Association between serum concentrations of micronutrients and lower urinary tract symptoms in older men in the Third National Health and Nutrition Examination Survey

Pathophysiology of Overactive Bladder and Pharmacologic Treatments Including β3-Adrenoceptor Agonists -Basic Research Perspectives

Overactive bladder (OAB) is a symptom-based syndrome defined by urinary urgency, frequency, and nocturia with or without urge incontinence. The causative pathology is diverse; including bladder outlet obstruction (BOO), bladder ischemia, aging, metabolic syndrome, psychological stress, affective disorder, urinary microbiome, localized and systemic inflammatory responses, etc. Several hypotheses have been suggested as mechanisms of OAB generation; among them, neurogenic, myogenic, and urothelial mechanisms are well-known hypotheses. Also, a series of local signals called autonomous myogenic contraction, micromotion, or afferent noises, which can occur during bladder filling, may be induced by the leak of acetylcholine (ACh) or urothelial release of adenosine triphosphate (ATP). They can be transmitted to the central nervous system through afferent fibers to trigger coordinated urgency-related detrusor contractions. Antimuscarinics, commonly known to induce smooth muscle relaxation by competitive blockage of muscarinic receptors in the parasympathetic postganglionic nerve, have a minimal effect on detrusor contraction within therapeutic doses. In fact, they have a predominant role in preventing signals in the afferent nerve transmission process. β3-adrenergic receptor (AR) agonists inhibit afferent signals by predominant inhibition of mechanosensitive Aδ-fibers in the normal bladder. However, in pathologic conditions such as spinal cord injury, it seems to inhibit capsaicin-sensitive C-fibers. Particularly, mirabegron, a β3-agonist, prevents ACh release in the BOO-induced detrusor overactivity model by parasympathetic prejunctional mechanisms. A recent study also revealed that vibegron may have 2 mechanisms of action: inhibition of ACh from cholinergic efferent nerves in the detrusor and afferent inhibition via urothelial β3-AR.

Serum Copper and Zinc Levels and Urinary Incontinence in Adult Women

Recent findings show that oxidative damage may contribute to lower urinary tract symptoms. Copper can induce oxidative stress while zinc is involved in the defense against oxidative stress. We examined the associations between serum copper and zinc levels and urinary incontinence (UI) in adult women. Data were retrieved from the 2011-2016 National Health and Nutrition Examination Surveys. Outcomes for multivariate logistic regression were any UI (AUI), urge UI (UUI), stress UI (SUI), mixed UI (MUI), and moderate/severe UI. Questions on urinary incontinence were asked by trained interviewers. The weighted UI prevalences were 44.89% for AUI, 28.12% for UUI, 41.64% for SUI, 17.27% for MUI, and 20.79% for moderate/severe UI in adult women. After adjusting for multiple factors, serum copper levels in the highest quartile were associated with UUI [odds ratios (95% confidence intervals): 1.74 (1.11-2.74)]. In women older than 50 years, serum copper levels in the highest quartile were associated with UUI [2.94 (1.57-5.49)], AUI [1.97 (1.19-3.27)], MUI [2.43 (1.19-4.97)], and moderate/severe UI [2.37 (1.06-5.31)]. Serum copper levels in the second quartile were also associated with MUI overall [1.75 (1.03-2.97)] and in young women (20-49 years) [2.29 (1.02-5.17)]. Positive associations were also found between serum copper levels and UUI in non-obese women. There were no associations between serum zinc levels and UI outcomes. Serum copper levels were associated with UUI, MUI, AUI, and moderate/severe UI in adult women, especially women older than 50 years. Causality deserves to be confirmed further.

Carotenoid metabolism in mitochondrial function

Mitochondria are highly dynamic organelles that are found in most eukaryotic organisms. It is broadly accepted that mitochondria originally evolved from prokaryotic bacteria, e.g. proteobacteria. The mitochondrion has its independent genome that encodes 37 genes, including 13 genes for oxidative phosphorylation. Accumulative evidence demonstrates that mitochondria are not only the powerhouse of the cells by supplying adenosine triphosphate, but also exert roles as signalling organelles in the cell fate and function. Numerous factors can affect mitochondria structurally and functionally. Carotenoids are a large group of fat-soluble pigments commonly found in our diets. Recently, much attention has been paid in carotenoids as dietary bioactives in mitochondrial structure and function in human health and disease, though the mechanistic research is limited. Here, we update the recent progress in mitochondrial functioning as signalling organelles in human health and disease, summarize the potential roles of carotenoids in regulation of mitochondrial redox homeostasis, biogenesis, and mitophagy, and discuss the possible approaches for future research in carotenoid regulation of mitochondrial function.

Inflammatory mediators in the development and progression of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the most common urological disease in elderly men. Epidemiological data suggest a causal link between this condition and prostatic inflammation. The prostate is an immune-competent organ characterized by the presence of a complex immune system. Several stimuli, including infectious agents, urinary reflux, metabolic syndrome, the ageing process, and autoimmune response, have been described as triggers for the dysregulation of the prostatic immune system via different molecular pathways involving the development of inflammatory infiltrates. From a pathophysiological standpoint, subsequent tissue damage and chronic tissue healing could result in the development of BPH nodules.

Increased dietary and circulating lycopene are associated with reduced prostate cancer risk: a systematic review and meta-analysis

BACKGROUND

Prostate cancer (PCa) is the fifth leading cause of cancer-related deaths worldwide. Many epidemiological studies have investigated the association between prostate cancer and lycopene, however, results have been inconsistent. This study aims to determine the impact of dietary and circulating concentrations of lycopene on PCa risk and to investigate potential dose-response associations.

METHODS

We conducted a systematic review and dose-response meta-analysis for the for the association between dietary and circulating lycopene and PCa risk. Eligible studies were published before 1 December 2016 and were identified from PubMed, Web of Science and the Cochrane Library. We estimated pooled relative risk ratios (RR) and 95% confidence intervals (CI) using random and fixed effects models. Linear and nonlinear dose-response relationships were also evaluated for PCa risk.

RESULTS

Forty-two studies were included in the analysis, which included 43 851 cases of PCa reported from 692 012 participants. Both dietary intake (RR=0.88, 95% CI: 0.78-0.98, P=0.017) and circulating concentrations (RR=0.88, 95% CI: 0.79-0.98, P=0.019) of lycopene were significantly associated with reduced PCa risk. Sensitivity analyses within the dose-response analysis further revealed a significant linear dose-response for dietary lycopene and PCa risk such that PCa decreased by 1% for every additional 2 mg of lycopene consumed (P=0.026). Additionally, PCa risk decreased by 3.5 to 3.6% for each additional 10 μgdl^-1 of circulating lycopene in the linear and nonlinear models respectively (p_linear=0.004, p_nonlinear=0.006). While there were no associations between lycopene and advanced PCa, there was a trend for protection against PCa aggressiveness (RR=0.74, 95% CI: 0.55-1.00, P=0.052).

CONCLUSIONS

Our data demonstrate that higher dietary and circulating lycopene concentrations are inversely associated with PCa risk. This was accompanied by dose-response relationships for dietary and circulating lycopene. However, lycopene was not associated with a reduced risk of advanced PCa. Further studies are required to determine the mechanisms underlying these associations.

Dietary Antioxidants and Longitudinal Changes in Lower Urinary Tract Symptoms in Elderly Men: The Osteoporotic Fractures in Men Study

BACKGROUND

Antioxidants can potentially alter the progression of lower urinary tract symptoms (LUTS) through anti-inflammatory mechanisms.

OBJECTIVE

To determine if dietary antioxidants are associated with reduced likelihood of LUTS progression or increased likelihood of LUTS remission in untreated elderly men.

DESIGN, SETTING, AND PARTICIPANTS

A prospective cohort study of 1670 US men aged 65-100 yr.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Baseline variables included the American Urological Association Symptom Index, dietary intake assessed via a 69-item Block food frequency questionnaire (FFQ), demographics, lifestyle characteristics, quality of life (SF-12), and medication use. LUTS was assessed at four time points over a mean ± standard deviation period of 6.9±0.4 yr. Group-based trajectory modeling was performed for men without prostate cancer who did not undergo LUTS treatment with medication or surgery during follow-up (n=1670). Analyses were stratified by LUTS symptoms at baseline. For men with mild baseline LUTS, we examined the likelihood of LUTS progression relative to LUTS stability. For men with moderate baseline LUTS, we analyzed the likelihood of both LUTS progression relative to LUTS stability and LUTS remission relative to progression. Odds ratios and 95% confidence intervals were estimated for quartiles of daily antioxidant intake using multivariable logistic regression.

RESULTS AND LIMITATIONS

None of the dietary antioxidants (vitamin C, vitamin E, β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein/zeaxanthin) was associated with a lower probability of LUTS progression or LUTS remission. The study was limited by use of the brief Block FFQ, which contains only 69 food items and may have biased results toward the null hypothesis because of nondifferential misclassification.

CONCLUSIONS

In this large cohort of US men, there were no significant associations between multiple dietary antioxidants and LUTS progression or remission over 7 yr.

PATIENT SUMMARY

In a large cohort of elderly men, there were no significant longitudinal associations between multiple dietary antioxidants and lower urinary tract symptoms (LUTS). Our data suggest that dietary antioxidant consumption may not influence the natural history of LUTS in older men.

Effects of selenium status, dietary glucosinolate intake and serum glutathione S-transferase α activity on the risk of benign prostatic hyperplasia

Study Type--Prognosis (case control) Level of Evidence 2. What's known on the subject? and What does the study add? Geographical and ethnic differences in the distribution of BPH and the results of migrant studies indicate that not only age, androgens and genetics, but also modifiable factors may play a role in the aetiology of BPH. Oxidative stress induced by chronic inflammation could be a cause and antioxidants, including selenoproteins, may reduce the risk. The published data related to this topic are scarce and are mainly based on cross-sectional and case-control studies. In a nested case-control study, we observed a significant inverse association between serum selenium concentrations and the risk of BPH. These results need to be confirmed in larger, prospective epidemiological studies. Prostate enlargement is an increasing health problem as a result of an ageing population in many countries. Modifiable factors may also play a role. In the present study, before this antioxidant can be recommended as a preventive measure.

OBJECTIVE

• To determine whether geographical differences in the distribution of benign prostatic hyperplasia (BPH) and migrant studies indicate that modifiable factors play a role in the aetiology of BPH. Oxidative stress produced by chronic inflammation could represent one of the causes, and antioxidants, including selenoproteins, may reduce the risk.

SUBJECTS AND METHODS

• Conditional logistic regression was used to examine the associations of serum selenium and selenoprotein P concentrations and glutathione peroxidase activity with respect to the risk of BPH in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition-Heidelberg cohort, including 111 cases and 214 matched controls. • In addition, dietary glucosinolate intake and the serum glutathione S-transferase α concentration was investigated.

RESULTS

• The risk of BPH significantly decreased with an increasing serum selenium concentration; the risk estimate was 0.83 (35% CI 0.69-0.99) per 10 µg/L increase in serum selenium concentration. • However, no significant association was present for serum selenoprotein P concentration or glutathione peroxidase activity. Risk estimates for BPH decreased with a higher intake of glucosinolates, although the results were not statistically significant.

CONCLUSION

• A low serum selenium concentration may increase the risk of BPH, although the findings reported in the present study need to be confirmed in larger, well-designed epidemiological studies.

Are metabolic syndrome and its components associated with lower urinary tract symptoms? Results from a Chinese male population survey

OBJECTIVE

To investigate the association between severity of lower urinary tract symptoms (LUTS) and metabolic syndrome (MetS) and its components in a large male population in China.

METHODS

Data were collected from 3103 men attending the Fangchenggang Area Male Healthy and Examination Survey (FAMHES) from September 2009 to December 2009. LUTS were assessed by the International Prostate Symptom Score (IPSS) and MetS were defined using a modification of the Adult Treatment Panel III guidelines. Blood samples were drawn to determine serum lipids and glucose levels. Comprehensive information on demographic characteristics and medication was also collected through questionnaires. The association between LUTS and MetS was presented as odds ratios and 95% confidence intervals estimated using a logistic regression model.

RESULTS

The presence of MetS was not associated with the severity of LUTS (multivariate OR=0.97, 95% CI=0.67-1.39), but its subcategories of moderate or severe storage symptoms were inversely related to MetS (multivariate OR=0.64, 95% CI=0.44-0.91). Aging was observed to be a major risk factor for LUTS, such that men 60 years or older experienced 2-fold the odds of moderate or severe LUTS (OR=2.79, 95% CI=1.82-4.29) when compared with men 40 years or less). Component of MetS, such as systolic blood pressure, has increased odds for moderate or severe postmicturition symptoms but with no statistically significant results in multivariate analysis (multivariate OR=1.22, 95% CI=0.93-1. 60).

CONCLUSIONS

Our data suggest that the MetS is not associated with LUTS. However, for subcategory symptoms, decreased odds of MetS was observed in moderate or severe voiding storage symptoms.

[Primary and secondary prevention of benign prostatic hyperplasia: current knowledge and implications for clinical management]

Histological benign prostatic hyperplasia (BPH) and the BPH disease are frequent, lead to a reduction of quality of life, are both progressive and potentially associated with complications in the lower and upper urinary tract. A PubMed/MEDLINE search was conducted for the years 1990 to 2011. This article summarizes known selective measures of primary and secondary disease prevention.Measures of primary disease prevention aim to inhibit histological BPH and the development of clinically relevant BPH. Weight loss, regular physical activity, vegetable consumption, alcohol intake, 5α-reductase inhibitors, avoidance of overweight and reduction of fatty food can reduce the probability of histological and clinical BPH. Selective measures of secondary prevention aim to inhibit disease progression and BPH-associated complications. The regular and long-term use of α1-blockers reduces lower urinary tract symptoms (LUTS) and inhibits symptomatic disease progression but cannot prevent BPH-associated complications (e.g. urinary retention or need for prostate surgery). 5α-Reductase inhibitors can reduce the probability of symptomatic disease progression, urinary retention or need for surgery but the combination of α1-blocker and 5α-reductase inhibitor is more efficacious than either monotherapy. Especially older men with enlarged prostates (>40 cm(3)) and elevated serum PSA concentration (>1.6 µg/l) profit from measures of secondary disease prevention.For primary disease prevention, data quality is low and early treatment with 5α-reductase inhibitors is not been approved. For secondary disease prevention, men with risk factors of disease progression should use a treatment containing 5α-reductase inhibitors. Despite several epidemiological and clinical investigations on BPH disease progression no official programme exists in Germany for disease prevention.

Lifestyle factors, benign prostatic hyperplasia, and lower urinary tract symptoms

PURPOSE OF REVIEW

Although age, genetics, and sex steroid hormones play prominent roles in the cause of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), recent epidemiological studies suggest that modifiable lifestyle factors also contribute substantially to the pathogenesis of these conditions.

RECENT FINDINGS

Lifestyle and metabolic factors associated with significantly increased risks of benign prostatic hyperplasia and lower urinary tract symptoms include obesity, diabetes, and meat and fat consumption. Factors associated with decreased risks include physical activity, moderate alcohol intake, and vegetable consumption. Factors for which no clear risk patterns have emerged include lipids and smoking. Randomized clinical trials of lifestyle alterations - such as weight loss, exercise, and diet - for the prevention or treatment of benign prostatic hyperplasia and lower urinary tract symptoms have yet to be performed.

SUMMARY

Lifestyle factors present a novel opportunity for the prevention and treatment of benign prostatic hyperplasia and lower urinary tract symptoms. Although clinical trials of lifestyle modifications have not yet been undertaken, promotion of healthy lifestyle alternatives within the context of standard benign prostatic hyperplasia and lower urinary tract symptoms treatment algorithms is potentially beneficial.

Dietary, but not supplemental, intakes of carotenoids and vitamin C are associated with decreased odds of lower urinary tract symptoms in men

Lower urinary tract symptoms (LUTS) in men may be related to micronutrients involved in prevention of oxidative damage or cell growth and differentiation. We tested the hypothesis that carotenoid, vitamin A, and vitamin C intake were inversely associated with total LUTS, voiding, and storage symptoms. We conducted a cross-sectional multivariate analysis of 1466 men aged 30-79 y in the Boston Area Community Health survey (2002-2005), a population-based random sample survey. Data were collected by in-person interview and validated FFQ. Moderate-to-severe LUTS were defined using the American Urological Symptom Index and analyzed using multivariate logistic regression. Overall, men consuming greater dietary lycopene, β-carotene, total carotenoid, or vitamin A had ~40-50% decreased odds of LUTS compared with the lowest intake quartiles (e.g. β-carotene and storage symptoms, OR = 0.56, 95% CI = 0.39, 0.82; P-trend = 0.02). Interactions were observed between dietary iron and vitamin C or β-cryptoxanthin, whereby inverse associations with LUTS, particularly voiding symptoms, occurred only among men with moderate-to-high iron intake (P-interaction = 0.001). High-dose supplemental and total vitamin C were positively associated with LUTS (e.g. supplemental vitamin C ≥ 250 mg/d, OR = 1.83, 95% CI = 1.21, 2.77; P-trend = 0.02). An interaction between β-carotene and smoking status (P-interaction = 0.004) indicated greater odds of LUTS with higher β-carotene intake among current smokers. Results suggest that modifying consumption of carotenoids and vitamin C may influence LUTS in men.

Prevalence and factors associated with uncomplicated storage and voiding lower urinary tract symptoms in community-dwelling Australian men

PURPOSE

To determine the prevalence of, and associated risk factors for, voiding and storage lower urinary tract symptoms (LUTS) in a population-based sample of Australian men.

METHODS

Data were collected from 1,103 men randomly selected, community-dwelling men, as part of the Florey Adelaide Male Ageing Study, after exclusion of men with prostate or bladder cancer or prior surgery to either organ. The presence of LUTS was assessed using the International Prostate Symptom Score. Urine flow was measured via flow meter. Demographic, clinical, and bio-psychosocial data were collected by questionnaire.

RESULTS

The prevalence of total, storage, and voiding LUTS was 18.1, 28.0 and 12.6%, respectively. The most common storage symptoms were frequency (12.3%), nocturia (9.9%) and urgency (8.1%), and voiding symptoms were weak stream (8.5%), intermittency (5.4%), incomplete emptying (5.1%) and straining (2.4%). There were linear associations between storage LUTS and increased abdominal fat mass, plasma glucose and low HDL cholesterol (components of the metabolic syndrome), obstructive sleep apnoea (OSA) risk, and retirement. Voiding symptoms were associated with a previous diagnosis of benign prostatic enlargement (BPH), mean peak urine flow, total energy intake, elevated risk of OSA, erectile dysfunction, physician-diagnosed thyroid dysfunction and higher household income.

CONCLUSIONS

The close association of storage LUTS with the metabolic syndrome, and of both storage and voiding LUTS with OSA, suggest that these conditions should be considered in men presenting with LUTS.

Dietary patterns, supplement use, and the risk of benign prostatic hyperplasia

It has long been appreciated that a healthy lifestyle plays a critical role in cardiovascular health. It is now apparent that the same is true in the development of benign prostatic hyperplasia (BPH). Prospective cohort data originating from recently published randomized trials on the medical treatment of BPH and prevention of prostate cancer have been invaluable. A growing body of evidence suggests that exercise and the intake of specific macronutrients and micronutrients through regular diet play a beneficial role. Most strikingly, the magnitude of these effects is similar to medical therapies using alpha-blockers and 5-alpha-reductase inhibitors. The use of supplements for prostate disease is a multibillion dollar business in the United States, and supplements are more commonly prescribed than medical therapy in many countries. In contrast to consumption of micronutrients through regular diet, supplemental intake of micronutrients and phytotherapies currently lack evidence to support their efficacy.

Modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms: new approaches to old problems

PURPOSE

Benign prostatic hyperplasia is generally not regarded as a preventable disease. However, accumulating evidence suggests that modifiable factors may influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms.

MATERIALS AND METHODS

A structured, comprehensive literature review was done to identify modifiable risk factors for benign prostatic hyperplasia and lower urinary tract symptoms among observational studies of older men.

RESULTS

Outcome measures used to define benign prostatic hyperplasia in clinical studies include histological analysis of prostate tissue, radiographically determined prostate enlargement, acute urinary retention, decreased urinary flow rate, pressure flow studies consistent with bladder outlet obstruction, history of benign prostatic hyperplasia surgery, physician diagnosed benign prostatic hyperplasia and American Urological Association symptom score or International Prostate Symptom Score. Factors that potentially increase the risk of benign prostatic hyperplasia and lower urinary tract symptoms include obesity and diabetes. Factors that potentially decrease the risk include increased physical activity and moderate alcohol consumption. Other candidate factors for which clear risk patterns have not yet emerged are dyslipidemia, hypertension, smoking, diet and environment.

CONCLUSIONS

Obesity, diabetes, physical activity and alcohol intake may substantially influence the risk of benign prostatic hyperplasia and lower urinary tract symptoms in older men. Further analyses of these and other potential modifiable risk factors may identify novel interventions for the prevention, diagnosis and treatment of these highly prevalent conditions.

Fruit and vegetable consumption, intake of micronutrients, and benign prostatic hyperplasia in US men

BACKGROUND

Nutrients with antioxidant properties or that influence cell growth and differentiation might reduce the risk of benign prostatic hyperplasia (BPH).

OBJECTIVE

The objective was to evaluate the association of fruit, vegetable, and micronutrient intakes with BPH.

DESIGN

The participants were members of the Health Professionals Follow-Up Study and were aged 46-81 y in 1992. In 1992 and biennially thereafter, the men reported having surgery for an enlarged prostate, and in 1992 and on 3 subsequent questionnaires they completed the American Urological Association symptom index (AUASI). BPH cases were men who reported having surgery or who had an AUASI score of 15-35 (n = 6092). Control subjects were men who had not had surgery and never had an AUASI score >7 (n = 18 373). Men with a score of 8-14 were excluded (n = 7800). Intakes of fruit, vegetables, and antioxidants were assessed with a food-frequency questionnaire in 1986. We calculated odds ratios (ORs) of BPH and 95% CIs using logistic regression.

RESULTS

Vegetable consumption was inversely associated with BPH (fifth compared with first quintile-OR: 0.89; 95% CI: 0.80, 0.99; P for trend = 0.03), whereas fruit intake was not. Consumption of fruit and vegetables rich in beta-carotene (P for trend = 0.004), lutein (P for trend = 0.0004), or vitamin C (P for trend = 0.05) was inversely related to BPH. With increasing vitamin C intake from foods, men were less likely to have BPH (P for trend = 0.0009). Neither alpha- nor gamma-tocopherol intake from foods was associated with BPH (P for trend = 0.05 and 0.84, respectively).

CONCLUSION

Our findings are consistent with the hypothesis that a diet rich in vegetables may reduce the occurrence of BPH.

Are men with low selenium levels at increased risk of prostate cancer?

A meta-analysis was undertaken to quantitatively determine if men with low selenium levels were at increased risk of prostate cancer. PubMed, EMBASE and current contents were searched to identify relevant studies. The effect size was calculated by pooling the mean difference for serum, plasma and toenail selenium levels (95% confidence intervals) separately and combined using a random effects model. Meta-regression analysis explored possible sources of heterogeneity. Twenty epidemiologic studies were selected. Mean differences were: -5.55 microg/l (-9.82; -1.27; p=0.01), -0.01 microg/g (-0.03; 0.006; p=0.19), -0.52 microg/l (-4.63; 3.58; p=0.80) for serum, toenail and plasma studies, respectively. Overall, the pooled standardized mean difference between cases and controls was; -0.23 (-0.40; -0.05; p=0.01) indicating a possible inverse association between selenium levels and risk of prostate cancer. Differences in selenium levels between populations, a possible threshold effect and the relationship between selenium and the different stages of prostate cancer require further investigation.

Conference overview: Molecular mechanisms of metal toxicity and carcinogenesis

Chronic exposure to many heavy metals and metal-derivatives is associated with an increased risk of cancer, although the mechanisms of tumorigenesis are largely unknown. Approximately 125 scientists attended the 3rd Conference on Molecular Mechanisms of Metal Toxicity and Carcinogenesis and presented the latest research concerning these mechanisms. Major areas of focus included exposure assessment and biomarker identification, roles of ROS and antioxidants in carcinogenesis, mechanisms of metal-induced DNA damage, metal signalling, and the development of animal models for use in metal toxicology studies. Here we highlight some of the research presented, and summarize the conference proceedings.