School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.
School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.
Am J Obstet Gynecol. 2021 Aug;225(2):164.e1-164.e13. doi: 10.1016/j.ajog.2021.02.029. Epub 2021 Feb 27.
Current evidence suggests that excess weight and obesity are important risk factors for urinary incontinence in women. However, limited data exist regarding the relationships among body mass index, physical activity, and urinary incontinence in women in their 20s.
This study aimed to (1) compare prevalence rates of urinary incontinence and high body mass index in 2 cohorts of young women, (2) explore associations between changes in body mass index and urinary incontinence using analysis of combined data from the 2 cohorts, and (3) explore the associations between physical activity and urinary incontinence, with adjustment for body mass index.
Data were collected from 2 cohorts of young women in the Australian Longitudinal Study of Women's Health (n=16,065), born 17 years apart: 1973-1978 (cohort 1) and 1989-1995 (cohort 2). The women in both cohorts completed the surveys at age 18 to 23 years (T1), with follow-up 4 years later (age, 22-27 years; T2). Self-reported urinary incontinence and body mass index were assessed in both surveys. As physical activity was measured using different questions in cohort 1 at T1, self-reported physical activity data were from T2 only. A total of 9 body mass index transition categories (based on body mass index status at baseline and follow-up) and 4 physical activity categories were created to assess multivariate-adjusted prevalence ratios for urinary incontinence at T2, using Poisson regression.
Rates of obesity increased in both cohorts over 4 years, from 6.6%% (95% confidence interval, 6.1-7.2) to 10.4% (95% confidence interval, 9.7-11.0) in cohort 1 and from 11.7% (95% confidence interval, 11.0-12.4) to 19.6% (95% confidence interval, 18.7-20.5) in cohort 2. Compared with women who maintained normal body mass index at T1 and T2, the prevalence ratio for urinary incontinence among those with body mass index >30 at age 22 to 27 years was higher, regardless of body mass index category at age 18 to 23 years (prevalence ratio at T1: 1.39 for normal body mass index [95% confidence interval, 1.1-1.76]; 1.44 for overweight [95% confidence interval, 1.27-1.63]; and 1.51 for obese [95% confidence interval, 1.36-1.67]). In cohort 1, there was no relationship between physical activity and urinary incontinence. However, in cohort 2 there was an inverse dose-response relationship between physical activity and urinary incontinence.
The strong association between obesity and urinary incontinence in young women is a public health concern, given that obesity rates are likely to increase further with age and parity. The potential mitigating effects of physical activity on the obesity-incontinence relationship merit further investigation.
目前的证据表明，超重和肥胖是女性尿失禁的重要危险因素。然而，关于 20 多岁女性的体重指数、身体活动与尿失禁之间的关系，数据有限。
本研究旨在：(1)比较两组年轻女性的尿失禁和高体重指数的患病率；(2)通过对两组数据的联合分析，探讨体重指数变化与尿失禁之间的关系；(3)在调整体重指数后，探讨身体活动与尿失禁之间的关系。
本研究的数据来自澳大利亚女性健康纵向研究中的两组年轻女性(1973-1978 年出生的队列 1 和 1989-1995 年出生的队列 2)，两组相隔 17 年。两组女性在 18-23 岁时(T1)完成了问卷调查，4 年后(T2，年龄 22-27 岁)进行了随访。在两次调查中都评估了自我报告的尿失禁和体重指数。由于队列 1 在 T1 时使用了不同的问题来测量身体活动，因此只使用 T2 的自我报告身体活动数据。使用泊松回归，共创建了 9 个体重指数转换类别(基于基线和随访时的体重指数状况)和 4 个身体活动类别，以评估 T2 时尿失禁的多变量调整患病率比值。
在 4 年期间，两组的肥胖率均有所上升，队列 1 从 6.6%(95%置信区间为 6.1-7.2)上升至 10.4%(95%置信区间为 9.7-11.0)，队列 2 从 11.7%(95%置信区间为 11.0-12.4)上升至 19.6%(95%置信区间为 18.7-20.5)。与 T1 和 T2 时保持正常体重指数的女性相比，22-27 岁时体重指数>30 的女性尿失禁的患病率比值更高，而不论 18-23 岁时的体重指数类别如何(在 T1 时的患病率比值：正常体重指数为 1.39[95%置信区间为 1.1-1.76]；超重为 1.44[95%置信区间为 1.27-1.63]；肥胖为 1.51[95%置信区间为 1.36-1.67])。在队列 1 中，身体活动与尿失禁之间没有关系。然而，在队列 2 中，身体活动与尿失禁之间存在着一种剂量反应关系。
在年轻女性中，肥胖与尿失禁之间的强烈关联是一个公共卫生问题，因为随着年龄的增长和生育次数的增加，肥胖率很可能会进一步上升。身体活动对肥胖-尿失禁关系的潜在缓解作用值得进一步研究。
