Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
Departments of Nutrition and Epidemiology, Harvard School of Public Health and Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.
J Urol. 2014 Mar;191(3):715-21. doi: 10.1016/j.juro.2013.08.110. Epub 2013 Sep 25.
We prospectively evaluated the association between adiposity and the risk of lower urinary tract symptoms incidence and progression in the Health Professionals Followup Study (HPFS).
At baseline participants reported current height and weight, and weight at age 21 years. A year later they reported waist and hip circumferences, and every 2 years thereafter they reported weight. Participants periodically completed the International Prostate Symptom Score (I-PSS) and reported surgery or medication use for lower urinary tract symptoms. We used Cox proportional hazards regression to estimate the multivariable adjusted association between adiposity and lower urinary tract symptoms incidence and progression. The incidence analytical cohort of 18,055 men had no lower urinary tract symptoms at baseline. A total of 6,461 men entered the progression analytical cohort when they first experienced lower urinary tract symptoms.
The risk of lower urinary tract symptoms in 4,088 cases increased with increasing body mass index (35 kg/m(2) or greater vs 23 to less than 25 HR 1.61, 95% CI 1.31-1.99), waist circumference (greater than 42 inches vs 33 or less HR 1.39, 95% CI 1.19-1.63) and weight gain since age 21 years (50 pounds or greater vs stable weight HR 1.31, 95% CI 1.17-1.46, each p trend <0.0001). The risk of lower urinary tract symptom progression in 1,691 cases increased with body mass index (35 kg/m(2) or greater vs 23 to less than 25 HR 1.44, 95% CI 1.04-2.00, p trend <0.0001), weight gain since age 21 years (50 pounds or greater vs stable weight HR 1.35, 95% CI 1.14-1.60, p trend <0.0001) and waist circumference (greater than 42 inches vs 33 or less HR 1.32, 95% CI 0.95-1.85, p trend 0.005).
Men with higher total and abdominal adiposity and those who gained weight were more likely to have lower urinary tract symptoms develop or progress. Our findings support the notion that obesity may be an important target for lower urinary tract symptom prevention and intervention.
我们前瞻性地评估了肥胖与下尿路症状（LUTS）发病和进展风险之间的关联，该研究来自于医务人员随访研究（HPFS）。
参与者在基线时报告了当前身高和体重，以及 21 岁时的体重。一年后，他们报告了腰围和臀围，此后每两年报告一次体重。参与者定期完成国际前列腺症状评分（I-PSS），并报告下尿路症状的手术或药物治疗情况。我们使用 Cox 比例风险回归来估计肥胖与下尿路症状发病和进展之间的多变量调整关联。发病分析队列中 18055 名男性在基线时没有下尿路症状。当 6461 名男性首次出现下尿路症状时，他们进入了进展分析队列。
4088 例下尿路症状患者的风险随着体重指数（BMI）（35kg/m²或更高 vs 23 至小于 25，HR 1.61，95%CI 1.31-1.99）、腰围（大于 42 英寸 vs 33 或更小，HR 1.39，95%CI 1.19-1.63）和自 21 岁以来体重增加（50 磅或更多 vs 稳定体重，HR 1.31，95%CI 1.17-1.46，每项趋势 p<0.0001）而增加。1691 例下尿路症状进展患者的风险随着 BMI（35kg/m²或更高 vs 23 至小于 25，HR 1.44，95%CI 1.04-2.00，p 趋势<0.0001）、自 21 岁以来体重增加（50 磅或更多 vs 稳定体重，HR 1.35，95%CI 1.14-1.60，p 趋势<0.0001）和腰围（大于 42 英寸 vs 33 或更小，HR 1.32，95%CI 0.95-1.85，p 趋势 0.005）而增加。
总脂肪和腹部脂肪较多且体重增加的男性更容易出现下尿路症状的发生或进展。我们的研究结果支持肥胖可能是下尿路症状预防和干预的重要目标的观点。
