Normalized Creatinine-to-Cystatin C Ratio and Risk of Diabetes in Middle-Aged and Older Adults: The China Health and Retirement Longitudinal Study.

The triglyceride glucose (TyG) index has been proposed to be a surrogate of insulin resistance. In the present study, we aimed to examine the relationship between TyG index and the risk of incident diabetes in middle-age and older adults in China using nationally representative data from the China Health and Retirement Longitudinal Study 2011–2015. Information on socio-demographics, medical background, anthropometric measurement, and laboratory information were collected. The association between TyG index and diabetes was examined by Cox proportional hazards models and restricted cubic spline regression, and the results were presented in hazard ratio (HR) with 95% confidence interval (CI). Subgroup analyses were also conducted to examine potential interactions between demographics and TyG index. Among 7,428 participants, 791 (10.6%) of them developed diabetes over 3.4 years of follow-up. The multivariate HR for every SD increment in TyG index was 1.22 (95% CI, 1.14–1.31). When comparing to the lowest quartile of TyG index, the multivariate HRs for new-onset diabetes were 1.22 (0.96–1.54) for Q2, 1.61 (1.28–2.01) for Q3, and 1.73 (1.38–2.16) for Q4 (P for trend <0.001). The restricted cubic spline regression also showed a linear association. No interaction was found between subgroup variables and the association between TyG index and the risk of diabetes. In conclusion, higher TyG index associated with the elevated risk of new-onset diabetes in middle-aged and older adults.

Specific depressive symptoms, body mass index and diabetes in middle-aged and older Chinese adults: Analysis of data from the China Health and Retirement Longitudinal Study (CHARLS)

Distinct depressive symptom trajectories are associated with incident diabetes among Chinese middle-aged and older adults: The China Health and Retirement Longitudinal Study

Body-weight fluctuation and risk of diabetes in older adults: The China Health and Retirement Longitudinal Study (CHARLS)

Creatinine-to-cystatin C ratio has attracted substantial interest as a measure to reflect health well-being, but no studies have assessed whether its longitudinal changes are associated with risk of diabetes. We aimed to examine their association, along with the exploration of the relationship of such changes with cardiometabolic control in middle-aged and older adults. We included a total of 3278 participants aged ≥45 years who provided measurements of creatinine and cystatin C at baseline and 4 years later from the China Health and Retirement Longitudinal Study. Diabetes was diagnosed based on glucose, hemoglobin A1c (HbA1c), medical history, or use of antidiabetic mediations. Odds ratio (OR) and 95% confidence interval (CI) were obtained using logistic regression analyses. After 4-year follow-up, 272 participants developed diabetes. Larger increases in creatinine-to-cystatin C ratio were associated with lower risk of diabetes. The multivariable-adjusted OR for diabetes per 1 SD increase in creatinine-to-cystatin C ratio was 0.84 (95% CI 0.72-0.98). Compared with participants showing decreases in creatinine-to-cystatin C ratio but increases in body mass index (BMI), those experiencing increases in creatinine-to-cystatin C ratio and decreases in BMI had the largest risk reduction (multivariable-adjusted OR 0.52). Changes in creatinine-to-cystatin C ratio showed inverse correlation with blood pressure, HbA1c, lipids, and C-reactive protein at the 4-year follow-up. Moreover, they also correlated inversely with changes in HbA1c and C-reactive protein (all P ≤ 0.004). Increases in creatinine-to-cystatin C ratio led to reduced risk of diabetes and may benefit cardiometabolic control.

The associations of muscle mass and strength with new-onset Type 2 diabetes mellitus (T2DM) remain controversial. We aimed to longitudinally evaluate muscle mass and strength in predicting T2DM among Chinese middle-aged and older adults. We enrolled 6033 participants aged ≥ 45years from the China Health and Retirement Longitudinal Study (CHARLS), a cohort survey, between 2011 and 2012. The appendicular skeletal muscle mass (normalized by weight, ASM/BW%), relative hand grip strength (normalized by weight, HGS/BW), and five-repetition chair stand test (5CST). were all categorized into tertiles (lowest, middle, and highest groups) at baseline, respectively. Individuals were followed up until the occurrence of diabetes or the end of CHARLS 2018, whichever happened first. Cox proportional hazards models to calculate hazard ratios with 95% confidence intervals (CI) and mediation analysis were used. During follow-up, 815 (13.5%) participants developed T2DM. After adjusting for covariates, lower ASW/BW% was not associated with a higher risk of diabetes. Compared with individuals in the highest tertile of HGS/BW, those in the lowest tertile had 1.296 (95%CI 1.073-1.567) higher risk of diabetes. Compared with individuals in the lowest tertile of 5CST, those in the highest tertile had 1.329 times (95%CI 1.106-1.596) higher risk of diabetes. Bysubgroup,both the lowest HGS/BW and highest 5CST were risk factors for diabetes among obesity. The mediation analysis revealed that the effect of HGS/BW on therisk of diabetes is mainly mediated by insulin resistance. Lower muscle strength is associated withan increased risk of diabetes, especially in obese populations.

It has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored. This study aims to explore the correlation and dose-response relationship between different PAL and the diabetes incidence in middle-aged and older adults. Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose-response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings. In the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% (p = 0.005) and 33% (p < 0.001), respectively (p for trend < 0.001). In subgroup analyses, the fourth quartile PAL significantly reduced the diabetes incidence among females, individuals aged 60-69, and rural residents by 25% (p = 0.011), 38% (p < 0.001) and 28% (p < 0.001), respectively. For males, middle-aged (45-59 years), and urban residents, the third quartile PAL reduced diabetes incidence by 22% (p = 0.004), 24% (p = 0.012), 21% (p = 0.013), respectively. When the fourth quartile PAL was reached, the diabetes incidence was significantly reduced in these populations by 41% (p < 0.001), 39% (p < 0.001), and 41% (p < 0.001), respectively. There was a negative dose-response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings. Higher PAL was associated with lower diabetes incidence in specific Chinese middle-aged and older adults population. It is feasible to use physical activity to predict diabetes incidence in this demographic, and high PAL may be an effective means of preventing and controlling diabetes.

Background Normalized creatinine-to-cystatin C ratio (NCCR) was reported to approximate relative skeletal muscle mass and diabetes risk. However, the association between NCCR and cardiometabolic multimorbidity (CMM) remains elusive. This study aimed to explore their relationship in a large-scale prospective cohort.Methods This study included 5,849 middle-age and older participants from the China Health and Retirement Longitudinal Study (CHARLS) enrolled between 2011 and 2012. The baseline NCCR was determined as creatinine (mg/dL)/cystatin C (mg/L)×10/body mass (kg). CMM was defined as the simultaneous occurrence of two or more of the following conditions: heart disease, stroke, and type 2 diabetes mellitus. Logistic regression analysis and Cox regression analysis were employed to estimate the relationship between NCCR and CMM. The joint effect of body mass index and NCCR on the risk of CMM were further analyzed.Results During a median 4-year follow-up, 227 (3.9%) participants developed CMM. The risk of CMM was significantly decreased with per standard deviation increase of NCCR (odds ratio, 0.72; 95% confidence interval, 0.62 to 0.85) after adjustment for confounders (P<0.001). Further sex-specific analysis found significant negative associations between NCCR and CMM in female either without or with one CMM component at baseline, which was attenuated in males but remained statistically significant among those with one basal CMM component. Notably, non-obese individuals with high NCCR levels had the lowest CMM risk compared to obese counterparts with low NCCR levels in both genders.Conclusion High NCCR was independently associated with reduced risk of CMM in middle-aged and older adults in China, particularly females.

Hearing loss (HL) is a common health issue among older adults worldwide, and its incidence is expected to increase as the population ages. A study has shown that among the estimated 500 million people with hearing impairments worldwide, 28 million Americans suffer from hearing disabilities, and the highest number of individuals with hearing impairments is found in the 45-to-64 years old age group. Depression is a significant public health concern for middle-aged and older adults. In 2015, researchers used data from over 100,000 participants that were collected by the UK Biobank to perform a cross-sectional study and reported that the association between hearing impairment and depression was more pronounced among younger participants (aged 40–49 years) and among those with milder forms of depression. These findings suggest that the impact of hearing impairment on mental health may begin to emerge in middle age. Hearing loss may lead to more obstacles for middle-aged individuals in terms of work and social interactions, thereby increasing the risk of depression. Early intervention for hearing impairment is particularly important for middle-aged people, as it can help identify early risk factors and provide more effective interventions to improve mental health and quality of life. Therefore, building on the existing literature that predominantly focused on older adults, this study involved analysing data from the China Health and Retirement Longitudinal Study(CHARLS) database, expanding the age range to 45 years, to investigate the relationship between self-reported hearing loss and depression among middle-aged and older adults. This research used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), including data from 5207 individuals aged 45 years and older. Hearing status was self-reported by the participants, whereas depression was assessed with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). A multivariable logistic regression model was used to investigate the association between self-reported hearing loss and depression, controlling for sociodemographic variables that are associated with depression in middle-aged and older populations. This study involved the use of a multinomial logistic regression model to analyse the relationship between self-reported hearing loss and depression among middle-aged and older adults, with adjustments made for potential confounding variables. The analysis revealed significant relationships between depression and factors such as hearing status, sex, place of residence, self-rated health, chronic diseases, disabilities with respect to activities of daily living (ADLs), and satisfaction with life. Specifically, individuals with self-reported hearing loss, female individuals, individuals residing in rural areas, individuals with poor self-rated health, individuals with chronic diseases, and individuals with disabilities related to ADLs were more likely to experience depression. In the unadjusted model that was used to analyse the relationship between self-reported hearing loss and depression among middle-aged and older adults, both fair hearing (unadjusted OR = 1.556, 95% CI 1.377–1.758) and poor hearing (unadjusted OR = 2.001, 95% CI 1.630–2.457) were significantly associated with the prevalence of depression. After controlling for various covariates, including sex, age, residential status, education level, marital status, health status, physical disability, chronic diseases, activities of daily living (ADLs), and satisfaction with life, our study revealed that both fair hearing (adjusted OR = 1.235, 95% CI: 1.078, 1.415) and poor hearing (adjusted OR = 1.335, 95% CI: 1.063, 1.677) remained significantly correlated with the prevalence of depression among middle-aged and older adults. Previous research has focused primarily on older adults. Therefore, the present study expanded the age range to include individuals as young as 45 years old. The results show that fair hearing and poor hearing are significantly associated with the prevalence of depression among middle-aged and older adults. These findings suggest that self-reported hearing loss is a risk factor for depression in this population in China. The association between self-reported hearing loss and depression is not limited to older adults but also includes middle-aged individuals.

Changes in objectively-measured physical capability over 4-year, risk of diabetes, and glycemic control in older adults: The China Health and Retirement Longitudinal study

IntroductionChina bears the world's largest diabetes burden (116 million adults). The Cumulative Atherosclerosis Index of Plasma (CumAIP), reflecting lipid-driven atherogenicity, may contribute to diabetes pathogenesis. This study investigates longitudinal associations between cumulative CumAIP exposure and diabetes incidence in middle-aged and older Chinese adults.MethodUsing data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed 10,395 diabetes-free participants at baseline (2011) with follow-ups in 2013, 2015, and 2018. Multivariable logistic regression adjusted for sociodemographic (age, gender, education), lifestyle (smoking, alcohol, sleep, physical activity), and clinical factors (systolic and diastolic blood pressure, BMI, waist circumference). Restricted cubic splines assessed dose-response relationships.ResultOver 7 years, 793 participants (15.73%) developed diabetes. The highest CumAIP quartile (Q4) had a 3.43-fold elevated diabetes risk vs. Q1 (OR = 3.82, 95% CI: 3.13–4.67). A linear dose-response relationship was observed (p for nonlinearity=0.44); each interquartile increase in CumAIP above 1.03 elevated risk by 90% (OR = 1.90, 95% CI: 1.75–2.07). CumAIP predicted diabetes moderately (AUC=0.64, cutoff = 1.03).ConclusionCumulative CumAIP exposure independently predicts diabetes incidence in middle-to-older adults, highlighting its potential for clinical risk stratification.

Longitudinal changes in frailty and incident diabetes in middle-aged and older adults: evidence from CHARLS.

Hypertension is a significant public health issue, particularly among middle-aged and older adults. This study investigated the impact of multidimensional social participation, including its diversity and frequency, on hypertension in this population in China, with a focus on urban-rural differences. Using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), which included 12165 participants aged 45 and older, social participation was categorized by diversity (e.g., voluntary activities, Mahjong, cards, chess, or other clubs) and frequency. Hypertension was determined based on self-reported diagnoses, medication use, and blood pressure measurements. Logistic regression analyses, adjusted for demographic and health-related factors, revealed that more diverse social participation was associated with lower hypertension rates (OR=0.718, 95% CI=0.612, 0.840). Participating more than once a week also correlated with reduced hypertension risk (OR=0.877, 95% CI=0.803, 0.958). Specific activities, such as volunteering, internet use, and Mahjong, were notably protective against hypertension. Subgroup analyses highlighted urban-rural disparities, with differing impacts of social participation observed. However, interaction analyses showed that urban-rural residency did not significantly modify the relationship between social participation and hypertension. These findings emphasize the role of social participation in mitigating hypertension risk among middle-aged and older Chinese adults, and underscore the need for targeted public health strategies to address urban-rural disparities and promote social participation.

Chronic diseases have become one of the most important factors threatening human health. Subjective life expectancy (SLE) describes an individual's expectation or subjective perception of lifespan. This article aims to explore the relationship between chronic diseases and SLE, as well as the differences among different age groups and different types of chronic diseases in this relationship. China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal study that evaluates the social, economic, and health conditions of middle-aged and older adult families and individuals aged 45 and above in China. In this study, CHARLS used probability proportional to size sampling (PPS sampling) to ensure the breadth and representativeness of the sample. This study selected cross-sectional data from CHARLS 2018, removed missing values, and obtained a valid sample of 10,658 middle-aged and older individuals, of whom 8564 had chronic diseases. After controlling demographic, health behavior, socioeconomic, psychological, and social security factors, an ordered logistic regression was performed to explore the relationship between chronic disease and SLE in middle-aged and older adults. The results show that chronic diseases negatively correlate with SLE in middle-aged and older adults. Middle-aged and older adults with chronic diseases are 36.2% less likely to have high life expectancy than those without chronic diseases. Many different types of chronic diseases are negatively correlated with SLE. Cancer is most negatively correlated with SLE, far exceeding other chronic diseases. Chronic disease and SLE of middle-aged and older adults have age-heterogeneous differences. For middle-aged people aged 45-59 and young older adults aged 60-79, there is a significant correlation between chronic diseases and SLE. However, there is no correlation between chronic diseases and subjective life expectancy in the older population aged 80 and above. The government and society should pay close attention to the prevention and treatment of chronic diseases among middle-aged and older adults and adjust policies and measures according to the population's age structure. In addition, the government and society should pay attention to the spiritual needs of middle-aged and older adults. The government and society should pay more attention to cancer patients. Finally, the scientific research team should also strengthen research on chronic diseases, research and development of specific drugs and vaccines, improve the cure rate of chronic diseases, promote people's health, and make people no longer afraid of diseases.

BackgroundThe increasing prevalence of obesity across all age groups has become a major health concern in China. Previous studies have found strong links between population density, sedentary lifestyle, and the risk of being overweight among adults and adolescents in Western countries. However, little research has been conducted to disentangle this relationship in China, which is rapidly urbanizing and densely populated. Compared to other age groups, middle-aged and older adults tend to have a higher risk of being overweight, which increases their risk of diabetes, high blood pressure, and other weight-related chronic diseases. In addition, they are especially sensitive to neighbourhood environmental factors such as population density. Therefore, we aimed to unravel the link between population density and the risk of being overweight among Chinese middle-aged and older adults, with a particular focus on the mediating role of lifestyle choices.MethodsData from the 2011 China Health and Retirement Longitudinal Study were analysed. Individuals (N = 5285) were sampled from 405 neighbourhoods nested within 150 cities. Body Mass Index (BMI) was calculated based on self-reported body weight and height (being overweight was defined as a BMI ≥ 24 kg/m2). Multilevel regression and mediation analyses were applied to explore associations between population density, a sedentary lifestyle, and the risk of being overweight.ResultsMiddle-aged and older adults who lived in densely populated neighbourhoods had higher odds of being overweight. Further, this link was mediated by residents’ mode of travel and physical exercise; specifically, these residents had higher odds of owning a car and spending lesser time on weekly physical exercise, thereby increasing their risk of being overweight. Furthermore, the association between car ownership and the odds of being overweight varied by neighbourhood population density.ConclusionsThere was a positive association between neighbourhood population density and middle-aged and older adults’ risk of being overweight. This relationship may exist because people who live in densely populated neighbourhoods tend to lead a sedentary lifestyle. Our findings also suggest that, in rapidly urbanizing countries, a sedentary lifestyle may be especially harmful to middle-aged and older adults who live in densely populated neighbourhoods.