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JU INSIGHT Association of Obesity, Metabolic Syndrome, and Diabetes With Urinary Incontinence and Chronic Kidney Disease
By: Chyng-Wen Fwu, DrPH, Social & Scientific Systems, Inc, A DLH Holdings Corp (DLH) Company, Silver Spring, Maryland; Ivonne H. Schulman, MD, MA, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Jean M. Lawrence, ScD, MPH, MSSA, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Paul L. Kimmel, MD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Paul Eggers, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Jenna Norton, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Kevin Chan, MD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Susan R. Mendley, MD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; Julia S. Barthold, MD, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland | Posted on: 19 Jan 2024
Fwu CW, Schulman IH, Lawrence JM, et al. Association of obesity, metabolic syndrome, and diabetes with urinary incontinence and chronic kidney disease: analysis of the National Health and Nutrition Examination Survey, 2003-2020. J Urol. 2024;211(1):124-133.
Study Need and Importance
Urinary incontinence (UI) and chronic kidney disease (CKD) are associated with each other and additionally, each has been associated with obesity, diabetes, and metabolic syndrome (MetS). Diabetes is a component of MetS, likely contributing to the positive association of MetS with UI and/or CKD. This study used NHANES (National Health and Nutrition Examination Survey) data, a large nationally representative and diverse population, to examine sex-specific associations between UI and/or CKD and nondiabetic obesity/metabolic phenotypes (ie, non-MetS/nonobese, MetS/nonobese, non-MetS/obese, and MetS/obese) with diabetes as a comparison group.
What We Found
In females, any UI, stress UI, and mixed UI were each positively associated with obesity and/or MetS, as well as diabetes, while in males, any UI and urgency UI were positively associated with diabetes and MetS/obese (Table). In females with UI/CKD, we observed stronger associations (diabetes: OR 5.48 [95% CI 3.76-7.98], MetS/obese: 2.25 [1.64-3.09], and MetS/nonobese: 1.99 [1.39-2.85]), than in those with CKD alone or with any UI alone as compared with non-MetS/nonobese. Similarly, ORs were strengthened with UI/CKD co-occurrence in males with metabolic disease (diabetes: 7.93, 5.21-12.10; MetS/obese: 3.23, 2.00-5.22) compared to CKD alone or any UI alone.
Table. Multivariable Logistic Regression Model to Examine Adjusted Associations of Urinary Incontinence and Chronic Kidney Disease With Obesity/Metabolic Phenotypes, by Sex, National Health and Nutrition Examination Survey 2003-2020
| Femalesa | Malesb | |||
|---|---|---|---|---|
| OR | 95% CI | OR | 95% CI | |
| Any UI | ||||
| Non-MetS/nonobese | 1.00 | 1.00 | ||
| MetS/nonobese | 1.40 | 1.11-1.77 | 0.74 | 0.57-0.96 |
| Non-MetS/obese | 2.00 | 1.56-2.58 | 1.31 | 0.96-1.77 |
| MetS/obese | 2.16 | 1.76-2.66 | 1.25 | 1.00-1.57 |
| Diabetes | 2.33 | 1.88-2.87 | 1.35 | 1.07-1.70 |
| SUI | ||||
| Non-MetS/nonobese | 1.00 | 1.00 | ||
| MetS/nonobese | 1.41 | 1.06-1.86 | 0.77 | 0.38-1.56 |
| Non-MetS/obese | 1.37 | 1.06-1.78 | 0.73 | 0.32-1.68 |
| MetS/obese | 1.51 | 1.21-1.87 | 0.84 | 0.44-1.60 |
| Diabetes | 1.34 | 1.04-1.72 | 0.87 | 0.47-1.62 |
| UUI | ||||
| Non-MetS/nonobese | 1.00 | 1.00 | ||
| MetS/nonobese | 0.98 | 0.71-1.36 | 0.73 | 0.54-0.98 |
| Non-MetS/obese | 1.21 | 0.87-1.67 | 1.46 | 0.98-2.18 |
| MetS/obese | 1.15 | 0.87-1.53 | 1.36 | 1.03-1.80 |
| Diabetes | 1.15 | 0.84-1.58 | 1.48 | 1.11-1.97 |
| MUI | ||||
| Non-MetS/nonobese | 1.00 | 1.00 | ||
| MetS/nonobese | 1.10 | 0.83-1.45 | 0.55 | 0.31-0.99 |
| Non-MetS/obese | 1.64 | 1.25-2.16 | 1.26 | 0.63-2.54 |
| MetS/obese | 1.66 | 1.31-2.11 | 1.14 | 0.64-2.01 |
| Diabetes | 1.90 | 1.41-2.57 | 1.03 | 0.64-1.68 |
| CKD | ||||
| Non-MetS/nonobese | 1.00 | 1.00 | ||
| MetS/nonobese | 1.50 | 1.12-1.99 | 1.94 | 1.41-2.68 |
| Non-MetS/obese | 0.83 | 0.57-1.21 | 0.90 | 0.63-1.29 |
| MetS/obese | 1.14 | 0.90-1.46 | 1.83 | 1.40-2.38 |
| Diabetes | 2.41 | 1.84-3.14 | 5.66 | 4.37-7.34 |
| Abbreviations: CKD, chronic kidney disease; MetS, metabolic syndrome; MUI, mixed urinary incontinence; OR, odds ratio; SUI, stress urinary incontinence; UI, urinary incontinence; UUI, urgency urinary incontinence. aAdjusted for age, race/ethnicity, education, marital status, poverty income ratio, insurance, smoking status, alcohol use, parity, hysterectomy, cardiovascular disease, and cancer. bAdjusted for age, race/ethnicity, education, marital status, poverty income ratio, insurance, smoking status, alcohol use, cardiovascular disease, and cancer. |
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Limitations
While NHANES may uncover underreported symptoms in a large, diverse sample, it does not include clinical data that would inform diagnostic misclassification or heterogeneity. Moreover, the cross-sectional design does not address causation or mechanism.
Interpretation for Patient Care
These data suggest that individuals without diabetes that have obesity and/or MetS have higher odds of UI or UI/CKD than nonobese/non-MetS individuals, but lower odds than individuals with diabetes. Improved understanding of modifiable factors associated with UI and CKD provide additional avenues for prevention and treatment.
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