The overall prevalence of nocturia (≥2 voids/night) was 5.8%, and prevalence was higher in older age groups. In the multivariate analysis, a significant relationship was found between nocturia and the following factors: age, male gender, low BMI (<18.5) and high BMI, high blood pressure, and impaired glucose tolerance. We

also analyzed the relationship between nocturia and the number of components of MetS. The risk for nocturia significantly increased with a higher number of MetS components. The ORs of nocturia for those with two, three or four components of MetS were 1.4, 1.6, and 2.3, respectively, compared to those without MetS components (P < 0.05).39 The results were adjusted for age and gender. Our results indicate that nocturia can be a diagnostic marker not only of MetS, but also of the precursor mTOR inhibitor of MetS. In a previous study, a relationship between autonomic hyperactivity and MetS was proposed.40 Aging, physical inactivity, increased BMI, and hyperinsulinemia result in autonomic hyperactivity, which may lead to LUTS or nocturnal frequency.40 In addition,

nocturia is strongly associated with nocturnal polyuria. Many MetS-related factors, such as congestive heart failure, venous insufficiency, nephrosis, or late-night diuretic administration are potential underlying causes of nocturnal polyuria.1 The individual components of MetS and other risk factors AZD3965 datasheet seem to contribute to the risk of nocturia both individually and in combination. But it is not clear how these risk factors interact with each other. “Metabolic domino” (Fig. 1) may help to explain how metabolic factors tend to cluster together and increase nocturia.41 Metabolic domino is a new concept, which has been proposed to capture the flow of events NADPH-cytochrome-c2 reductase and chain reactions associated with cardiovascular risk.41 These dominos include many causes of nocturia. The components of MetS, obesity, diabetes, HT, and dyslipidemia, are not mutually exclusive, but could interact with each other. Therefore, during progression of metabolic domino, nocturia (or nocturnal polyuria) may increase. As such, nocturia may also be a marker for progression

of MetS. These hypotheses need further study for confirmation. It is recommended that individuals with MetS be targeted for therapeutic lifestyle changes, which consist mainly of increases in physical activity and improvement in diet.42 In this early stage of metabolic domino, nocturia could respond to therapeutic lifestyle changes. Soda reported that lifestyle modification, including moderate exercise and fluid restriction, is effective for patients with nocturia, especially those with nocturnal polyuria, in a prospective pilot study (53.1% of patients improved).43 When obesity or diabetes occurs and dominos are simultaneously toppled, nocturia may increase and be difficult to treat. In this stage, men with nocturia often have multiple risk factors for nocturia.