IS OBESITY REALLY ASSOCIATED WITH LOWER URINARY TRACT DYSFUNCTION IN CHILDREN?
Ubirajara Barroso, Jr., M.D.1, Luis gustavo Fraga, Medical Studentcal Student2, Isabela W. Carvalho, Medical Student3, Ana Aparecida M. Braga, Psychologist2, Ney Boa-Sorte, M.D.1, José Murillo B. Netto, M.D.3.
1Federal University of Bahia, Bahiana School of Medicine, Salvador, Brazil, 2Bahiana School of Medicine, Salvador, Brazil, 3Federal University of Juiz de Fora, Juiz de Fora, Brazil.
BACKGROUND- Studies have been demonstrating that obese children have lower urinary tract dysfunction (LUTD). However, no one has control it for constipation. The aim of this study is to evaluate the relationship between obesity and overweight with lower urinary tract dysfunction (LUTD) in healthy children in a population-based study.
Methods: We selected children randomly in public spaces and schools and applied to them the DVSS LUTD diagnosis, added to a question about bedwetting and the questionnaire ROME III for constipation. We calculated the body mass index and ranked it in normal, risk of overweight, overweight and obesity, according to WHO. Questionnaires were completed by children with mother's help. The boys and girls who had a score equal to or greater than 9 or 6 in DVSS, respectively, were classified as positive for LUTD. Two or more points on the Rome III was considered constipation. Nocturnal enuresis (NE) was classified as mono (MSNE) or non-monosymptomatic (NMNE) enuresis according the presence or not of daytime urinary symptoms.
Results: The prevalence of LUTD was 7.1%, with 13,5% of overweigh and 12.1% of obesity. Constipation and enuresis were observed in 5.9% and 10.8% of the participants, respectively. In the univariate analysis, obesity (OR:2.88 [95%CI:1.31-6.35]), female gender (OR:4.88 [95%CI:1.91-12.51]), enuresis (OR:5.04 [95%CI:2.55-9.97]), constipation (OR:5.79 [95%CI:2.87-11.67]) and age less than 10 years (RP:3.04 [95%CI:1.38-6.67]) were associated with LUTD. In the multivariate analysis, stratified by gender, we found that for boys only constipation was independently associated with LUTD (OR:6.00 [95%CI:1.01-35.59]), when adjusted for obesity, enuresis and age. Among the girls, constipation (OR:4.80 [95%CI:1.87-12.33]), and enuresis (RP:3.83 [95%CI:1.59-9.23]) were independently associated with LUTD, when adjusted for obesity and age.
Conclusion: Obesity was not associated with LUTD when it was adjusted for age, enuresis and constipation in boys and girls. Enuresis and constipation were associated with LUTD in girls and only constipation had this association in boys. The association between obesity and LUTD previously described in the literature seems to be resulted of the presence of constipation as a confounding factor.
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