Vitamin D insufficiency ups risk of LUTS

Vitamin D insufficiency is significantly associated with the risk of developing lower urinary tract symptoms (LUTS), but supplementation may potentially improve these symptoms, according to a study.

“It would be of great guiding significance to consider vitamin D status when treating LUTS,” the researchers said.

The databases of PubMed, Scopus, and Embase were searched for articles up to June 2020. The researchers then conducted a meta-analysis to assess the effects of vitamin D insufficiency or intake on LUTS and a sensitivity analysis to examine heterogeneity and the robustness of the results. A qualitative description summarized vitamin D supplementation for treating LUTS.

Twenty-three studies including a total of 86,332 participants met the eligibility criteria. The meta-analysis revealed that vitamin D insufficiency correlated with a 1.37-fold to 2.06-fold increased odds of developing LUTS and that patients with LUTS had significantly lower levels of vitamin D. [J Urol 2021;205:1584-1594]

In addition, vitamin D intake significantly correlated with an 11-percent decrease in the risk of LUTS. Subgroup analysis revealed the notable effects of vitamin D insufficiency on the risk of LUTS in non-Asians, females, and patients with urinary incontinence.

“In our separate analysis according to research region, we found that non-Asians seemed to be more prone to develop LUTS with vitamin D insufficiency,” the researchers said. “Ethnicity is also an important factor affecting vitamin D status, especially in dark-skinned and African American subgroups.” [Nutr Res Rev 2009;22:188-203]

Moreover, the findings showed that “vitamin D insufficiency seemed to have a stronger impact on LUTS in women than men,” the researchers noted. “Compared with men, women were more inclined to develop pelvic flood dysfunction (PFD), and parity, mode of delivery, and menopause are unique risk factors for urinary incontinence among them.” [Maturitas 2010;65:167-171]

LUTS are common in men and women, resulting in bothersome symptoms particularly among those aged 40 years and above. Recent studies on the pharmacology of LUTS demonstrated the potential role of the vitamin D receptor in future treatment of these symptoms. [Urol Ann 2017;9:170-173; Int J Surg 2016;25:164-171]

Causes of LUTS in male and female patients included prostatic diseases, bladder disorder, and PFD. The potential role of vitamin D on easing LUTS could be due to the former’s interaction with these sites. Of note, vitamin D receptors have been found in muscular layers of the bladder wall, urothelium, prostate, and pelvic floor musculature. [Int Urogynecol J 2015;26:1179-1184; Urol Ann 2017;9:170-173; Eur J Clin Nutr 2016;70:987-989]

“In the future, biological experiments and well-designed prospective studies would provide more conclusive results regarding vitamin D status and LUTS,” the researchers said.

The current study was limited by potential confounders affecting vitamin D and LUTS, substantial heterogeneity between studies, the wide range of symptoms for LUTS, and the distinct outcome variables of randomized controlled trials that were difficult to pool.