Skip to main content

Advertisement

SpringerLink
Log in

Relationship between non-alcoholic fatty liver disease and benign prostatic hyperplasia/lower urinary tract symptoms: new insights from an Italian cross-sectional study

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 13 January 2015

Abstract

Purpose

To investigate the prevalence of non-alcoholic fatty liver disease (NAFLD) assessed by the fatty liver index (FLI), in lower urinary tract symptoms (LUTS) patients and to estimate its ability in predicting LUTS.

Methods

We performed a cross-sectional analysis of 448 consecutive patients affected by LUTS. LUTS were evaluated using the IPSS questionnaire and metabolic syndrome (MetS) criteria (by International Diabetes Federation). FLI, prostate volume (PV), serum prostate-specific antigen, total testosterone (TT) and homeostasis model assessment (HOMA) index were evaluated. A value of FLI ≥40 was set to predict NAFLD. Patients were divided into Group A (FLI <40) and Group B (FLI ≥40). Odds ratios (OR) for having moderate–severe LUTS were calculated. Logistic regression model was fitted adjusting for confounding factors.

Results

Group B showed higher prevalence of MetS, IR, moderate–severe LUTS and ED, higher IPSS, IPSS-storage, IPSS-voiding, total prostate volume, insulin, HOMA and lower TT and IIEF-5. Univariate logistic regression analysis demonstrated that continuous FLI (OR = 1.03, p < 0.05) and FLI ≥40 (OR = 2.41, p < 0.01) significantly increase the risk of moderate–severe LUTS. Continuous FLI (OR = 1.12, p < 0.01) and FLI ≥40 (OR = 5.39, p < 0.01) were independent predictors of moderate–severe LUTS at the multivariate logistic regression analysis, after adjusting for confounding factors. Subjects with MetS and FLI ≥40 had 2.0-fold the risk of moderate–severe LUTS (OR = 2.10, p < 0.01).

Conclusions

Non-alcoholic fatty liver disease (NAFLD) subjects have higher risk of LUTS. The presence of FLI ≥40 can be used to predict subjects at high risk of LUTS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gacci M, Eardley I, Giuliano F, Hatzichristou D, Kaplan SA, Maggi M, McVary KT, Mirone V, Porst H, Roehrborn CG (2011) Critical analysis of the relationship between sexual dysfunctions and lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol 60(4):809–825. doi:10.1016/j.eururo.2011.06.037

    Article  PubMed  Google Scholar 

  2. Lee JH, Kwon H, Park YW (2013) Association of lower urinary tract symptom/benign prostatic hyperplasia measures with international index of erectile function 5 in middle-aged policemen of Korea and the role of metabolic syndrome and testosterone in their relationship. Urology 82(5):1008–1012. doi:10.1016/j.urology.2013.07.003

    Article  PubMed  Google Scholar 

  3. Smits MM, Ioannou GN, Boyko EJ, Utzschneider KM (2013) Non-alcoholic fatty liver disease as an independent manifestation of the metabolic syndrome: results of a US national survey in three ethnic groups. J Gastroenterol Hepatol 28(4):664–670. doi:10.1111/jgh.12106

    Article  CAS  PubMed  Google Scholar 

  4. Watanabe S, Yaginuma R, Ikejima K, Miyazaki A (2008) Liver diseases and metabolic syndrome. J Gastroenterol 43(7):509–518. doi:10.1007/s00535-008-2193-6

    Article  CAS  PubMed  Google Scholar 

  5. Rafiq N, Younossi ZM (2009) Nonalcoholic fatty liver disease: a practical approach to evaluation and management. Clin Liver Dis 13(2):249–266. doi:10.1016/j.cld.2009.02.009

    Article  PubMed  Google Scholar 

  6. Lee JH, Kim D, Kim HJ, Lee CH, Yang JI, Kim W, Kim YJ, Yoon JH, Cho SH, Sung MW, Lee HS (2010) Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease. Dig Liver Dis 42(7):503–508. doi:10.1016/j.dld.2009.08.002

    Article  CAS  PubMed  Google Scholar 

  7. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830

    Article  CAS  PubMed  Google Scholar 

  8. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419

    Article  CAS  PubMed  Google Scholar 

  9. Bedogni G, Bellentani S, Miglioli L, Masutti F, Passalacqua M, Castiglione A, Tiribelli C (2006) The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol 6:33. doi:10.1186/1471-230X-6-33

    Article  PubMed Central  PubMed  Google Scholar 

  10. Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M, Mullen KD, Cooper JN, Sheridan MJ (2002) The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 123(3):745–750

    Article  PubMed  Google Scholar 

  11. Russo GI, Cimino S, Fragala E, Privitera S, La Vignera S, Condorelli R, Calogero AE, Castelli T, Favilla V, Morgia G (2014) Insulin resistance is an independent predictor of severe lower urinary tract symptoms and of erectile dysfunction: results from a cross-sectional study. J Sex Med. doi:10.1111/jsm.12587

    Google Scholar 

  12. Sebastiano C, Vincenzo F, Tommaso C, Giuseppe S, Marco R, Ivana C, Giorgio R, Massimo M, Giuseppe M (2012) Dietary patterns and prostatic diseases. Front Biosci (Elite Ed) 4:195–204

    Article  Google Scholar 

  13. Park YW, Kim SB, Kwon H, Kang HC, Cho K, Lee KI, Kim YJ, Lee JH (2013) The relationship between lower urinary tract symptoms/benign prostatic hyperplasia and the number of components of metabolic syndrome. Urology 82(3):674–679. doi:10.1016/j.urology.2013.03.047

    Article  PubMed  Google Scholar 

  14. Vanella L, Russo GI, Cimino S, Fragala E, Favilla V, Volti GL, Barbagallo I, Sorrenti V, Morgia G (2014) Correlation between lipid profile and heme oxygenase system in patients with benign prostatic hyperplasia. Urology 83 (6):1444 e1447–E1413. doi:10.1016/j.urology.2014.03.007

  15. Parsons JK, Carter HB, Partin AW, Windham BG, Metter EJ, Ferrucci L, Landis P, Platz EA (2006) Metabolic factors associated with benign prostatic hyperplasia. J Clin Endocrinol Metab 91(7):2562–2568. doi:10.1210/jc.2005-2799

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Vignozzi L, Rastrelli G, Corona G, Gacci M, Forti G, Maggi M (2014) Benign prostatic hyperplasia: a new metabolic disease? J Endocrinol Invest. doi:10.1007/s40618-014-0051-3

    PubMed  Google Scholar 

  17. Minutoli L, Altavilla D, Marini H, Rinaldi M, Irrera N, Pizzino G, Bitto A, Arena S, Cimino S, Squadrito F, Russo GI, Morgia G (2014) Inhibitors of apoptosis proteins in experimental benign prostatic hyperplasia: effects of serenoa repens, selenium and lycopene. J Biomed Sci 21:19. doi:10.1186/1423-0127-21-19

    Article  PubMed Central  PubMed  Google Scholar 

  18. Morgia G, Cimino S, Favilla V, Russo GI, Squadrito F, Mucciardi G, Masieri L, Minutoli L, Grosso G, Castelli T (2013) Effects of Serenoa repens, selenium and lycopene (Profluss(R)) on chronic inflammation associated with benign prostatic hyperplasia: results of “FLOG” (Flogosis and Profluss in Prostatic and Genital Disease), a multicentre Italian study. Int Braz J Urol 39(2):214–221. doi:10.1590/S1677-5538.IBJU.2013.02.10

    PubMed  Google Scholar 

  19. Gacci M, Vignozzi L, Sebastianelli A, Salvi M, Giannessi C, De Nunzio C, Tubaro A, Corona G, Rastrelli G, Santi R, Nesi G, Serni S, Carini M, Maggi M (2013) Metabolic syndrome and lower urinary tract symptoms: the role of inflammation. Prostate Cancer Prostatic Dis 16(1):101–106. doi:10.1038/pcan.2012.44

    Article  CAS  PubMed  Google Scholar 

  20. Vignozzi L, Gacci M, Cellai I, Morelli A, Maneschi E, Comeglio P, Santi R, Filippi S, Sebastianelli A, Nesi G, Serni S, Carini M, Maggi M (2013) PDE5 inhibitors blunt inflammation in human BPH: a potential mechanism of action for PDE5 inhibitors in LUTS. Prostate 73(13):1391–1402. doi:10.1002/pros.22686

    Article  CAS  PubMed  Google Scholar 

  21. Morelli A, Comeglio P, Filippi S, Sarchielli E, Cellai I, Vignozzi L, Yehiely-Cohen R, Maneschi E, Gacci M, Carini M, Adorini L, Vannelli GB, Maggi M (2012) Testosterone and farnesoid X receptor agonist INT-747 counteract high fat diet-induced bladder alterations in a rabbit model of metabolic syndrome. J Steroid Biochem Mol Biol 132(1–2):80–92. doi:10.1016/j.jsbmb.2012.02.007

    Article  CAS  PubMed  Google Scholar 

  22. Bugianesi E, McCullough AJ, Marchesini G (2005) Insulin resistance: a metabolic pathway to chronic liver disease. Hepatology 42(5):987–1000. doi:10.1002/hep.20920

    Article  CAS  PubMed  Google Scholar 

  23. Lotti F, Corona G, Vignozzi L, Rossi M, Maseroli E, Cipriani S, Gacci M, Forti G, Maggi M (2014) Metabolic syndrome and prostate abnormalities in male subjects of infertile couples. Asian J Androl. doi:10.4103/1008-682X.122341

    PubMed Central  PubMed  Google Scholar 

  24. Vignozzi L, Filippi S, Comeglio P, Cellai I, Sarchielli E, Morelli A, Rastrelli G, Maneschi E, Galli A, Vannelli GB, Saad F, Mannucci E, Adorini L, Maggi M (2014) Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: an experimental study in the rabbit. Mol Cell Endocrinol 384(1–2):143–154. doi:10.1016/j.mce.2014.01.014

    Article  CAS  PubMed  Google Scholar 

  25. Cersosimo E, DeFronzo RA (2006) Insulin resistance and endothelial dysfunction: the road map to cardiovascular diseases. Diabetes/Metab Res Rev 22(6):423–436. doi:10.1002/dmrr.634

    Article  CAS  Google Scholar 

  26. Karthikeyan VJ, Blann AD, Baghdadi S, Lane DA, Beevers DG, Lip GY (2011) Endothelial dysfunction in hypertension in pregnancy: associations between circulating endothelial cells, circulating progenitor cells and plasma von Willebrand factor. Clin Res Cardiol 100(6):531–537. doi:10.1007/s00392-010-0277-9

    Article  CAS  PubMed  Google Scholar 

  27. Vignozzi L, Morelli A, Filippi S, Comeglio P, Chavalmane AK, Marchetta M, Toce M, Yehiely-Cohen R, Vannelli GB, Adorini L, Maggi M (2011) Farnesoid X receptor activation improves erectile function in animal models of metabolic syndrome and diabetes. J Sex Med 8(1):57–77. doi:10.1111/j.1743-6109.2010.02073.x

    Article  CAS  PubMed  Google Scholar 

  28. Favilla V, Cimino S, Castelli T, Madonia M, Barbagallo I, Morgia G (2010) Relationship between lower urinary tract symptoms and serum levels of sex hormones in men with symptomatic benign prostatic hyperplasia. BJU Int 106(11):1700–1703. doi:10.1111/j.1464-410X.2010.09459.x

    Article  PubMed  Google Scholar 

  29. Maneschi E, Vignozzi L, Morelli A, Mello T, Filippi S, Cellai I, Comeglio P, Sarchielli E, Calcagno A, Mazzanti B, Vettor R, Vannelli GB, Adorini L, Maggi M (2013) FXR activation normalizes insulin sensitivity in visceral preadipocytes of a rabbit model of MetS. J Endocrinol 218(2):215–231. doi:10.1530/JOE-13-0109

    Article  CAS  PubMed  Google Scholar 

  30. Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC, Skinner JS, Wilmore JH, Despres JP, Bouchard C (2000) Contribution of body fatness and adipose tissue distribution to the age variation in plasma steroid hormone concentrations in men: the HERITAGE Family Study. J Clin Endocrinol Metab 85(3):1026–1031

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Each author declares no conflict of interest.

Ethical standard

All participants provided written informed consent before enrollment, and the study was conducted in accordance with regulatory standards of Good Clinical Practice and the Declaration of Helsinki (1996). The study was approved by our Institutional Research Ethics Committee.

Author information

Authors and Affiliations

  1. Department of Urology, School of Medicine Policlinico Hospital, University of Catania, Catania, Italy

    Giorgio Ivan Russo, Sebastiano Cimino, Eugenia Fragalà, Salvatore Privitera, Mario Chisari, Tommaso Castelli, Vincenzo Favilla & Giuseppe Morgia

  2. Section of Endocrinology, Andrology, and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy

    Sandro La Vignera, Rosita Condorelli & Aldo E. Calogero

Authors
  1. Giorgio Ivan Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sebastiano Cimino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugenia Fragalà
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Salvatore Privitera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sandro La Vignera
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosita Condorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aldo E. Calogero
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mario Chisari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tommaso Castelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Vincenzo Favilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giuseppe Morgia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giorgio Ivan Russo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Russo, G.I., Cimino, S., Fragalà, E. et al. Relationship between non-alcoholic fatty liver disease and benign prostatic hyperplasia/lower urinary tract symptoms: new insights from an Italian cross-sectional study. World J Urol 33, 743–751 (2015). https://doi.org/10.1007/s00345-014-1392-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1392-4

Keywords

Search

Navigation