ORIGINAL ARTICLE Bali Medical Journal (Bali Med J) 2017, Volume 6, Number 1: 204-210 P-ISSN.2089-1180, E-ISSN.2302-2914 204 Open access: www.balimedicaljournal.org and ojs.unud.ac.id/index.php/bmj CrossMark Published by DiscoverSys 1 Endocrinology Division 2 Department of Internal Medicine, Udayana School of Medicine, Sanglah General Hospital, Denpasar, Indonesia 3 Hematology and Oncology Division, Department of Internal Medicine, Udayana School of Medicine, Sanglah General Hospital, Denpasar, Indonesia 4 Urology Department, Udayana School of Medicine, Sanglah General Hospital, Denpasar, Indonesia 5 Faculty of Mathematic and Natural Science, Udayana University, Denpasar, Indonesia 6 Neurosurgery Department, Udayana School of Medicine, Sanglah General Hospital, Denpasar, Indonesia * Correspondence to: Wira Gotera, Endocrinology Division wiragotera@yahoo.co.id Received:  2016-02-7 Accepted: 2017-03-07 Published: 2017-03-10 ABSTRACT Infammation in abdominal obesity (Ab-Ob) is associated with insulin resistance condition and hyperinsulinemia. Numerous studies have found that prevalence of prostatic hyperplasia was higher in individuals with central obesity. This study is aimed at testing and verifying whether and to what extent waist circumference (WC), interleukin-6 (IL-6), and insulin resistance (HOMA-IR) increase the risk of benign prostatic hyperplasia (BPH) in Ab-Ob. The study design was match-paired case-control. Eighty patients were recruited for this study. Data analysis was done with student t-test, multivariate logistic regression analysis, and path analysis. IL-6 was measured with sandwich enzyme immunoassay with Quantikine Immunoassay Kit (R&D System, Inc. USA), hsCRP was measured with the immunometric assay, and fasting insulin level was measured with Chemiluminescence Immunometric method (Immulite ®2000). From multivariate logistic regression analysis, we found that WC, IL-6, and HOMA-IR increase the risk of BPH significantly with an odds ratio (OR) value of 1.09 (IK = 1.03–1.15), p = 0.005; 1.69 (IK = 1.10–2.58), p = 0.015; and 1.37 (IK = 1.05–1.79), p = 0.021, respectively. Path analysis showed the existence of a significant relationship between WC and BPH (critical ratio [CR] = 2.87, p = 0.004), between WC and IL-6 (CR = 5.9, p < 0.001), and between WC and HOMA-IR (CR = 3.87, p ≤ 0.001). There was a significant correlation between HOMA-IR and BPH (CR = 2.07, p = 0.039), between IL-6 and BPH (CR = 2.19, p = 0.029), and also an indirect relationship between WC and BPH through the increase of IL-6 and HOMA-IR. We concluded that WC increased the risk of BPH through the increase of IL-6 and HOMA-IR in abdominal obesity patient. Keywords: Waist Circumference, IL-6, HOMA-IR, Benign Prostatic Hyperplasia Cite This Article: Gotera, W., Mahadita, W., Bakta, I.M., Oka, A.A.G., Budiartha, A.A.G., Manuaba, P., Maliawan, S. 2017. Waist circumference increased risk of benign prostatic hyperplasia through an increase in the level of interleukin-6 and insulin resistance in abdominal obesity patients. Bali Medical Journal 6(1): 204-210. DOI:10.15562/bmj.v6i1.464 INTRODUCTION Obesity pandemic, particularly abdominal obesity (Ab-Ob), has become a global threat. Ab-Ob is ofen found simultaneously with another symp- tom, known as metabolic syndrome (MS), which is another risk factor for cardiovascular disease (CVD). Ab-Ob acts as a fundamental principle in the clinical course of MS as a risk factor for CVD. Data from WHO in 2014 showed that more than 1.9 billion people were overweight. Out of this, 200 million men and 300 million women sufered from obesity. 1 Overall, more than 10% of world population is obese. MS is mostly found in India due to high prevalence of Ab-Ob, with 1.091 people out of 100 and afected men and women constitut- ing 8% and 18% in this group. 2 Aside from the constellation of risk factors giving rise to DM and CVD, MS or its component, particularly Ab-Ob, insulin resistance was asso- ciated with a degenerative disease called benign prostate hyperplasia (BPH). 1,3 BPH is one out of three degenerative diseases that is most commonly found in men (aside from hypogonadism and erec- tile dysfunction). As much as 15% of men age above 40 years were found with prostate disorders and prostatitis and as much as 20–40% among those also sufered BPH. Ab-Ob is associated with a low-grade chronic systemic infammatory condition, mobilization of macrophage infltration to fat tissue, and an increase of pro-infammatory cytokines such as TNF-α, IL-6, and CRP which are involved in insu- lin resistance and BPH pathogenesis. Secondary hyperinsulinemia due to insulin resistance has been thought to have association with clinical manifes- tation of lower urinary tract symptoms (LUTS). Hyperinsulinemia is associated with an increase in sympathetic nerve activity, increasing prostate’s sympathetic nerve tone and aggravating LUTS. Te focus of studies nowadays is limited to analyzing the metabolic efect of insulin, even Waist circumference increased risk of benign prostatic hyperplasia through an increase in the level of interleukin-6 and insulin resistance in abdominal obesity patients Wira Gotera, 1* Wira Mahadita, 2 I. Made Bakta, 3 A.A. Gde Oka, 4 A.A.G. Budiartha, 1 Putra Manuaba, 5 Sri Maliawan 6