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

Figures & data

Table 1. Baseline characteristics of all the analysed cohorts.

Variable	BMI < 25 (kg/m^2)	BMI < 30 (kg/m^2)	BMI > 30 (kg/m^2)	BMI > 35 (kg/m^2)	BMI > 40 (kg/m^2)	No metabolic syndrome	Metabolic syndrome
No. in cohort	9,516,366	15,399,671	7,137,799	3,314,462	1,543,526	32,059,747	1,011,728
Age (years)	37 + 26	43 + 25	51 + 18	50 + 18	49 + 17	40 + 23	65 + 13
Gender
Male	45%	53%	42%	36%	32%	45%	46%
Female	55%	47%	57%	63%	67%	55%	53%
Race
White	60%	62%	62%	61%	59%	58%	67%
Black	15%	14%	18%	21%	23%	11%	21%
Asian	4%	3%	1%	1%	1%	3%	1%
Native	<1%	1%	1%	1%	1%	1%	<1%
American
Unknown	21%	20%	18%	16%	16%	27%	11%
Ethnicity
Hispanic	6%	7%	8%	7%	7%	9%	9%
Not Hispanic	65%	66%	69%	72%	71%	52%	67%
Unknown	29%	27%	23%	21%	22%	39%	24%
Hypertension	19%	24%	38%	39%	41%	0%	100%
Type 2 Diabetes	7%	8%	19%	22%	24%	0%	100%
Hyperlipidaemia	15%	19%	27%	27%	27%	0%	100%
Ischaemic heart disease	8%	10%	11%	10%	10%	2%	42%
Smoking history	11%	11%	12%	11%	12%	4%	20%
Alcohol use	4%	3%	3%	2%	2%	1%	5%

Figure 1. Forest plot of the odds ratio of metabolic syndrome and body mass index in urologic diseases.

Table 2. Measures of association of common urologic diseases with different obesity BMI-thresholds.

Disease	N BMI < 25	BMI < 25 vs BMI > 30			BMI < 25 vs BMI > 35			BMI < 25 vs BMI > 40
		N BMI > 30	Unbalanced OR (95% CI)	Balanced OR (95% CI)	N BMI > 35	Unbalanced OR (95% CI)	Balanced OR (95% CI)	N BMI > 40	Unbalanced OR (95% CI)	Balanced OR (95% CI)
Urolithiasis	129,626	209,241	2.19 (2.17–2.20)	1.38 (1.37–1.39)	98,523	2.22 (2.20–2.24)	1.38 (1.36–1.39)	44,141	2.13 (2.11–2.15)	1.34 (1.32–1.36)
Ureteral cancer	1743	1449	1.11 (1.03–1.19)	0.76 (0.70–0.82)	557	0.92 (0.83–1.01)	0.68 (0.61–0.76)	180	0.63 (0.55–0.74)	0.60 (0.50–0.73)
Kidney cancer	17,044	28,859	2.03 (1.99–2.07)	1.31 (1.28–1.34)	12,140	2.05 (2.00–2.10)	1.32 (1.28–1.35)	5332	1.93 (1.87–1.99)	1.34 (1.29–1.40)
Bladder cancer	22,243	19,308	1.16 (1.14–1.18)	0.80 (0.78–0.81)	6924	0.89 (0.87–0.92)	0.66 (0.64–0.68)	2386	0.66 (0.63–0.69)	0.59 (0.56–0.62)
Prostate cancer	51,172	60,083	1.79 (1.77–1.81)	1.02 (1.00–1.03)	18,940	1.40 (1.38–1.43)	0.89 (0.97–0.91)	5501	0.98 (0.95–1.01)	0.76 (0.74–0.79)
Overactive bladder	64,928	49,530	2.18 (2.15–2.21)	1.52 (1.50–1.54)	26,950	2.39 (2.35–2.43)	1.67 (1.64–1.71)	12,862	2.45 (2.40–2.50)	1.75 (1.70–1.80)
Male hypogonadism	17,656	69,020	5.70 (5.60–5.79)	2.81 (2.76–2.86)	31,449	6.50 (6.38–6.62)	3.10 (3.03–3.17)	12,873	6.44 (6.30–6.59)	2.99 (2.89–3.09)
Erectile dysfunction	57,182	152,948	3.98 (3.94–4.01)	1.79 (1.77–1.81)	58,932	3.81 (3.77–3.86)	1.70 (1.68–1.72)	20,456	3.18 (3.13–3.23)	1.42 (1.39–1.45)
BPH	155,142	205,320	1.96 (1.94–1.97)	1.10 (1.10–1.11)	72,623	1.71 (1.69–1.73)	1.02 (1.01–1.03)	24,354	1.37 (1.36–1.39)	0.94 (0.92–0.96)

Notes: N = number of patients; propensity score matched by age, race, ethnicity; prior to matching, BMI < 25 N = 9,511,236; BMI > 30 N = 7,135,035; BMI > 35 N = 3,314,462; BMI > 40 N = 1,543,526; male hypogonadism, benign prostatic hyperplasia and erectile dysfunction were calculated only in males (BMI > 40 N = 494,080; BMI > 35 N = 1,196,555; BMI > 30 N = 2,841,383; BMI < 25 N = 4,265,626). p<.05 for all comparison except where p= .75.

Table 3. Measures of association between metabolic syndrome and no metabolic syndrome.

Disease	Metabolic syndrome N	No metabolic syndrome N	Unbalanced OR (95% CI)	Balanced OR (95% CI)
Urolithiasis	60,815		7.55 (7.48–7.62)	5.97 (5.84–6.09)
Kidney cancer	9577	22,463	13.12 (12.81–13.44)	5.44 (5.17–5.72)
Bladder cancer	7152	25,647	8.56 (8.34–8.79)	2.81 (2.68–2.94)
Overactive bladder	21,065	46,731	14.03 (13.80–14.26)	7.53 (7.24–7.83)
Prostate cancer	22,769	125,108	9.00 (8.87–9.13)	2.53 (2.47–2.60)
Male hypogonadism	19,359	53,048	18.36 (18.05–18.67)	13.00 (12.35–13.70)
Erectile dysfunction	54,448	132,057	22.45 (22.22–22.69)	11.26 (10.95–11.58)
Benign prostatic hyperplasia	90,832	180,343	30.06 (29.81–30.32)	10.00 (9.80–10.20)

Notes: N = number of patients; propensity score matched by age; prior to matching, metabolic syndrome N = 1,011,239; no metabolic syndrome N = 32,040,979; male hypogonadism, benign prostatic hyperplasia and erectile dysfunction were calculated only in males (metabolic syndrome N = 466,011; no metabolic syndrome N = 23,998,575). p<.0001 for all comparison.

Table 4. Measure of association between metabolic syndrome components and urology diseases.

	Diabetes mellitus type 2^b				Hypertension^c				Dyslipidaemia^d
Disease	Yes	No	Unbalanced OR (95% CI)	Balanced OR (95% CI)	Yes	No	Unbalanced OR (95% CI)	Balanced OR (95% CI)	Yes	No	Unbalanced OR (95% CI)	Balanced OR (95% CI)
Lithiasis	81,543	174,485	2.14 (2.13–2.16)	2.33 (2.30–2.35)	155,775	94,464	2.83 (2.81–2.85)	2.35 (2.32–2.38)	131,208	118,065	2.70 (2.68–2.72)	2.17 (2.14–2.19)
Ureteral cancer	839	^a1399	2.67 (2.46–2.91)	2.32 (2.07–2.60)	1728	476	6.03 (5.45–6.68)	2.38 (2.12–2.68)	1400	794	4.15 (3.80–4.53)	1.69 (1.51–1.90)
Kidney cancer	13,471	20,007	3.02 (2.95–3.09)	2.76 (2.68–2.84)	25,447	7,798	5.46 (5.32–5.60)	2.74 (2.66–2.83)	19,701	13,334	3.50 (3.42–3.57)	1.57 (1.52–1.62)
Bladder cancer	11,088	18,190	2.73 (2.67–2.80)	1.81 (1.75–1.86)	21,628	7,317	4.94 (4.81–5.07)	1.85 (1.79–1.91)	18,223	10,638	4.05 (3.96–4.15)	1.55 (1.50–1.60)
Overactive bladder	23,364	43,345	2.42 (2.39–2.46)	2.32 (2.27–2.37)	46,752	18,856	4.17 (4.10–4.24)	2.36 (2.31–2.42)	41,969	23,030	4.34 (4.27–4.41)	2.43 (2.37–2.49)
Prostate cancer	29,514	62,244	1.88 (1.85–1.91)	0.83 (0.82–0.84)	65,590	23,052	3.70 (3.65–3.76)	1.74 (1.71–1.77)	57,417	32,990	3.40 (3.35–3.44)	1.47 (1.44–1.49)
Male hypogonadism	25,546	55,208	1.83 (1.80–1.86)	1.43 (1.40–1.46)	52,214	27,142	2.69 (2.65–2.73)	2.30 (2.25–2.43)	51,150	27,231	3.66 (3.60–3.71)	3.49 (3.41–3.57)
Erectile dysfunction	69,780	126,201	2.27 (2.25–2.29)	1.36 (1.35–1.38)	140,948	52,314	3.96 (3.92–4.00)	2.56 (2.53–2.60)	133,560	56,546	4.87 (4.82–4.92)	3.36 (3.32–3.41)
BPH	118,654	172,650	2.99 (2.97–3.02)	1.26 (1.25–1.27)	231,255	55,584	6.53 (6.47–6.60)	2.70 (2.67–2.73)	213,574	69,935	6.74 (6.68–6.80)	2.88 (2.85–2.92)

Notes: Male hypogonadism, benign prostatic hyperplasia and erectile dysfunction were calculated only in males (type 2 diabetes mellitus N = 740,996; no type 2 diabetes mellitus N = 2,884,093; essential hypertension N = 1,529,491; no essential hypertension N = 2,094,572; dyslipidaemia N = 1,254,746; no dyslipidaemia N = 2,369,317); p<.0001 for all comparison.

^aPropensity score matched by age, race, ethnicity.

^bPropensity score matched by age, hyperlipidaemia and hypertension.

^cPropensity score matched by age, hyperlipidaemia and diabetes mellitus.

^dPropensity score matched by age, diabetes mellitus and hypertension.

Data availability statement

The data that support the findings of this study are available from TriNetX, LLC. Restrictions apply to the availability of these data, which were used under licence for this study. Data are available at https://trinetx.com/products/real-world-datasets/ with the permission of TriNetX, LLC.