JU INSIGHT Food Insecurity and Urge Urinary Incontinence: 2005-2010 National Health and Nutrition Examination Survey

By: Chihiro Okada, BA, Albert Einstein College of Medicine, Bronx, New York; Joseph I. Kim, BA, Albert Einstein College of Medicine, Bronx, New York; Nicole Roselli, MD, Montefiore Medical Center, Bronx, New York; Priyanka Kadam Halani, MD, Montefiore Medical Center, Bronx, New York; Michal L. Melamed, MD, Montefiore Medical Center, Bronx, New York, Albert Einstein College of Medicine, Bronx, New York; Nitya Abraham, MD, Montefiore Medical Center, Bronx, New York | Posted on: 19 Sep 2023

Okada C, Kim JI, Roselli N, Halani PK, Melamed ML, Abraham N. Food insecurity is associated with urge urinary incontinence: an analysis of the 2005-2010 National Health and Nutrition Examination Survey. J Urol. 2023;210(3):481-491.

Study Need and Importance

Although numerous biological risk factors for urge urinary incontinence (UUI) have been previously characterized, the effect of social determinants of health is incompletely understood. Food insecurity is a social determinant of health that we studied for 2 reasons. First, food insecurity influences dietary behavior. Specifically, food-insecure individuals tend to consume less costly, more calorically dense foods. Second, dietary behavior can influence UUI. In particular, caffeinated and carbonated drinks are bladder irritants thought to potentially worsen UUI symptoms. Taken together, we examined the association between UUI and food insecurity, as well as the potential role of diet on UUI.

What We Found

Our analysis found that adults reporting food insecurity were significantly more likely to experience UUI than those who did not (see Figure). Consumption of bladder irritants (caffeine and alcohol) was significantly lower in food-insecure vs -secure participants. When stratified by food insecurity status (yes vs no), caffeine consumption did not differ by UUI status and alcohol consumption was lower among participants with vs without UUI. These data indicate that diet alone does not drive the association between UUI and food insecurity. Rather, food insecurity may be a proxy for social inequity, perhaps the greatest driver of disease.

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Figure. Association between urge urinary incontinence and food insecurity in 14,847 participants of National Health and Nutrition Examination Survey 2005-2010. Logistic regression analysis was adjusted for age, gender, race, education, health insurance coverage, poverty income ratio, smoking history, alcohol use, body mass index (BMI), diabetes, stroke, and number of comorbidities. CI indicates confidence interval.

Limitations

The National Health and Nutrition Examination Survey reflects participants’ diet from a 24-hour snapshot, which may not fully represent dietary behavior. Our results comparing diets of various populations found statistically significant differences which may not be clinically relevant. Further, residents of elderly care or nursing homes are not included in National Health and Nutrition Examination Surveys, which excluded a meaningful portion of UUI patients.

Interpretation for Patient Care

The relationship between social inequity, like food insecurity, and UUI can inform public health policy changes that may ultimately be more beneficial in improving patient outcomes on a population level.

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