Insulin Resistance Is Associated with Prevalence of Physician-Diagnosed Urinary Incontinence in Postmenopausal Non-Diabetic Adult Women: Data from the Fourth Korea National Health and Nutrition Examination Survey.

Byung Il Yoon,Dong Wan Sohn,Yong-Hyun Cho,Kyung-Do Han,Sun Wook Kim,U-Syn Ha,Kyu Won Lee,Hyuk Sang Kwon,Tatsuo Shimosawa

doi:10.1371/journal.pone.0141720

Abstract

ObjectiveTo investigate the association between insulin resistance (IR) and urinary incontinence in Korean adult women by analyzing the data from the Korea National Health and Nutrition Examination Survey IV (KNHANES) 2007–2009MethodsA nationally representative sample of 5318 non-diabetic Korean women ≥19-years-of-age (3043 premenopausal and 2275 postmenopausal women) was included from KNHANES 2008–2010. IR was measured using the homeostasis model assessment of IR (HOMA-IR). Participants in the highest and lowest quartile of HOMA-IR were defined as insulin-resistant and insulin-sensitive respectively. Women who have current physician-diagnosed urinary incontinence were classified as having urinary incontinence.ResultsIncontinence was found in 9.18% of the total population, 8.51% of the premenopausal population, and 10.86% of the postmenopausal population. The prevalence of incontinence increased with age, reaching a peak at 60-69-years-of-age. The prevalence of urinary incontinence increased significantly with higher HOMA-IR quartiles in pre- and post-menopausal women (p for linear association = 0.0458 and 0.0009 respectively). Among post-menopausal women, those in the highest quartile of HOMA-IR were significantly more likely to have urinary incontinence compared to those in the lowest quartile [adjusted odds ratio, 1.72; 95% confidence interval, 1.07–2.77]. However premenopausal population exhibited no association between incontinence and HOMA-IR quartilesConclusionOur results suggest that the prevalence of incontinence increased across HOMA-IR in non-diabetic adult women, and especially, IR might be a risk factor for incontinence in postmenopausal non-diabetic women.

Highlights

Urinary incontinence is a major health issue for women, which diminishes their quality of life (QoL)
Our results suggest that the prevalence of incontinence increased across homeostasis model assessment (HOMA)-insulin resistance (IR) in nondiabetic adult women, and especially, IR might be a risk factor for incontinence in postmenopausal non-diabetic women
The main findings of this study are as follows: (1) the prevalence of incontinence increased across the homeostasis model assessment of IR (HOMA-IR) quartiles, regardless of the menopause state. (2) postmenopausal nondiabetic women in the higher quartile of HOMA-IR were more likely to be incontinent compared to counterparts in the lowest quartile independent of age, body mass index (BMI), smoking, drinking, exercise, education, income, and hypertension. (3) elevation of IR is implicated as a risk factor of incontinence in postmenopausal non-diabetic women

Summary

Introduction

Urinary incontinence is a major health issue for women, which diminishes their quality of life (QoL). This condition exacts emotional and hygienic impairments and economic expense [1,2]. Hyperinsulinemia, and insulin resistance (IR) are associated with the risk of lower urinary tract symptoms (LUTS) [7,8,9]. Subsequent to IR, associated hyperinsulinemia leads to vascular endothelial dysfunction, abnormal lipid profile, and vascular inflammation, all of which promote the development of vascular impairment [11,12]. IR might promote LUTS through vascular impairment and might be a key step in early pathogenesis

Results

Discussion

Conclusion