Association between Insulin Resistance and Benign Prostatic Hyperplasia in Healthy Middle-aged Korean Men

Heeseung Son; Byungseong Suh; Soogeun Kim; Junpyo Myong; Youil Shon; Heeyun Kim; Hanseur Jeong

doi:10.15384/kjhp.2015.15.4.202

Journal List > Korean J Health Promot > v.15(4) > 1089860

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Son, Suh, Kim, Myong, Shon, Kim, and Jeong: Association between Insulin Resistance and Benign Prostatic Hyperplasia in Healthy Middle-aged Korean Men

Original Article

Korean J Health Promot 2015;15(4):202-208.

Published online: 19 December 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.4.202

Association between Insulin Resistance and Benign Prostatic Hyperplasia in Healthy Middle-aged Korean Men

Heeseung Son¹, Byungseong Suh¹, Soogeun Kim¹, Junpyo Myong¹, Youil Shon¹, Heeyun Kim¹, Hanseur Jeong¹

¹Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Medical Center of Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Occupational & Environmental Medicine, Seoul Mary's Hospital, The Catholic University School of Medicine, Seoul, Korea

￭ Corresponding author：Byungseong Suh, MD, PhD Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Medical Center of Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea Tel: +82-2-2001-1863, Fax: +82-2-2001-2748 E-mail: byungseong.suh@samsung.com

Received 25 September 2015 Accepted 5 November 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

We examined the association between insulin resistance assessed by homeostatic model assessment-insulin resistance (HOMA-IR) and benign prostatic hyperplasia (BPH) in healthy middle-aged male subjects.

Methods

A cross-sectional study included 1,727 male subjects, aged 40-59 year, free of medication history for BPH who received a transrectal ultrasonography and completed a structured questionnaire in 2011. Multiple logistic regression analysis was performed to evaluate the relationships of HOMA-IR with BPH across the tertile of HOMA-IR.

Results

The prevalence of BPH was 24.4% (421 out of 1,727). It was increased across HOMA-IR tertiles in crude and age-adjusted models. In a multivariable-adjusted model after adjusting potential confounders such as age, body mass index (BMI), triglyceride, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), alcohol consumption, smoking, exercise and meat consumption, odds ratios (95% confidence intervals, CIs) of BPH for 2nd tertile and 3rd tertile compared to 1st tertile were 1.76 (1.31-2.35), and 1.83 (1.34-2.48), respectively.

Conclusions

In middle-aged, healthy men, higher HOMA-IR was significantly associated with higher prevalence of BPH, supporting insulin resistance as an independent risk factor for BPH.

Keywords: Insulin resistance, Benign prostatic hyperplasia, Middle-aged

REFERENCES

1.Oesterling JE. Benign prostatic hyperplasia: a review of its histogenesis and natural history. Prostate Suppl. 1996. 6:67–73.

2.Garraway WM., Collins GN., Lee RJ. High prevalence of benign prostatic hypertrophy in the community. Lancet. 1991. 338(8765):469–71.

3.Park HK., Park H., Cho SY., Bae J., Jeong SJ., Hong SK, et al. The prevalence of benign prostatic hyperplasia in elderly men in Korea: a community-based study. Korean J Urol. 2009. 50(9):843–7.

4.Yim SJ., Cho YS., Joo KJ. Relationship between metabolic syndrome and prostate volume in Korean men under 50 years of age. Korean J Urol. 2011. 52(6):390–5.

5.Nandeesha H., Koner BC., Dorairajan LN., Sen SK. Hyperinsulinemia and dyslipidemia in non-diabetic benign prostatic hyperplasia. Clin Chim Acta. 2006. 370(1-2):89–93.

6.The Korean Urological Association. The textbook of urology. 4th ed.Seoul: ilchokak;2007.

7.Lee C., Kozlowski JM., Grayhack JT. Etiology of benign prostatic hyperplasia. Urol Clin North Am. 1995. 22(2):237–46.

8.Sanda MG., Beaty TH., Stutzman RE., Childs B., Walsh PC. Genetic susceptibility of benign prostatic hyperplasia. J Urol. 1994. 152(1):115–9.

9.Hammarsten J., Högstedt B. Hyperinsulinaemia as a risk factor for developing benign prostatic hyperplasia. Eur Urol. 2001. 39(2):151–8.

10.Vikram A., Jena GB., Ramarao P. Increased cell proliferation and contractility of prostate in insulin resistant rats: linking hyperinsulinemia with benign prostate hyperplasia. Prostate. 2010. 70(1):79–89.

11.Zhang X., Zeng X., Liu Y., Dong L., Zhao X., Qu X. Impact of metabolic syndrome on benign prostatic hyperplasia in elderly Chinese men. Urol Int. 2014. 93(2):214–9.

12.Goh HJ., Kim SA., Nam JW., Choi BY., Moon HS. Community-based research on the benign prostatic hyperplasia prevalence rate in Korean rural area. Korean J Urol. 2015. 56(1):68–75.

13.Wen CP., David Cheng TY., Tsai SP., Chan HT., Hsu HL., Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009. 12(4):497–506.

14.Matthews DR., Hosker JP., Rudenski AS., Naylor BA., Treacher DF., Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985. 28(7):412–9.

15.Ziada A., Rosenblum M., Crawford ED. Benign prostatic hyperplasia: an overview. Urology. 1999. 53(3 Suppl 3a):1–6.

16.Reaven GM. The role of insulin resistance and hyperinsulinemia in coronary heart disease. Metabolism. 1992. 41(5 Suppl 1):16–9.

17.McAuley KA., Williams SM., Mann JI., Walker RJ., Lewis-Barned NJ., Temple LA, et al. Diagnosing insulin resistance in the general population. Diabetes Care. 2001. 24(3):460–4.

18.Joseph MA., Harlow SD., Wei JT., Sarma AV., Dunn RL., Taylor JM, et al. Risk factors for lower urinary tract symptoms in a population-based sample of African-American men. Am J Epidemiol. 2003. 157(10):906–14.

19.Hammarsten J., Damber JE., Karlsson M., Knutson T., Ljunggren O., Ohlsson C, et al. Insulin and free oestradiol are independent risk factors for benign prostatic hyperplasia. Prostate Cancer Prostatic Dis. 2009. 12(2):160–5.

20.Hautanen A. Synthesis and regulation of sex hormone-binding globulin in obesity. Int J Obes Relat Metab Disord. 2000. 24(Suppl 2):S64–70.

21.Peehl DM., Cohen P., Rosenfeld RG. The role of insulin-like growth factors in prostate biology. J Androl. 1996. 17(1):2–4.

22.Stattin P., Kaaks R., Riboli E., Ferrari P., Dechaud H., Hallmans G. Circulating insulin-like growth factor-I and benign prostatic hyperplasia--a prospective study. Scand J Urol Nephrol. 2001. 35(2):122–6.

23.Shpakov AO., Plesneva SA., Kuznetsova LA., Pertseva MN. Study of the functional organization of a novel adenylate cyclase signaling mechanism of insulin action. Biochemistry (Mosc). 2002. 67(3):335–42.

24.Pertseva MN., Shpakov AO., Plesneva SA., Kuznetsova LA. A novel view on the mechanisms of action of insulin and other insulin superfamily peptides: involvement of adenylyl cyclase signaling system. Comp Biochem Physiol B Biochem Mol Biol. 2003. 134(1):11–36.

25.Becker S., Dossus L., Kaaks R. Obesity related hyperinsulinaemia and hyperglycaemia and cancer development. Arch Physiol Biochem. 2009. 115(2):86–96.

26.Kogai MA., Lutov UV., Selyatitskaya VG. Hormonal and biochemical parameters of metabolic syndrome in male patients with body weight excess and obesity. Bull Exp Biol Med. 2008. 146(6):806–8.

27.Vogeser M., Schwandt P., Haas GM., Broedl UC., Lehrke M., Parhofer KG. BMI and hyperinsulinemia in children. Clin Biochem. 2009. 42(13-14):1427–30.

28.Giovannucci E., Rimm EB., Chute CG., Kawachi I., Colditz GA., Stampfer MJ, et al. Obesity and benign prostatic hyperplasia. Am J Epidemiol. 1994. 140(11):989–1002.

29.Parsons JK. Benign prostatic hyperplasia and male lower urinary tract symptoms: epidemiology and risk factors. Curr Bladder Dysfunct Rep. 2010. 5(4):212–8.

30.Parsons JK. Lifestyle factors, benign prostatic hyperplasia, and lower urinary tract symptoms. Curr Opin Urol. 2011. 21(1):1–4.

31.Rahman NU., Phonsombat S., Bochinski D., Carrion RE., Nunes L., Lue TF. An animal model to study lower urinary tract symptoms and erectile dysfunction: the hyperlipidaemic rat. BJU Int. 2007. 100(3):658–63.

32.DeFronzo RA., Tobin JD., Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979. 237(3):E214–23.

Figure 1.

Flow for the selection of study subjects.

Table 1.

Baseline characteristics of study participants by the presence of BPH

	Overall	Normal	BPH	P
Number	1,727	1,306 (75.6%)	421 (24.4%)
Age, y^a	45.6±4.3	45.6±4.4	45.6±4.2	0.949^c
BMI, kg/m^2a	22.72±1.56	22.67±1.59	22.90±1.46	0.006^c
WC, cm^a	81.9±4.5	81.6±4.6	82.7±4.1	＜0.001^c
Systolic BP, mmHg^a	112.4±10.1	111.6±10.0	114.8±10.0	＜0.001^c
Diastolic BP, mmHg^a	72.4±8.1	71.6±8.1	74.6±7.8	＜0.001
Glucose, mg/dL^b	96 (91-102)	96 (91-101)	99 (94-105)	＜0.001^d
Fasting insulin, mIU/L^b	3.87 (2.67-5.41)	3.76 (2.56-5.33)	4.30 (3.03-5.69)	＜0.001^d
HOMA-IR^b	0.93 (0.62-1.33)	0.89 (0.59-1.30)	1.04 (0.74-1.44)	＜0.001^d
Triglyceride, mg/dL^b	112 (83-154)	111 (81-155)	113 (87-153)	0.276^d
Total cholesterol, mg/dL^a	202.3±32.3	202.4±32.5	202.2±31.7	0.900^c
HDL-C, mg/dL^a	56.0±13.1	56.0±12.9	55.9±13.8	0.872^c
LDL-C, mg/dL^a	128.0±29.4	128.4±29.7	126.8±28.7	0.343^c
PSA, ng/mL^b	0.88 (0.63-1.24)	0.83 (0.59-1.17)	1.06 (0.79-1.43)	＜0.001^d
Alcohol use^a				0.976^e
Normal	55.6%	55.7%	55.6%
High risk	44.4%	44.3%	44.4%
Smoking^a				0.441^e
Non and ex-smoker	54.4%	53.9%	56.1%
Current smoker	45.6%	46.1%	43.9%
Regular exercise^a				0.073^e
≥ 5 times/week	48.9%	50.2%	45.1%
＜5 times/week	51.1%	49.8%	54.9%
Meat consumptiona				0.111^e
＜1 time/week	56.1%	57.1%	52.7%
1-2 times/week	37.0%	36.2%	39.4%
≥ 3 times/week	6.9%	6.7%	7.8%

Abbreviations: BPH, benign prostatic hyperplasia; BMI, body mass index; WC, waist circumference; BP, blood pressure; HOMA-IR, homeostasis model of insulin resistance; HDL-C, high-density lipoprotein√cholesterol; LDL-C, low-density lipoprotein cholesterol; PSA, prostate specific antigen.

^a Values were presented as N (%) or mean±SD.

^b Values were presented as medians (interquartile range).

^c Calculated by t-test.

^d Calculated by Mann-Whitney test.

^e Calculated by chi-square test.

Table 2.

Baseline characteristics and prevalence of benign prostatic hyperplasia by HOMA-IR categories

	The 1^st tertile (n＝576)	The 2^nd tertile (n＝584)	The 3^rd tertile (n＝567)	P-trend
	HOMA-IR ≤ 0.72	0.72＜HOMA-IR ≤ 1.19	1.19＜HOMA-IR	P-trend
Age, y^a	45.8±4.5	45.7±4.4	45.1±4.0	0.011^c
BMI, kg/m^2a	22.12±1.74	22.80±1.45	23.26±1.25	＜0.001^c
WC, cm^a	80.0±4.8	82.1±4.2	83.6±3.7	＜0.001^c
Systolic BP, mmHg^a	110.1±10.0	113.1±9.9	114.0±10.0	＜0.001^c
Diastolic BP, mmHg^a	70.3±8.2	73.1±7.9	73.7±7.8	＜0.001^c
Triglyceride, mg/dL^b	102.0±57.8	128.1±59.7	158.8±113.5	＜0.001^c
Total cholesterol, mg/dL^a	197.9±30.7	202.7±31.4	206.4±34.2	＜0.001^c
HDL-C, mg/dL^a	59.2±13.6	56.4±12.9	52.3±12.0	＜0.001^c
LDL-C, mg/dL^a	124.4±28.9	128.3±28.7	131.3±30.4	＜0.001^c
PSA, ng/mL^b	1.02±0.57	1.05±0.59	0.95±0.52	0.025^c

Abbreviations: BMI, body mass index; WC, waist circumference; BP, blood pressure; HOMA-IR, homeostasis model of insulin resistance HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; PSA, prostate specific antigen; BPH, benign prostatic hyperplasia.

^a Values were presented as mean±SD.

^b Log transformed values were used for analysis.

^c Calculated by linear regression analyses for linear trend.

Table 3.

Odds ratios and 95% confidence intervals for the prevalence of benign prostatic hyperplasia in HOMA-IR and HOMA-IR categories^a

	Prevalence of BPH	Model 1	Model 2	Model 3
HOMA-IR (continuous variable)		1.28 (1.09-1.50)	1.28 (1.09-1.50)	1.25 (1.04-1.50)
The 1^st tertile (n＝576)	17.4%	1.00	1.00	1.00
The 2^nd tertile (n＝584)	27.4%	1.80 (1.36-2.38)	1.80 (1.36-2.38)	1.76 (1.31-2.35)
The 3^rd tertile (n＝567)	28.4%	1.89 (1.42-2.50)	1.89 (1.42-2.51)	1.83 (1.34-2.48)

Abbreviations: HOMA-IR, homeostasis model of insulin resistance; BPH, benign prostatic hyperplasia.

Model 1: crude.

Model 2: age-adjusted.

Model 3: age, triglyceride, HDL-cholesterol, LDL-cholesterol, BMI, exercise, alcohol consumption, smoking, meat consumption adjusted.

^a Values are presented as odds ratio and 95% confidence interval using logistic regression model.

TOOLS

Similar articles