Central Obesity in Cases of OAB
Condition: Urologic Diseases; Overactive Bladder Syndrome; Obesity, Abdominal
MeSH terms: Urinary Bladder, Overactive; Urologic Diseases; Obesity; Obesity, Abdominal
Study type: Interventional

Summary: 
      Obesity is not a homogeneous condition and that the regional distribution of adipose tissue
      is important to understanding the relation of obesity to disturbances in glucose and lipid
      metabolism. Central abdominal fat is composed of abdominal subcutaneous fat and visceral fat.
      Regional distribution appears to be an important indicator for metabolic alterations since an
      inconstant correlation between body mass index (BMI) and these disturbances have been found.
      Visceral obesity is associated with increased adipocytokine production, proinflammatory
      activity, deterioration of insulin sensitivity, increased risk of developing diabetes,
      "high-triglyceride/low-HDL cholesterol dyslipidemia," hypertension and atherosclerosis. It
      might be more precise to divide central abdominal fat into subcutaneous(S) and visceral (V)
      fat surface area and volume and even ratio (S/V); risk factors for cardiovascular disease,
      particularly those related to glucose and lipid metabolism and hypertension, being>0.4; with
      evaluation of visceral fat functionality by visceral adiposity index (VAI) with integration
      with lipid profile. Adding bladder wall thickness with perivesical fat as a factor may impair
      bladder function and contribute to dysregulation. The data on the association between central
      adiposity with OAB symptoms and Urodynamics is not mature.
    

Detailed description: 
      Overactive bladder (OAB) is defined by international continence society (ICS) as urinary
      urgency with or without incontinence often associated with frequency and nocturia. As a
      chronic, unbearable condition, OAB has a deeply negative impact on QoL, including social,
      physical, psychological, occupational and sexual domains. Overactive bladder (OAB) is a
      highly prevalent symptom complex that is estimated to affect 12.8% of women and 10.8% of men.

      The underlying pathophysiological mechanism of OAB and DO is poorly understood. It is thought
      that not only the detrusor muscle but also urothelium, peripheral afferent terminals, and
      pelvic blood vessels may play a role.

      More recently, overweight and central obesity was found to be an independent risk factor for
      overactive bladder (OAB) in women. The most likely explanation is the occurrence of chronic
      inflammation in the bladder indicated by increased urinary chemokines. Adipocytes surrounding
      the human bladder can be affected, thus leading to inflammation and triggering OAB symptoms.
      Other authors showed that OAB is associated with increased BMI and increase of waist
      circumference at the upper end of the adiposity distribution for both men and women.

      Obesity is not a homogeneous condition and that the regional distribution of adipose tissue
      is important to understanding the relation of obesity to disturbances in glucose and lipid
      metabolism. Central abdominal fat is composed of abdominal subcutaneous fat and visceral fat.
      Regional distribution appears to be an important indicator for metabolic alterations since an
      inconstant correlation between body mass index (BMI) and these disturbances have been found.
      Visceral obesity is associated with increased adipocytokine production, proinflammatory
      activity, deterioration of insulin sensitivity, increased risk of developing diabetes,
      "high-triglyceride/low-HDL cholesterol dyslipidemia," hypertension and atherosclerosis.

      Away from that anthropometric measures as BMI, waist circumference (WC), waist to hip ratio
      (WHR) are crude measures for adiposity. WHR has been advocated as a measure of central
      obesity because BMI does not describe the distribution of obesity. This measurement, however,
      was found to be associated with SUI but not with OAB or mixed urinary incontinence, further
      suggesting a non-mechanical mechanism for OAB in obese women. WC is a major clinical
      parameter used for the indirect evaluation of increased visceral fat, In addition, WC showed
      shared variance with visceral adipose fat up to 75% (42) (38). Nevertheless, WC alone does
      not help in distinguishing between subcutaneous and visceral fat mass.

      So, it might be more precise to divide central abdominal fat into subcutaneous(S) and
      visceral (V) fat surface area and volume and even ratio (S/V); risk factors for
      cardiovascular disease, particularly those related to glucose and lipid metabolism and
      hypertension, being>0.4; with evaluation of visceral fat functionality by visceral adiposity
      index (VAI) with integration with lipid profile. Adding bladder wall thickness with
      perivesical fat as a factor may impair bladder function and contribute to dysregulation.

      The data on the association between central adiposity with OAB symptoms and Urodynamics is
      not mature. So, the investigators intend to conduct this study evaluating the surface area of
      both subcutaneous and visceral fat and its functionality with incorporation with lipid
      profile and bladder wall thickness and perivesical fat.
    

Intervention name(s): visceral fat obesity (surface area and function)
Intervention type(s): Diagnostic Test
Intervention description(s): WC is evaluated at the midpoint between the lower border of the rib cage and the iliac crest. The surface area of subcutaneous fat (S) and visceral (V) is calculated using slices between L4-L5 and umbilicus according to ct detection fat methods Also bladder wall thickness was calculated by measuring average bladder wall thickness at three different levels.
Subcutaneous fat to visceral fat ratio was calculated. Assays for serum total and high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were performed in the hospital's chemistry laboratory with an autoanalyzer. VAI was calculated for females as this formula like the previous study.
VAI: WC/ [36.58 + (1.89 × BMI)] × TG/0.81 × 1.52/HDL.
And in males:
VAI: WC / [39.68 + (1.88 x BMI)] x TG/ 1.03 x 1.31/ HDL WC: waist circumference, BMI: body mass index, TG: triglyceride, HDL: high-density lipoprotein
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: abdominal obesity; OAB