The relationships among physical activity, smoking status, alcohol intake, body mass index (BMI), and stress (all of which are factors considered relevant to LUTS) and living habits were comparatively analyzed through a survey targeting a large sample of respondents residing in different regions of South Korea.

We analyzed raw data from the Korean Community Health Survey (KCHS) performed by the KCDC from August to November 2011. This survey targets South Koreans older than 19 years of age and was performed based on 1:1 direct interviews using Computer Assisted Personal Interviewing (CAPI). At the nationwide level, the survey targeted a total of 229,226 respondents. It comprises a total of 247 question items in 18 areas including household survey, health condition, preventive vaccination, disease contraction, social, physical environment, and education. Local community health surveys targeted 229,226 respondents and men were 103,017 individuals. Aged over 40 years of men was 73,643, excluding 1,002 whose question items were not completed (who refused answering questions or not answering over one question), 8,006 were incomplete and complete of doctor-diagnosed BPH and current-treatment status, and 196 were incomplete status of BPH treatment (include refused to answer) leaving a final sample of 64,439 respondents. We surveyed South Korean males (64,439) who were 40 years of age or older and conducted interviews with questionnaires. Trained interviewers performed face-to-face surveys of sociodemographic questionnaires using CAPI, International Prostate Symptom Score (IPSS), and standard questions. We assessed life style factors (physical activity, cigarette smoking, alcohol intake, height, weight, and stress) with LUTS.

We observed higher IPSS in the no-exercise group (n=6,008 (74.3%), IPSS = 3.19±5.36) compared to the severe physical activity group (n = 10,657 (16.4%), IPSS = 2.28±4.15). Former smokers showed the highest IPSS total, storage, and voiding symptom scores compared to current smokers and non-smokers. Non-alcohol-drinkers had higher IPSS than current alcohol drinkers. In the low weight group, mild LUTS severity was less common than in the normal weight and overweight groups at 71.1%, and severe LUTS was the highest compared with the normal weight and overweight group (25.81±4.87, 167(7.8%), p<0.0001). When analyzing LUTS based on stress level, the group reporting hard stress showed higher average IPSS ( 3.38±5.77 vs. 2.88±4.90) than those who felt slight or no stress. In multivariable logistic regression, correlations with physical activity, the less exercise an individual engaged in, the higher the correlation with LUTS while the risk of increased severity was also high (moderate: OR=1.11, 95%CI (1.11, 1.11), p<0.0001, severe: OR=1.14, 95%CI (1.14, 1.14), p<0.0001). In both former and current smokers, correlations with LUTS were high (former smoker: OR=1.28, 95% CI (1.28, 1.28), <0.0001, current smoker: OR= 1.18, 95% CI (1.18, 1.18), <0.0001). Among those with severe LUTS, former smokers exhibited the same risk as non-smokers but risk was higher among current smokers (current smoker: OR= 1.2, 95% CI (1.2,  1.2), <0.0001).  we detected no relationships between LUTS and current alcohol drinking in the moderate and severe IPSS groups compared to the mild group (moderate: 0.91, 95% CI (0.91, 0.91), p<0.0001, severe: 0.78, 95% CI (0.78, 0.78), p<0.0001). The moderate to severe stress group showed higher IPSS compared to the no stress to mild stress group in total IPSS ( 3.38±5.77 vs. 2.88±4.90 ) with stronger relationships with LUTS in the moderate and severe IPSS groups. Storage and voiding symptoms showed stronger relationships with the moderate and severe stress groups compared to the mild stress group in logistic regression.

Physical activity was correlated with LUTS and exhibited particularly close correlations with voiding symptoms compared to storage symptoms. In an analysis of smoking status, former smokers and current smokers were more likely to report LUTS than non-smokers and correlations between LUTS and voiding symptoms were much higher than with storage symptoms. Alcohol drinking status and LUTS were not correlated. Underweight individuals were more likely than obese individuals to report LUTS. Stress was correlated with LUTS and the correlation increased with severity of stress.

A history of smoking, low levels of physical activity, low BMI, and moderate to severe stress were associated with LUTS deterioration. Moderate to severe stress was also related to voiding symptoms. However, there was no association between alcohol intake and LUTS deterioration.

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