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Impact of Obesity on Urinary Tract Infections in Korean Adults: Secondary Data Analysis Using Community-Based Cohort Study

  • 투고 : 2020.09.21
  • 심사 : 2021.02.10
  • 발행 : 2021.04.30

초록

Purpose: This study investigated the incidence of urinary tract infection (UTI) in community-dwelling adults and identified the association between obesity and UTI. Methods: The participants were 4,926 adults aged over 40 years who had no UTIs at the baseline survey of the Korean Genome Epidemiology Study. Obesity was defined according to the cirtieria of Korean Society for the Study of Obesity using body mass index (BMI) data. UTI was defined as those who had self-reported UTI or had either nitrite, or both leukocytes and blood in the urine dipstick test. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariate Cox proportional hazards regression analysis to identify the association between the obesity and UTI. Results: The incidence proportion of UTI was 5.1%, and the incidence density per 1,000 person-years was 25.5. After controlling general characteristics, people with BMI ≥30.0 kg/m2 remained 1.66 times (HR = 1.66, 95% CI = 1.06~2.60; p < .05) more likely to have UTI than those with normal weight. This trend was also present in men or people aged ≥ 60 years. Among women aged ≥ 60 years, people with BMI ≥ 30.0 kg/m2 were 1.98 times (HR = 1.98, 95% CI = 1.01~3.86; p < .05) more likely to have UTI than those with normal weight. Conclusion: The BMI ≥ 30.0 kg/m2 is a risk factor of UTIs in Korean adult men over 40 years and women aged ≥ 60 years. It is necessary to emphasize the importance of obesity management to men or women aged ≥ 60 years, specifically.

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참고문헌

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026): 1377-1396. https://doi.org/10.1016/S0140-6736(16)30054-X
  2. Ministry of Health & Welfare (MOHW), Korea Disease Control and Prevention Agency (KDCA). Korea health statistics 2018: Korea National Health and Nutrition Examination Survey (KNHANES VII-3). Cheongju: KDCA; 2019 Dec. Report No.: 11-1351159-000027-10.
  3. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health effects of overweight and obesity in 195 countries over 25 years. The New England Journal of Medicine. 2017;377(1):13-27. https://doi.org/10.1056/NEJMoa1614362
  4. Song HJ, Hwang J, Pi S, Ahn S, Heo Y, Park S, et al. The impact of obesity and overweight on medical expenditures and disease incidence in Korea from 2002 to 2013. PLoS One. 2018;13(5):e0197057. https://doi.org/10.1371/journal.pone.0197057
  5. Dobner J, Kaser S. Body mass index and the risk of infection - from underweight to obesity. Clinical Microbiology and Infection. 2018;24(1):24-28. https://doi.org/10.1016/j.cmi.2017.02.013
  6. Shang Q, Wang H, Song Y, Wei L, Lavebratt C, Zhang F, et al. Serological data analyses show that adenovirus 36 infection is associated with obesity: A meta-analysis involving 5739 subjects. Obesity (Silver Spring). 2014;22(3):895-900. https://doi.org/10.1002/oby.20533
  7. Harpsoe MC, Nielsen NM, Friis-Moller N, Andersson M, Wohlfahrt J, Linneberg A, et al. Body mass index and risk of infections among women in the Danish National Birth Cohort. American Journal of Epidemiology. 2016;183(11):1008-1017. https://doi.org/10.1093/aje/kwv300
  8. Ghilotti F, Bellocco R, Ye W, Adami HO, Trolle Lagerros Y. Obesity and risk of infections: Results from men and women in the Swedish National March Cohort. International Journal of Epidemiology. 2019;48(6):1783-1794. https://doi.org/10.1093/ije/dyz129
  9. Guilherme A, Virbasius JV, Puri V, Czech MP. Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nature Reviews Molecular Cell Biology. 2008;9(5):367-377. https://doi.org/10.1038/nrm2391
  10. Tagliabue C, Principi N, Giavoli C, Esposito S. Obesity: Impact of infections and response to vaccines. European Journal of Clinical Microbiology & Infectious Diseases. 2016;35(3):325-331. https://doi.org/10.1007/s10096-015-2558-8
  11. Kanneganti TD, Dixit VD. Immunological complications of obesity. Nature Immunology. 2012;13(8):707-712. https://doi.org/10.1038/ni.2343
  12. Green WD, Beck MA. Obesity altered T cell metabolism and the response to infection. Current Opinion in Immunology. 2017;46:1-7. https://doi.org/10.1016/j.coi.2017.03.008
  13. Torres L, Martins VD, Faria AMC, Maioli TU. The intriguing relationship between obesity and infection. Journal of Infectiology. 2018;1(1):6-10. https://doi.org/10.29245/2689-9981/2018/1.1104
  14. Wie SH. Diagnosis and treatment of urinary tract infections. Proceedings of The Korean Journal of Medicine, Annual spring conference 2014; 2014 Apr 1; Seoul. Seoul: The Korean Association of Internal Medicine; c2014. p. 22-26.
  15. National Health Insurance Service. Cystitis, it is the most common in the 50's women [internet]. Wonju: National Health Insurance Service; c2016 [cited 2020 Aug 20]. Available from: https://www.nhis.or.kr/nhis/healthin/wbhace05000m01.do?mode=view&articleNo=206010.
  16. Health Insurance Review and Assessment Service (HIRA). 2019 Medical expenditure review results [Internet]. Wonju: HIRA; c2020 [cited 2020 Aug 20]. Available from: http://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020045030000&brdScnBltNo=4&brdBltNo=2405&pageIndex=1#-none.
  17. Okubo Y, Handa A. The impact of obesity on pediatric inpatients with urinary tract infections in the United States. Journal of Pediatric Urology. 2017;13(5):455.e1-455.e5. https://doi.org/10.1016/j.jpurol.2017.03.038
  18. Kim YJ, Lee JH. Disseminated osteomyelitis after urinary tract infection in immunocompetent adult: A case report. World Journal of Clinical Cases. 2020;8(16):3542-3547. https://doi.org/10.12998/wjcc.v8.i16.3542
  19. Jo YS, Choi JY, Chung H, Kim Y, Na SJ. Recurrent Guillain-Barre syndrome following urinary tract infection by Escherichia coli. Journal of Korean Medical Science. 2018;33(4):e29. https://doi.org/10.3346/jkms.2018.33.e29
  20. Lee JH, Subhadra B, Son YJ, Kim DH, Park HS, Kim JM, et al. Phylogenetic group distributions, virulence factors and antimicrobial resistance properties of uropathogenic Escherichia coli strains isolated from patients with urinary tract infections in South Korea. Letters in Applied Microbiology. 2016;62(1):84-90. https://doi.org/10.1111/lam.12517
  21. Shin HR, Moon J, Lee HS, Ahn SJ, Kim TJ, Jun JS, et al. Increasing prevalence of antimicrobial resistance in urinary tract infections of neurological patients, Seoul, South Korea, 2007-2016. International Journal of Infectious Diseases. 2019;84:109-115. https://doi.org/10.1016/j.ijid.2019.05.002
  22. Semins MJ, Shore AD, Makary MA, Weiner J, Matlaga BR. The impact of obesity on urinary tract infection risk. Urology. 2012;79(2):266-269. https://doi.org/10.1016/j.urology.2011.09.040
  23. Saliba W, Barnett-Griness O, Rennert G. The association between obesity and urinary tract infection. European Journal of Internal Medicine. 2013;24(2):127-131. https://doi.org/10.1016/j.ejim.2012.11.006
  24. Nseir W, Farah R, Mahamid M, Sayed-Ahmad H, Mograbi J, Taha M, et al. Obesity and recurrent urinary tract infections in premenopausal women: A retrospective study. International Journal of Infectious Diseases. 2015;41:32-35. https://doi.org/10.1016/j.ijid.2015.10.014
  25. Kaspersen KA, Pedersen OB, Petersen MS, Hjalgrim H, Rostgaard K, Moller BK, et al. Obesity and risk of infection: Results from the Danish Blood Donor Study. Epidemiology. 2015;26(4):580-589. https://doi.org/10.1097/EDE.0000000000000301
  26. Nassaji M, Ghorbani R, Tamadon MR, Bitaraf M. Association between body mass index and urinary tract infection in adult patients. Nephro-Urology Monthly. 2014;7(1):e22712. https://doi.org/10.5812/numonthly.22712
  27. Seo MH, Lee WY, Kim SS, Kang JH, Kang JH, Kim KK, et al. 2018 Korean Society for the Study of Obesity guideline for the management of obesity in Korea. Journal of Obesity & Metabolic Syndrome. 2019;28(1):40-45. https://doi.org/10.7570/jomes.2019.28.1.40
  28. Kim Y, Han BG; KoGES group. Cohort profile: The Korean Genome and Epidemiology Study (KoGES) consortium. International Journal of Epidemiology. 2017;46(4):1350. https://doi.org/10.1093/ije/dyx105
  29. Korea Disease Control and Prevention Agency (KDCA). Status by cohort [Internet]. Cheongju: KDCA; c2020 [cited 2020 Aug 20]. Available from: http://www.kdca.go.kr/contents.es?mid=a40504030900.
  30. Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA, et al. Dipsticks and diagnostic algorithms in urinary tract infection: Development and validation, randomised trial, economic analysis, observational cohort and qualitative study. Health Technology Assessment. 2009;13(19):iii-iv, ix-xi, 1-73. https://doi.org/10.3310/hta13190
  31. Detweiler K, Mayers D, Fletcher SG. Bacteruria and urinary tract infections in the elderly. The Urologic Clinics of North America. 2015;42(4):561-568. https://doi.org/10.1016/j.ucl.2015.07.002
  32. Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asymptomatic bacteriuria in older adults. Infectious Disease Clinics of North America. 2017;31(4):673-688. https://doi.org/10.1016/j.idc.2017.07.002
  33. Ingersoll MA. Sex differences shape the response to infectious diseases. PLoS Pathogens. 2017;13(12):e1006688. https://doi.org/10.1371/journal.ppat.1006688
  34. Mama M, Manilal A, Gezmu T, Kidanewold A, Gosa F, Gebresilasie A. Prevalence and associated factors of urinary tract infections among diabetic patients in Arba Minch Hospital, Arba Minch province, South Ethiopia. Turkish Journal of Urology. 2018;45(1):56-62. https://doi.org/10.5152/tud.2018.32855
  35. Aydin A, Kocaoz S, Kara P. Prevalence of lower urinary tract symptoms in pregnant adolescents and the influencing factors. Journal of Pediatric and Adolescent Gynecology. 2020;33(2):160-166. https://doi.org/10.1016/j.jpag.2019.10.007
  36. Nichols GA, Brodovicz KG, Kimes TM, Deruaz-Luyet A, Bartels DB. Prevalence and incidence of urinary tract and genital infections among patients with and without type 2 diabetes. Journal of Diabetes and its Complications. 2017; 31(11):1587-1591. https://doi.org/10.1016/j.jdiacomp.2017.07.018
  37. Duanngai K, Sirasaporn P, Ngaosinchai SS. The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients. Journal of Family Medicine and Primary Care. 2017;6(3):578-582. https://doi.org/10.4103/2249-4863.222024
  38. Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric. 2019;22(3):242-249. https://doi.org/10.1080/13697137.2018.1551871