Insulin Resistance Is Associated with Prevalence of Physician-Diagnosed Urinary Incontinence in Postmenopausal Non-Diabetic Adult Women: Data from the Fourth Korea National Health and Nutrition Examination Survey

Correlation Between Insulin Resistance and Urinary Incontinence in Female Patients with Type 2 Diabetes Mellitus

INTRODUCTION AND HYPOTHESIS

Patients with type 2 diabetes mellitus (T2DM) are at a high risk of developing urinary incontinence; however, its pathogenesis is unclear. The purpose of this study is to explore the relationship between insulin resistance and urinary incontinence and its severity in female patients with T2DM.

METHODS

A total of 366 women with T2DM aged ≥18 years were enrolled in this study. Insulin resistance was evaluated by the homeostasis model insulin resistance (HOMA-IR) index and urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). All subjects were divided into four groups according to HOMA-IR quartiles. Logistic regression analysis was performed to investigate the relationship between insulin resistance and urinary incontinence and its severity.

RESULTS

Among the 366 patients, 186 (50.8%) had urinary incontinence. The prevalence of urinary incontinence increased significantly with HOMA-IR quartiles (p < 0.001). Adjusted logistic regression analysis showed that compared with HOMA-IR ≤ 1.76, 2.81 ≤ HOMA-IR ≤ 4.27 was associated with a significantly increased risk of moderate incontinence (OR = 2.197, 95% CI 1.031-4.683, p = 0.041), and HOMA-IR ≥ 4.28 was associated with a significantly increased risk of severe incontinence (OR = 5.699, 95% CI 1.685-19.276, p = 0.005). Binary logistic regression analysis showed that HOMA-IR was the independent risk factor for urinary incontinence (p < 0.001).

CONCLUSIONS

Higher levels of insulin resistance are associated with urinary incontinence and its severity in female patients with type 2 diabetes mellitus.

The association between the metabolic score for insulin resistance (METS-IR) index and urinary incontinence in the United States: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018

BACKGROUND

The association between insulin resistance and urinary incontinence (UI) has not been investigated widely. The purpose of this study is to assess the relationship between a novel indicator for assessing insulin resistance the metabolic score for insulin resistance (METS-IR) index and urinary incontinence (UI).

METHODS

This study utilized data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression models were conducted to explore the association of METS-IR index with three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. Smooth curve fitting was utilized to investigate the linear relationship. Subgroup analysis was used to examine the stability of the connection between METS-IR index and UI in different stratifications.

RESULTS

A total of 17,474 participants were included in this study, of whom 23.76% had SUI, 20.05% had UUI, and 9.59% had MUI. METS-IR index was positively associated with three types of UI with full adjustment [SUI: odds ratio (OR) = 1.023, 95% confidence interval (CI) 1.019-1.027; UUI: OR = 1.015, 95% CI 1.011-1.019; MUI: OR = 1.020, 95% CI 1.016-1.025, all p < 0.001]. After transferring METS-IR index into a categorical variable by quartiles, the positive connection between METS-IR index and UI was still observed in the highest METS-IR group compared to the lowest METS-IR interval (SUI: OR = 2.266, 95% CI 1.947-2.637, p < 0.001; UUI: OR = 1.534, 95% CI 1.344-1.750, p < 0.001; MUI: OR = 2.044, 95% CI 1.707-2.448, p < 0.001). The analysis of smooth curves fitting showed that METS-IR index was positively linearly related to three types of UI. Moreover, the association between METS-IR index and SUI was more significant in females compared to males (p for interaction < 0.05).

CONCLUSION

An elevated METS-IR index was related to increased risks of three types of UI (SUI, UUI, and MUI) in the United States population. METS-IR index was more significantly connected to SUI in females than males. The association between insulin resistance and UI needs to be explored with more studies.

Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review

Pelvic floor dysfunction is one of the most common disorders in women that is associated with social and economic consequences. In general, this disorder imposes direct and indirect costs on the economy of various societies. This review aimed to investigate pelvic floor dysfunction in women with polycystic ovary syndrome (PCOS). In this narrative review, the published articles on pelvic floor dysfunction were examined in PubMed, Scopus, Web of Sciences and Google Scholar. We searched for terms related to polycystic ovary syndrome and pelvic floor dysfunction. Inclusion criteria of this research were observational, experimental, and review studies. In this investigation, the complications associated with polycystic ovary syndrome were examined as risk factors for pelvic floor dysfunction. In this narrative review, we discuss about changes in hormone levels, obesity and overweight, hormonal medications and complications such as diabetes and metabolic disorders and obstetric complications of PCOS can be involved in the pathophysiology of pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse in women with PCOS. This review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS. Further cohort and prospective studies are recommended in women with PCOS to investigate the concept of pelvic organ dysfunction in these women.

Effects of low-frequency intravaginal electrical stimulation on female urinary incontinence, quality of life, and urinary symptoms: A pilot study

This study investigated the effects of a low-frequency home-based incontinence therapy device on quality of life (QoL) and urinary symptoms in women with urinary incontinence. From May 2017 to February 2018, 34 patients, aged ≥ 20 years, with involuntary urine leakage >2 times/week, were recruited to this study. Patients with severe pelvic organ prolapse, pregnancy, virgin status, and psychological problems were excluded. The incontinence home-care device treatments were administered in 12-minute sessions, twice daily for 8 weeks. Simultaneously, hyperthermic conditions of 35°C to 40°C and microvibrations were administered. All patients completed urinary incontinence questionnaires (King's Health Questionnaire [KHQ], Bristol Female Lower Urinary Tract Symptoms [BFLUTS] questionnaire, and the Overactive Bladder Symptom Score [OABSS]) before treatment, as well as 4 and 8 weeks into treatment. Changes in the questionnaire responses over time were compared. Two participants dropped out of the study and there was one screening failure, leaving 31 patients for analysis. After 4 weeks treatment, there were significant improvements in symptoms, such as role limitation, physical limitation, social limitation, personal relationship, emotion, sleep/energy, and severity measures. After 8 weeks treatment, almost all parameters on the KHQ revealed symptomatic improvement. On the BFLUTS, voiding times during activity, nocturia, urgency, urge incontinence, incontinence frequency, stress incontinence, volume leakage, strain to start, intermittency, reduced stream, acute retention, incomplete emptying, and stopping flow showed significant improvements. On the OABSS, almost all storage symptoms improved. Low-frequency electrical stimulation devices were effective at improving urinary incontinence, which became evident as the duration of treatment increased. Improvement of urgency and frequency was more evident after treatment.

Female urinary incontinence and obesity assessed by anthropometry and dual-energy X-ray absorptiometry: Analysis from the 2008-09 Korean National Health and Nutrition Examination Survey

OBJECTIVE

In the present study we evaluated the association between obesity, assessed by dual energy X-ray absorptiometry (DEXA), and urinary incontinence (UI).

METHODS

The study was performed on 5792 women who had taken part in the Korean National Health and Nutrition Examination Survey. UI was deemed to be present if a woman answered "yes" to the question "Do you have current UI?". Obesity was assessed using anthropometry and DEXA. Data were analyzed using Chi-squared tests, t-tests, receiver operating characteristic curves, and logistic regression analysis.

RESULTS

The UI group had significantly higher mean (±SD) waist circumference (78.5 ± 10.0 vs, 82.4±9.1 kg) and body mass index (23.3 ± 3.4 vs. 24.2 ± 3.1 kg/m² ) than the non-UI group. In addition, total fat mass (18.5 ± 5.3 vs. 19.4 ± 4.9 kg), trunk fat mass (9.3 ± 3.4 vs. 10.1 ± 3.2 kg), the trunk fat/leg fat (mass) ratio (1.58 ± 0.54 vs. 1.73 ± 0.50), total body fat percentage (32.3 ± 5.4% vs. 33.0 ± 5.0%), and trunk fat percentage (32.4 ± 7.3% vs. 33.9 ± 6.6%) were significantly higher in the UI group. Of these parameters, the trunk fat/leg fat ratio showed highest sensitivity (83.6%), with a cut-off value of 1.272. Before and after adjustment, trunk fat/leg fat ratio >1.272 was significantly related to UI and had the highest odds ratio (OR) among all DEXA parameters (adjusted OR 1.807; 95% confidence interval 1.343-2.431).

CONCLUSION

Obesity parameters obtained using DEXA are closely related to UI. Of these parameters, the trunk fat/leg fat ratio is the strongest in predicting the presence of UI. In addition, the present study has found a novel trunk fat/leg fat ratio cut-off value for defining obesity related to the UI.

Metabolic syndrome in menopause and associated factors: a meta-analysis

OBJECTIVE

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes. Menopause is associated with an increased risk for MetS. The purpose of this meta-analysis is to better understand the relationship between MetS and menopause.

METHODS

MEDLINE and EMBASE were searched for all the associated articles on (1) MetS components in postmenopausal women vs. premenopausal women, (2) comparison of MetS incidence between surgical menopause and natural menopause, (3) the effect of hormone therapy (HT) with 17β-estradiol (E2) compared to conjugated equine estrogen (CEE) on MetS components among postmenopausal women. A meta-analysis was applied by Review Manager 5.3 software.

RESULTS

All comparable indicators were significantly unfavorably changed in postmenopausal women compared to premenopausal women except for high density lipoprotein cholesterol. Women who underwent surgical menopause suffered a 1.51-fold higher risk for MetS compared to those with natural menopause. HT with E2 provided more benefits for levels of triglyceride and diastolic blood, while CEE showed a better effect on both high and low density lipoprotein cholesterol levels.

CONCLUSIONS

Menopause nearly adversely affects all components of MetS, and surgical menopause may lead to a higher incidence of MetS compared to natural menopause. HT with various preparations may have different effects on MetS components. These results may clarify the management of menopause-related MetS in clinical practice.

Urinary incontinence is associated with the development of peptic ulcers in adult women: Data from the KNHANES IV

The aim of this study was to investigate the association between urinary incontinence (UI) and peptic ulcer (PU) and how this is related to psychological stress in Korean women by analyzing the data from the Korea National Health and Nutrition Examination Survey IV (KNHANES).A nationally representative sample of data on 7475 Korean women ≥19 years of age from the KNHANES 2008 to 2010 was included. Physician-diagnosed UI and PU were assessed using questionnaires and surveys. Psychological stress was assessed through a questionnaire using a 4-point Likert scale. Data were analyzed using logistic regression to determine the association between UI and PU according to the level of psychological stress perception.PU was found in 1.41% of the total population. Breaking this down by the existence of UI, PU was found in 3.5% of the population with UI, and 1.4% of the population without UI, which showed a significant difference. A statistically significant trend for increasing prevalence of UI and PU with increasing psychological stress perception levels was found among the study population. Multivariable logistic regression analyses for PU showed that UI was significantly associated with a higher probability of PU in an adjusted model, which means that members of the population with UI were more likely to have PU than those without UI. A higher level of psychological stress perception was also significantly associated with increased odds of PU in the adjusted model.UI could potentiate the development of PU through increasing levels of psychological stress perception.

Nutrient intake and urinary incontinence in Korean women: A propensity score-matched analysis from the Korea National Health and Nutrition Examination Survey data

OBJECTIVES

To evaluate the relationship between dietary nutrients and female urinary incontinence using nationally representative data from Korea.

METHODS

We included 8090 women aged >20 years who had participated in the Korea National Health and Nutrition Examination Survey IV. We carried out a propensity-matched study by identifying women with urinary incontinence. Women without urinary incontinence, matched for age, body mass index, menopause, delivery history, hypertension, diabetes, hypercholesterolemia, stroke, asthma, chronic obstructive pulmonary disease and amount of total food intake, were included as a control group at a 2:1 ratio (661 women with urinary incontinence; 1322 women without urinary incontinence). Data were analyzed using the χ² -test, Mann-Whitney test, Fisher's exact test and logistic regression.

RESULTS

Following propensity score matching, 661 women with urinary incontinence and 1322 women without urinary incontinence were included; the confounders were evenly dispersed and did not differ significantly between the groups. There was no significant difference in the intake of water, fat, protein, calcium, phosphorus, iron, sodium, potassium, vitamin A, carotene, riboflavin, niacin and vitamin C. However, carbohydrate intake was significantly higher in the urinary incontinence group than in the control group (median [interquartile range]: 282.3 g/day [214.7; 352.0] vs 267.7 g/day [212.6; 339.1]; P = 0.041).

CONCLUSION

High carbohydrate intake seems to be significantly related to female urinary incontinence in the Korean population.