行為介入可改善過重、肥胖婦女的尿失禁

e48585 發表於 2009-2-17 13:28:27 [顯示全部樓層] 回覆獎勵 閱讀模式 1 1943
作者:Laurie Barclay, MD  
出處:WebMD醫學新聞

  January 28, 2009 — 根據1月29日新英格蘭醫學期刊中的一篇隨機控制試驗結果,過重與肥胖婦女在6個月的減重行為介入後,尿失禁有所改善。
  
  加州大學舊金山分校的Leslee L. Subak醫師與「飲食與運動研究以減少尿失禁計畫」的研究者寫道,已知肥胖是尿失禁的可修改風險因素,但是減重對尿失禁的好處並沒有決定性的證據。
  
  研究目的是確認過重和肥胖婦女之減重行為在6個月時對尿失禁的結果是否優於控制組。
  
  研究樣本包括338位過重和肥胖婦女,平均年紀為53±11歲,每週至少有10次尿失禁;研究對象被隨機指派密集的6個月飲食運動和行為修飾減重計畫(n = 226),或者結構式教育計畫(n = 112)。
  
  開始時,介入組和控制組的身體質量指數 (分別是36 ± 6與36 ± 5 kg/m2)與每週排尿日記(diary of voiding)中的尿失禁次數(分別是24 ± 18與24 ± 16)相似。
  
  介入組平均減重8.0% (7.8 kg) ,控制組為1.6% (1.5 kg) (P < .001);6個月後,介入組平均每週尿失禁次數減少47%,控制組為28% (P = .01)。介入組的壓力性尿失禁次數比控制組少很多(P = .02),但是急迫性尿失禁頻率則無顯著差異(P = .14)。
  
  相較於控制組,介入組之整體尿失禁頻率(P < .001)、壓力性尿失禁次數(P = .009)、急迫性尿失禁次數(P = .04)減少超過70%者明顯較多。
  
  研究限制包括難以一般化,因為研究對象經過挑選,對於減重行為介入方式比較會遵守,且這些參與者的一些醫療狀況被排除;缺乏對治療方式的雙盲對照,不同之報告狀況的可能性。
  
  研究作者寫道,相較於控制組,6個月的行為介入減重治療減少了過重與肥胖婦女之自我報告尿失禁次數。 尿失禁次數減少可能是密集健康管理在適度減重之外的另一個好處。
  
  國家糖尿病與消化道和腎臟疾病研究中心、婦女健康研究辦公室支持本研究。4名研究作者宣稱與Pfizer、Bionovo、Eli Lilly、Pfizer、deCODE Genetics、Astellas和/或GlaxoSmithKline等藥廠有各種財務關係,其他研究作者宣稱沒有相關財務關係。

Urinary Incontinence in Overweight, Obese Women May Respond to Behavioral Intervention

By Laurie Barclay, MD
Medscape Medical News

January 28, 2009 — Urinary incontinence in overweight and obese women may respond to a 6-month behavioral intervention targeting weight loss, according to the results of a randomized clinical trial reported in the January 29 issue of the New England Journal of Medicine.

"Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking," write Leslee L. Subak, MD, from the University of California-San Francisco, and colleagues from the Program to Reduce Incontinence by Diet and Exercise Investigators.

The purpose of this study was "to determine whether a behavioral weight-reduction intervention for overweight and obese women with incontinence would result in greater reductions in the frequency of incontinence episodes at 6 months as compared with a control group."

The study sample consisted of 338 overweight and obese women, mean age 53 ± 11 years, with at least 10 episodes of urinary incontinence per week. Participants were randomly assigned to an intensive 6-month weight loss program including diet, exercise, and behavior modification (n = 226) or to a structured education program (n = 112).

At baseline, the intervention group and the control group had similar body mass index (36 ± 6 and 36 ± 5 kg/m2, respectively) and weekly number of incontinence episodes recorded in a 7-day diary of voiding (24?± 18 and 24 ± 16, respectively).

Mean weight loss was 8.0% (7.8 kg) in the intervention group vs 1.6% (1.5 kg) in the control group (P < .001). After 6 months, the mean number of incontinence episodes per week decreased by 47% in the intervention group and 28% in the control group (P = .01). The intervention group had a greater decrease in the frequency of stress incontinence episodes vs the control group, (P = .02) but not in the frequency of urge incontinence episodes (P = .14).

Compared with the control group, the intervention group had a higher proportion with a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (P < .001), stress incontinence episodes (P = .009), and urge incontinence episodes (P = .04).

Limitations of this study include limited generalizability because the participants were selected for their potential to adhere to the behavioral weight loss intervention and because participants with certain medical conditions were excluded; and lack of blinding of participants to their treatment assignment, creating the potential for differential reporting.

"A 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a control group," the study authors write. "A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction."

The National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Research on Women's Health supported this study. Four of the study authors have disclosed various financial relationships with Pfizer, Bionovo, Eli Lilly, Pfizer, deCODE Genetics, Astellas and/or GlaxoSmithKline. The remaining study authors have disclosed no relevant financial relationships.

N Engl J Med. 2009;360:481-490.

[ 本帖最後由 goodcat1111 於 2009-2-17 23:27 編輯 ]

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