OVERACTIVE bladder (OAB) is a chronic condition characterised by urgency, with or without urgency urinary incontinence, typically accompanied by frequent urination during the day and nocturia. It affects both men and women, with prevalence rates of 12.8% in women and 10.8% in men. The impact of OAB on quality of life is significant, and in the United States alone, the economic burden associated with its underdiagnosis and inadequate treatment is substantial, with estimated healthcare costs reaching $86 billion annually. The underlying causes of OAB are complex, with systemic and urothelial inflammation being potential contributing factors. Various theories, including myogenic, urothelial dysfunction, neurogenic, and detrusor underactivity hypotheses, have been proposed to explain its pathophysiology.
Obesity has been increasingly recognised as a risk factor for OAB, with visceral fat being particularly implicated due to its inflammatory nature. The weight-adjusted waist index (WWI) has emerged as a superior predictor of cardiometabolic diseases compared to body mass index (BMI), providing a more accurate measure of fat distribution. Given the role of obesity in metabolic syndrome and cardiovascular disease, its association with OAB warrants further investigation. Metabolic syndrome, characterised by abdominal obesity, insulin resistance, hypertension, and dyslipidaemia, has been linked to cardiovascular disease, and studies suggest a strong relationship between metabolic syndrome and OAB.
Recent developments in cardiovascular health assessment, including Life’s Crucial 9 (LC9), which incorporates mental health, provide a comprehensive framework for evaluating overall health. Given that weight loss in abdominal obesity has been shown to improve metabolic syndrome, and LC9 includes modifiable lifestyle factors, it is hypothesised that WWI mediates the relationship between LC9 and OAB. Higher LC9 scores may promote healthier behaviours, reducing obesity and, in turn, mitigating OAB symptoms. Using data from NHANES (2005–2018), a study investigating 25,319 participants found a negative correlation between LC9 and OAB prevalence, while WWI showed a positive correlation with OAB. Mediation analysis indicated that WWI partially explained the relationship between LC9 and OAB, highlighting its potential role in OAB pathogenesis.
These findings suggest that strategies targeting visceral fat reduction may aid in OAB management. Furthermore, the incorporation of mental health considerations within LC9 underscores the need for a holistic approach to OAB prevention and treatment. Further research is required to establish causality and explore potential interventions that address both metabolic and cardiovascular health in the context of OAB.
Katie Wright, EMJ
Reference
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