August 2, 2012 — For the first time in a comprehensive way, researchers have associated obesity in men, particularly large waist circumference (WC), with sexual and urologic dysfunction, in addition to metabolic effects. The results of the new study are published in the August issue of the British Journal of Urology International.
Richard K. Lee, MD, from the Department of Urology, Weill Medical College of Cornell University, New York City, and colleagues analyzed the records of 409 men aged 40 to 91 years who came to the Institute for Bladder and Prostate Health at New York–Presbyterian Hospital/Weill Cornell between January 2006 and June 2008. The men had moderate to severe lower urinary tract symptoms (LUTS), based on scores of 8 or higher on the International Prostate Symptom Score (IPSS).
The researchers divided the men into 3 groups based on WCs of less than 90 cm (<36 inches; 153 men), 90 to 99 cm (36 - 39 inches; 137 men), and more than 100 cm (39+ inches; 119 men), to determine whether WC could be a simple metric to predict LUTS prevalence. Median age for all men was 57.6 years.
"The overall prevalence of lower urinary tract symptoms as measured by the IPSS did not differ significantly among the three WC groups (P = 0.10), although subgroup analysis showed that the group with WC ≥ 100 cm had a higher proportion of men with severe symptoms (IPSS 20 – 35, P = 0.003); this effect was not seen for the two lower IPSS groups (P = 0.07 and P = 0.36)," the researchers write.
"Sexual dysfunction significantly differed with WC. The prevalence of erectile dysfunction increased from 32.1% to 74.5% as WC increased (P = 0.001). The prevalence of ejaculatory dysfunction also increased from 21.4% to 64.7% as WC increased (P = 0.002)," they continue. In addition, the prevalence of ejaculatory dysfunction went up from 21.4% to 64.7% for the same groupings (P = .002).
The researchers also found that as WC increased, prevalences increased from 14.5% to 33.5% for hypertension (P = .02), 8.4% to 29.4% for coronary artery disease (P =.004), and 11.3% to 32.6% for type 2 diabetes (P = .001), and that mean serum cholesterol rose from 148 mg/dL to 254 mg/dL (P = .001) among the same groups.
Using multiple logistic regression modeling, the researchers calculated odds ratios (ORs) for both urological and metabolic associations with WC size. For example, as WC increases from the smallest WC group to the largest WC group, the ORs are 2.32 (95% confidence interval [CI], 1.26 - 3.93; P = .01) for erectile dysfunction, 3.02 (95% CI, 1.31 - 5.78; P = .03) for ejaculatory dysfunction, 2.31 (95% CI, 1.53 - 3.87; P = .001) for hypertension, 2.88 (95% CI, 1.68 - 4.32; P = .002) for type 2 diabetes, and 3.50 (95% CI, 1.32 - 5.12; P = .001) for coronary artery disease.
"The findings demonstrate that obesity in men — part of a growing global epidemic — affects their well-being in profound ways," Steven A. Kaplan, MD, the study's senior investigator, the E. Darracott Vaughan Jr professor of urology at Weill Cornell Medical College, director of the Iris Cantor Men's Health Center, and chief of the Institute for Bladder and Prostate Health at NewYork–Presbyterian/Weill Cornell, said in a Cornell news release. "What we eat can have devastating consequences on more than just our hearts. Quality of life issues, such as sexual and voiding health, can be affected as well in drastic ways."
Study limitations include its confinement to a single, high-volume institution, the researchers write, and randomized trials are needed to validate the results.
The researchers conclude, however, "Waist circumference may represent an easy diagnostic tool to elucidate the presence of occult voiding dysfunction."
"Measuring a man's waistline is easy, noninvasive and does not require extensive testing," Dr. Kaplan said in the press release.
The authors have disclosed no relevant financial relationships.
BJUI. 2012;110:540-545. Abstract
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