Association of nocturia and cardiovascular disease: Data from the National Health and Nutrition Examination Survey

Racial Disparities in Nocturia Persist Regardless of BMI Among American Women

IMPORTANCE

It is crucial to understand the racial and ethnic disparities that exist in nocturia prevalence to appropriately manage nocturia.

OBJECTIVES

Nocturia is associated with increased body mass index (BMI) and is most prevalent in Black and Hispanic women, who also have the highest and second highest prevalence of obesity, respectively. We sought to better understand the association of nocturia with BMI category by race and ethnicity in U.S. women.

STUDY DESIGN

This was a cross-sectional study using publicly available data from the National Health and Nutrition Examination Survey data from 2005 to 2018. We estimated the prevalence of moderate to severe nocturia (defined as 2 or more episodes of nighttime urination) by BMI category within each racial and ethnic (Black, White, Hispanic, and other) group of adult women. Logistic regression was performed to determine the odds ratio of nocturia by race.

RESULTS

The odds of nocturia was 2.25 (2.04-2.49) for Black women, 1.27 (1.15-1.4) for Hispanic women and 0.96 (0.82-1.13) for other women compared to White women. After accounting for BMI, socioeconomic status and comorbidities, the adjusted odds ratio was 1.76 (1.42-2.16) for Black women, 1.1 (.0.88-1.38) for Hispanic women, and 0.81 (0.5-1.29) for other women compared to White women.

CONCLUSIONS

Black women were nearly twice as likely to have nocturia than White women. The increased odds of nocturia, while not sustained for Hispanic women, persisted for Black women regardless of socioeconomic status, BMI, and comorbidities. Our study suggests that there are factors other than weight driving the prevalence of nocturia in Black women that require further investigation.

The relationships between blood lead levels and nocturia prevalence in adults: A retrospective study

PURPOSE

The purpose of this study was to examine the association between blood lead levels and the prevalence of nocturia in American adults.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020, focusing on individuals aged 20 years or older (n = 11,919). Blood lead levels were categorized into two groups (<2 µg/dL and ≥2 µg/dL), and the presence of nocturia was assessed based on questionnaire responses. We used multivariable logistic regression models to explore the association between blood lead levels and nocturia while adjusting for various covariates, including sex, ratio of family income to poverty (RIP), lipid profile, age, body mass index (BMI), race, citizenship, sleep trouble, diabetes, and hypertension. To verify whether certain covariates influence blood lead levels and the risk of nocturia, we conducted subgroup analyses.

RESULTS

Of the study participants, 31.70% reported experiencing nocturia. Individuals with higher blood lead levels (≥2 µg/dL) exhibited a higher likelihood of experiencing nocturia compared to those with lower levels (<2 µg/dL) in all three models (Model 1: OR 1.46, 95% CI 1.29-1.66, p < 0.0001; Model 2: OR 1.25, 95% CI 1.09-1.44, p = 0.002; Model 3: OR 1.22, 95%CI 1.06-1.41, p = 0.01). Subgroup analyses revealed that factors such as age, sex, sleep trouble, diabetes, hypertension, BMI, RIP, and race did not affect the association between blood lead levels and the risk of nocturia (P for interaction >0.05).

CONCLUSIONS

This study reported the correlation between blood lead levels and nocturia. We found that compared to blood lead levels below 2 µg/dL, when lead levels reached or exceeded 2 µg/dL, the risk of nocturia occurrence increased by 22%.

CLINICAL TRIAL REGISTRATION

This study is based on existing data from a public database and not from a specific clinical trial; hence, clinical registration information is not provided.

The relationship between nocturia and suicidal ideation: A study on The National Health and Nutrition Survey data

OBJECTIVES

The focus of this research was to explore any potential link between nocturia and the risk of suicidal ideation.

METHODS

Drawing from the National Health and Nutrition Survey, data relating to 25 241 participants was scrutinized. This included 13 421 individuals identifying as male and 11 820 individuals identifying as female. Participants provided information on nocturia and suicidal ideation via self-completed questionnaires. To determine if nocturia was independently related to suicidal ideation, a multivariable logistic regression analysis was employed. Analyses were also undertaken separately for adult males and females.

RESULTS

It was found that around 3.5% of participants had experienced suicidal ideation. The results indicated that nocturia increased the risk for suicidal ideation in all adult groups (odds ratio [OR] = 1.67, 95% confidence interval[CI]: 1.37-2.03, p < 0.0001), including both males (OR = 1.91, 95% CI: 1.38-2.65, p < 0.001) and females (OR = 1.48, 95% CI: 1.158-1.90, p = 0.002). The risk for suicidal ideation increased with the severity of nocturia, with significant trends observed in adult males (p for trend = 0.04) and adult females (p for trend = 0.01). Additionally, subgroup examination showed a significant interaction between nocturia and educational level in adult males (p for interaction = 0.03). Among adult females, a noteworthy interaction was observed between nocturia and body mass index (p for interaction = 0.02).

CONCLUSION

The research uncovered a connection between nocturia and an elevated risk of suicidal ideation.

Prevalence and relevant factors of nocturia and its impact on sleep quality in Chinese university students

The purpose of this study was to investigate the prevalence and relevant factors of nocturia and its impact on sleep quality in university students in Mainland China. A large-scale survey was conducted on 14,000 university students from 3 universities in Henan province, China by using an anonymous questionnaire. The questionnaire collected the information from the past six months. The relationships between the prevalence of nocturia and its relevant factors were evaluated. A total of 13,874 questionnaires were collected and 13,104 qualified for statistical analysis. A total of 659 students suffered from clinically relevant nocturia (CRN) (4.56% in male and 5.34% in female). Both univariate analysis and the logistic stepwise regression model showed that the prevalence of nocturia was significantly related to female, history of enuresis, ease of waking up, urgency, frequency and RUTI (P < 0.05). The sleep quality and the university entrance score of CRN group was significantly lower than that of control group (P < 0.05). Nocturia was common in Chinese university students and showed a negative impact on sleep and academic performance. Gender of female, history of enuresis, ease of waking up, urgency, frequency and RUTI were relevant factors for CRN.

The mediating effect of 24-h time-use behaviors on the relationship between depression and mortality: A compositional mediation analysis for survival outcomes

BACKGROUND

A compositional mediation model of survival outcomes was established to explore whether 24-h time-use behaviors mediate the relationship between depression and mortality.

METHODS

4137 adults from the National Health and Nutrition Examination Survey (NHANES 2005-2006) were followed up to 2019. Cox proportional hazards regression model was used to estimate the total effect of depression on mortality. Compositional data analysis was used to examine the relationship between 24-h time-use compositions and mortality. Furthermore, we constructed a compositional mediation model for survival outcomes to investigate the mediating effect of 24-h time-use behaviors on depression and mortality.

RESULTS

Compared with participants without depression, depressive patients had a significantly higher risk of overall mortality (HR = 1.49, 95 % CI: 1.25,1.79), cardiovascular disease -specific mortality (HR =1.89, 95 % CI: (1.37,2.63)) and mortality from causes other than cardiovascular disease or cancer (HR = 1.62, 95 % CI: (1.25,2.08)). Physical activity, especially moderate-to-vigorous physical activity, significantly mediated the relationship between depression and all-cause and CVD-specific mortality.

LIMITATIONS

Despite being a cohort study, the exposure and mediatiors were measured at the baseline. Further research is necessary to require a temporal order between the exposure and mediating variables.

CONCLUSIONS

Our findings indicate that 24-h time-use behaviors link depression to mortality. In particular, increasing the time spent on physical activity can reduce the risk of death in patients with depression. This finding provides potential interventions for reducing the risk of death in patients with depression.

Pathophysiology of Overactive Bladder and Pharmacologic Treatments Including β3-Adrenoceptor Agonists -Basic Research Perspectives

Overactive bladder (OAB) is a symptom-based syndrome defined by urinary urgency, frequency, and nocturia with or without urge incontinence. The causative pathology is diverse; including bladder outlet obstruction (BOO), bladder ischemia, aging, metabolic syndrome, psychological stress, affective disorder, urinary microbiome, localized and systemic inflammatory responses, etc. Several hypotheses have been suggested as mechanisms of OAB generation; among them, neurogenic, myogenic, and urothelial mechanisms are well-known hypotheses. Also, a series of local signals called autonomous myogenic contraction, micromotion, or afferent noises, which can occur during bladder filling, may be induced by the leak of acetylcholine (ACh) or urothelial release of adenosine triphosphate (ATP). They can be transmitted to the central nervous system through afferent fibers to trigger coordinated urgency-related detrusor contractions. Antimuscarinics, commonly known to induce smooth muscle relaxation by competitive blockage of muscarinic receptors in the parasympathetic postganglionic nerve, have a minimal effect on detrusor contraction within therapeutic doses. In fact, they have a predominant role in preventing signals in the afferent nerve transmission process. β3-adrenergic receptor (AR) agonists inhibit afferent signals by predominant inhibition of mechanosensitive Aδ-fibers in the normal bladder. However, in pathologic conditions such as spinal cord injury, it seems to inhibit capsaicin-sensitive C-fibers. Particularly, mirabegron, a β3-agonist, prevents ACh release in the BOO-induced detrusor overactivity model by parasympathetic prejunctional mechanisms. A recent study also revealed that vibegron may have 2 mechanisms of action: inhibition of ACh from cholinergic efferent nerves in the detrusor and afferent inhibition via urothelial β3-AR.

Association of nocturia of self-report with estimated glomerular filtration rate: a cross-sectional study from the NHANES 2005-2018

Nocturia is a manifestation of systemic diseases, in which chronic kidney disease (CKD) is an independent predictor of nocturia due to its osmotic diuretic mechanism. However, to our knowledge, previous studies have not examined the association between nocturia and estimated glomerular filtration rate (eGFR). The purpose of this study was to assess the association between nocturia exposure and eGFR in the general US population. This study presents a cross-sectional analysis of the general US population enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. To account for potential confounding factors, linear regression analysis was conducted to investigate the association between nocturia and eGFR. Stratified analyses and interaction tests were employed to examine the variables of interest. Additionally, sensitivity analyses were conducted across diverse populations. A total of 12,265 individuals were included in the study. After controlling for confounding factors, the results of the linear regression analysis indicated that a single increase in nocturnal voiding frequency was associated with a decrease in eGFR by 2.0 mL/min/1.73 m2. In comparison to individuals with a nocturnal urinary frequency of 0, those who voided 1, 2, 3, 4, and ≥ 5 times at night experienced a decrease in eGFR by 3.1, 5.4, 6.4, 8.6 and 4.0 mL/min/1.73 m2, respectively. Nocturia was found to be associated with a decreased eGFR of 4 mL/min/1.73 m2 when compared to individuals without nocturia. The sensitivity analysis yielded consistent findings regarding the association between nocturia and eGFR in both CKD and non-CKD populations, as well as in hypertensive and non-hypertensive populations. Nevertheless, inconsistent conclusions were observed across various prognostic risk populations within the CKD context. The presence of nocturia and heightened frequency of nocturnal urination have been found to be associated with a decline in eGFR.

Relationship between nocturia and hypertension: findings from the NHANES 2005-2016

Objectives

The objective of this study was to explore the association between nocturia and hypertension in a large, nationally representative adult sample.

Methods

We used data from 2005 to 2016 National Health and Nutritional Examination Surveys (NHANES). A total of 29,505 participants aged 20 years old or older were included. A participant was considered to have nocturia if he or she had two or more voiding episodes at night. Multivariable logistic regression models were used to explore the association between nocturia and hypertension.

Results

Participants with nocturia were associated with a higher risk of hypertension (OR, 1.36; 95% CI, 1.28-1.45). Interaction tests revealed no significant effect of sex, age, race, or body mass index on the association of nocturia with hypertension. As the severity of nocturia increases, the risk of hypertension increases (P for trend <0.0001). In addition, nocturia was also related to different grades of hypertension (II vs. I: OR, 1.34, 95% CI, 1.16-1.55; III vs. I: OR, 1.67, 95% CI, 1.32-2.13).

Conclusion

In this cross-sectional study, our results suggest that nocturia is associated with an increased risk for hypertension.

Association between nutrient patterns and hyperuricemia: mediation analysis involving obesity indicators in the NHANES

Background

Diet has long been hypothesized to play an important role in hyperuricemia, and weight gain is a factor that is strongly associated with the rise in serum urate. We aimed to clarify the mediating role of obesity in the relationship between diet and hyperuricemia and to determine whether a weight-loss diet is an effective way to prevent hyperuricemia.

Methods

This cross-sectional study analysed representative samples of United States (n = 20,081; NHANES 2007–2016) adults. Nutrient patterns were derived with two methods: principal component analysis (PCA) and reduced rank regression (RRR) with obesity. Logistic regression and multivariable linear regression were applied to analyse the association between nutrient patterns in obesity and hyperuricemia. Mediation analyses were used to determine whether four obesity indicators, including body mass index (BMI), waist circumference (WC), visceral adiposity index (VAI) and lipid accumulation product index (LAP), mediated the relationship between nutrient patterns and hyperuricemia.

Results

PCA revealed three nutrient patterns (including “Low energy diet”, “Lower vitamin A, C, K pattern” and “Vitamin B group”), and only Vitamin B group had a total effect on hyperuricemia. RRR revealed one main nutrient pattern associated with obesity, which was characterized by High fat and low vitamin levels and was significantly associated with hyperuricemia. Mediation analysis showed that obesity mostly or even completely mediated the relationship between nutrient patterns and hyperuricemia, especially traditional obesity indicators, which played a key intermediary effect. The proportions of indirect effects for BMI and WC were as high as 53.34 and 59.69, respectively.

Conclusions

Our findings suggest that the direct effect of diet on hyperuricemia is weak, and obesity plays a critical mediating role in the relationship between diet and hyperuricemia, which confirms that a weight-loss diet such as a “Low fat and high vitamin diet” may be useful in preventing hyperuricemia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14357-5.

Urination Frequency Ranges in Healthy Women

BACKGROUND

Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts.

OBJECTIVES

This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake.

METHODS

A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake.

RESULTS

Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies.

DISCUSSION

Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.

The Relationship Between Nocturia and Mortality: Data From the National Health and Nutrition Examination Survey

Purpose

We investigated the relationship between nocturia and mortality risk in the United States.

Methods

Data were obtained from the National Health and Nutrition Examination Survey 2005–2010. Mortality data were obtained by linking the primary database to death certificate data found in the National Death Index with mortality follow-up up to December 31, 2015. Nocturia was defined based on symptoms reported in the symptom questionnaire. We categorized patients into 2 groups: mild nocturia (2–3 voids/night) and moderate-to severe nocturia (≥4 voids/night). Multiple Cox regression analyses were performed with adjustment for confounding variables at the baseline survey.

Results

This study included 9,892 adults (4,758 men, 5,134 women). Nocturia occurred in 3,314 individuals (33.5%). Nocturia was significantly associated with all-cause mortality (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.10–1.39) and cardiovascular disease (CVD) mortality (HR, 1.55; 95% CI, 1.19–2.01). Moreover, the mortality risk increased with increasing nocturia severity. Further analysis with propensity score matching showed that nocturia was still significantly associated with all-cause mortality and CVD mortality. In subgroup analysis according to sex, nocturia was significantly associated with allcause mortality and CVD mortality in men. In women, moderate-to-severe nocturia was significantly associated with allcause mortality and CVD mortality. In subgroup analysis according to cardio-metabolic diseases, nocturia was associated with CVD mortality in patients with diabetes mellitus, hypertension, dyslipidemia, or CVD at baseline. In subgroup analysis of patients without diabetes mellitus, hypertension or CVD, nocturia was significantly associated with all-cause mortality.

Conclusions

Nocturia was significantly associated with mortality in men and women after adjusting for major confounding factors.