kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.4.202 kjhp-15-202 Original Article Association between Insulin Resistance and Benign Prostatic Hyperplasia in Healthy Middle-aged Korean Men SonHeeseung 1 SuhByungseong 1 KimSoogeun 1 MyongJunpyo 1 ShonYouil 1 KimHeeyun 1 JeongHanseur 1 Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Medical Center of Sungkyunkwan University School of Medicine, Seoul, Korea Department 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 122015 19122015 154 202208 25092015 05112015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 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. 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.

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Flow for the selection of study subjects.

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, ya 45.6±4.3 45.6±4.4 45.6±4.2 0.949c
BMI, kg/m2a 22.72±1.56 22.67±1.59 22.90±1.46 0.006c
WC, cma 81.9±4.5 81.6±4.6 82.7±4.1 ＜0.001c
Systolic BP, mmHga 112.4±10.1 111.6±10.0 114.8±10.0 ＜0.001c
Diastolic BP, mmHga 72.4±8.1 71.6±8.1 74.6±7.8 ＜0.001
Glucose, mg/dLb 96 (91-102) 96 (91-101) 99 (94-105) ＜0.001d
Fasting insulin, mIU/Lb 3.87 (2.67-5.41) 3.76 (2.56-5.33) 4.30 (3.03-5.69) ＜0.001d
HOMA-IRb 0.93 (0.62-1.33) 0.89 (0.59-1.30) 1.04 (0.74-1.44) ＜0.001d
Triglyceride, mg/dLb 112 (83-154) 111 (81-155) 113 (87-153) 0.276d
Total cholesterol, mg/dLa 202.3±32.3 202.4±32.5 202.2±31.7 0.900c
HDL-C, mg/dLa 56.0±13.1 56.0±12.9 55.9±13.8 0.872c
LDL-C, mg/dLa 128.0±29.4 128.4±29.7 126.8±28.7 0.343c
PSA, ng/mLb 0.88 (0.63-1.24) 0.83 (0.59-1.17) 1.06 (0.79-1.43) ＜0.001d
Alcohol usea 0.976e
Normal 55.6% 55.7% 55.6%
High risk 44.4% 44.3% 44.4%
Smokinga 0.441e
Non and ex-smoker 54.4% 53.9% 56.1%
Current smoker 45.6% 46.1% 43.9%
Regular exercisea 0.073e
≥ 5 times/week 48.9% 50.2% 45.1%
＜5 times/week 51.1% 49.8% 54.9%
Meat consumptiona 0.111e
＜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.

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

Values were presented as medians (interquartile range).

Calculated by t-test.

Calculated by Mann-Whitney test.

Calculated by chi-square test.

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

The 1st tertile (n＝576) The 2nd tertile (n＝584) The 3rd tertile (n＝567) P-trend
HOMA-IR ≤ 0.72 0.72＜HOMA-IR ≤ 1.19 1.19＜HOMA-IR
Age, ya 45.8±4.5 45.7±4.4 45.1±4.0 0.011c
BMI, kg/m2a 22.12±1.74 22.80±1.45 23.26±1.25 ＜0.001c
WC, cma 80.0±4.8 82.1±4.2 83.6±3.7 ＜0.001c
Systolic BP, mmHga 110.1±10.0 113.1±9.9 114.0±10.0 ＜0.001c
Diastolic BP, mmHga 70.3±8.2 73.1±7.9 73.7±7.8 ＜0.001c
Triglyceride, mg/dLb 102.0±57.8 128.1±59.7 158.8±113.5 ＜0.001c
Total cholesterol, mg/dLa 197.9±30.7 202.7±31.4 206.4±34.2 ＜0.001c
HDL-C, mg/dLa 59.2±13.6 56.4±12.9 52.3±12.0 ＜0.001c
LDL-C, mg/dLa 124.4±28.9 128.3±28.7 131.3±30.4 ＜0.001c
PSA, ng/mLb 1.02±0.57 1.05±0.59 0.95±0.52 0.025c

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.

Values were presented as mean±SD.

Log transformed values were used for analysis.

Calculated by linear regression analyses for linear trend.

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

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 1st tertile (n＝576) 17.4% 1.00 1.00 1.00
The 2nd tertile (n＝584) 27.4% 1.80 (1.36-2.38) 1.80 (1.36-2.38) 1.76 (1.31-2.35)
The 3rd 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.

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