Potential Association Between Severity Of Nonalcoholic Fatty Liver Disease (NAFLD) And Lower Urinary Tract Symptoms (LUTS) In South Chinese Male

BackgroundLower urinary tract symptoms(LUTS)is a group of clinical symptoms refering to various abnormalities in the urination cycle caused by changes in the structure and function of the lower urinary tract.LUTS seriously affects patients' quality of life with a high prevalence in China and around the world.Studies have reported that the occurrence of LUTS is related to internal factors of the urinary system such as bladder outlet obstruction,urinary tract infection,and bladder tumor.And age is an important factor in the occurrence of LUTS.The prevalence of LUTS will increase with age.Therefore,with the aging of the world population,the prevalence of LUTS may keep increasing.Current studies suggest that LUTS are associated with bladder outlet obstruction,urinary tract infection,inflammation and neurological dysfunction.However,the pathogenesis of LUTS is not yet clear.Nonalcoholic fatty liver disease(NAFLD)refers to the liver histologically or radiographically observed at least 5% of steatosis after excluding drug-induced liver damage and alcoholic fatty liver disease.It is characterized by the accumulation of fat cells in the liver.NAFLD is closely related to metabolic disorders(such as insulin resistance,hypertension,high-level LDL,etc.),and can cause systemic low-grade inflammation.Some studies have suggested that NAFLD is a manifestation of metabolic syndrome in the liver.There is currently clinical evidence that NAFLD may promote prostate tissue proliferation and local tissue inflammation,and there may be a link between NAFLD and LUTS.But another cross-sectional study based on healthy people found no association.The relationship between NAFLD and LUTS is still controversial.It is necessary to explore the relationship between NAFLD and LUTS in a larger sample size population.ObjectiveThis study will explore the correlation between the severity of non-alcoholic fatty liver disease and lower urinary tract symptoms through a cross-sectional study based on Fangchenggang Area Male Healthy and Examination Survey(FAMHES).MethodsThe study was conducted in the Guangxi Fangchenggang Men's Health Survey(FAMHES),a cross-sectional survey based on demographics.Using a convenient sampling method,adult male healthy people who come to the hospital for a physical examination will conduct a health survey after obtaining their permission.The demographic information,lifestyle,basic health information,medication history,past history,family history,etc.of the subjects were obtained through face-to-face questionnaires.Anthropometric parameters include height,weight,waist circumference,and blood pressure.Blood tests include HDL,LDL,TG,TC,hsCRP,C3,and C4,TPSA,total testosterone.Finally,4303 subjects were included.Diagnosis of LUTS was evaluated by trained personnel according to the Chinese version of the International Prostate Symptom Rating Scale(IPSS).The urinary status of the subjects were assessed.The IPSS score ? 8 points was determined to be suffering from LUTS.According to the IPSS rating scale,LUTS were divided into total symptoms of LUTS,urination,storage and urination.NAFLD was diagnosed by a professional doctor who used a portable ultrasound device to perform liver ultrasound exploration of the longitudinal,subcostal,ascending and oblique positions.Then the results were confirmed and diagnosed by two experienced ultrasound doctors.According to the degree of infiltration of fat cells,NAFLD was divided into three grades: mild,moderate and severe(mild NAFLD: 10%-30% fat cell infiltration;moderate NAFLD: 30%-70% fat cell infiltration;severe NAFLD: >70% fat cell infiltration).Anthropometric parameters such as height,weight,waist circumference,and blood pressure were measured by professionally trained personnel using standardized protocols.HDL,LDL,TG,and TC of blood lipids and TPSA were detected by the oxidative enzyme method via the automatic serum biochemical analyzer(Dade Behring,Newark,DE,USA)at the Fangchenggang First People's Hospital Laboratory.Serum hypersensitive C-reactive protein(hsCRP)was detected at the Department of Clinical Laboratory of the First Affiliated Hospital of Guangxi Medical University via automatic biochemical analyzer(Japan Hitachi 7600-020)for detection.The serum complement C3 and C4 and total testosterone indexes were detected by COBAS system.Continuity variables were described in mean and standard deviation(Mean ± SD).The difference between the LUTS group and the non-LUTS group variables was compared via a two-sided t test.The classification data was analyzed by X2 test or Fisher exact probability method.The association analysis between different degrees of NAFLD and LUTS was described by odds ratio(OR)and 95% confidence interval(CI).Univariate logistic regression was used to analyze the correlation between the severity of NAFLD and LUTS,multivariate logistic Regression analysis was used to correct for age factors.During the analysis of this study,a P value of less than 0.05 was considered statistically significant(two-sided test).Results1.In total,this study included 4303 subjects,aged between 17 and 88 years,of which 3,593 subjects had questionnaires and information sheets.After excluding the unsuitable inclusion of the study according to the exclusion criteria,2,581 subjects were finally included for analysis.The basic characteristics of the subjects included: 736 people under 30 years old,857 people aged 30-39 years old,592 people aged 40-49 years old,223 people aged 50-59 years old,and 173 people older than 60 years old.Among them,there were 2,356 people(91.29%)in the LUTS group and 225(8.71%)in the LUTS group.2.Univariate logistic regression was used to analyze the effect of different degrees of NAFLD on lower urinary tract symptoms.The results showed that there was no correlation between mild NAFLD and the overall risk of LUTS in the absence of NAFLD;moderate NAFLD significantly increased the risk of developing total LUTS symptoms(OR=1.55,95% CI=1.02-2.36);due to severe NAFLD The number of patients was 0 in the LUTS group,and the association between severe NAFLD and total symptoms of LUTS could not be analyzed.After adjusting for correction of BMI,smoking,drinking,exercise,marriage,and education level,there was no correlation between mild NAFLD,moderate NAFLD,and total risk of LUTS with no NAFLD as a reference.3.Univariate logistic regression was used to analyze the effects of varying degrees of NAFLD on urination,storage,and post-urinary symptoms.The results showed no NAFLD as a reference.There was no correlation between mild NAFLD and the risk of urinary symptoms.Moderate NAFLD significantly increased the risk of urinary symptoms(OR=2.42,95% CI=1.49-3.93);moderate NAFLD was significant Increased risk of post-urinary symptoms(OR=1.62,95% CI = 1.07-2.44);NAFLD progression was not associated with the risk of symptoms during storage.After adjusting for correction of BMI,smoking,drinking,exercise,marriage,and education,no NAFLD was used as a reference.Moderate NAFLD significantly increased the risk of urinary symptoms.The degree of NAFLD progressed with storage and post-urinary symptoms.The risk is not relevant.4.In subjects over 60 years of age,there was no association between mild NAFLD and the overall risk of LUTS in the absence of NAFLD;moderate nonalcoholic fatty liver significantly increased the risk of developing total LUTS symptoms(OR=3.46),95% CI = 1.11-10.75).Mild NAFLD was not associated with the risk of urinary symptoms;moderate NAFLD significantly increased the risk of symptomatic urination(OR = 6.00,95% CI = 1.72-20.99).The degree of progression of NAFLD was not associated with symptoms of storage and symptoms of post-urinary symptoms.After adjusting for correction of BMI,smoking,drinking,exercise,marriage,and education level,moderate NAFLD still significantly increased the risk of total LUTS symptoms without NAFLD;moderate NAFLD significantly increased the risk of symptomatic urination;NAFLD The degree of progression is not related to the symptoms of the storage period and the risk of developing symptoms after urination.At the same time,in the subjects of the <30,30-39,40-49,and 50-59 age groups,the degree of progression of NAFLD was not associated with the risk of developing LUTS symptoms.ConclusionsOur results suggest that NAFLD is a risk factor for the occurrence of LUTS,particularly affected men over 60 years old,and the symptoms are mainly focused on the voiding phase.Further research is needed to design longitudinally based on a larger population to provide better evidence of the relationship between NAFLD and LUTS.