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Larger waist circumference linked to sexual, urinary dysfunction in men
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New data suggest that central obesity may worsen voiding function and erectile and ejaculatory dysfunction in men.
“The findings demonstrate that obesity in men — part of a growing global epidemic — affects their well-being in profound ways,” Steven A. Kaplan, MD, researcher and E. Darracott Vaughan Jr. Professor of Urology at Weill Cornell Medical College and director of the Iris Cantor Men’s Health Center, said in a press release.
Kaplan, who is also chief of the Institute for Bladder and Prostate Health at New York-Presbyterian/Weill Cornell, and colleagues examined three groups of 409 men aged at least 40 years (median age, 57.6 years) with waist circumferences of <90 cm (n=153), 90 cm to 99 cm (n=137), and ≥100 cm (n=119).
“The prevalence of erectile dysfunction increased from 32.1% to 74.5% as waist circumference increased (P=.001). The prevalence of ejaculatory dysfunction also increased from 2.14% to 64.7% as waist circumference increased (P=.001),” researchers wrote.
They also determined that a larger waist size was associated with more frequent urination. Data showed that 39% of men with the biggest waistlines urinated more than eight times in 24 hours vs. 27% of men in the middle range and 16% in the smaller waist size group. A similar pattern was observed for nighttime urination.
Moreover, the researchers found that the prevalence of several other metabolic syndrome components was linked to waist circumference. Prevalence of hypertension increased from 14.5% to 33.5% as waist circumference increased (P=.02) and mean serum cholesterol increased from 148 mg/dL to 254 mg/dL (P=.001). Prevalence of coronary artery disease also increased (8.4% to 29.4%; P=.004), as did the prevalence of type 2 diabetes (11.3% to 32.6%; P=.001).
“Overall, waist circumference may therefore represent a simple and easy metric in diagnosing not only the sequelae normally associated with the metabolic syndrome (ie, hypertension, type 2 diabetes, dyslipidemia and erectile and ejaculatory dysfunction) but also occult voiding dysfunction,” researchers wrote.
They said prospective, randomized trials with longer duration of follow-up should be conducted to confirm their suggestion that treating central obesity can lead to improved voiding function.
Perspective
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Kevin L. Billups, MD
From a men’s health perspective, I think this is a very useful and timely article, supporting the medical literature suggesting an important role for the metabolic syndrome in a number of urologic conditions including BPH/LUTS, erectile dysfunction and testosterone deficiency. The authors point out that metabolic syndrome is associated with increased risk to develop cardiometabolic diseases and highlight the growing interest in this link between lower urinary tract symptoms (LUTS) and metabolic syndrome.
Waist circumference is an important measure when assessing a patient for metabolic syndrome and it’s probably one that a lot of times clinicians don’t routinely perform, especially in urology. I believe that measuring waist circumference is an important part of the overall assessment for increased cardiometabolic risk and use this measurement in my Men's Health practice for this reason.
This study provides further evidence linking the importance of looking at metabolic syndrome and waist circumference in men with common urologic problems including BPH/LUTS. I also feel that this paper supports the concept that healthcare providers need to take a more holistic view in the area of urology and men's health. Many common urologic disorders (erectile dysfunction, low testosterone, BPH/LUTS) are increasingly being linked to increased risk for cardiometabolic disease and the metabolic syndrome is one factor that needs to be recognized and further investigated as a possible common denominator. One important implication is that lifestyle modification with diet and exercise could be used in addition to pharmacologic therapy to impact the metabolic syndrome and possibly improve conditions like LUTS, erectile dysfunction and testosterone deficiency. More research studies are clearly needed but this is certainly an exciting area with great potential to affect overall healthcare and quality of life.
The authors linked it nicely to the LUTS to the larger picture of metabolic syndrome and increased cardiometabolic risk using waist circumference as a straightforward clinical measurement. Perhaps this study will maybe help increase awareness among physicians and all healthcare providers of the need to look at other factors when seeing patients for prostate related conditions like BPH/LUTS.
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