https://orcid.org/0000-0002-2637-9405
We read with great interest the study by Suarez Arbelaez, M. C., et al. on the association of body mass index (BMI), metabolic syndrome (MS) and common urologic conditions [Citation1]. The study revealed MS is a significant risk factor for common urologic conditions, but some possible confounding biases should be considered for further discussion.
First, the papulation of MS in this article was restricted to individuals diagnosed with type 2 diabetes mellitus (DM), overweight and obesity, essential hypertension and disorders of lipoprotein metabolism, which is more restricted than the criteria used in clinical conditions [Citation2]. The selection bias might magnify the association between MS and common urologic conditions.
Second, although the relationship between the use of metformin and prostate cancer remains controversial [Citation3], we should keep in mind that DM medication might be a confounding factor for DM and prostate cancer.
Third, in Table 2 of this article (Suarez Arbelaez et al. 2023), the balanced OR of prostate cancer was decreased when patients had a BMI > 35 kg/m2 (OR 0.89; p<.05) and a BMI > 40 kg/m2 (OR 0.76; p<.05). The propensity score only matched by age, race and ethnicity, but the prevalence of DM was also increased in high BMI group as shown in Table 1 (BMI < 25 kg/m2: 7%, BMI > 35 kg/m2: 22% and BMI > 40 kg/m2: 24%). As a result, DM medication might be a confounding factor hidden in the study design.
In conclusion, this article makes a great contribution to evaluating the association of BMI, MS and common urologic conditions. However, we suggest further discussions on the limitations.
Author contribution statement
WH Lin drafted the manuscript. JY Huang and James CC Wei revised it for intellectual content and James CC Wei reviewed and approved the final version of this manuscript. All authors agreed to be accountable for all aspects of the work.
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No potential conflict of interest was reported by the author(s).
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References
- Suarez Arbelaez MC, Nackeeran S, Shah K, et al. Association between body mass index, metabolic syndrome and common urologic conditions: a cross-sectional study using a large multi-institutional database from the United States. Ann Med. 2023;55(1):1.
- Fahed G, Aoun L, Bou Zerdan M, et al. Metabolic syndrome: updates on pathophysiology and management in 2021. Int J Mol Sci. 2022;23(2):786.
- Ahn HK, Lee YH, Koo KC. Current status and application of metformin for prostate cancer: a comprehensive review. Int J Mol Sci. 2020;21(22):8540.