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Original Research

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Association between lipid accumulation product index and lower urinary tract symptom—benign prostatic hyperplasia: a 7-year follow-up study

  • Shuqin Zhang1,2
  • Zhen Yao3
  • Shengyu Zhou2,4
  • Lisi Zhang2,5
  • Jiayu Liang6,*,

1Operating room, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

2West China School of Nursing, Sichuan University, 610041 Chengdu, Sichuan, China

3Department of Urology, Tangdu Hospital, the Air Force Medical University, 710038 Xi’an, Shaanxi, China

4Department of Orthopedics, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

5Department of Nephrology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

6Department of Urology, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

DOI: 10.22514/jomh.2024.032

Submitted: 29 October 2023 Accepted: 28 November 2023

Online publish date: 12 March 2024

*Corresponding Author(s): Jiayu Liang E-mail:


The distribution of adipose tissue plays a crucial role in the progression of lower urinary tract symptoms suggestive of benign prostate hyperplasia (LUTS/BPH). This study was performed to explore the longitudinal association between the lipid accumulation product index (LAPI) and LUTS/BPH. Based on logistic and restricted cubic spline (RCS) regressions, data from the China Health and Retirement Longitudinal Study were used to evaluate the odds ratio (OR) and non-linear correlation between LAPI and LUTS/BPH. Subgroup and interactive analyses were adopted to determine the interactive effects of covariates. In addition, a 7-year retrospective cohort from 2011–2018 was constructed to investigate the longitudinal association. After data cleansing, this study included 3967 males aged >40 years in 2011. In the full model, high LAPI was significantly associated with prevalent LUTS/BPH (OR = 1.007; 95% CI (confidence interval): 1.001–1.013, p = 0.016). Furthermore, as a categorical variable, the ORs were 1.21 (95% CI = 0.91–1.62, p = 0.197) and 1.56 (95% CI = 1.09–2.23, p = 0.014) for the second and third tertile groups, respectively. No significant interactive effects were detected (all p for interaction > 0.05). The RCS regression revealed a linear association between LAPI and prevalent LUTS/BPH in the overall population (p for overall < 0.05) and an L-shaped association in males aged ≥60 years (p for non-linear = 0.006). In the 2011–2018 cohort, the ORs for the second and third tertile groups were 1.51 (95% CI = 1.11–2.04, p = 0.008) and 1.74 (95% CI = 1.21–2.50, p = 0.003) in the full models, respectively. All the sensitivity analyses supported similar findings. In conclusion, aging males with high LAPI have a higher risk of developing LUTS/BPH than their counterparts.


Aging male; Benign prostatic hyperplasia; Lower urinary tract symptom; Lipid accumulation product index; CHARLS

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Shuqin Zhang,Zhen Yao,Shengyu Zhou,Lisi Zhang,Jiayu Liang. Association between lipid accumulation product index and lower urinary tract symptom—benign prostatic hyperplasia: a 7-year follow-up study. Journal of Men's Health. 2024.doi:10.22514/jomh.2024.032.


[1] Xiong Y, Zhang Y, Li X, Qin F, Yuan J. The prevalence and associated factors of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging males. The Aging Male. 2020; 23: 1432–1439.

[2] Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. Journal of Urology. 1984; 132: 474–479.

[3] Johnson TV, Abbasi A, Ehrlich SS, Kleris RS, Chirumamilla SL, Schoenberg ED, et al. Major depression drives severity of American urological association symptom index. Urology. 2010; 76: 1317–1320.

[4] Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014; 384: 766–781.

[5] Hall KD, Farooqi IS, Friedman JM, Klein S, Loos RJ, Mangelsdorf DJ, et al. The energy balance model of obesity: beyond calories in, calories out. The American Journal of Clinical Nutrition. 2022; 115: 1243–1254.

[6] Hwaung P, Bosy-Westphal A, Muller MJ, Geisler C, Heo M, Thomas DM, et al. Obesity tissue: composition, energy expenditure, and energy content in adult humans. Obesity. 2019; 27: 1472–1481.

[7] Fu W, Wang C, Zou L, Jiang H, Miller M, Gan Y, et al. Association of adiposity with diabetes: a national research among Chinese adults. Diabetes/Metabolism Research and Reviews. 2021; 37: e3380.

[8] Khanmohammadi S, Tavolinejad H, Aminorroaya A, Rezaie Y, Ashraf H, Vasheghani-Farahani A. Association of lipid accumulation product with type 2 diabetes mellitus, hypertension, and mortality: a systematic review and meta-analysis. Journal of Diabetes and Metabolic Disorders. 2022; 21: 1943–1973.

[9] Yin Z, Huang M, Yang Y, Chen C, Luo R, Wen C, et al. Comparison of the predictive value of anthropometric indicators for the risk of benign prostatic hyperplasia in southern China. Asian Journal of Andrology. 2023; 25: 265–270.

[10] Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China health and retirement longitudinal study (CHARLS). International Journal of Epidemiology. 2014; 43: 61–68.

[11] Wan H, Wang Y, Xiang Q, Fang S, Chen Y, Chen C, et al. Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference. Cardiovascular Diabetology. 2020; 19: 118.

[12] Xiong Y, Zhang Y, Tan J, Qin F, Yuan J. The association between metabolic syndrome and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging males: evidence based on propensity score matching. Translational Andrology and Urology. 2021; 10: 384–396.

[13] Zhang W, Cao G, Sun Y, Wu F, Wang Q, Xu T, et al. Depressive symptoms in individuals diagnosed with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) in middle-aged and older Chinese individuals: results from the China Health and Retirement Longitudinal Study. Journal of Affective Disorders. 2022; 296: 660–666.

[14] Xiong Y, Zhang Y, Jin T, Qin F, Yuan J. Depressive males have higher odds of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a retrospective cohort study based on propensity score matching. Asian Journal of Andrology. 2021; 23: 633–639.

[15] Devlin CM, Simms MS, Maitland NJ. Benign prostatic hyperplasia—what do we know? BJU International. 2021; 127: 389–399.

[16] Wang YB, Yang L, Deng YQ, Yan SY, Luo LS, Chen P, et al. Causal relationship between obesity, lifestyle factors and risk of benign prostatic hyperplasia: a univariable and multivariable Mendelian randomization study. Journal of Translational Medicine. 2022; 20: 495.

[17] Chughtai B, Forde JC, Thomas DD, Laor L, Hossack T, Woo HH, et al. Benign prostatic hyperplasia. Nature Reviews Diseases Primers 2016; 2: 16031.

[18] Parsons JK, Sarma AV, McVary K, Wei JT. Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. Journal of Urology. 2013; 189: S102–S106.

[19] Vignozzi L, Gacci M, Maggi M. Lower urinary tract symptoms, benign prostatic hyperplasia and metabolic syndrome. Nature Reviews Urology. 2016; 13: 108–119.

[20] Xia B, Zhao S, Chen Z, Chen C, Liu T, Yang F, et al. The underlying mechanism of metabolic syndrome on benign prostatic hyperplasia and prostate volume. The Prostate. 2020; 80: 481–490.

[21] Wang S, Mao Q, Lin Y, Wu J, Wang X, Zheng X, et al. Body mass index and risk of BPH: a meta-analysis. Prostate Cancer and Prostatic Diseases. 2012; 15: 265–272.

[22] Udo CO, Robinson ED, Ijeruh OY, Nwankwo NC. Correlation between transabdominal sonographic prostate volume and anthropometric parameters. Journal of Medical Ultrasound. 2022; 30: 261–265.

[23] Burke JP, Rhodes T, Jacobson DJ, McGree ME, Roberts RO, Girman CJ, et al. Association of anthropometric measures with the presence and progression of benign prostatic hyperplasia. American Journal of Epidemiology. 2006; 164: 41–46.

[24] Besiroglu H, Ozbek E, Dursun M, Otunctemur A. Visceral adiposity index is associated with benign prostatic enlargement in non-diabetic patients: a cross-sectional study. The Aging Male. 2018; 21: 40–47.

[25] Zhang Y, He Q, Zhang W, Xiong Y, Shen S, Yang J, et al. Non-linear associations between visceral adiposity index and cardiovascular and cerebrovascular diseases: results from the NHANES (1999–2018). Frontiers in Cardiovascular Medicine. 2022; 9: 908020.

[26] Ebrahimi M, Seyedi SA, Nabipoorashrafi SA, Rabizadeh S, Sarzaeim M, Yadegar A, et al. Lipid accumulation product (LAP) index for the diagnosis of nonalcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis. Lipids in Health and Disease. 2023; 22: 41.

[27] Ray L, Ravichandran K, Nanda SK. Comparison of lipid accumulation product index with body mass index and waist circumference as a predictor of metabolic syndrome in Indian population. Metabolic Syndrome and Related Disorders. 2018; 16: 240–245.

[28] Dai D, Chang Y, Chen Y, Chen S, Yu S, Guo X, et al. Visceral adiposity index and lipid accumulation product index: two alternate body indices to identify chronic kidney disease among the rural population in northeast China. International Journal of Environmental Research and Public Health. 2016; 13: 1231.

[29] Friedenreich CM, Ryder‐Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Molecular Oncology. 2021; 15: 790–800.

[30] Belladelli F, Montorsi F, Martini A. Metabolic syndrome, obesity and cancer risk. Current Opinion in Urology. 2022; 32: 594–597.

[31] Chang W, Tsai Y, Wang J, Chen H, Yang W, Lee C. Sex hormones and oxidative stress mediated phthalate-induced effects in prostatic enlargement. Environment International. 2019; 126: 184–192.

[32] Han Y, Forno E, Celedón JC. Sex steroid hormones and asthma in a nationwide study of U.S. adults. American Journal of Respiratory and Critical Care Medicine. 2020; 201: 158–166.

[33] Heikkinen A, Bollepalli S, Ollikainen M. The potential of DNA methylation as a biomarker for obesity and smoking. Journal of Internal Medicine. 2022; 292: 390–408.

[34] Keil KP, Vezina CM. DNA methylation as a dynamic regulator of development and disease processes: spotlight on the prostate. Epigenomics. 2015; 7: 413–425.

[35] Zhou Y, Hambly BD, McLachlan CS. FTO associations with obesity and telomere length. Journal of Biomedical Science. 2017; 24: 65.

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