PROVIDED.Scientific: Urinary incontinence (Ul) is a common problem in middle-aged and older women that resultsintens of billions of dollars in health care expenditures and has been associated with an increased risk ofnursing home admissions, falls, and decreased quality of life. The proposed epidemiologic study wouldfollow a well-characterized cohort of 2000 women original enrolled under the Reproductive Risks ofIncontinence Study at Kaiser (RRISK). The RRISK cohort is probably unique in being apopulation-basedprospective cohort with excellent representation of Black, Asian, Hispanic and non-Hispanic Whitewomendevoted to the study of voiding dysfunction and incontinence. It is also part of the UCSF SpecializedCenterof Research which includes a laboratory-based research group investigating underlying mechanisms forvoiding dysfunction and incontinence. The proposed study will continue this highly successful collaborationby investigating questions that have arisen from our clinical and basic science investigations underthecurrent SCOR. The overall goal of our proposed study is to advance our understanding of the mechanismsof voiding dysfunction and Ul and to facilitate the translational development of novel approaches totreatmentand prevention. Specifically, we propose to address the following 6 questions: what is the basis for the two tothree fold higher prevalence of stress incontinence in White, comparedto Black or Asian women; what is thelongitudinal relationship between pre-diabetes and Ul; do adipocytokines explain the relationship betweenobesity and incontinence; do phytoestrogens increase the risk of Ul; are estrogen receptor genepolymorphisms risk factors for Ul; and what are risk factors for incident Ul and progression of existingUl.Lay Language: Urinary incontinence is a common problem for which there are limited treatments. Ourstudywill investigate several promising areas to increase our understanding of the mechanisms underlyingincontinence and suggest new approaches to treatment and prevention. We will study an ethnicallyandracially diverse group of 2000 women to determine the nature of the recently reported relationship betweenpre-diabetes and incontinence, and to investigate 3 possible new risk factors for incontinence:adipocytokines (substances secreted by fat cells), phytoestrogens (plant molecules with estrogen-likeeffects) and genetic variations in estrogen receptors (molecules that allow estrogen to act on cells).
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