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Youcheng L, Xun W, Zhufeng C. Association between nonalcoholic fatty liver disease and erectile dysfunction among American Adults from the National Health and Nutrition Examination Survey: a cross-sectional study. Int J Impot Res 2024:10.1038/s41443-024-00914-6. [PMID: 38783042 DOI: 10.1038/s41443-024-00914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a pressing public health concern. NAFLD is recognized as a disease with systemic involvement. Erectile dysfunction is a prevalent condition among men. The study examined the relationship between NAFLD, assessed via U.S. Fatty Liver Index (USFLI), and erectile dysfunction. The study used cross-sectional data from the National Health and Nutrition Examination Survey conducted between 2001 and 2004 to examine the health of those over 20 years of age, collecting details on their erectile dysfunction, USFLI, and several other essential variables. A USFLI score equal to or exceeding 30 was chosen to diagnose NAFLD, while a USFLI score below 10 was utilized to exclude the presence of fatty liver. There were 3763 participants, with 29.1% (1095/3763) who experienced erectile dysfunction. After accounting for all potential covariates, USFLI was positively associated with erectile dysfunction (OR, 1.02; 95% CI, 1.02 ~ 1.03; P < 0.001). Compared with individuals with Q1 (USFLI < 10), the adjusted odds ratio values for USFLI and erectile dysfunction in Q2 (10 ≤ USFLI < 30) and Q3 (USFLI ≥ 30, NAFLD) were 1.84 (95% CI: 1.46 ~ 2.32, p < 0.001) and 2.18 (95% CI: 1.66 ~ 2.87, p < 0.001), respectively. The association USFLI and erectile dysfunction exhibited an L-shaped curve (nonlinear, P = 0.014). The odds ratio value of developing erectile dysfunction was 1.03 (95% CI: 1.021 ~ 1.04, P < 0.001) in participants with USFLI < 50.18. This study identified a positive correlation between USFLI and erectile dysfunction within the adult American population. Our findings imply that NAFLD might constitute an independent risk factor for erectile dysfunction.
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Affiliation(s)
- Lin Youcheng
- Shengli Clinical Medical College Surgical Teaching Office, Fujian Medical University, Fuzhou, China
- Department of Urology, Urology and Nephrology Medical Center, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Wu Xun
- Department of Urology, The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital, Wuhu, China
| | - Chen Zhufeng
- Department of Infectious diseases, Fujian Provincial Hospital South Branch, Fuzhou, China.
- Shengli Clinical Medical College Internal Medicine Teaching Office, Fujian Medical University, Fuzhou, China.
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Heo JE, Kim DG, Yoo JW, Lee KS. Metabolic syndrome-related factors as possible targets for lower urinary tract symptoms in Korean males. Aging Male 2023; 26:6-12. [PMID: 36633207 DOI: 10.1080/13685538.2023.2166920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION A positive association between benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and metabolic syndrome (MetS) was reported in several studies, but studies from Asia often showed conflicting results. MATERIALS AND METHODS Medical records were obtained from a health promotion center database between 2021 and 2022. Men without a history of treatment for LUTS were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), transrectal ultrasonography. RESULTS Of 1345 individuals, 603 (44.8%) had MetS. Older age, higher IPSS values, higher prevalence rates of BPH and overactive bladder, higher triiodothyronine, and lower testosterone and sex-hormone binding globulin were observed in individuals with MetS than in individuals without MetS. The severity of LUTS significantly increased in the individuals with MetS (p = .002). In individuals with MetS, age, HbA1c, and cerebrovascular disease (CVD) were associated with IPSS. For OABSS, age, HbA1c, thyroid-stimulating hormone (TSH), coronary artery occlusive disease, and CVD were identified as predictors. CONCLUSIONS We confirmed the positive correlation between MetS and BPH/LUTS in Korean. Factors including TSH and atherosclerosis affected LUTS in individuals with MetS. These findings suggested a potential role of thyroid hormones and atherosclerosis in the etiology and treatment of BPH/LUTS in patients with MetS.
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Affiliation(s)
- Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Gyun Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Woo Yoo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Suk Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Besiroglu H, Kadihasanoglu M. Is There a Link Between Non-Alcoholic Fatty Liver Disease and Benign Prostate Hyperplasia/Lower Urinary Tract Symptoms: A Systematic Review and a Meta-Analysis. Metab Syndr Relat Disord 2023; 21:370-377. [PMID: 37341680 DOI: 10.1089/met.2023.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Background: Prostatic growth has been thought to be the systemic manifestation of some metabolic derangements in recent studies. Nonalcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, might be closely linked with benign prostate hyperplasia and lower urinary tract symptoms (BPH/LUTS). Several studies have been conducted regarding NAFLD and BPH/LUTS association. However, the results are yet to reach a clear conclusion. We aimed to gather these studies' results to make a more robust analysis through a systematic review and meta-analysis. Methods: We systematically searched Pubmed-Medline, Cochrane Library, and Science Direct databases. We excluded all experimental studies, case reports, and reviews. Our search was restricted to the English language. We used standard mean difference for BPH/LUTS-related parameters. We identified the study qualities by the Newcastle-Ottawa Scale. We conducted a publication bias analysis. Results: A total of six studies involving 7089 participants fulfilled the inclusion criteria. Our meta-analysis revealed that patients with NAFLD have larger prostate volume [0.553 (0.303-0.802), P ˂ 0.001; Q = 97.41; P-value for heterogeneity = P < 0.0001; I2 = 94.86%]. However, the summary effect size of the other parameters of BPH/LUTS (prostate-specific antigen and international prostate symptom score) computed in our meta-analysis did not yield significant results. Conclusions: The prostate size was larger in patients with NAFLD, but the meta-analysis did not reach a significant result for LUTS among the studies. These results should be tested with well-designed studies, in particular, to clarify the association of LUTS with NAFLD.
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Affiliation(s)
- Huseyin Besiroglu
- Department of Urology, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Mustafa Kadihasanoglu
- Department of Urology, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
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Opara NU. Diabetes mellitus-induced lower urinary tract symptoms and hepatic steatosis in an older male. Endocrinol Diabetes Metab Case Rep 2022; 2022:22-0290. [PMID: 36125050 PMCID: PMC9513662 DOI: 10.1530/edm-22-0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Summary Diabetes mellitus type 2 (DM-2) is one of the important causes of low-grade chronic inflammation (meta inflammation) seen in almost all tissues in the body. Other possible mechanisms involved in the development of lower urinary tract symptoms (LUTS) with DM-2 are the hypertonicity of the peripheral sympathetic nerves and hyperinsulinemia effects on the autonomous nervous system activity. These further suggests that abnormalities in glucose homeostasis influence the hyperproliferation of the prostate cells resulting in benign prostatic hyperplasia (BPH). Similarly, hepatic steatosis, a form of non-alcoholic fatty liver disease (NAFLD) prevalence among patients with DM-2, is as high as 75%. NAFLD has no symptoms in most diabetic patients. In this study, we present a case of a 64-year-old Black male who had worsening urinary urgency and hesitancy for 4 months, with increasing abdominal girth. Patient was found to have symptoms, diagnostic studies, and physical exam findings indicative of BPH and fatty liver disease. He was treated with hepato-protective medications, tighter control of his blood glucose levels, and blood pressure meds for 13 months. Upon follow-up, most of his symptoms were resolved. Timeline of BPH resolution and decrease in liver size following treatment suggest that DM-2 has a strong correlation with the development of BPH and fatty liver disease in most patients living with diabetes. Learning points Men with type 2 diabetes mellitus (DM-2) tend to have significantly lower serum PSA level, lower testosterone levels, and larger prostate volume compared to non-diabetic male patients. Patients with DM-2 have higher prevalence of hepatic steatosis, liver cirrhosis, and end-stage liver failure. The role of metformin in reducing hepatic steatosis as stated by several studies is yet to be validated as our patient has been on metformin for 22 years for the management of DM-2 with fatty liver disease.
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Affiliation(s)
- Nnennaya U Opara
- Emergency Medicine, Charleston Area Medical Centre, Institute for Academic Medicine, Charleston, West Virginia, USA
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Zhao S, Wang Y, Wu W, Yang S, Feng L, Tao F, Ge W, Shen M, Xu W. Nonalcoholic fatty liver disease and risk of prostatic diseases: Roles of insulin resistance. Andrologia 2021; 53:e14060. [PMID: 33782980 DOI: 10.1111/and.14060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 12/12/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), the liver component of metabolic syndrome, is considered to be associated with high risk of prostatic diseases but a systematic review has not been conducted. Under a comprehensive review of the eligible clinical studies, a potential positive association between NAFLD and benign prostatic hyperplasia/prostate cancer (BPH/PCa) has been postulated. Insulin resistance and metabolic aberrations are considered to be the potential mechanism for such association. However, the relationship between NAFLD and other prostatic diseases, that is, prostatic inflammation and lower urinary tract symptoms, seems vague due to limited relevant studies in the literatures. The present review highlights that clinicians should be conscious of the detrimental effect of NAFLD on the development of BPH and PCa.
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Affiliation(s)
- Shankun Zhao
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Yaoyao Wang
- Second School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Weizhou Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Suqing Yang
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Lili Feng
- Nursing Department, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Fangfang Tao
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Weiwei Ge
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Maolei Shen
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Weifang Xu
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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Omran A, Leca BM, Oštarijaš E, Graham N, Da Silva AS, Zaïr ZM, Miras AD, le Roux CW, Vincent RP, Cardozo L, Dimitriadis GK. Metabolic syndrome is associated with prostate enlargement: a systematic review, meta-analysis, and meta-regression on patients with lower urinary tract symptom factors. Ther Adv Endocrinol Metab 2021; 12:20420188211066210. [PMID: 34900218 PMCID: PMC8664322 DOI: 10.1177/20420188211066210] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is defined by at least three of the following five criteria: blood pressure ⩾130/85 mmHg, fasting blood glucose ⩾5.6 mmol/l, triglycerides concentration ⩾1.7 mmol/l, waist circumference ⩾102 cm (for men), and high-density lipoprotein cholesterol concentration <1.03 mmol/l (for men). MetS has been associated with worse lower urinary tract symptoms (LUTS) and higher International Prostate Symptom questionnaire scores. MATERIALS AND METHODS MEDLINE, Cochrane, ClinicalTrials.gov, and SCOPUS were critically appraised for all peer-reviewed manuscripts that suitably fulfilled our protocol's inclusion criteria established a priori. Meta-analytical and meta-regression calculations were performed in R using the Sidik-Jonkman and Hartung-Knapp random effects model and predefined covariates. RESULTS A total of 70 studies (n = 90,206) were included in qualitative synthesis. From these, 60 studies focused on MetS and LUTS: 44 reported positive correlations, 5 reported negative correlations, 11 reported no association, and 10 studies focused on MetS and total prostate volume (TPV). MetS positively correlated with moderate LUTS [odds ratio (OR) = 1.56, 95% confidence interval (CI) = 1.35-1.80], severe LUTS (OR = 2.35, 95% CI = 1.82-3.03), overactive bladder (OAB; OR = 3.2, 95% CI = 1.6-5.8), and nocturia severity (OR = 2.509, 95% CI = 1.571-4.007) at multivariate analysis. A total of 30 studies (n = 22,206) were included in meta-analysis; MetS was significantly associated with higher TPV (mean differences = 4.4450 ml, 95% CI = 2.0177-6.8723), but no significant predictive factors for effect sizes were discovered. CONCLUSION Our meta-analysis demonstrates a significant association between the aggravating effects of MetS, which commonly coexists with obesity and benign prostate enlargement.
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Affiliation(s)
| | | | - Eduard Oštarijaš
- Institute for Translational Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Natasha Graham
- Department of Obstetrics & Gynaecology, Queen Elizabeth Hospital, London, UK
| | - Ana Sofia Da Silva
- Department of Urogynaecology, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Alexander D. Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Carel W. le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Royce P. Vincent
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King’s College London, London, UKDepartment of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital NHS Foundation Trust, London, UK
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Chung GE, Yim JY, Kim D, Kwak MS, Yang JI, Park B, An SJ, Kim JS. Nonalcoholic Fatty Liver Disease Is Associated with Benign Prostate Hyperplasia. J Korean Med Sci 2020; 35:e164. [PMID: 32508064 PMCID: PMC7279945 DOI: 10.3346/jkms.2020.35.e164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/31/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is associated with a wide spectrum of metabolic abnormalities. This study aimed to evaluate whether NAFLD is associated with benign prostatic hyperplasia (BPH) independent of other risk factors. METHODS A total of 3,508 subjects who underwent prostate and hepatic ultrasonography were enrolled. NAFLD was diagnosed and graded by ultrasonographic findings. BPH was defined by total prostate volume. RESULTS The prevalence of BPH was significantly increased according to NAFLD severity (P < 0.001). The multivariate analysis showed that NAFLD was associated with a 22% increase in the risk of BPH (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.02-1.45). In non-obese subjects, NAFLD was associated with a 41% increase in the risk of BPH (OR, 1.41; 95% CI, 1.14-1.73), and an incremental increase in the risk of BPH according to NAFLD severity was pronounced (adjusted OR [95% CI], 1.32 [1.05-1.68] for mild NAFLD, 1.55 [1.15-2.10] for moderate to severe NAFLD vs. no NAFLD, P for trend = 0.004). However, in the obese population, the association of NAFLD in the risk of BPH was insignificant (P = 0.208). CONCLUSION NAFLD is associated with an increased risk of BPH regardless of metabolic syndrome, especially in non-obese subjects. An incrementally increased risk of BPH according to NAFLD severity is prominent in non-obese subjects with NAFLD. Thus, physicians caring for non-obese patients with NAFLD may consider assessing the risk of BPH and associated urologic conditions.
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Affiliation(s)
- Goh Eun Chung
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jeong Yoon Yim
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
| | - Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Min Sun Kwak
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Jong In Yang
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Boram Park
- Department of Public Health Science, Seoul National University, Seoul, Korea
| | | | - Joo Sung Kim
- Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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