Associations of sarcopenia, obesity, and metabolic health with the risk of urinary incontinence in U.S. adult women: a population-based cross-sectional study

Fei-Xue Shao; Wei-Jia Luo; Li-Qun Lou; Sheng Wan; Shi-Feng Zhao; Tian-Fan Zhou; Chen-Chen Zhou; Ying-Ying Yang; Gui-Zhu Wu; Xiao-Lin Hua

doi:10.3389/fnut.2024.1459641

Associations of sarcopenia, obesity, and metabolic health with the risk of urinary incontinence in U.S. adult women: a population-based cross-sectional study

Front Nutr. 2024 Oct 14:11:1459641. doi: 10.3389/fnut.2024.1459641. eCollection 2024.

Authors

Fei-Xue Shao^#^{1

2}, Wei-Jia Luo^#^{1

2}, Li-Qun Lou^#^{1

2}, Sheng Wan², Shi-Feng Zhao¹, Tian-Fan Zhou^{1

2}, Chen-Chen Zhou², Ying-Ying Yang³, Gui-Zhu Wu^{1

4}, Xiao-Lin Hua^{1

2}

Affiliations

¹ Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
² Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China.
³ Clinical Research Unit, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
⁴ Department of Gynecology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China.

^# Contributed equally.

Abstract

Introduction: Urinary incontinence (UI) significantly impairs women's quality of life. Identifying its risk factors is essential for developing effective interventions. Sarcopenia, characterized by the accelerated loss of muscle mass and function, is an emerging concern often linked to obesity and abnormal metabolic status, exacerbating various adverse health outcomes. This population-based study aimed to explore the independent and joint associations of sarcopenia, obesity, and metabolic health with UI risk, as well as to evaluate the mediating role of metabolic indicators in these associations.

Methods: A total of 3,557 women aged ≥20 years from the National Health and Nutrition Examination Survey were included. Sarcopenia was assessed using the appendicular lean mass index (ALMI), and obesity was defined by body mass index and waist circumference. Metabolic health was evaluated using revised criteria from the National Cholesterol Education Program-Adult Treatment Panel III. UI was identified through responses to the "Kidney Conditions-Urology" questionnaire and classified into stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Multivariable logistic regression and restricted cubic spline models were used to evaluate the associations and visualize the relationship between ALMI and UI. Mediation models were constructed to assess the mediating role of metabolic indicators.

Results: We found that sarcopenia was significantly associated with an increased risk of MUI in the general population. Age-specific analysis revealed that sarcopenia is an independent risk factor for SUI in women aged ≥60, and for MUI in women aged 40-59 years. Sarcopenic obesity, particularly under central obesity criteria, further elevated the risk of UI. Notably, women with the metabolically unhealthy obese phenotype with sarcopenia were at the highest risk for both SUI and MUI. Metabolically unhealthy status, glycohemoglobin, vitamin D, and serum albumin levels were partial mediators of these associations.

Conclusion: Our findings elucidated the complex interactions between sarcopenia, obesity, and metabolic health, underscoring the critical need for integrated therapeutic strategies that address both metabolic health and targeted nutritional interventions, aiming to enhance muscular health and effectively manage and prevent UI.

Keywords: DXA; NHANES; metabolic health; obesity; sarcopenia; urinary incontinence.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (grant numbers: 82071629 and 82404279), the Shanghai Health System Excellent Discipline Leader Training Program (grant number: 2022XD004), the Shanghai Hospital Development Center (grant number: SHDC2023CRS027), and the Shanghai First Maternity and Infant Hospital (grant number: 2024B23).