Skip to main content

Main menu

  • Home
  • Content
    • Latest
    • Archive
    • home
  • Info for
    • Authors
    • Reviewers
    • Subscribers
    • Institutions
    • Advertisers
    • Join SMJ
  • About Us
    • About Us
    • Editorial Office
    • Editorial Board
  • More
    • Advertising
    • Alerts
    • Feedback
    • Folders
    • Help
  • Other Publications
    • NeuroSciences Journal

User menu

  • My alerts
  • Log in

Search

  • Advanced search
Saudi Medical Journal
  • Other Publications
    • NeuroSciences Journal
  • My alerts
  • Log in
Saudi Medical Journal

Advanced Search

  • Home
  • Content
    • Latest
    • Archive
    • home
  • Info for
    • Authors
    • Reviewers
    • Subscribers
    • Institutions
    • Advertisers
    • Join SMJ
  • About Us
    • About Us
    • Editorial Office
    • Editorial Board
  • More
    • Advertising
    • Alerts
    • Feedback
    • Folders
    • Help
  • Follow psmmc on Twitter
  • Visit psmmc on Facebook
  • RSS
Research ArticleOriginal Article
Open Access

Impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms in older males

Deniz M. Surmeli, Hulusi C. Karpuzcu, Volkan Atmis, Caglar Cosarderelioglu, Ahmet Yalcin, Murat Varli and Sevgi Aras
Saudi Medical Journal June 2024, 45 (6) 598-605; DOI: https://doi.org/10.15537/smj.2024.45.6.20240166
Deniz M. Surmeli
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Deniz M. Surmeli
  • For correspondence: [email protected]
Hulusi C. Karpuzcu
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Volkan Atmis
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Caglar Cosarderelioglu
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ahmet Yalcin
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Murat Varli
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sevgi Aras
From the Department of Geriatrics (Surmeli, Atmis, Cosarderelioglu, Yalcin, Varli, Aras); from the Department of Internal Medicine (Karpuzcu), Ankara University Faculty of Medicine, Ibn-i Sina Hospital, from the Department of Gastroenterology (Karpuzcu) Etlik City Hospital, Ankara, and from the Department of Geriatrics (Aras), Istanbul Medipol Hospital, Istanbul, Turkey.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • References
  • PDF
Loading

Abstract

Objectives: To assess the impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms (LUTS).

Methods: A total of 193 male patients, aged 60 years and above, who visited the geriatric outpatient clinic at Ibn-i Sina Hospital in Ankara, Turkey, between December 2019 and March 2021, were enrolled. Sarcopenia was diagnosed according to the criteria set by the European Working Group on Sarcopenia in Older People. The presence and severity of lower urinary tract symptoms were assessed using the International Prostate Symptom Score questionnaire, categorizing symptom severity as mild or moderate-to-severe.

Results: The median patient age was 71 years (range: 66-77). Sarcopenia affected 24.9% of the population studied. Mild LUTS was observed in 43.5% and moderate-to-severe LUTS was observed in 56.5% of patients. Sarcopenia prevalence was significantly higher in the individuals with moderate-to-severe LUTS compared to those with mild-LUTS (p=0.021). After adjusting for Charlson comorbidity index and age, only vitamin D levels were significantly associated with increased odds of moderate-to-severe LUTS (odds ratio [OR]=0.95, 95% confidence interval [CI]: [0.92-0.98], p=0.002). Sarcopenia was not significantly associated with the severity of LUTS (OR=2.04, 95% CI: [0.94-4.45], p=0.070). An inverse linear trend was observed between quartiles of 25 (OH) vitamin D and LUTS severity. As 25 (OH)vitamin D levels increased, the proportion of patients with moderate-to-severe LUTS decreased (p=0.023).

Conclusion: Sarcopenia did not significantly impact LUTS severity, but low vitamin D levels were associated with moderate-to-severe LUTS.

Keywords:
  • aged
  • prostatic hyperplasia
  • lower urinary tract symptoms
  • sarcopenia
  • vitamin D

As individuals age, the likelihood of having lower urinary tract symptoms (LUTS) significantly increases, leading to a notable rise in prevalence. It was found that 44.7% of men worldwide were affected by LUTS, and in various studies, the prevalence was reported to be as high as 70% in those aged 80 years and above.1 Lower urinary tract symptoms can result from structural or functional abnormalities in the lower urinary tract, as well as from abnormalities in the peripheral or central nervous systems. Although benign prostate hyperplasia (BPH) related bladder outflow obstruction is the most common cause of LUTS in elderly men, various neurological diseases, as well as neuromuscular issues such as detrusor muscle weakness or overactivity, prostate or other urinary tract infections, and prostate cancer, may also significantly contribute to the development of LUTS.2 Lower urinary tract symptoms are classified as categories: storage, voiding, and post-micturition symptoms. Feeling of urgency, frequent urination during the day, nocturia, urinary incontinence, and unusual sensations in the bladder are related to urine storage. Voiding symptoms include a weak urine stream, stopping and starting during urination, difficulty initiating urination, straining to urinate, dribbling at the end of urination, and dysuria. Post-micturition symptoms involve a sense of incomplete emptying of the bladder after urination and dribbling of urine after urination.2 Despite not being a life-threatening condition, LUTS can markedly influence quality of life, leading to increased use of medication, higher risk of falls, social isolation, anxiety, and depression, particularly among elderly men.1,3

Vitamin D acts via vitamin D receptors (VDR) throughout the body and exerts important beneficial effects beyond the skeleton, including on muscle health.4 Vitamin D binds to the VDR on muscle fibers, promoting muscle hypertrophy and thereby enhancing muscle strength and physical performance.5 This relationship between vitamin D levels and the loss of muscle mass and decline in muscle strength with aging, is independent and increases the risk of developing sarcopenia, particularly in older individuals.6 Sarcopenia, defined by gradual reduction in skeletal muscle mass, strength, and function, poses a heightened risk for falls, fractures, limitations in mobility, and mortality in older adults.7,8

In vivo investigations have revealed the presence of VDR within the urothelium and smooth muscle layers of the bladder wall, prompting extensive investigation into the possible connection between vitamin D levels and LUTS.9 Nonetheless, it is crucial to acknowledge that current research on this subject remains limited and inconclusive. Sarcopenia and LUTS are multifactorial conditions with complex pathogenesis, sharing potential etiological factors such as age-related changes, hormonal imbalances, inflammation, and neuromuscular alterations. Given these common factors and existing knowledge gaps, our research intends to explore the impact of sarcopenia and vitamin D levels on the severity of LUTS in older males.

Methods

The data analyzed in this cross-sectional study were collected as part of a previously reported research project, assessing patients who attended the geriatric outpatient clinic at Ibn-i Sina Hospital, Ankara, Turkey, from December 2019 to March 2021.10 Therefore, the methods are identical to those published in the previous publication. The inclusion criteria encompassed men aged 60 years or above who could engage in verbal communication, possessed the cognitive capacity to comprehend and respond to questionnaires, and were capable of walking unaided. Those patients meeting these criteria were enrolled in the study. We excluded individuals who met any of the following conditions: I) patients with a diagnosis of physical impairments (namely, limb amputation, hearing loss, speech difficulties, post-stroke conditions, or bedridden status), malignancies, chronic kidney disease necessitating hemodialysis, major psychiatric illnesses, and advanced dementia; II) patients currently undergoing corticosteroid treatment, androgen synthesis inhibition, or receiving testosterone replacement; III) individuals who had undergone transurethral resection of the prostate or had a previous history of pelvic surgery; IV) patients with medical conditions that may hinder the accuracy of bioelectrical impedance analysis (BIA) for assessing skeletal muscle mass. These conditions include the existence of implants such as prostheses, mechanical heart valves, pacemakers, substantial edema in the extremities or sacral region, or significant disruptions in electrolyte balance.

The ethics committee at Ankara University granted approval for this study (approval number: İ6-280-19), and all participants willingly gave written informed consent in accordance with the guidelines established in the Declaration of Helsinki.

We gathered comprehensive medical histories from all patients, which included information regarding their tobacco use, alcohol consumption, and substance use, prior surgical interventions, underlying health conditions, and both prescribed and over-the-counter (OTC) medications. Patients were categorized as having BPH based on whether they were currently receiving any BPH treatment (alpha blockers), as indicated by their medication list. Each patient’s Charlson comorbidity index (CCI) was determined and recorded.11

A comprehensive geriatric assessment was carried out for all patients. Katz activities of daily living (ADL) scale and the Lawton instrumental activities of daily living (IADL) scale were utilized to evaluate the patients’ physical activity levels and functional capacities. Disability in either ADL or IADL was defined as the inability to carry out one or more activities as outlined in the respective scale.12,13 Cognitive status was evaluated using the mini mental state exam test, with scores below 24 points indicating cognitive dysfunction.14 The Yesavage geriatric depression scale was used to assess depression, with scores above 4 points indicating depression.15 We assessed malnutrition by employing the mini nutritional assessment test. Patients scoring 11 points or less in the initial screening section underwent additional evaluation through the assessment component. Patients achieving a total score exceeding 24 points were classified as having a “normal nutritional status,” those falling within the range of 17-23.5 points were classified as “at risk of malnutrition,” and individuals scoring below 17 points were categorized as “malnourished”.16

Each patient’s height, body weight, upper arm circumference, and calf circumference were measured and documented. Calf circumference measurement was carried out by encircling the broadest part of the left calf with a tape measure while the patient was seated, with their knees bent at a 90-degree angle and both feet resting flat on the floor. The mid-upper arm circumference was measured on the patient’s left arm while they were seated, with their elbow flexed at a 90-degree angle. Arm circumference was assessed by positioning a tape measure between the olecranon and the acromial process and measuring from this midpoint.

Patients underwent an assessment to determine the existence and severity of LUTS, employing the international prostate symptom score (IPSS). The IPSS is a well-established measure intended to assess disease severity and treatment outcomes. The IPSS questionnaire comprises 7 inquiries aimed at evaluating voiding symptoms experienced within the previous month. Depending on the overall score, symptom severity is categorized as either mild (scoring between 0-7), or moderate to severe (scoring between 8-35).17 In this study, we merged these 3 categories into 2: mild (0-7) and moderate to severe symptoms (8-35 points).

Three-step criteria of European working group on sarcopenia in older people (EWGSOP2) were used for the sarcopenia diagnosis.7 Patients’ hand grip strength (measured in kilograms) was assessed with the use of an electronic hand dynamometer (Takei Scientific Instruments, Niigata, Japan). The measurements were obtained while the patients were seated with their elbows flexed at a 90-degree angle. They were instructed to exert their maximum force on the dynamometer, with 3 measurements recorded for both the right and left hands, allowing adequate intervals for rest. The recorded hand grip strength was based on the highest value obtained. We identified low muscle strength by referring to the cut-off values specific to the Turkish population.18 Individuals with muscle strength values below 32 kg were classified as belonging to the low muscle strength group.

Each patient’s muscle mass was evaluated in the morning, following an overnight fast and after completely emptying their bladder, using a portable BIA device (BodyStat QuadScan 4000, Douglas, Isle of Man, UK). Prior to the measurement, the device underwent calibration based on the patients’ age, gender, height, and weight. During the assessment, patients were positioned in a supine posture without any conductive materials on their bodies, and the measurement was carried out using an 800 mA current with a 50 kHz frequency. We computed skeletal muscle mass (SMM) by applying the subsequent formula:19

SMM (kg) = [(height (cm)2 / resistance (ohms) × 0.401) + (gender ×3.825) + (age (years) × -0.071)] + 5.102. (For gender man=1)

We computed the skeletal muscle mass index (SMMI) by dividing SMM (in kilograms) by the square of the patient’s height (in square meters).20 The SMMI values less than 9.2 kg/m2 in men were classified into the group with low muscle mass.18 We assessed the patients’ physical performance using a 4-meter usual walking speed examination, during which we measured gait speed with a stopwatch and recorded gait timing. Individuals with a gait speed not exceeding 0.8 m/sec were placed in the group characterized by low physical performance.18 After the assessments, individuals demonstrating diminished muscle strength (below 32 kg) and reduced muscle mass (SMMI<9.2 kg/m²) were identified as having sarcopenia. Individuals with diminished muscle strength but intact muscle mass were categorized as having dynapenia. Participants who were diagnosed with sarcopenia and additionally exhibited diminished physical performance were classified into the severe sarcopenia group.7

We measured and recorded the patients’ levels of total testosterone, 25 (OH) vitamin D, serum calcium, C-reactive protein (CRP), and sedimentation rates. Blood specimens were collected between 08:00-09:00 am, following an overnight period of fasting. We determined the total testosterone level using an automated chemiluminescence immunoassay system via the UniCel Dxl 800 autoanalyzer (Beckman Coulter, CA, USA), which had an analytical sensitivity of 10 ng/mL. Total prostate-specific antigen (PSA) level was assessed by using the Access Hybritech PSA kit on the Beckman Coulter DXI immunoassay. We determined the serum 25(OH) vitamin D level through the application of high-performance liquid chromatography (Immuchrom GmBH, Heppenheim, Germany). The coefficients of variation for intraassay was less than 3% and for interassay was less than 5%.

Statistical analysis

Categorical variables were expressed using frequencies and percentages, while continuous variables were described using the median and interquartile range (IQR). We used Chi-square tests or Fisher’s exact tests to analyze categorical variables, and the Wilcoxon rank-sum test was applied to evaluate disparities in continuous variables across the 2 groups. To account for potential factors that could influence the severity of LUTS, we carried out a multivariate logistic regression analysis and computed odds ratios (ORs). The outcome variable was the severity of LUTS and the independent variables were presence of sarcopenia, vitamin D levels, and clinically relevant variables that may act as confounders. We regarded p-values below 0.05 as indicative of statistical significance. We used the Statistical Package for the Social Sciences statistics for Windows, version 18.0 (SPSS Inc., Chicago, Ill, USA) to carry out all statistical analyses.

Results

The study included 193 individuals, all aged 60 years and above. Among the patients, 84 (43.5%) exhibited mild LUTS, while 109 (56.5%) presented with moderate to severe LUTS. Table 1 displays the main features of the patients categorized by the severity of LUTS. The patients had a median age of 71 years, with ages ranging from 66-77 years. Patients with mild LUTS symptoms had a median age of 70, while patients with moderate to severe LUTS had a median age of 73 (p<0.001). Marital status and smoking status exhibited consistent characteristics within the various LUTS severity categories. Notably, none of the patients indicated alcohol consumption. While BMI and upper arm circumference did not significantly differ based on LUTS severity, patients with moderate to severe LUTS exhibited a significantly lower calf circumference (p=0.048). Patients with moderate to severe LUTS demonstrated higher CCI levels (p=0.002). A total of 69 (35.8%) of the patients participating in the study were diagnosed with BPH and were currently receiving alpha blocker treatment. The prevalence of BPH was higher among patients with moderate to severe LUTS (p<0.001). Table 2 presents the patients’ geriatric assessment results according to the severity of LUTS. Patients with moderate to severe LUTS showed increased dependence on ADL (p<0.001) and IADL (p=0.003). Additionally, they demonstrated a higher incidence of polypharmacy (p=0.037), depression (p<0.001), urinary incontinence (p<0.001), and falls within the past year (p=0.049). Nevertheless, there were no notable distinctions between the groups regarding malnutrition (p=0.065) and cognitive impairment (p=0.332). Sarcopenia was identified in 48 (24.9%) patients. The moderate to severe LUTS group exhibited a significantly higher prevalence of sarcopenia than the mild LUTS group (p=0.021). Among the group with mild LUTS, sarcopenia was observed in 14 (16.7%) patients, whereas among the group with moderate to severe LUTS, 34 (31.2%) patients had sarcopenia. Upon separate evaluation of the components contributing to sarcopenia, it became evident that muscle strength, gait speed, and muscle mass exhibited lower values within the group characterized by moderate to severe LUTS. The median muscle strength was 31.1 kg in the mild LUTS group, whereas it was 29.3 kg in the moderate to severe LUTS group (p=0.045). The median gait speed was 0.67 m/sec in the mild LUTS group, contrasting with 0.57 m/sec in the moderate to severe LUTS group (p=0.007). The median muscle mass was 10.4 kg/m² in the mild LUTS group and 10.1 kg/m² in the moderate to severe LUTS group (p=0.028).

View this table:
  • View inline
  • View popup
Table 1

- Main features of the patients based on the lower urinary tract symptoms severity.

View this table:
  • View inline
  • View popup
Table 2

- Comprehensive geriatric assessment results according to the lower urinary tract symptoms severity.

The median serum 25(OH) vitamin D levels were significantly reduced in the moderate to severe LUTS group compared to the mild LUTS group (10.7 vs. 13.3 ng/mL, p=0.027). Furthermore, there was an evident inverse linear association observed between the quartiles of 25(OH) vitamin D and LUTS severity, signifying that the number of patients with moderate to severe LUTS decreased as the quartiles of 25(OH) vitamin D increased (p=0.023; Figure 1).

Figure 1
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1

- Associations of serum 25 (OH) vitamin D levels with lower urinary tract symptoms severity. LUTS: lower urinary tract symptoms

Serum total testosterone, total PSA, serum calcium, CRP levels, and sedimentation rates were similar between the groups. Table 3 provides detailed information on 25(OH) vitamin D levels and additional laboratory results in the mild and moderate to severe LUTS groups.

View this table:
  • View inline
  • View popup
Table 3

- The 25 (OH) vitamin D levels and other laboratory results according to the lower urinary tract symptoms severity.

In the multivariate logistic regression analysis, adjusting for age and CCl, there was a significant correlation between vitamin D levels and higher odds of experiencing moderate to severe LUTS (OR=0.95, 95% CI: [0.92-0.98], p=0.002). However, presence of sarcopenia did not exhibit a significant association with the severity of LUTS (OR=2.04, 95%CI: [0.94-4.45], p=0.070; Table 4).

View this table:
  • View inline
  • View popup
Table 4

- Results of univariate and multivariate analysis of predictors of lower urinary tract symptoms severity.

Discussion

In this research, we investigated how sarcopenia and vitamin D levels influence the severity of LUTS in older male individuals. Our findings indicate that sarcopenia did not have a significant impact on the severity of LUTS. However, we observed a link between diminished vitamin D levels and moderate to severe LUTS, irrespective of advanced age, a high CCI, and the presence of sarcopenia.

Conflicting findings in the literature complicate the understanding of the relationship between low levels of vitamin D and LUTS. A previous study involving more than 2000 men over 20 years old reported that individuals with low vitamin D levels experienced at least one LUTS.21 It is important to note, though, that not all LUTS were examined in that study, unlike in ours. In another study, it was found that low levels of vitamin D correlated with increased overactive bladder (OAB) symptom scores in men, but did not correlate with higher IPSS scores.22 The expression of VDR has been observed in the smooth muscle layers of the bladder wall and urothelium.9 Therefore, there may be a potential link between the development of LUTS and low vitamin D levels through the manifestation of OAB or urinary incontinence, which can result from abnormal detrusor contractions characterized by either hypercontractility or weakness. Vitamin D has the ability to stimulate the expression of occludin and claudin-14, which are tight junction proteins located at the intercellular junctions of urothelial cells and provide a barrier function. Additionally, the production of cathelicidin and certain other antimicrobial peptides depends upon vitamin D levels, particularly during the infection process.23,24 Consequently, the enhanced expression of these proteins mediated by vitamin D may serve to mitigate bacterial invasion, reduce the occurrence of recurrent urinary tract infections, and potentially alleviate LUTS. Vitamin D could exert various effects on prostate tissue, which could contribute to the prevention of LUTS in men. The presence of the 1α-hydroxylase enzyme in the prostate epithelium allows for the synthesis of 1,25(OH) vitamin D, making it an autocrine hormone within the prostate.22 It was demonstrated that VDR agonists exhibit antiproliferative and proapoptotic effects in BPH cells.25 These protective effects are achieved by inhibiting the inflammatory response through the COX2/PGE2 and NF-KB pathways.26 Furthermore, a specific variant of the vitamin D receptor has been found to have a protective effect against LUTS in men.27 Considering the influence of vitamin D on prostate tissue, particularly in men with LUTS attributed to BPH, reduced vitamin D levels may correlate with the severity of LUTS.

The recent findings from studies indicate that low lean body mass in men is linked to an elevated risk of LUTS, but no significant association has been found between pelvic floor muscle activity and the severity of LUTS.28,29 These results are inconsistent, and there is still limited research on the specific relationship between sarcopenia and LUTS. In contrast to our study, a case-control study carried out with patients diagnosed with systemic sclerosis revealed a significant association between sarcopenia and LUTS.30 However, this study had a relatively small sample size (n=42), consisting of both male and female patients, and included a comparatively younger population (median age of 61 years). These demographic characteristics, as well as the assessment of sarcopenia, differed from those of our study cohort. Another study investigated the association between sarcopenia and OAB in elderly patients with diabetes mellitus, revealing a significant correlation between OAB and sarcopenia.31 However, this study did not assess muscle mass; instead, it relied on a questionnaire for diagnosing sarcopenia. In a separate study exploring the relationship between sarcopenia and OAB, researchers identified sarcopenia as an independent risk factor for OAB.32 But this study included both male and female patients, who were significantly younger (with a mean age of 39) than the participants in our study. Furthermore, sarcopenia was defined using an index derived from the ratio of muscle mass, measured via Dual-energy X-ray absorptiometry, to BMI. Additionally, these studies primarily investigated the association between vitamin D levels and OAB, rather than LUTS.

Both smooth and skeletal muscles play critical roles in maintaining normal urination and urine storage. While sarcopenia may impact pelvic floor skeletal muscles and the external urethral sphincter, which are also skeletal muscles, its role in the development of LUTS in men, particularly in older men, seems to be limited. Moreover, our study’s findings suggest that the relationship between vitamin D deficiency and the severity of LUTS is governed by a distinct mechanism separate from sarcopenia and its impact on skeletal muscles. Considering the existing research that establishes a link between low vitamin D levels and LUTS, our study’s investigation of the relationship between sarcopenia and LUTS in older males, even in the absence of a direct link, contributes to our understanding of these complex factors affecting LUTS.

Study limitations

Lower urinary tract symptoms severity was assessed using a self-assessment questionnaire, and we did not carry out uroflowmetry tests or measure post-void residual urine. These omissions may have inherent limitations in terms of capturing objective measurements, potentially impacting the accuracy and reliability of the results. The study did not consider additional potential variables, such as the presence of urinary tract infections, prostatitis, or the use of medications like diuretics and anticholinergics, which could potentially influence the severity of LUTS. Additionally, it’s essential to note that this cross-sectional study is unable to establish a definitive causal link between low vitamin D levels and the severity of LUTS.

In conclusion, while the presence of sarcopenia did not demonstrate a significant influence on the severity of LUTS, our findings highlight the association between low vitamin D levels and moderate to severe LUTS. Therefore, monitoring serum 25(OH) vitamin D levels in older male patients with LUTS and ensuring appropriate treatment for vitamin D deficiency may offer benefits in managing LUTS, regardless of whether they have sarcopenia or not. However, further prospective trials are needed to explore the roles of sarcopenia and vitamin D in relation to LUTS.

Acknowledgment

The authors gratefully acknowledge EnglishEdited for the English language editing.

Footnotes

  • Disclosure. Authors have no conflict of interests, and the work was not supported or funded by any drug company.

  • Received February 26, 2024.
  • Accepted May 6, 2024.
  • Copyright: © Saudi Medical Journal

This is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work.

References

  1. 1.↵
    1. Zhang AY,
    2. Xu X
    . Prevalence, burden, and treatment of lower urinary tract symptoms in men aged 50 and older: a systematic review of the literature. SAGE Open Nurs 2018; 4: 2377960818811773.
    OpenUrl
  2. 2.↵
    1. Baboudjian M,
    2. Hashim H,
    3. Bhatt N,
    4. Creta M,
    5. De Nunzio C,
    6. Gacci M, et al.
    Summary paper on underactive bladder from the European Association of Urology guidelines on non-neurogenic male lower urinary tract symptoms. Eur Urol 2024; S0302-2838; 02273–02275.
    OpenUrl
  3. 3.↵
    1. Hwang TY,
    2. Kim SK,
    3. Kim KH,
    4. Kim JY
    . Association between lower urinary tract symptoms and falls in adults males: based on the Korean community health survey. Asia Pac J Public Health 2019; 31: 643–651.
    OpenUrl
  4. 4.↵
    1. Zhang S,
    2. Miller DD,
    3. Li W
    . Non-musculoskeletal benefits of vitamin D beyond the musculoskeletal system. Int J Mol Sci 2021; 22: 2128.
    OpenUrl
  5. 5.↵
    1. Dzik KP,
    2. Kaczor JJ
    . Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism, and anabolic state. Eur J Appl Physiol 2019; 119: 825–839.
    OpenUrlPubMed
  6. 6.↵
    1. Remelli F,
    2. Vitali A,
    3. Zurlo A,
    4. Volpato S
    . Vitamin D deficiency and sarcopenia in older persons. Nutrients 2019; 11: 2861.
    OpenUrl
  7. 7.↵
    1. Cruz-Jentoft AJ,
    2. Bahat G,
    3. Bauer J,
    4. Boirie Y,
    5. Bruyère O,
    6. Cederholm T, et al.
    Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16–31.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Xia L,
    2. Zhao R,
    3. Wan Q,
    4. Wu Y,
    5. Zhou Y,
    6. Wang Y, et al.
    Sarcopenia and adverse health-related outcomes: an umbrella review of meta-analyses of observational studies. Cancer Med 2020; 9: 7964–7978.
    OpenUrl
  9. 9.↵
    1. Crescioli C,
    2. Morelli A,
    3. Adorini L,
    4. Ferruzzi P,
    5. Luconi M,
    6. Vannelli GB, et al.
    Human bladder as a novel target for vitamin D receptor ligands. J Clin Endocrinol Metab 2005; 90: 962–972.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Surmeli DM,
    2. Karpuzcu HC,
    3. Atmis V,
    4. Cosarderelioglu C,
    5. Yalcin A,
    6. Varli M, et al.
    Association between sarcopenia and erectile dysfunction in older males. Arch Gerontol Geriatr 2022; 99: 104619.
    OpenUrl
  11. 11.↵
    1. Charlson ME,
    2. Pompei P,
    3. Ales KL,
    4. MacKenzie CR
    . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.
    OpenUrlCrossRefPubMed
  12. 12.↵
    1. Arik G,
    2. Varan HD,
    3. Yavuz BB,
    4. Karabulut E,
    5. Kara O,
    6. Kilic MK, et al.
    Validation of Katz index of independence in activities of daily living in Turkish older adults. Arch Gerontol Geriatr 2015; 61: 344–350.
    OpenUrl
  13. 13.↵
    1. Isik EI,
    2. Yilmaz S,
    3. Uysal I,
    4. Basar S
    . Adaptation of the Lawton instrumental activities of daily living scale to Turkish: validity and reliability study. Ann Geriatr Med Res 2020; 24: 35–40.
    OpenUrl
  14. 14.↵
    1. Güngen C,
    2. Ertan T,
    3. Eker E,
    4. Yaşar R,
    5. Engin F
    . [Reliability and validity of the standardized mini mental state examination in the diagnosis of mild dementia in Turkish population]. Turk Psikiyatri Derg 2002; 13: 273–281. [In Turkish].
    OpenUrlPubMed
  15. 15.↵
    1. Durmaz B,
    2. Soysal P,
    3. Ellidokuz H,
    4. Isik AT
    . Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. North Clin Istanb 2018; 5: 216–220.
    OpenUrl
  16. 16.↵
    1. Sarikaya D,
    2. Halil M,
    3. Kuyumcu ME,
    4. Kilic MK,
    5. Yesil Y,
    6. Kara O, et al.
    Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015; 61: 56–60.
    OpenUrl
  17. 17.↵
    1. Barry MJ,
    2. Fowler FJ Jr.,
    3. O’Leary MP,
    4. Bruskewitz RC,
    5. Holtgrewe HL,
    6. Mebust WK, et al.
    The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 1992; 148: 1549–1557.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Bahat G,
    2. Tufan A,
    3. Tufan F,
    4. Kilic C,
    5. Akpinar TS,
    6. Kose M, et al.
    Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition. Clin Nutr 2016; 35: 1557–1563.
    OpenUrlPubMed
  19. 19.↵
    1. Janssen I,
    2. Heymsfield SB,
    3. Ross R
    . Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002; 50: 889–896.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Cruz-Jentoft AJ,
    2. Baeyens JP,
    3. Bauer JM,
    4. Boirie Y,
    5. Cederholm T,
    6. Landi F, et al.
    Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Vaughan CP,
    2. Johnson TM 2nd.,
    3. Goode PS,
    4. Redden DT,
    5. Burgio KL,
    6. Markland AD
    . Vitamin D and lower urinary tract symptoms among US men: results from the 2005-2006 National Health and Nutrition Examination Survey. Urology 2011; 78: 1292–1297.
    OpenUrlPubMed
  22. 22.↵
    1. Yoo S,
    2. Oh S,
    3. Kim HS,
    4. Choi HS,
    5. Park J,
    6. Cho SY, et al.
    Impact of serum 25-OH vitamin D level on lower urinary tract symptoms in men: a step towards reducing overactive bladder. BJU Int 2018; 122: 667–672.
    OpenUrl
  23. 23.↵
    1. Deng QF,
    2. Chu H,
    3. Wen Z,
    4. Cao YS
    . Vitamin D and urinary tract infection: a systematic review and meta-analysis. Ann Clin Lab Sci 2019; 49: 134–142.
    OpenUrlAbstract/FREE Full Text
  24. 24.↵
    1. Mohanty S,
    2. Kamolvit W,
    3. Hertting O,
    4. Brauner A
    . Vitamin D strengthens the bladder epithelial barrier by inducing tight junction proteins during E. coli urinary tract infection. Cell Tissue Res 2020; 380: 669–673.
    OpenUrl
  25. 25.↵
    1. Yuan P,
    2. Wang T,
    3. Li H,
    4. Lan R,
    5. Li M,
    6. Liu J
    . Systematic review and meta-analysis of the association between vitamin D status and lower urinary tract symptoms. J Urol 2021; 205: 1584–1594.
    OpenUrl
  26. 26.↵
    1. Adorini L,
    2. Penna G,
    3. Fibbi B,
    4. Maggi M
    . Vitamin D receptor agonists target static, dynamic, and inflammatory components of benign prostatic hyperplasia. Ann N Y Acad Sci 2010; 1193: 146–152.
    OpenUrlPubMed
  27. 27.↵
    1. Cartwright R,
    2. Mangera A,
    3. Tikkinen KA,
    4. Rajan P,
    5. Pesonen J,
    6. Kirby AC, et al.
    Systematic review and meta-analysis of candidate gene association studies of lower urinary tract symptoms in men. Eur Urol 2014; 66: 752–768.
    OpenUrl
  28. 28.↵
    1. Qin Z,
    2. Zhao J,
    3. Li J,
    4. Yang Q,
    5. Geng J,
    6. Liao R, et al.
    Low lean mass is associated with lower urinary tract symptoms in US men from the 2005-2006 national health and nutrition examination survey dataset. Aging (Albany NY) 2021; 13: 21421–21434.
  29. 29.↵
    1. Vrolijks RO,
    2. Notenboom-Nas FJM,
    3. de Boer D,
    4. Schouten T,
    5. Timmerman A,
    6. Zijlstra A, et al.
    Exploring pelvic floor muscle activity in men with lower urinary tract symptoms. Neurourol Urodyn 2020; 39: 732–737.
    OpenUrl
  30. 30.↵
    1. Pacini G,
    2. Paolino S, C
    3. Trombetta A,
    4. Goegan F,
    5. Pizzorni C,
    6. Alessandri E, et al.
    Lower urinary tract symptoms in systemic sclerosis: a detailed investigation. Rheumatology (Oxford) 2020; 59: 1315–1324.
    OpenUrl
  31. 31.↵
    1. Ida S,
    2. Kaneko R,
    3. Nagata H,
    4. Noguchi Y,
    5. Araki Y,
    6. Nakai M, et al.
    Association between sarcopenia and overactive bladder in elderly diabetic patients. J Nutr Health Aging 2019; 23: 532–537.
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. Song W,
    2. Hu H,
    3. Ni J,
    4. Zhang H,
    5. Zhang Y,
    6. Zhang H, et al.
    The role of sarcopenia in overactive bladder in adults in the United States: retrospective analysis of NHANES 2011-2018. J Nutr Health Aging 2023; 27: 734–740.
PreviousNext
Back to top

In this issue

Saudi Medical Journal: 45 (6)
Saudi Medical Journal
Vol. 45, Issue 6
1 Jun 2024
  • Table of Contents
  • Cover (PDF)
  • Index by author
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on Saudi Medical Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms in older males
(Your Name) has sent you a message from Saudi Medical Journal
(Your Name) thought you would like to see the Saudi Medical Journal web site.
Citation Tools
Impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms in older males
Deniz M. Surmeli, Hulusi C. Karpuzcu, Volkan Atmis, Caglar Cosarderelioglu, Ahmet Yalcin, Murat Varli, Sevgi Aras
Saudi Medical Journal Jun 2024, 45 (6) 598-605; DOI: 10.15537/smj.2024.45.6.20240166

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Impact of sarcopenia and vitamin D levels on the severity of lower urinary tract symptoms in older males
Deniz M. Surmeli, Hulusi C. Karpuzcu, Volkan Atmis, Caglar Cosarderelioglu, Ahmet Yalcin, Murat Varli, Sevgi Aras
Saudi Medical Journal Jun 2024, 45 (6) 598-605; DOI: 10.15537/smj.2024.45.6.20240166
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Acknowledgment
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Hematological parameters in recent and past dengue infections in Jazan Province, Saudi Arabia
  • Longitudinal analysis of foodborne disease outbreaks in Saudi Arabia
  • Psychological stress and its association with bronchial asthma in Saudi Arabia
Show more Original Article

Similar Articles

Keywords

  • aged
  • prostatic hyperplasia
  • lower urinary tract symptoms
  • sarcopenia
  • vitamin D

CONTENT

  • home

JOURNAL

  • home

AUTHORS

  • home
Saudi Medical Journal

© 2025 Saudi Medical Journal Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention.  Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.

Powered by HighWire