Introduction: Increased abdominal visceral fat induces abnormal adipocytokine secretion. This leads to overproduction of various inflammatory cytokines, which induce systemic chronic inflammation and can result in metabolic syndrome (MetS). Although it is understood that systemic inflammation spread due to MetS can cause various lifestyle diseases, it was recently reported that MetS is also an important factor in lower urinary tract symptoms (LUTS), including overactive bladder (OAB). A recent study of women showed that excessive visceral fat accumulation, which triggers MetS, is related to OAB presence and severity. However, there has been no such research on men, who are considered more susceptible to the effects of visceral fat than women. Therefore, the objective of this study was to clarify the relationship between visceral fat volume and OAB in men.
Methods: Men who underwent abdominal CT as part of health checks and had not been treated for LUTS before the study were included. OAB was defined as scoring =2 points on question 3 (urinary urgency) of the Overactive Bladder Symptom Score (OABSS) and a total score of =3 points. Visceral fat area (VFA), visceral fat volume (VFV), and total abdominal fat volume (TAV) calculated from abdominal CT, the presence of OAB, associations between these fat parameters; and OABSS total score were examined. Visceral fat was measured using a 3-dimensional image analysis system (SYNOSE VINCENT®, FUJIFILM Corporation, Tokyo, Japan).
Results: There were 519 participants in the analysis set. The mean age was 57.4±15.2 years. There were 135 patients (26.0%) who met the criteria for OAB. From the abdominal CT results, the OAB group exhibited statistically and significantly higher values than the non-OAB group for the following factors: VFA (non-OAB; 72.1±39.6 cm2, OAB; 113.5±72.2 cm2, P<0.001), VFV (non-OAB; 1829.1±1249.6 cm3, OAB; 3299.6±2380.2 cm3, P<0.001), and VFV/TAV (non-OAB; 0.32±0.12, OAB; 0.50±0.15, P<0.001). When correlations between these factors obtained from the image findings and the OABSS total score were examined, VFV/TAV had the strongest correlation with the OABSS total score (r=0.511, P<0.001). The area under the receiver operating characteristic curve for the presence of OAB and VFV/TAV was 0.821. At a cutoff value of 0.409, the sensitivity and specificity were 0.741 and 0.732, respectively. Multivariate analysis of VFV/TAV and factors contributing to OAB, such as age, prostate volume, hypertension, and diabetes, showed that high VFV/TAV (=0.409) was an independent risk factor for OAB in univariate and multivariate analyses (odds ratio 4.51, 95% confidence interval: 2.57-7.89, P<0.001).
Conclusions: We found that VFA and increased VFA were closely associated with OAB presence and severity in men. The results also indicated that excessive abdominal visceral fat accumulation itself is an important risk factor for OAB.
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