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Published on: February 10, 2023
Obesity and lower urinary tract dysfunction in children and adolescents: Further research into new relationships
L G A Fraga1, A Sampaio1, N Boa-Sorte1
1CEDIMI (Center of Micturition Disturbance), Bahiana School of Medicine, Federal University of Bahia, Bahia, Brazil.
Insights
Obesity in children is linked to bladder emptying symptoms, not filling issues. This finding suggests a potential neurological link and warrants further research into pediatric lower urinary tract dysfunction (LUTD) and weight management.
Area of Science:
- Pediatric Urology
- Childhood Obesity
- Neuroscience
Background:
- Lower urinary tract dysfunction (LUTD) affects bladder filling and emptying in children.
- LUTD is associated with conditions like urinary infections and reduced quality of life.
- While a link between LUTD and obesity is suggested, individual symptom associations require evaluation.
Purpose of the Study:
- To investigate the association between excess weight and LUTD in a community sample of children and adolescents.
- To determine if specific LUTD symptoms correlate with obesity in pediatric populations.
Main Methods:
- Cross-sectional study of 423 children and adolescents (aged 5-17).
- Utilized Dysfunctional Voiding Scoring System (DVSS) and Rome III questionnaires.
- Classified participants' weight status using BMI-for-age (normal, overweight, obese).
Main Results:
- Prevalence of LUTD was 7.1%, with 13.5% overweight and 12.1% obese.
- Constipation affected 5.9% and enuresis 10.8% of participants.
- Multivariate analysis revealed age <10 years, constipation, and obesity were independently associated with positive DVSS scores.
Conclusions:
- Obesity in children is specifically associated with bladder emptying symptoms of LUTD.
- This association may stem from shared alterations in brain regions controlling voiding.
- Future research should explore this link further, acknowledging the limitation of questionnaire-based diagnoses.
Introduction:
Lower urinary tract dysfunction (LUTD) involves faults in the filling and emptying phases of bladder function in toilet-trained children with no previous infection or any other obvious pathology. Lower urinary tract dysfunction is associated with conditions such as vesicoureteral reflux, recurrent urinary infection, behavioral alterations and decreased quality of life. The literature suggests an association between LUTD and obesity; however, the association between each individual symptom and obesity has yet to be evaluated.
Objective:
To evaluate the association between excess weight and LUTD in children and adolescents in a community-based sample.
Study Design:
This cross-sectional study included 423 children and adolescents aged 5-17 years, and randomly selected in public places and schools between May and July 2015. The participants and their mothers completed the Dysfunctional Voiding Scoring System (DVSS) questionnaire, except for the questions on constipation and with the addition of a question on enuresis. They also completed the Rome III questionnaire, in which two positive responses defined the presence of constipation. Participants were classified as being of normal weight, overweight or obese, which was based on the BMI-for-age indicator.
Results:
Mean age was 9.7 years (SD 2.9), with girls comprising 50.6% of the sample and adolescents 52.5%. The prevalence of LUTD was 7.1%, with 13.5% of participants being overweight and 12.1% obese (Figure). Constipation was present in 5.9% of participants and enuresis in 10.8%. In the multivariate analysis, three factors were independently and significantly associated with a positive DVSS: age <10 years (β = 0.76; 95% CI: 0.34-1.18), constipation (β = 1.79; 95% CI: 0.88-2.70) and obesity (β = 0.89; 95% CI: 0.25-1.52).
Discussion:
Only bladder filling symptoms were associated with obesity. This may be explained by the fact that both obese individuals and those with emptying symptoms were shown to have activation alterations in the same brain regions. One limitation of this study was the use of questionnaires alone to diagnose LUTD and constipation.
Conclusion:
Only the bladder-emptying symptoms of LUTD appear to be associated with obesity. This hypothesis may serve as a basis for future studies.
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