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

Purpose

In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome.

Materials and Methods

The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models.

Results

Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21–2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06–2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66–1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older).

Conclusions

The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract.

Key Words: metabolic syndrome X, urinary tract, signs and symptoms, epidemiology

Abbreviations and Acronyms: ATP III, Adult Treatment Panel III, AUASI, American Urological Association symptom index, BACH, Boston Area Community Health, BMI, body mass index, BPH, benign prostatic hyperplasia, CES-D, Center for Epidemiological Studies–Depression scale, HDL, high-density lipoprotein, LUTS, lower urinary tract symptoms, MetS, the metabolic syndrome, NHANES III, Third National Health and Nutrition Examination Survey, SES, socioeconomic status