Gender differences in the effect of obesity on chronic diseases among the elderly Koreans

Weight-adjusted-waist index is positively associated with urinary incontinence: results from the National Health and Nutrition Examination Survey (NHANES) 2001-2018

BACKGROUND

Urinary incontinence (UI) is closely related to obesity. The aim of this study is to evaluate the association of a novel anthropometric indicator weight-adjusted-waist index (WWI) with UI.

METHODS

This cross-sectional study used the data from National Health and Nutrition Examination Survey (NHANES) 2001-2018. Weighted multivariable logistic regression was used to evaluate the relationship between WWI and three types of UI [stress UI (SUI), urgency UI (UUI), and mixed UI (MUI)]. The receiver operating characteristic (ROC) curve and Delong et al.'s test were utilized for comparison of the predictive capability for UI between WWI and body mass index (BMI), waist circumference (WC).

RESULTS

A total of 41,614 participants were included in this study, of whom 23.57% had SUI, 19.24% had UUI, and 9.43% had MUI. In the fully adjusted model, WWI was positively associated with three types of UI [SUI: odds ratio (OR) = 1.19, 95%Confidence interval (CI) 1.13-1.25; UUI: OR = 1.18, 95%CI 1.13-1.24; MUI: OR = 1.19, 95%CI 1.11-1.27, all p < 0.001]. Compared to the lowest WWI interval, the positive correlation between WWI and UI still existed in the highest WWI group after converting WWI to a categorical variable by quartiles (SUI: OR = 1.52, 95%CI 1.35-1.71, p < 0.001; UUI: OR = 1.50, 95%CI 1.33-1.69, p < 0.001; MUI: OR = 1.55, 95%CI 1.32-1.83, p < 0.001). WWI had a stronger prediction for three types of UI than BMI and WC (all p < 0.001).

CONCLUSION

A higher WWI was linked with an increased likelihood of three types of UI (SUI, UUI, and MUI) in the United State population. Compared to BMI and WC, WWI had a stronger predictive power for UI. WWI may be a better adiposity parameter for evaluating UI.

Association between obesity and urinary incontinence in older adults from multiple nationwide longitudinal cohorts

BACKGROUND

Obesity and urinary incontinence (UI) among older adults, particularly older men, are yet to be fully explored. Utilizing multiple nationwide prospective longitudinal cohorts representative of the US, UK, and European samples, we examined the association of body mass index (BMI) and waist circumference (WC) with UI among both older women and men.

METHODS

We derived the data from multiple longitudinal cohorts that surveyed UI. Participants were asked if they had experienced urine leakage within the past 12 months or within the past six months. The measure of obesity was based on BMI and WC. We employed a random-effect logistic model to associate BMI and WC with UI, adjusting for covariates including age, race, education, residence area, marital status, number of children, smoking, drinking, hypertension, diabetes, cancer, stroke, functional ability, and cognitive impairment. We visualized the associations by using restricted cubic spline curves.

RESULTS

A total of 200,717 participants with 718,822 observations are included in the baseline analysis. Compared to those without UI, both female and male participants with UI demonstrate a higher BMI and WC. Among females, the fully adjusted models show linear associations between BMI, WC, and UI (Ps < 0.001). However, we observe U-shaped associations of BMI, WC with UI among males. The lowest likelihood of having UI is found among male participants with a BMI between 24 and 35 kg/m2.

CONCLUSIONS

Interventions aimed at preventing UI among older adults must take sex into account. Weight loss intervention could be an effective treatment among older females who are overweight and with obesity as well as older males with obesity rather than all older males.

The use of SCL-k-9 to measure general psychopathology in women and men with skin conditions

Objectives

To measure general psychopathology in dermatologic outpatients using the Symptom-Checklist-K-9 (SCL-K-9); to investigate whether the SCL-K-9 is able to categorize patients with and without significant non-psychotic disorders; and to perform a single-item analysis of the SCL-K-9, with a focus on gender differences.

Methods

Cross-sectional study on consecutive dermatological patients. We used two self-administered questionnaires to assess general psychopathology symptoms: General Health Questionnaire-12 (GHQ-12) and SCL-K-9. Sociodemographic information was collected with standardized forms. The performance of the SCL-K-9 in classifying patients according to their current emotional distress severity was assessed using a ROC procedure. Finally, we measured differences in scores obtained among women and men in SCL-K-9 single items.

Results

A total of 292 patients were studied (71.2% women). We observed statistically significant differences in SCL-K-9 total mean scores and in most single items among genders. We found that it would be more appropriate to use gender-specific cut-offs when using SCL-K-9 to screen dermatological patients for general psychopathology.

Conclusion

The SCL-K-9, with its compact format could provide, in a short time, a wide range of information related to critical areas that challenge the mental health of patients with skin diseases.

Benefits of Thai Yoga on physical mobility and lower limb muscle strength in overweight/obese older women: A randomized controlled pilot trial

BACKGROUND AND PURPOSE

Although Thai Yoga (TY) is reported to improve health-related fitness for the elderly, no study has yet carried out the effect of TY Program on physical mobility and lower-limb muscle strength in overweight/obese older women.

MATERIALS AND METHODS

In a randomized controlled pilot design, twenty-two sedentary women with a BMI ≥ 23 kg/m², aged 62 ± 1 years were randomly assigned to either a TY group for 60 min, 3 times a week or to a "no exercise" control (CON) group. Sit and reach (SRT), functional reach (FRT) and 30-s chair stand (CST-30), 8-foot up and go (8UGT), 6-min walk (6MWT)) and lower-limb muscle strength were measured at the beginning, 4, and 8 weeks.

RESULTS

At week 4, a significant between groups was obtained in CST-30, 8UGT, and 6MWT. At week 8, FRT, 8UGT, 6MWT and knee flexor and extensor muscle strength were improved in the TY over the CON. Significant improvement was found in all variables within the TY, but no change was observed in the CON.

CONCLUSION

An 8-week TY program appears to provide beneficial improvements in physical mobility in overweight/obese older women.

Efficacy and Safety of Combined Extracts of Cornus officinalis and Ribes fasciculatum for Body Fat Reduction in Overweight Women

Obesity is a medical condition that presents excessive fat accumulation with high risk of serious chronic diseases. The aim of this clinical trial is to investigate the anti-obesity effects of Cornus officinalis (CO) and Ribes fasciculatum (RF) on body fat reduction in Korean overweight women. A total of 147 overweight female participants enrolled in double-blinded clinical trial for 12 weeks and 76 participants completed the clinical study. Participants were treated with four CO and RF mixture (COEC; 400 mg per tablet) or four placebo tablets once a day. Obesity associated parameters (body weight, body mass index (BMI), waist circumference, waist-to-hip ratio, body fat percentage and body fat mass) and safety assessment were analyzed. After 12 weeks of COEC treatment, primary outcomes such as body fat percentage (0.76% vs. 0.01%; p = 0.022) and mass (1.1 kg vs. 0.5 kg; p = 0.049) were significantly decreased. In addition, the results were statistically significant between the COEC and placebo groups, strongly indicated that COEC had anti-obesity effects on overweight women. Secondary outcomes—including body weight, waist and hip circumference, waist-to-hip ratio, body mass index and computed tomography measurement of visceral fat area, subcutaneous fat area, total abdominal fat area and visceral-to-subcutaneous fat ratio—were reduced in COEC-treated group, but no statistical differences were found between the COEC and placebo groups. The safety assessment did not differ between the two groups. These results suggest that treatment of COEC extract reduces body fat percentage and mass in Korean overweight women, indicating it as a protective functional agent for obesity.

A Reversal of the Association between Education Level and Obesity Risk during Ageing: A Gender-Specific Longitudinal Study in South Korea

This study aimed to examine and quantify obesity risk across different education levels during ageing using the dataset of a nationally representative longitudinal survey. A total of 45,391 observations of 9991 individuals aged ≥45 years were included in this study. Obesity was defined as a body mass index of ≥25, according to a guideline for Asians by the World Health Organization, and education level was grouped into three categories. Socio-demographics, lifestyles, and health conditions were used as covariates. Adjusted odds ratios and predicted probabilities of obesity were computed and adjusted for a complex survey design. With respect to gender, education level and age were significantly associated with obesity risk, and the association was stronger in women than in men. Furthermore, education level was negatively associated with obesity risk in the middle age in each gender. However, the association became positive in the old age, specifically among highly educated women. Therefore, policy efforts to reduce obesity risk and the resulting education gradients should be established based on studies considering their old age. Further longitudinal studies are required to examine whether these findings are valid in other socio-cultural or economic settings.

Urinary Incontinence and Nocturia in Older Men: Associations with Body Mass, Composition and Strength in the Health ABC Study

PURPOSE

In younger men lower body mass is associated with fewer urinary symptoms, including incontinence and nocturia. However, lower body mass may have different implications in older men due to age associated muscle atrophy and decreased strength.

MATERIALS AND METHODS

We performed a prospective analysis of community dwelling men 70 to 79 years old in the multicenter Health ABC (Aging and Body Composition) study who underwent measurement of body mass on physical examination, composition using dual x-ray absorptiometry and strength according to grip and lower leg dynamometry. We evaluated associations with prevalent incontinence and nocturia on structured questionnaires as well as concurrent changes in urinary symptoms during 3 years using multivariate logistic regression.

RESULTS

Of the 1,298 men analyzed 22% reported incontinence and 52% reported nocturia at baseline. Higher body mass index, fat mass and lower appendicular lean mass, and grip and quadriceps strength corrected for body mass index were associated with an increased prevalence of incontinence (each p <0.05). Higher body mass index and greater fat mass were also associated with an increased nocturia prevalence (each p <0.05). Concurrent 5% or greater decrease in body mass or fat mass was not associated with lower odds of new or worsening incontinence or nocturia, whereas a 5% or greater decrease in maximum grip strength was associated with higher odds of new or worsening incontinence.

CONCLUSIONS

Older men with a higher body mass index and greater fat mass are more likely to report prevalent incontinence and nocturia. However, late life decreases in strength but not increases in body mass or fat mass were associated with a concurrent increase in urinary incontinence.

Obesity and sickness absence: results from a longitudinal nationally representative sample from Germany

OBJECTIVES

The current study aimed at investigating the longitudinal association between obesity and sickness absence in women and men in Germany.

METHODS

Data were derived from the German Socio-Economic Panel (GSOEP) which is a nationally representative, longitudinal study of private households in Germany. We draw on data from 2002 to 2012. Information on self-rated body mass index has been collected every second wave since 2002. Sick leave days (total number of working days missed due to illness in the past calendar year) and sick from work for more than 6 weeks in the preceding 12 months (yes/no) were used as outcome measures. Fixed-effects (FE) regression models were used for the total sample and stratified by sex. Gender differences were examined using interaction terms (sex × weight category).

RESULTS

Controlling for several potential confounders, Poisson FE regression analysis showed that transitions from normal weight to obesity were associated with an increase in sick leave days in women (incidence rate ratio (IRR) 1.27, 95% CI 1.02 to 1.57) but not in men (IRR 0.85, 95 % CI 0.68 to 1.06)-with significant gender differences (sex × obesity, p<0.01). Moreover, conditional FE logistic regressions showed that transitions from normal weight to overweight were associated with an increase in the probability of long-term absenteeism in women (overweight, OR 1.41, 95% CI 1.08 to 1.85) but not in men (overweight, OR 0.84, 95% CI 0.65 to 1.09). Gender differences were significant (sex × overweight, p<0.01).

CONCLUSIONS

Our findings stress the longitudinal association between excess weight and increased likelihood of sick leave days as well as long-term absenteeism in women.

Effectiveness of A Body Shape Index (ABSI) in predicting chronic diseases and mortality: a systematic review and meta-analysis

Anthropometric measures are simple, inexpensive, noninvasive tools to assess the risk of morbidity and mortality. This systematic review assessed the performance of A Body Shape Index (ABSI) in predicting hypertension, cardiovascular disease, type 2 diabetes and all-cause mortality and compared the differential predictability between ABSI and two other common anthropometric measures - body mass index and waist circumference. A keyword and reference search were conducted in the PubMed and Web of Science for articles published until 1 November 2017. Thirty-eight studies were included in the review, including 24 retrospective cohort studies and 14 cross-sectional studies conducted in 15 countries. Meta-analysis found that a standard deviation increase in ABSI was associated with an increase in the odds of hypertension by 13% and type 2 diabetes by 35% and an increase in cardiovascular disease risk by 21% and all-cause mortality risk by 55%. ABSI outperformed body mass index and waist circumference in predicting all-cause mortality but underperformed in predicting chronic diseases. ABSI is highly clustered around the mean with a rather small variance, making it difficult to define a clinical cutoff for clinical practice. Future studies are warranted to assess ABSI's potential usefulness as an anthropometric measure in population-level health surveillance.

Overweight in rural elderly: association with health conditions and quality of life

This study aimed to verify the association of overweight with functional disability, self-reported morbidities and quality of life (QoL) among rural elderly dwellers. This is a domestic and cross-sectional survey conducted in the rural region of a municipality of Southeast Brazil. Three hundred seventy non-overweight elderly people and 192 overweight elderly people were evaluated with the following tools: semi-structured; Katz and Lawton and scales; World Health Organization Quality of Life - BREF and World Health Organization Quality of Life Assessment for Older Adults. Overweight was associated with morbidities arthritis/osteoarthritis (p = 0.002), systemic arterial hypertension (p < 0.001), varicose veins (p = 0.009), heart problems (p = 0.028), diabetes mellitus (p = 0.001), cerebrovascular accident (p = 0.044) and urinary incontinence (p = 0.032). Overweight elderly had lower scores in the physical realm (p = 0.005) and higher scores in social relationships (p = 0.033) compared to those without this condition. Results point to the importance of monitoring the nutritional status of rural elderly to prevent comorbidities and improve the quality of life.

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.

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.

Effect of a High-Protein Energy-Restricted Diet Combined with Resistance Training on Metabolic Profile in Older Individuals with Metabolic Impairments

Adequate protein intake and resistance training are effective strategies to maintain muscle mass, but the effect of their combination on metabolic profile during weight loss remains to be determined in older adults. The main objective of this study was to determine the effect of a 16-week high-protein caloric restriction combined with resistance training on chronic disease risk factors in obese older individuals with metabolic impairments. A total of 26 overweight adults aged between 60 and 75 years (BMI 32.4 ± 3.9 kg/m2) with at least 2 factors of the metabolic syndrome participated in this study and were randomized into two groups: 1) high-protein caloric restriction (HP; n= 12) and 2) high-protein caloric restriction combined with dynamic-resistance training (HP+RT; n=14). Caloric intake was reduced by 500 kcal/d in all participants and protein intake equated 25-30% of total calories (~1.4 g/kg/d). Exercise training consisted of 3 session/week of resistance training on pulley machines. Outcome measures included total and trunk fat mass (FM), total and appendicular lean body mass (LBM), fasting glucose level, lipid profile and blood pressure. Our results showed that total and trunk FM (all p<0.0001) as well as fasting glucose (p<0.0001), triglycerides (p=0.002) and total cholesterol (p=0.03) levels decreased similarly in both groups. However, total (p=0.04) and appendicular (p=0.02) LBM decreased in the HP group only. Our data show that high-protein energy restriction improves health profile of obese elderly at high risk of chronic disease but needs to be combined with resistance training to maintain LBM.

The relationship between the presence of lower urinary tract symptoms and waist circumference

PURPOSE

The aim of the study is to evaluate the pressure of the pelvic floor muscles (PFM) according to waist circumference (WC) and correlate the presence of urinary tract symptoms (UTS) with WC.

PATIENTS AND METHODS

The study was observational and cross-sectional. One-hundred and sixty-four females between 45 and 65 years of age were evaluated. The sample was divided into two groups, according to WC: Group ≤80 (G≤80) was composed of females in whom WC was up to 80 cm; and Group >80 (G>80) was composed of females with WC above 80 cm. The subjects were assessed in terms of sociodemographic data, pre-existing conditions, urogynecological and obstetric history, and the presence of lower UTS (LUTS), as well as physical examination, measurement of WC, height, and weight. The PFM assessment was made by perineometry. To compare the mean between groups, the independent samples t-test was applied, and to correlate the WC with perineometry and LUTS, the Pearson's correlation test was used.

RESULTS

The final sample was composed of 156 patients. The average age of participants was 55.21 (±24.5) years in G≤80 and 57.23 (±6.12) years in G>80. There were significant differences regarding the presence of LUTS between the groups (P<0.05); as to the perineometry, there was a significant difference (P=0.03) between the groups: 38.68±13.63 cmH2O for G≤80 and 30.11±11.20 cmH2O for G>80. There was a correlation between the presence of urinary urgency (r=0.7; P=0.00), nocturia (r=0.7; P=0.00), and urinary incontinence (r=0.9; P=0.00) with WC.

CONCLUSION

Females with larger abdominal diameter have a higher prevalence of LUTS such as urinary incontinence, nocturia, and urinary urgency, as well as a lower PFM pressure. Furthermore, a relationship between LUTS with WC was also observed.

Waist circumference and risk of lower urinary tract symptoms: a meta-analysis

BACKGROUND AND OBJECTIVE

Epidemiological studies have reported conflicting results concerning the role of central obesity in lower urinary tract symptoms. We performed a meta-analysis to determine whether larger waist circumference (WC) is a predicted signal for Lower Urinary Tract Symptoms (LUT). Data resource: Eligible studies were retrieved by searching PubMed, Web of science, and the Cochrane Library database up to January 2014.

STUDY ELIGIBILITY CRITERIA

Prospective and retrospective cohort, case-controlled trials and observational studies.

DATA EXTRACTION

Data were extracted and analyzed using random effect models to reveal an array of risk factors. Dose-response meta-analysis was performed for studies reporting categorical risk estimates at multiple exposure levels. Study heterogeneity and publication biases were assessed.

DATA SYNTHESIS

A total of 12 studies met the inclusion criteria of the meta-analysis. A positive association with waist circumference (WC) was observed between WC and LUTS at an odds ratio of 1.49, (95% confidence intervals 1.34-1.64). In subgroup analysis, WC exhibited a positive dose-dependent relationship with LUTS in mostly study design, region and primary outcomes.

LIMITATION

Potential biases from preferential publication and selective reporting.

CONCLUSION

Large WC is associated with increased risk of LUTS. Further studies are needed to confirm this finding and to define related biological mechanisms.

Gender differences and socioeconomic status in relation to overweight among older Korean people

Background

The ever-increasing older population and its association with serious overweight problems have garnered much attention. The correlation between being overweight and socioeconomic status factors could be helpful for understanding the inequalities among the overweight population. We examined the correlation between being overweight and some key variables, such as demographics, socioeconomic status, general health status, and health behavior in a large sample of older individuals, by each gender.

Methods

We used data from the 2008 Korean Longitudinal Study of Aging and it included 8,157 participants who were 45 years or older. To understand the relationship between the overweight participants in accordance to demographic and socioeconomic characteristics, health status, and health behaviors, a weighted chi-square test and logistic regression analysis were conducted by separating variables related to overweight, according to the genders.

Results

The number of people in the normal group was 6,347 (77.8%), while the people who were considered overweight were 1,810 (22.2%). Women (n = 4,583) constituted 52.7% of the subject, 24.9% of whom were classified as overweight. Meanwhile, 20.6% of the 47.3% (n = 3,574) of the sample who were men were classified as overweight. Participants between the ages of 45 and 64 with chronic diseases were more likely to be overweight. Men in the 4th quartile of household income were more likely to be overweight than those who were in the 1st quartile, in contrast, while unemployed women with lower education levels and urban residents were at greater risk for being overweight.

Conclusions

Among the men, health status and health behavior appeared to show a correlation with being overweight; however, among women, socioeconomic status factors were strongly related to being overweight. These findings appear to support the association of gender-specifics with the prevalence of being overweight.

Waist circumference and health-related quality of life by sex in the Korean elderly

OBJECTIVE

This study aims to explore the impact of differential degrees of obesity on health-related quality of life (HRQL) by sex in the Korean elderly.

METHOD

We analyzed data on those aged between 65 and 74 years from the Korean National Health and Nutrition Examination Survey (KNHANES) using multiple regression analysis.

RESULTS

Compared with the lowest waist circumference (WC) quintile, the women in the fourth and fifth quintiles demonstrated significantly lower unadjusted HRQL but not the men in any quintiles. Whereas higher WC quintiles impaired mobility, usual activities, and pain/discomfort in women, the fourth WC quintile improved usual activities in men. After adjustment, only the women of the highest WC quintile reported impaired mobility.

DISCUSSION

Extreme obesity worsens mobility, and comorbidity in combination with obesity worsens HRQL in elderly women. Monitoring and controlling comorbidity and maintaining adequate WC decreases the risks of lowered HRQL in Korean elderly women.

Sex and age differences in the effect of obesity on incidence of hypertension in the Japanese population: A large historical cohort study

Elevated risk of death from any cause and stroke associated with high body mass index (BMI) values decline with aging. However, it is not clear whether the effect of obesity on the incidence of hypertension varies by sex or age. Cox regression analyses were performed using a large historical cohort composed of 6803 men and 22,800 women. In the final model, which included the main effect (sex, age, and BMI), all two-way interactions (sex*age, sex*BMI, and age*BMI), a three-way interaction (sex*age*BMI), and adjusted variables determined by backward elimination, the three-way interaction and two of the two-way interactions (age*sex and age*BMI) were not significant; the remaining two-way interaction between sex and BMI was significant (P = .016). In the next step, the effect of BMI on the incidence of hypertension stratified by sex was evaluated. Hazard ratios (HRs) were significantly higher for BMI 27.0 to <29.0 and ≥29.0 kg/m(2) than for the HR for BMI 21.0 to <23.0 kg/m(2) in women (HR, 1.45; 95% confidence interval [CI], 1.32-1.59 and HR, 1.46; 95% CI, 1.29-1.65, respectively), but not in men (HR, 1.14; 95% CI, 0.98-1.33 and HR, 1.01; 95% CI, 0.77-1.32, respectively). The effect of obesity on the incidence of hypertension is stronger in women than in men.

Sex differences in the physiology and pharmacology of the lower urinary tract

Sexual dimorphism is not only noticed in the prevalence of many diseases, but also in multiple physiological functions in the body. This review has summarized findings from published literature on the sex differences of the pathophysiology and pharmacology of the lower urinary tract (LUT) of humans and animals. Sex differences have been found in several key areas of the LUT, such as overactive bladder, expression and function of neurotransmitter receptors in the bladder and urethra, and micturition patterns in humans and animals. It is anticipated that this review will not only evoke renewed interest for further research on the mechanism of sex differences in the pathophysiology of the LUT (especially for overactive bladder), but might also open up the possibilities for gender-based drug development by pharmaceutical industries in order to find separate cures for men and women with diseases of the LUT.

Multimorbidity and associated factors in Brazilian women aged 40 to 65 years: a population-based study

OBJECTIVE

The aim of this study was to evaluate the presence of multimorbidity and associated factors in Brazilian women aged 40 to 65 years with 11 or more years of school education.

METHODS

A secondary analysis of a cross-sectional population-based study was conducted using an anonymous self-report questionnaire completed by 377 women. The number of reported morbid conditions was evaluated (depression, hypertension, diabetes mellitus, urinary incontinence, and insomnia) and classified as none or one and two or more morbid conditions. The sociodemographic, behavioral, clinical, and reproductive factors associated with these conditions were also assessed. The χ test and multiple logistic regression analysis with stepwise selection criteria were used to select the major factors associated with morbid conditions, with a significance level set at 5%.

RESULTS

Insomnia was reported by 38.5%, depression by 31%, hypertension by 28.4%, urinary incontinence by 23.2%, and diabetes by 6.3% of the participants. In this sample, 28.9% did not report any morbid conditions, 31.8% reported one morbid condition, and 39.3% reported two or more morbid conditions. On logistic regression analysis, the increased likelihood of having two or more morbid conditions was associated with bad/fair self-perception of health (increased 5.1 times; 95% CI, 1.85-14.1), nonperformance of physical activity (increased by 2.7 times; 95% CI, 1.08-6.81), obesity (increased by 30.3 times; 95% CI, 3.17-250), postmenopause (increased by 4.4 times; 95% CI, 1.57-12.11), and nervousness (increased by 3.8 times; 95% CI, 1.45-9.8).

CONCLUSIONS

A worse self-perception of health, sedentariness, obesity, nervousness, and being postmenopausal were associated with multimorbidity.