TO know the relationship between serum 25-hydroxyvitamin D (25(OH)D) and urinary incontinence (UI) subtypes in elderly men

Methodology 
Study Design and Setting:
This particular cross-sectional study was carried out at Khyber Teaching Hospital (KTH), Peshawar, Pakistan from January 2023 to December 2025. KTH is a tertiary healthcare hospital for the North Western part of Pakistan and captures the male geriatric population indicator for this zone. 
Study Population:
The study recruited 1250 men aged “over or equal to” 50 years visiting KTH for the outpatient department. The exclusion filters were incomplete urinary incontinence (UI) or vitamin D data, clinically significant cognitive impairment which was operationalized as a Mini-Mental State Examination score of less than 18 [22], and terminal illnesses that included metastatic cancer or renal failure which is on stage three or four. 
Serum 25-Hydroxyvitamin D Measurement:
Blood samples were collected as per the standard protocol. The samples were processed with liquid chromatography tandem mass spectrometry (LC-MS/MS) [6]. The participants were grouped as deficient (less than 50nmol/L), insufficient (50-75nmol/L), or sufficient (over 75nmol/L) [8].
Urinary Incontinence Assessment:
UI subtypes were evaluated using a culturally validated Urdu/Pashto questionnaire adapted from the International Consultation on Incontinence Modular Questionnaire (ICIQ) [23]. The questionnaire demonstrated high reliability (Cronbach’s α = 0.84). Subtypes were defined as follows: stress UI (SUI)—leakage during physical exertion (e.g., coughing, lifting); urge UI (UUI)—leakage preceded by urgency; and mixed UI (MUI)—co-occurrence of SUI and UUI.

Results:


Variable	Deficient (<50 nmol/L)	Insufficient (50–75 nmol/L)	Sufficient (≥75 nmol/L)	p-value
Age (years), Mean ± SD	65.2 ± 8.1	67.1 ± 7.9	68.5 ± 7.9	<0.001
BMI ≥30, n (%)	160 (38.1%)	160 (31.4%)	90 (28.1%)	0.002
Hypertension, n (%)	290 (69.0%)	320 (62.7%)	200 (62.5%)	0.12
Diabetes, n (%)	150 (35.7%)	170 (33.3%)	90 (28.1%)	0.08
Interpretation: Vitamin D deficiency was associated with higher prevalence of all

Interpretation: 



1.	Vitamin D deficiency has SUI (OR = 1.72, 95% CI: 1.10 - 2.70) and MUI (OR = 1.89, 95% CI: 1.05 - 3.40) as the most significant correlated Features. 
2.	 The reference line at OR=1 shows no impact at all, but both SUI and MUI have CIs that do not cross this line, thus confirming their significance. 
3.	 UUI was excluded because it had no significant association. 

Among the 1250 attended Khyber teaching hospital in Peshawar, 33.6% had vitamin D deficiency(<50nmol/L). Deficient respondents were younger (mean age: 65.2 versus 68.5 years). Obese respondents had higher BMI (38.1% versus 28.1%) and were compared to sufficient counterparts (p<0.05). Urinary incontinence (UI) subtypes SUI (9.1% versus 6.8%), UUI (28.3% versus 20.1%) and MUI (6.2% versus 3.9%) was significantly higher in vitamin D deficient group. Adjusting for age, BMI, comorbidities, and socio-economic factors, vitamin D deficiency increased the odds of SUI (OR = 1.72; 95% CI = 1.10-2.70).  MUI (OR=1.89; 1.05- 3.40), but not UUI.

Conclusion:
This study identifies vitamin D deficiency as an important changeable risk factor for stress and mix urinary incontinence in elderly Pakistani men. 33.6% of participants were deficient and the deficiency rate nationwide exceeds 49% [16]. Therefore, this problem needs to be solved urgently. 

Public health efforts in Pakistan must give special attention to: 
1.	Routine vitamin D screening for elderly men with UI.
2.	Fortification of staple foods (e.g., wheat, dairy) with vitamin D.
3.	Community education on sun exposure and nutrition.

These actions could greatly help preventable disability in older populations and improve life in low-resourced countries, which is why they would enhance Pakistan's National Health Vision 2025[20].

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4.	Bikle, D., & Christakos, S. (2020). New aspects of vitamin D metabolism and action—Addressing the skin as source and target. Nature Reviews Endocrinology, 16(4), 234–252. https://doi.org/10.1038/s41574-019-0312-5
3.	Vaughan, C. P., & Markland, A. D. (2020). Urinary incontinence in women. Annals of Internal Medicine, 172(5), ITC17–ITC32. https://doi.org/10.7326/AITC202002040