Parker-Autry Candace, Houston Denise K, Rushing Julia, Richter Holly E, Subak Leslee, Kanaya Alka M, Kritchevsky Stephen B
Departments of Obstetrics and Gynecology, Urology, Biostatistical Sciences, and Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; the Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; and the Department of Medicine, Epidemiology & Biostatistics, University of California-San Francisco, San Francisco, California.
Obstet Gynecol. 2017 Nov;130(5):1025-1032. doi: 10.1097/AOG.0000000000002322.
To characterize change in physical performance and differential prevalence of low skeletal muscle mass and strength (sarcopenia) and lower 25-hydroxyvitamin D concentrations among older women who developed urinary incontinence (UI) symptoms.
This is a secondary analysis of the Health, Aging, and Body Composition Study. Urinary incontinence symptoms were assessed using validated questions. The Short Physical Performance Battery measured physical performance. Sarcopenia, defined by low muscle mass and strength, was determined using validated cutoffs for gait speed, grip strength, and appendicular skeletal muscle mass. All parameters were evaluated at baseline and year 4. Serum 25-hydroxyvitamin D concentrations were assessed at year 2. The primary outcome was change in Short Physical Performance Battery total scores. Sarcopenia and lower serum 25-hydroxyvitamin D concentrations have been independently associated with poor physical performance and UI and were therefore included as secondary outcomes. Univariate and multivariate analyses were used to characterize the associations of change in physical performance from baseline to year 4, incidence of sarcopenia, and lower serum 25-hydroxyvitamin D on the development of UI symptoms.
Of the 1,583 women enrolled, 910 were excluded (730 had baseline UI; 180 with missing data). Six hundred seventy-three women were continent at baseline; 223 (33%) developed UI symptoms at year 4. SPPB total scores significantly declined in women with UI versus continent women (mean difference continent-incident UI 0.32, 95% CI 0.04-0.60, P=.02). Of subscale measures, standing balance showed the greatest decline at 0.20 (0.05-0.36; continent-incident UI, respectively; P=.009). Sarcopenia developed at a higher rate with incident UI (adjusted odds ratio [OR] 1.7, 95% CI 1.0-2.9). Low 25-hydroxyvitamin D was not associated with incident UI (adjusted OR 1.1, 95% CI 0.7-1.6 and 1.1, 95% CI 0.7-1.6 for deficient or insufficient versus sufficient status, respectively).
We observed a significant decline in standing balance among older women who developed UI symptoms. This decline may be associated with coinciding development of sarcopenia.
描述出现尿失禁（UI）症状的老年女性身体机能的变化、骨骼肌质量和力量低下（肌少症）以及25-羟维生素D浓度降低的差异患病率。
这是对健康、衰老和身体成分研究的二次分析。使用经过验证的问题评估尿失禁症状。简短身体机能测试电池评估身体机能。根据步态速度、握力和四肢骨骼肌质量的经过验证的临界值确定由低肌肉质量和力量定义的肌少症。所有参数在基线和第4年进行评估。在第2年评估血清25-羟维生素D浓度。主要结局是简短身体机能测试电池总分的变化。肌少症和较低的血清25-羟维生素D浓度已分别与身体机能差和尿失禁相关，因此被纳入次要结局。使用单变量和多变量分析来描述从基线到第4年身体机能变化、肌少症发生率以及较低的血清25-羟维生素D与尿失禁症状发生之间的关联。
在纳入的1583名女性中，910名被排除（730名基线时有尿失禁；180名数据缺失）。673名女性在基线时无尿失禁；223名（33%）在第4年出现尿失禁症状。与无尿失禁的女性相比，有尿失禁的女性简短身体机能测试电池总分显著下降（平均差异无尿失禁-新发尿失禁为0.32，95%可信区间为0.04-0.60，P=0.02）。在各子量表测量中，站立平衡下降最大，为0.20（分别为无尿失禁-新发尿失禁；P=0.009）。新发尿失禁时肌少症的发生率更高（调整后的优势比[OR]为1.7，95%可信区间为1.0-2.9）。低25-羟维生素D与新发尿失禁无关（缺乏或不足与充足状态相比，调整后的OR分别为1.1，95%可信区间为0.7-1.6和1.1，95%可信区间为0.7-1.6）。
我们观察到出现尿失禁症状的老年女性站立平衡显著下降。这种下降可能与肌少症的同时发生有关。
