Effect of obesity and metabolic health on urolithiasis: A nationwide population-based study

Abstract

Purpose: To investigate the risk of symptomatic urolithiasis requiring surgical treatment according to obesity and metabolic health status using a nationwide dataset of the Korean population.

Materials and methods: Of the 5,300,646 persons who underwent health examinations between the year 2009 and 2016, within one year after the health examination, 35,137 patients who underwent surgical treatment for urolithiasis were enrolled. Participants were classified as "obese" or "non-obese" using a body mass index (BMI) cutoff of 25 kg/m². People who developed ≥1 metabolic disease component in the index year were considered "metabolically unhealthy", while those with none were considered "metabolically healthy".

Results: Out of 34,330 participants excluding 843 missing, 16,509 (48.1%), 4,320 (12.6%), 6,456 (18.8%), and 7,045 (20.5%) subjects were classified into the metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) group, respectively. Mean BMI was 22.1±1.9 kg/m², 22.9±1.6 kg/m², 26.9±1.8 kg/m², and 27.9±2.4 kg/m² respectively. After adjusting the age and sex, the subjects in the MUNO group had an HR (95% CI) of 1.192 (1.120-1.268), those in the MHO group, 1.242 (1.183-1.305), and those in the MUO group, 1.341 (1.278-1.407) for either extracorporeal shockwave lithotripsy or surgery, compared to those in the MHNO group.

Conclusions: Metabolically healthy, obese individuals have a higher risk of developing symptomatic urolithiasis than non-obese, unhealthy, but have a lower risk than obese, unhealthy. It suggests that metabolic health and obesity have collaborative effects, independently affecting the development of symptomatic urinary stone diseases.

Keywords: Diabetes mellitus; Insulin resistance; Metabolic syndrome; Obesity; Urolithiasis.

Fig. 1. Flow diagram of study subjects. MUNO, metabolically unhealthy non-obese; MHNO, metabolically healthy non-obese; MUO, metabolically unhealthy obese; MHO, metabolically healthy obese; BMI, body mass index; MH, metabolically healthy; MU, metabolically unhealthy; DM, diabetes mellitus; HTN, hypertension.

Fig. 2. Distribution of study population according to body mass index and metabolic health status. MHNO, metabolically healthy non-obese; MUNO, metabolically unhealthy non-obese; MHO, metabolically healthy obese; MUO, metabolically unhealthy obese.