Dietary Macronutrients, Cholesterol, and Sodium and Lower Urinary Tract Symptoms in Men

doi:10.1016/j.eururo.2008.07.058

European Urology

Volume 55, Issue 5, May 2009, Pages 1179-1189

https://doi.org/10.1016/j.eururo.2008.07.058 Get rights and content

Abstract

Background

Little is known about dietary correlates of lower urinary tract symptoms (LUTS).

Objective

To examine associations between dietary intakes of total energy, carbohydrates, protein, fats, cholesterol, and sodium and LUTS in men.

Design, setting, and participants

Cross-sectional study of 1545 men aged 30–79 yr in the Boston Area Community Health survey (2002–2005), a random population-based sample. Dietary data were assessed by validated self-administered food frequency questionnaire. LUTS and covariate data were collected during in-person interviews. Primary analyses used multivariate logistic regression.

Measurements

Outcomes were moderate to severe LUTS, storage symptoms, and voiding symptoms as measured by the American Urological Association Symptom Index.

Results and limitations

Greater total energy intake was associated with higher LUTS symptom score (p_trend < 0.01) and increased likelihood of storage symptoms. No associations were observed with total, saturated, or monounsaturated fat intake or carbohydrates. Men who consumed more protein were less likely to report LUTS, particularly voiding symptoms (quintile 5 vs quintile 1 OR = 0.35; 95% CI, 0.17–0.74; p = 0.006). Sodium intake had positive linear associations with LUTS (p_trend = 0.01) and storage symptom score (p_trend = 0.004); this finding should be confirmed by studies using biomarkers of sodium exposure. Storage symptoms increased slightly with greater polyunsaturated fat intake (p_trend = 0.006). Data on specific polyunsaturated fats were unavailable.

Conclusions

This community-based study of men found that total energy and sodium intake were positively associated with LUTS, whereas greater protein intake was inversely associated with LUTS.

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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Benign Prostatic HyperplasiaDietary Macronutrients, Cholesterol, and Sodium and Lower Urinary Tract Symptoms in Men

Abstract

Background

Objective

Design, setting, and participants

Measurements

Results and limitations

Conclusions

Introduction

Section snippets

The Boston Area Community Health survey

Results

Discussion

Conclusions

J Urol

J Urol

Urology

Urology

Am J Clin Nutr

Eur Urol

J Urol

J Urol

Urology

Am J Clin Nutr

J Clin Epidemiol

Prostaglandins Leukot Essent Fatty Acids

Life Sci

J Steroid Biochem

Urology

The impact of lower urinary tract symptoms and comorbidities on quality of life: the BACH and UREPIK studies

BJU Int

Associations of obesity with lower urinary tract symptoms and noncancer prostate surgery in the Third National Health and Nutrition Examination Survey

Am J Epidemiol

Increase in muscle nerve sympathetic activity in humans after food intake

Clin Sci (Colch)

Relation of obesity and diet to sympathetic nervous system activity

Hypertension

Promotion of carcinogenesis and oxidative stress by dietary cholesterol in rat prostate

Carcinogenesis

Benign Prostatic Hyperplasia
Dietary Macronutrients, Cholesterol, and Sodium and Lower Urinary Tract Symptoms in Men