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BackgroundPhysical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI).MethodsWe evaluated the association of baseline self-reported physical activity and macronutrient intake, via food frequency questionnaire, with incident UI subtypes after 3 years among 19 741 postmenopausal women in the Women's Health Initiative Observational Study. Odds ratios (ORs) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression.ResultsWomen who reported total physical activity (metabolic equivalent task [MET]-hours/week) ≥30 versus .05 for all).ConclusionsAmong postmenopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increased risk of urgency UI, but no associations were observed between other macronutrient and UI subtypes.

A behavioral lifestyle intervention with partial meal replacement reduced excess gestational weight gain in ethnically diverse women with overweight/obesity, but the effects on micronutrient intake remained unknown. A secondary analysis of a randomized, controlled trial tested whether the intervention improved micronutrient intake relative to usual care. Pregnant women (n = 211; 30.5 years of age, body mass index, BMI, of 32.0 kg/m2) were enrolled and randomized within site and ethnicity (40% were Hispanic) into intervention (n = 102) or usual care (n = 109) groups. Two 24 h dietary recalls were conducted on random days at study entry and late pregnancy (35⁻36 weeks gestation). Nutrient adequacy was defined using the Estimated Average Requirement cut-point method. At study entry and including prenatal vitamins, ≥90% of participants reported inadequate intake of vitamins D and E and iron; 40⁻50% reported inadequate intake of calcium, protein, vitamins A, C, B6, folate, magnesium, and zinc. From study entry to late pregnancy, the behavioral intervention with partial meal replacement increased the overall intake of vitamins A, E, and D and copper and reduced the odds of inadequate intake of calcium (odds ratio (OR) = 0.37 (0.18, 0.76)), vitamins A (OR = 0.39 (0.21, 0.72)) and E (OR = 0.17 (0.06, 0.48)), and magnesium (OR = 0.36 (0.20, 0.65)). A behavioral intervention with partial meal replacement during pregnancy improved the intake of several micronutrients in Hispanic and non-Hispanic women with overweight/obesity.

Internet-based weight loss programs can be effective in promoting weight loss and are less-intensive than traditional face-to-face approaches, which may provide more flexibility for postpartum, low-income women to engage in such programs. Few studies have examined patterns of engagement in internet-based programs for this population. This article used data from the internet-based Fit Moms/"Mamás Activas" intervention, a 12-month cluster randomized controlled trial that was effective in promoting postpartum weight loss among low-income, predominantly Hispanic women. The overall objectives of this study were to (1) characterize patterns of engagement with the Fit Moms/"Mamás Activas" website among intervention participants and (2) explore associations between engagement and 12-month weight loss outcomes among study completers (87.4%). A number of engagement variables were calculated for each participant, including website logins; time spent on the website; number of posts to the "Discussion Forum;" number of days tracking weight, diet, and physical activity; number of page visits to various website components; and number of in-person visits attended. The average number of logins was 70.74 (approximately once weekly), and average total time spent on the website was 185.35 minutes (approximately 3 hours) over 1 year. Self-monitoring ("Web Diary") and social support ("Discussion Forum") were the most frequently visited components of the website, and more frequent engagement with these components, as well as greater attendance at in-person group sessions, predicted greater percent weight loss at 12 months. Interventions highlighting these features may be particularly effective for weight loss in this population.

To determine the feasibility, acceptability and preliminary efficacy of an eHealth intervention with charity-based incentives to increase physical activity (PA) among young adult cancer survivors. Participants were randomized into two groups: PA (N = 25; Fitbit, step goal, electronic weekly newsletter) or PA + Charity (N = 26; same as PA plus charity donation if step goal achieved). At baseline and 12 weeks, steps/day were assessed using an activPAL. Motivation (e.g., BREQ-3) and patient reported outcomes (e.g., sleep quality, fatigue) were self-reported. The mean age was 36.8 years, 56.9% were Non-Hispanic White. We retained 82% (42/51) of participants. The PA + Charity vs. PA group had significantly higher satisfaction with intervention experience (100% vs 85%), greater increases in steps/day (1689 vs 516) and increases in overall self-determination score (13.5 vs 2.2). Both groups significantly improved sleep quality and reduced fatigue. A low-intensity eHealth intervention with charity-based incentives was feasible, acceptable, increased PA and self-determination. Trial registration Clinicaltrials.gov NCT03322059., Author(s): Sarah Kozey Keadle [sup.1] , Leah Meuter [sup.1] , Suzanne Phelan [sup.1] , Siobhan M. Phillips [sup.2] Author Affiliations: (1) grid.253547.2, 000000012222461X, Department of Kinesiology and Public Health, California [...]

ObjectivesTo examine the long-term prevalence and predictors of weekly urinary incontinence in the Diabetes Prevention Program Outcomes Study, a follow-up study of the Diabetes Prevention Program randomized clinical trial of overweight adults with impaired glucose tolerance.MethodsThis analysis included 1778 female participants of the Diabetes Prevention Program Outcomes Study who had been randomly assigned during the Diabetes Prevention Program to intensive lifestyle intervention (n = 582), metformin (n = 589) or placebo (n = 607). The study participants completed semi-annual assessments after the final Diabetes Prevention Program visit and for 6 years until October 2008.ResultsAt the study entry, the prevalence of weekly urinary incontinence was lower in the intensive lifestyle intervention group compared with the metformin and placebo groups (44.2% vs 51.8%, 48.0% urinary incontinence/week, P = 0.04); during the 6-year follow-up period, these lower rates in intensive lifestyle intervention were maintained (46.7%, 53.1%, 49.9% urinary incontinence/week; P = 0.03). Statistically adjusting for urinary incontinence prevalence at the end of the Diabetes Prevention Program, the treatment arm no longer had a significant impact on urinary incontinence during the Diabetes Prevention Program Outcomes Study. Independent predictors of lower urinary incontinence during the Diabetes Prevention Program Outcomes Study included lower body mass index (odds ratio 0.988, 95% confidence interval 0.982-0.994) and greater physical activity (odds ratio 0.999, 95% confidence interval 0.998-1.000) at the Diabetes Prevention Program Outcomes Study entry, and greater reductions in body mass index (odds ratio 0.75, 95% confidence interval 0.60-0.94) and waist circumference (odds ratio 0.998, 95% confidence interval 0.996-1.0) during the Diabetes Prevention Program Outcomes Study. Diabetes was not significantly related to urinary incontinence.ConclusionsIntensive lifestyle intervention has a modest positive and enduring impact on urinary incontinence, and should be considered for the long-term prevention and treatment of urinary incontinence in overweight/obese women with glucose intolerance.

PURPOSE: We determined the effect of an intensive lifestyle intervention on the prevalence, incidence and resolution of bothersome nocturia, increased daytime urinary voiding and urinary incontinence in overweight/obese men with type 2 diabetes after 1 year in the Look AHEAD trial. MATERIALS AND METHODS: A subset of male Look AHEAD participants was selected for this secondary data analysis. Overall 1,910 men with an average (mean ± SD) age of 59.9 ± 6.7 years and body mass index of 35.2 ± 5.5 kg/m(2) were randomized to an intensive lifestyle intervention or diabetes support and education group. All participants self-reported information regarding incontinence, nocturia and daytime urinary voiding at entry and 1 year. RESULTS: After 1 year the intensive lifestyle intervention group lost significantly more weight than the diabetes support and education group (9.4% ± 7.0% vs 0.7% ± 4.5%, respectively; p

PurposeWe determined the effect of an intensive lifestyle intervention on the prevalence, incidence and resolution of bothersome nocturia, increased daytime urinary voiding and urinary incontinence in overweight/obese men with type 2 diabetes after 1 year in the Look AHEAD trial.Materials and methodsA subset of male Look AHEAD participants was selected for this secondary data analysis. Overall 1,910 men with an average (mean ± SD) age of 59.9 ± 6.7 years and body mass index of 35.2 ± 5.5 kg/m(2) were randomized to an intensive lifestyle intervention or diabetes support and education group. All participants self-reported information regarding incontinence, nocturia and daytime urinary voiding at entry and 1 year.ResultsAfter 1 year the intensive lifestyle intervention group lost significantly more weight than the diabetes support and education group (9.4% ± 7.0% vs 0.7% ± 4.5%, respectively; p

OBJECTIVE To determine the prevalence and risk factors for urinary incontinence among different racial/ethnic groups of overweight and obese women with type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional analysis of baseline data from the Action for Health in Diabetes (Look AHEAD) study, a randomized clinical trial with 2,994 overweight/obese women with type 2 diabetes. RESULTS Weekly incontinence (27%) was reported more often than other diabetes-associated complications, including retinopathy (7.5%), microalbuminuria (2.2%), and neuropathy (1.5%). The prevalence of weekly incontinence was highest among non-Hispanic whites (32%) and lowest among African Americans (18%), and Asians (12%) (P < 0.001). Asian and African American women had lower odds of weekly incontinence compared with non-Hispanic whites (75 and 55% lower, respectively; P < 0.001). Women with a BMI of > or =35 kg/m(2) had a higher odds of overall and stress incontinence (55-85% higher; P < 0.03) compared with that for nonobese women. Risk factors for overall incontinence, as well as for stress and urgency incontinence, included prior hysterectomy (40-80% increased risk; P < 0.01) and urinary tract infection in the prior year (55-90% increased risk; P < 0.001). CONCLUSIONS Among overweight and obese women with type 2 diabetes, urinary incontinence is highly prevalent and far exceeds the prevalence of other diabetes complications. Racial/ethnic differences in incontinence prevalence are similar to those in women without diabetes, affecting non-Hispanic whites more than Asians and African Americans. Increasing obesity (BMI > or =35 kg/m(2)) was the strongest modifiable risk factor for overall incontinence and stress incontinence in this diverse cohort.