Benign Prostatic HyperplasiaDietary Macronutrients, Cholesterol, and Sodium and Lower Urinary Tract Symptoms in Men
Introduction
Lower urinary tract symptoms (LUTS) are a source of daily bother and lower the quality of life for millions of adults [1]. Although LUTS is often associated with benign prostatic hyperplasia (BPH) in men, studies suggest various origins for LUTS, including increased sympathetic nervous system (SNS) activity, detrusor sensitivity, and oxidative damage [2], [3], [4].
These possible origins of LUTS are affected by macronutrient intake [5], [6], [7], [8], yet the extent to which macronutrients are associated with LUTS in men remains unclear. Previous research has focused on older men and BPH, accounting for only a subset of the larger population suffering these symptoms. Two case-control studies of surgically treated cases of BPH showed inconsistent results regarding macronutrients [9], [10]. One prospective study found a positive association between total fat and an inverse association between protein intake and BPH, defined by BPH treatment or a high symptom score [11]. Yet a separate prospective study showed that the role of protein differed by outcome definition; a positive association was observed for BPH surgery, but no association was found with high or moderate to severe LUTS [12]. Similarly, total energy and polyunsaturated fats were positively associated with BPH, as defined by BPH surgery or high symptom score, yet when the researchers separated these outcomes, they found that the associations held only for LUTS [12]. These results indicate that the pathophysiological mechanisms of LUTS are not completely aligned with BPH, and studies on more widespread LUTS, thoroughly considering voiding and storage symptoms, are necessary.
Our objective was to investigate the associations between macronutrients, dietary cholesterol and sodium intake, and moderate to severe symptoms of the lower urinary tract among men using cross-sectional data from a unique community-based random-sample survey.
Section snippets
The Boston Area Community Health survey
The Boston Area Community Health (BACH) survey is a community-based survey of urologic symptoms and risk factors. From 2002–2005, BACH used a multistage stratified random sample to recruit 2301 men aged 30–79 yr from three racial/ethnic groups in the Boston area. Information about urologic symptoms, comorbidities, lifestyle, and anthropometrics was obtained by in-person interview. Details on BACH's methods have been published [13]. Participants provided written informed consent, approved by the
Results
Of the 1545 men, 322 (20.0%) had a symptom score ≥8 and were therefore considered to have moderate to severe LUTS. Voiding symptoms were present in 13.4% (n = 214) and storage symptoms in 29.5% (n = 481) of all men. Voiding and storage scores were moderately correlated (r = 0.59). Among men with storage symptoms, 29.7% also had voiding symptoms. Among men with voiding symptoms, 65.2% also had storage symptoms. The most common symptoms were, for voiding, a sensation of incomplete bladder emptying, and
Discussion
In these cross-sectional analyses of a diverse, community-based sample of men, we found that greater total energy and sodium intake were positively associated with LUTS, whereas greater protein intake was inversely associated with LUTS. Protein intake was predominantly associated with voiding symptoms and sodium intake with storage symptoms. We also observed a modest positive trend between polyunsaturated fat and storage symptoms. Results were generally consistent when we examined the
Conclusions
This community-based study of men found that total energy and sodium intake were associated with increased LUTS, whereas greater protein intake was inversely associated with LUTS. Results differed when separately examining voiding and storage symptoms. While there are possible pathophysiologic explanations, these remain speculative until further experimental and epidemiological research is conducted to confirm our results.
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