Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose–response meta‐analysis of prospective studies

Abstract

Background Adiposity has been associated with elevated risk of urinary incontinence in epidemiological studies; however, the strength of the association has differed between studies.Objectives To conduct a systematic literature review and doseresponse meta-analysis of prospective studies on adiposity and risk of urinary incontinence.Search strategy We searched PubMed and Embase databases up to 19 July 2017.Selection criteria Prospective cohort studies were included.Data collection and analysis Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models.Main results Twenty-four prospective studies were included. The summary RR per 5 kg/m 2 increment in body mass index (BMI) was 1.20 (95% CI 1.16-1.25, I 2 = 62%, n = 11) for populationbased studies and 1.19 (95% CI 1.08-1.30, I 2 = 87.1%, n = 8) for pregnancy-based studies, 1.18 (95% CI 1.14-1.22, I 2 = 0%, n = 2) per 10 cm increase in waist circumference and 1.34 (95% CI 1.11-1.62, I 2 = 90%, n = 2) per 10 kg of weight gain. Although the test for nonlinearity was significant for BMI, P = 0.04, the association was approximately linear. For subtypes of urinary incontinence the summary RR per 5 BMI units was 1.45 (95% CI 1.25-1.68, I 2 = 85%, n = 3) for frequent incontinence, 1.52 (95% CI 1.37-1.68, I 2 = 34%, n = 4) for severe incontinence, 1.33 (95% CI 1.26-1.41, I 2 = 0%, n = 8) for stress incontinence, 1.26 (95% CI 1.14-1.40, I 2 = 70%, n = 7) for urge incontinence, and 1.52 (95% CI 1.36-1.69, I 2 = 0%, n = 3) for mixed incontinence.Conclusion These results suggest excess weight may increase risk of urinary incontinence.Keywords Body mass index, meta-analysis, obesity, overweight, prospective studies, urinary incontinence, waist circumference.Tweetable abstract Overweight and obesity increase the risk of urinary incontinence.Please cite this paper as: Aune D, Mahamat-Saleh Y, Norat T, Riboli E. Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose-response meta-analysis of prospective studies.

Weight loss interventions as an option for a lifestyle treatment in urinary incontinence

“…Based on this limited evidence there are signs that weight loss interventions may be considered as an option for a lifestyle treatment due to some signs of effectiveness to improve symptoms in UI, prevalence of weekly UI and there being limited adverse events. Previous systematic reviews have shown a positive association with increased BMI and risk of UI (Aune et al 2019;Lamerton et al 2018).…”

“…This condition can have a significant clinical (Yang et al 2018), psychological (Farage et al 2008;Sims et al 2011), and financial impact (Thom et al 2010) on an individual's life. The risk of developing UI is associated with several non-modifiable modifiable risk factors of age (Milsom and Gyhagen 2019), gender (Nitti 2001) and family history (von Gontard et al 2011) and modifiable risk factors of weight (Aune et al 2019), smoking (Kawahara et al 2020), diet (Maserejian et al 2010) and caffeine intake (Gleason et al 2013). Despite the association with such modifiable risk factors, there is limited evidence supporting interventions which aim to affect their influence (Imamura et al 2015).…”

Chronic diseases and obesity risk: Analysis of Turkish data

“…In this study, it was found that the lumbar disc herniation increased the frequency of obesity exclusively for women in various regression models by 1,156 and 1,229 times. Studies are indicating that the prevalence of urinary incontinence increases in parallel with the increase in BMI value [41][42]. In some cases, the disease increases the risk of obesity, while in other cases, obesity increases the risk of disease.…”

Management of urinary incontinence

“…Women with a body mass index (BMI) > 30 kg/m 2 should be advised to lose weight as increased BMI has an almost linear association with UI. 14 Smoking cessation should be encouraged as a large population-based study found that smoking was associated with UI. 15…”