Weight-Adjusted Waist Index Mediates the Association Between Cardiovascular Health (Life’s Crucial 9) and Stress Urinary Incontinence: A NHANES Study

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2026-03-31 DOI:10.1155/ijcp/9466687

Chen Chen, Lina Huang, Qifeng Song, Zhijun Xia

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Abstract

Background

Stress urinary incontinence (SUI) is a common and bothersome condition adversely affecting women’s well-being. Although growing evidence links cardiometabolic health to pelvic floor disorders, the role of multidimensional cardiovascular health metrics—particularly Life’s Crucial 9 (LC9)—has not been adequately examined. This study aimed to evaluate the association between LC9 and SUI and to investigate whether the weight-adjusted waist index (WWI), an indicator of central fat distribution, mediates this relationship.

Methods

We analyzed data from the 2005–2016 National Health and Nutrition Examination Survey (NHANES), including 8086 women with complete information. LC9 was constructed from nine components reflecting behavioral, biological, and psychological health. SUI was identified via a standardized questionnaire. Complex survey-weighted multivariable logistic models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Nonlinear associations were explored with restricted cubic splines, and causal mediation analysis was conducted to quantify the indirect effect through WWI.

Results

After full adjustment for confounders, a 10-point increase in LC9 score was associated with a significant reduction in SUI risk (OR = 0.82, 95% CI: 0.78–0.86). Women in the highest LC9 tertile had 45% lower odds of SUI compared to the lowest tertile (OR = 0.55, 95% CI: 0.47–0.64; p for trend < 0.001). Conversely, each unit increase in WWI was associated with elevated odds of SUI (OR = 1.22, 95% CI: 1.12–1.32), with the top tertile showing 37% higher odds (OR = 1.37, 95% CI: 1.16–1.62). Both exposures exhibited linear dose–response patterns (p for overall < 0.001). Mediation analysis suggested that WWI may account for 13% of the observed association between LC9 and SUI (p < 0.001).

Conclusions

Better cardiovascular health, as measured by LC9, is independently associated with a lower prevalence of SUI, and this relationship is partially mediated by central adiposity. These findings highlight the potential of composite health metrics in risk stratification and the development of integrated prevention strategies for SUI in women.

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体重调整腰围指数介导心血管健康（生命至关重要）和压力性尿失禁之间的关联：一项NHANES研究

背景：压力性尿失禁（SUI）是一种常见且困扰女性健康的疾病。尽管越来越多的证据将心脏代谢健康与盆底疾病联系起来，但多维心血管健康指标的作用-特别是生命关键9 (LC9) -尚未得到充分的研究。本研究旨在评估LC9与SUI之间的关系，并探讨体重调整腰围指数（WWI）作为中心脂肪分布的指标是否在这种关系中起中介作用。方法分析2005-2016年全国健康与营养检查调查（NHANES）的数据，包括8086名信息完整的女性。LC9由反映行为、生物和心理健康的九个成分组成。SUI是通过标准化问卷来确定的。使用复杂调查加权多变量logistic模型估计95%置信区间（ci）的优势比（ORs）。利用限制三次样条曲线探讨了非线性关联，并进行了因果中介分析，以量化WWI的间接影响。在对混杂因素进行全面调整后，LC9评分增加10分与SUI风险显著降低相关（OR = 0.82, 95% CI: 0.78-0.86）。LC9指数最高的妇女患SUI的几率比最低的妇女低45% （OR = 0.55, 95% CI: 0.47-0.64； p为趋势值<； 0.001）。相反，第一次世界大战中每增加一个单位，SUI的几率就会增加（OR = 1.22, 95% CI: 1.12-1.32），其中前五分位数的SUI的几率要高37% （OR = 1.37, 95% CI: 1.16-1.62）。两种暴露均呈现线性剂量-反应模式（p为总体<； 0.001）。中介分析表明WWI可能占LC9和SUI之间观察到的关联的13% （p < 0.001）。结论：LC9测量的心血管健康状况较好与SUI患病率较低独立相关，这种关系部分由中枢性肥胖介导。这些发现强调了综合健康指标在风险分层和制定女性SUI综合预防策略方面的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.