| Abstract|| |
Obesity forms a growing challenge in medicine worldwide. In Jordan, the obese and the overweight population form 49.7% of the total population. The latest national male to female ratio in Jordan is 1:1.06. There is a relation between obesity and renal stone formation. This study is conducted to study the relation of renal stone and obesity in the Jordanian population. All patients with urolithiasis that attended the urology clinic at Prince Hussein Bin Abdullah Urology Center at King Hussein Medical Center, Jordan, over the period from January 2006 to January 2011 were included in the study and analyzed for age, gender, body weight, number of visits to the clinic and number of procedures. Over a period of 60 months from January 2006 through January 2011, 8346 patients were treated for urolithiasis. The median age was 43.2 years. The male to female ratio was 1.46:1. 42.3% of the patients were obese, with body mass index (BMI) >30 kg/m 2 and 25.8% of the patients were overweight, with BMI >25 kg/m 2 . The normal body weight population formed 31.9% of the total population. The majority of our urolithiasis patients were obese and overweight, forming 68.1% of the population, with a higher number of clinical visits and higher number of surgical procedures. In the Jordanian population, there is a clear relation between obesity and stone formation, where the majority of stone formers was obese.
|How to cite this article:|
Abu Ghazaleh LA, Budair Z. The relation between stone disease and obesity in Jordan. Saudi J Kidney Dis Transpl 2013;24:610-4
| Introduction|| |
Obesity is a growing epidemic that forms a great challenge regarding diagnosis and treatment in the field of medicine. ,,,,,, Overweight is defined as body mass index (BMI) ≥25 kg/m 2 while obesity is defined as BMI ≥30 kg/m 2 . , The prevalence of overweight and obesity in the United States has reached 61%, of which 30% are obese. , In Jordan, the prevalence of obesity has reached 49.7%, with a higher incidence in women (53.1-59.8%). , The prevalence of obesity in children in Jordan has increased to up to 6.3%,  and it peaks to 24.4% in areas such as the northern parts.  Many studies has shown an increased incidence of stone disease with obesity due to metabolic changes that are associated with increased body weight. ,,,,,,,,,,,, This study aims to analyze the relation of obesity and stone disease in the Jordanian population.
| Materials and Methods|| |
This is a retrospective study that was conducted including all the patients with urolithiasis who attended the clinics at Prince Hussein Bin Abdullah Urology Center and Transplant Center at King Hussein Medical Center, Royal Medical Services, Jordan, during the period from January 2006 through January 201. The Prince Hussein Bin Abdullah Urology Center is the number one tertiary referral center in Jordan and the population presenting to the center can be considered to be representative of the whole country. The patients' age, gender, BMI, number of visits to the clinic and number of surgical interventions were documented and analyzed. The patients were divided into three groups according to body weight. Group A with normal BMI <25 kg/m 2 , group B represents patients who are overweight with BMI between 25 and 30 kg/m 2 and group C represents patients with obesity who had BMI >30 kg/m 2 . Male and female differences in each group were studied. The number of visits to the clinic and the number of surgical interventions performed in each patient were recorded and analyzed.
| Results|| |
Over the period of 60 months from January 2006 to January 2011, 8346 patients were treated for urolithiasis at the Prince Hussein Bin Abdullah Urology and Transplant Center. The median age of the patients was 43.2 years (5-82 years). Four thousand nine hundred and sixty-two (59.4%) of the patients were male and 3384 patients (40.6%) were female, with a male to female ratio of 1.46:1 [Table 1].
The number of patients with a BMI above 30 kg/m 2 (group C) was 3532 (42.3%), patients in group B with BMI between 25 and 30 kg/m 2 was 2152 (25.8%) and the patients with a normal BMI <25 kg/m 2 were 2662 (31.9%) that represented group A [Figure 1].
The obese group consisted of 1751 female patients (51.7% of all females) while the overweight and normal BMI groups comprised 1015 (29.9% of all females) and 618 (18.4%) female patients, respectively. In the males, the obese group comprised 1781 (35.8%) patients while 1137 (22.9%) and 2044 (41.3%) males were overweight and with normal BMI, respectively [Figure 2].
The median age of the patients was 43.2 years (5-82 years). The average age of females in group A was 25.6 years (5-45 years) while the average age for males in the same group was 26.2 years (6-68 years). In group B, the average age of the females was 52 years (23-78 years) while it was 36.7 years (16-52 years) for males. In group C, the average age for females was 48.4 years (17-64 years) while it was 42.1 years (22-72 years) for males [Table 2].
The number of visits to the clinic for group A was 2.3 times per year (two to three per year) while in group B it was 3.7 times/year (two to five per year). In group C, the average number of visits was 3.6 times per year (two to five per year) [Figure 3].
|Figure 3: The average number of clinical visits and operative interventions per year for each group.|
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The average number of surgical interventions for the normal weight group (group A) was 1.8 interventions per year (two to three per year) and for the overweight group (group B) was 3.4 interventions per year (two to five per year). In group C, the obese population, the average interventions was 3.6 per year (two to five per year) [Figure 3]. [Table 3] shows a summary of the above data.
| Discussion|| |
Obesity forms a major health problem with increased risk in morbidity and mortality world-wide. ,,,,,, In Jordan, there has been a marked increase in the incidence and prevalence of overweight and obesity, where it now reaches 49.7%. ,,, In our study, conducted over a period of 60 months from January 2006 through January 2011, all patients presenting to our center with urolithiasis were included in the study. The patients were studied to demonstrate the difference in the incidence of stone formation in relation to increased body weight. The number of patients with stones treated in this period was 8346 patients; 42.3% were obese and 25.8% were overweight, while only 31.9% were of normal body weight.
The number of females was higher in the over-weight and obese groups than the number of males; females with stones and normal body weight in group A formed only 18.4% of the females while males in the same group formed 41.3% of all males [Figure 2]. This finding is similar to the findings in other studies conducted worldwide. ,,, Another significant finding in our study was that the overweight and obese patients had a higher median age group than those with normal BMI in both males and females [Table 2] and [Table 3]).
The obese and overweight patients (groups C and B) formed the majority of our urolithiasis patients (68.1%) although the prevalence of obesity in Jordan is about 49.7%, , which indicates that obesity is associated with increased risk of stone formation.
The number of visits to the clinic was higher in the obese and overweight groups than in the normal population group; the average number of visits was two to five visits per year in the obese and overweight groups while it was two to three visits per year for the normal population. A support to this finding was found in the literature studied where the number of stone episodes was increased in obese patients, especially in women.  The visits were mostly due to pain or recurrent stones.
The number of procedures performed in the overweight and obese patients was slightly higher than the number of procedures performed in the normal weight population. Two to five procedures were performed in the obese group mostly for recurrent stones while one to three procedures were performed for the normal BMI group. This finding was not supported in the literature reviewed for this study. The significance of this finding needs to be evaluated further.
From this study, we find that the incidence of stones is higher in overweight and obese patients. ,,,,,,,,,, This increased incidence may be resulting from certain metabolic changes related to obesity that form an increased risk for stone disease. This issue has been discussed and analyzed in different studies. ,,,,,,,,, Some of the risk factors for stone disease that are associated with obesity include increased urinary excretion of calcium, oxalate, sulfate, phosphate, sodium and uric acid in obese stone formers than in non-obese stone formers. ,,,, A lower urinary volume with lower urinary pH and lower excretion of citrate was also documented as a cause of increased risk factor in obese stone formers. , Other risk factors that cause stone formation also include environmental factors as well as dietary factors such as high protein intake and chronic positive energy balance. This causes increased excretion of urinary lithogenic substances, which are also causative factors of obesity. Many studies have suggested that weight loss will decrease the incidence of stones in the obese population. ,,,,,,,,,,, Other studies have
demonstrated that obese patients have a higher incidence of metabolic syndrome and diabetes mellitus type 2. Therefore, they are more susceptible to urinary tract infections, which by itself may increase the incidence of urolithiasis, and the higher levels of uric acid may make them more prone to an increased incidence of gouty arthritis and uric acid stones. ,,,
From this study, we can conclude that, in the Jordanian population, there is a clear relation between obesity and stone formation. Further studies are needed to prove that reduction in body weight will decrease the incidence of stones in these obese patients.
| References|| |
|1.||Semins MJ, Shore AD, Makary MA, Magnuson T, Johns R, Matlaga BR. The association of increasing Body Mass Index and kidney stone disease. J Urol 2010;183:571-5. |
|2.||Anast JW, Stoller ML, Meng MV, et al. Differences in complications and outcomes for obese patients undergoing laparoscopic radical, partial, or simple nephrectomy. J Urol 2004; 172:2287-91. |
|3.||Mirsa A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 2008;93(11 Suppl 1):S9-30. |
|4.||Fuller A, Razvi H, Denstedt JD, et al. The CROES percutaneous nephrolithotomy global study: Influence of Body Mass Index on outcome. J Urol 2012;188:138-44. |
|5.||Ekeruo WO, Tan YH, Young MD, et al. Metabolic risk factors and the impact of medical therapy on the management of nephrolithiasis in obese patients. J Urol 2004;172:159-63. |
|6.||Sarica K, Altay B, Erturhan S. Effect of being overweight on stone- forming risk factors. J Urol 2007;71:771-4. |
|7.||Sarica K, Eryildirim B, Yencilek F, Kuyumcuoglu U. Role of overweight status on stone-Forming risk factors in children: A prospective study. Pediatr Urol 2009;73:1003-7. |
|8.||Lee SC, Kim YJ, Kim TH, Yun SJ, Lee NK, Kim WJ. Impact of obesity in patients with urolithiasis and its prognostic usefulness in stone recurrence. J Urol 2008;179:570-4. |
|9.||Ajlouni K, Jaddou H, Batieha A. Obesity in Jordan. Int J Obes Relat Metab Disord 1998;22: 624-8. |
|10.||Khader Y, Batieha A, Ajlouni K, El Khateeb M, Ajlouni K. Obesity in Jordan: Prevalence, associated factors, comorbidities, and change in prevalence over ten years. Metab Syndr Relat Disord 2008;6:113-20. |
|11.||Hamaideh SH, Al Khateeb RY, Al- Rawashdeh AB. Overweight and obesity and their correlates among jordanian adolescents. J Nurs Scholarsh 2010;42:387-94. |
|12.||Abu Baker NN, Daradkeh SM. Prevalence of overweight and obesity among adolescents in Irbid governorate, Jordan. East Mediterr Health J 2010;16:657-62. |
|13.||Kim YJ, Ha YS, Jo SW, et al. Changes in urinary lithogenic features over time in patients with urolithiasis. J Urol 2009;74:51-5. |
|14.||Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA 2005;293:455-62. |
|15.||Asplin JR. Obesity and urolithiasis. Adv Chronic Kidney Dis 2009;16:11-20. |
|16.||Charnow JA. Kidney stone disease tied to obesity. J Am Med Assoc 2005;293:455-62. |
|17.||Cheryl Guttman Krader. Obesity's impact on stone risk found greater in women. Urology Times; 2010. http://urologytimes.modernmedicine.com/urology-times/news/modernmedicine/ modern-medicine-news/obesitys-impact-stone-risk-found-greater-women. |
|18.||Brian R. Matlaga. Obesity-Mild or Severe-raises Kidney Stone Risk, John Hopkins Medicine 2010. http://www.hopkinsmedicine. org/news/media/releases/ObesityMild_or_Seve reraises_Kidney_Stone_Risk. |
|19.||Kim SS, Luan X, Canning DA, Landis JR, Keren R. Association between Body Mass Index and urolithiasis in children. J Urol 2011;186:1734-9. |
|20.||Kieran K, Giel DW, Morris BJ, et al. Pediatric urolithiasis-Does Body Mass Index influence stone presentation and treatment? J Urol 2010;184:1810-5. |
|21.||Reinberg S. As obesity rates rise, cases of kidney stones double: Study. Yahoo News release May 25, 2012. |
Lara Alex Abu Ghazaleh
Urology Department, Royal Medical Services, Amman
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]