huang, 2010;Baek et al, 2011;Gokce et al, 2013;Rais et al, 2013), whereas other studies found no such relationship (Oster, 1971;Delaney et al, 2004;Bae et al, 2014;Shafi et al, 2014).…”

A challenging ‘bag of worms’

“…As seen in Table 1, the largest nationwide population-based long-term study was that of Rais et al [8]. The explanation for the low results obtained in their study was that the investigators were inexperienced and that the study was not designed to determine the true incidence of varicocele in a general population of young men: it was part of a general health checkup for army recruits [9].…”

Adolescent Varicocele

“…Although some studies have revealed a positive correlation between the incidence of adolescent varicoceles and weight gain, it has been shown to be inversely proportional to reduced body mass index [23]- [28]. When the literature is examined, various studies have shown that the incidence of varicocele is decreased in overweight and obese men [29] [30] [31] [32]. In a large-scale study by Liu et al, it was shown that varicocele grade was decreased with reduced body mass index [22] [28].…”