Dietary Macronutrient and Energy Intake and Urinary Incontinence in Women
Dietary Macronutrient and Energy Intake and Urinary Incontinence in Women
Weight loss involving diet modification improves urinary incontinence (UI) in women, but little is known about dietary correlates of UI. The authors examined intakes of total energy, carbohydrate, protein, and fats in relation to UI in a cross-sectional sample of 2,060 women in the population-based Boston Area Community Health Survey (2002–2005). Data were collected from in-person home interviews and food frequency questionnaires. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the presence of moderate-to-severe UI; a severity index was analyzed in secondary analysis of 597 women with urine leakage. Greater total energy intake was associated with UI (Ptrend = 0.0001; highest quintile vs. lowest: adjusted odds ratio = 2.86, 95% confidence interval: 1.56, 5.23) and increased severity. No associations were observed with intake of carbohydrates, protein, or total fat. However, the ratio of saturated fat intake to polyunsaturated fat intake was positively associated with UI (highest quintile vs. lowest: adjusted odds ratio = 2.48, 95% confidence interval: 1.22, 5.06) and was strongly associated with severity (Ptrend < 0.0001). Results suggest that dietary changes, particularly decreasing saturated fat relative to polyunsaturated fat and decreasing total calories, could independently account for some of the benefits of weight loss in women with UI.
Urinary incontinence diminishes the quality of life for millions of women on a daily basis and has been associated with an estimated $20 billion in annual direct health-care costs. Recent population-based estimates from the United States show that approximately 16% of women report moderate-to-severe urinary incontinence. Pathophysiologic mechanisms of urinary incontinence may have various origins and generally have been theorized to be related to urothelium-based, myogenic, and/or neurogenic changes. In epidemiologic studies, urinary incontinence in women has been associated with increased age, white/Caucasian race/ethnicity, central obesity, vaginal child delivery, hysterectomy, heart disease, asthma, and arthritis/rheumatism.
Research priorities in urinary incontinence include identifying modifiable lifestyle factors. Recently, a randomized clinical trial of overweight women confirmed that weight loss significantly reduces the frequency of urinary incontinence episodes. The authors noted that 74% of the reduction in incontinence frequency was statistically explained by the weight change, proposing the mechanism that weight loss reduces intraabdominal pressure, thereby decreasing pressures on the bladder and pelvic floor. However, the authors acknowledged the possibility that changes in diet or physical activity may have accounted for some of the intervention effect. Women in the intervention group were instructed to reduce their total daily energy intake to 1,200–1,500 kcal/day, limit their fat intake, and consume a low-fat beverage daily as a meal replacement for part of the trial duration, along with increasing their physical activity to 200 minutes per week or more. Physical activity has been found to be inversely associated with urinary incontinence in women, although the relation is not observed across all studies and may be partly explained by weight maintenance. Considering that the sympathetic and parasympathetic nervous systems control micturition and that inflammation and endothelial dysfunction may be involved in urologic symptoms, it is plausible that changes in energy intake and specific macronutrients have direct effects on urinary incontinence, independently of weight loss or physical activity. In support of this hypothesis, investigators in the Leicestershire MRC Incontinence Study reported a positive association between total and saturated fat intake and onset of stress incontinence. A better understanding of the contribution of diet—specifically, the dietary changes that are often made for weight loss (i.e., changes in total energy intake and specific macronutrients such as fat)—would be helpful both for understanding pathophysiologic mechanisms and for clinical practice in treatment of urinary incontinence.
To test the hypothesis that increased total energy and macronutrient intakes are positively associated with urinary incontinence in women, we analyzed these dietary factors in relation to urinary incontinence symptoms in a population-based, racially/ethnically diverse cross-sectional study, the Boston Area Community Health (BACH) Survey. We focused our analysis on dietary factors, rather than physical activity, partly because in a previous report from the BACH Survey, Tennstedt et al. analyzed the relative contribution of physical activity and found that it was not associated with urinary incontinence in this sample of women.
Abstract and Introduction
Abstract
Weight loss involving diet modification improves urinary incontinence (UI) in women, but little is known about dietary correlates of UI. The authors examined intakes of total energy, carbohydrate, protein, and fats in relation to UI in a cross-sectional sample of 2,060 women in the population-based Boston Area Community Health Survey (2002–2005). Data were collected from in-person home interviews and food frequency questionnaires. Logistic regression was used to calculate odds ratios and 95% confidence intervals for the presence of moderate-to-severe UI; a severity index was analyzed in secondary analysis of 597 women with urine leakage. Greater total energy intake was associated with UI (Ptrend = 0.0001; highest quintile vs. lowest: adjusted odds ratio = 2.86, 95% confidence interval: 1.56, 5.23) and increased severity. No associations were observed with intake of carbohydrates, protein, or total fat. However, the ratio of saturated fat intake to polyunsaturated fat intake was positively associated with UI (highest quintile vs. lowest: adjusted odds ratio = 2.48, 95% confidence interval: 1.22, 5.06) and was strongly associated with severity (Ptrend < 0.0001). Results suggest that dietary changes, particularly decreasing saturated fat relative to polyunsaturated fat and decreasing total calories, could independently account for some of the benefits of weight loss in women with UI.
Introduction
Urinary incontinence diminishes the quality of life for millions of women on a daily basis and has been associated with an estimated $20 billion in annual direct health-care costs. Recent population-based estimates from the United States show that approximately 16% of women report moderate-to-severe urinary incontinence. Pathophysiologic mechanisms of urinary incontinence may have various origins and generally have been theorized to be related to urothelium-based, myogenic, and/or neurogenic changes. In epidemiologic studies, urinary incontinence in women has been associated with increased age, white/Caucasian race/ethnicity, central obesity, vaginal child delivery, hysterectomy, heart disease, asthma, and arthritis/rheumatism.
Research priorities in urinary incontinence include identifying modifiable lifestyle factors. Recently, a randomized clinical trial of overweight women confirmed that weight loss significantly reduces the frequency of urinary incontinence episodes. The authors noted that 74% of the reduction in incontinence frequency was statistically explained by the weight change, proposing the mechanism that weight loss reduces intraabdominal pressure, thereby decreasing pressures on the bladder and pelvic floor. However, the authors acknowledged the possibility that changes in diet or physical activity may have accounted for some of the intervention effect. Women in the intervention group were instructed to reduce their total daily energy intake to 1,200–1,500 kcal/day, limit their fat intake, and consume a low-fat beverage daily as a meal replacement for part of the trial duration, along with increasing their physical activity to 200 minutes per week or more. Physical activity has been found to be inversely associated with urinary incontinence in women, although the relation is not observed across all studies and may be partly explained by weight maintenance. Considering that the sympathetic and parasympathetic nervous systems control micturition and that inflammation and endothelial dysfunction may be involved in urologic symptoms, it is plausible that changes in energy intake and specific macronutrients have direct effects on urinary incontinence, independently of weight loss or physical activity. In support of this hypothesis, investigators in the Leicestershire MRC Incontinence Study reported a positive association between total and saturated fat intake and onset of stress incontinence. A better understanding of the contribution of diet—specifically, the dietary changes that are often made for weight loss (i.e., changes in total energy intake and specific macronutrients such as fat)—would be helpful both for understanding pathophysiologic mechanisms and for clinical practice in treatment of urinary incontinence.
To test the hypothesis that increased total energy and macronutrient intakes are positively associated with urinary incontinence in women, we analyzed these dietary factors in relation to urinary incontinence symptoms in a population-based, racially/ethnically diverse cross-sectional study, the Boston Area Community Health (BACH) Survey. We focused our analysis on dietary factors, rather than physical activity, partly because in a previous report from the BACH Survey, Tennstedt et al. analyzed the relative contribution of physical activity and found that it was not associated with urinary incontinence in this sample of women.
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