The International Society of Incontinence (ICS) reports Stress Urinary Incontinence (SUI) as the involuntary loss of urine, which happens when the urinary loss is associated with coughing, sneezing, or physical exertion [1]. Furthermore, it is known that SUI is associated with numerous risk factors, one of the most common of which is obesity, which generates an overload on the muscular, neural, and vascular structures of the pelvic floor [2]. 
Although the association between overweight/obesity and UI seems evident in the literature, it is necessary to investigate body composition's influence on urinary symptoms [3]. Thus, it becomes crucial to refining the body composition assessment using standard gold instruments, such as dual emission x-ray densitometry (DXA), to help identify the influence of fat mass on urinary symptoms. Thus, this study aims to investigate the influence between total fat mass and UI symptoms.

A cross-sectional study was approved by the Research Ethics Committee and was conducted according to the guidelines recommended by STROBE (STrengthening the Reporting of OBservational studies in Epidemiology).
Biological female participants aged between 18 and 49 years were included, and women who had previous pelvic surgery, post menopause, difficulty understanding the proposed procedures, pregnant women, and parity over two deliveries were excluded. Information was collected on sociodemographic data, obstetric and gynecological history. Participants also answered the 3-Incontinence Questions translated and validated for the Brazilian population (3IQ-Br)  to identify and classify UI as SUI and UUI. The body mass index (BMI) was calculated using an anthropometric scale, applying the mass divided by squared height formula (BMI= kg/m²), according to the World Health Organization (WHO) classification: Underweight, eutrophic, overweight, and obesity. 
Fat mass was measured using the DXA (Horizon® DXA System, Hologic Discovery A, Bendford, MA), a gold standard exam for evaluating body composition. The procedures for performing the tests followed the manufacturer's recommendations: 11- Participants should not do any physical exercise in the 24 hours before the exam; 2- Women should fast for at least 4 hours; 3- Women should be dressed in clothes that do not contain any metallic material (zippers or accessories); 4- During the examination, the participant should remain immobile, in dorsal decubitus, centered on the table, with the head 3 cm from the upper marking of the table, arms resting along the trunk, legs extended and hip-width apart (in internal rotation ). 
Data analysis was performed using Statistical Package for the Social Sciences versão 22.0 (SPSS Inc., Chicago, IL, EUA). The descriptive analysis of continuous variables by mean, standard deviation while categorical variables were presented through simple frequencies and percentages. The means of fat mass values of women with and without UI symptoms was compared using Student's T-test.

Most women were aged between 18-29 years (36.4%). Eutrophic (35.4%), overweight (30.3%), and obese (34.3%) women participated in the study. Approximately 67.7% of women are nulliparous, and when 39.4% reported exertion symptoms predominantly (Table 1). 
Table 2 shows a significant difference in total fat mass (p < 0.05) for symptoms of SUI, in which women with SUI had a higher concentration of total fat.

The results suggest that women with SUI had a higher concentration of total fat when compared to those that do not report symptoms of urinary leakage. This information is in line with what has already been found in other studies that suggest a relationship between overweight and obesity and UI [2]. This study was innovative and proposed to evaluate the total fat mass using DXA, an exam capable of properly quantifying the composition of total fat mass, to fill the gap in the literature that indicates the need for an adequate assessment of body composition [3].

The increase in total fat mass is associated with urinary leakage. Thus, this information will reinforce and direct clinical action in the treatment and prevention of SUI, with interventions that may also affect changes in body fat mass.

ICS. The 2019 compilation of the International Continence Society Standardisations , Consensus statements , Educational modules , Terminology and Fundamentals documents , with the International Consultation on Incontinence algorithms ICS STANDARDS 2019 2019.
Lamerton TJ, Torquati L, Brown WJ. Overweight and obesity as major, modifiable risk factors for urinary incontinence in young to mid-aged women: a systematic review and meta-analysis. Obesity Reviews 2018;19:1735–45. https://doi.org/10.1111/obr.12756.
Bazi T, Takahashi S, Ismail S, Bø K, Ruiz-Zapata AM, Duckett J, et al. Prevention of pelvic floor disorders: international urogynecological association research and development committee opinion. Int Urogynecol J 2016;27:1785–95. https://doi.org/10.1007/s00192-016-2993-9.

Continence 7S1 (2023) 100886
DOI: 10.1016/j.cont.2023.100886