Middle-aged Chinese Research Articles

Association of outdoor artificial light at night with metabolic syndrome and the modifying effect of tree and grass cover

BackgroundEpidemiological studies show that outdoor artificial light at night (ALAN) is linked to metabolic hazards, but its association with metabolic syndrome (MetS) remains unclear. We aimed to investigate the association of outdoor ALAN with MetS in middle-aged and elderly Chinese. MethodsFrom 2017–2020, we conducted a cross-sectional study in a total of 109,452 participants living in ten cities of eastern China. MetS was defined by fasting blood glucose (FG), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), blood pressure (BP), and waist circumference (WC). In 2021, we followed up 4395 participants without MetS at the baseline. Each participant's five-year average exposure to outdoor ALAN, as well as their exposure to green space type, were measured through matching to their address. Generalized linear models were used to assess the associations of outdoor ALAN with MetS. Stratified analyses were performed by sex, age, region, physical activity, and exposure to green space. ResultsIn the cross-sectional study, compared to the first quantile (Q1) of outdoor ALAN exposure, the odds ratios (ORs) of MetS were 1.156 [95 % confidence interval (CI): 1.111–1.203] and 1.073 (95 %CI: 1.021–1.128) respectively in the third and fourth quantiles (Q3, Q4) of outdoor ALAN exposure. The follow-up study found that, compared to the first quantile (Q1) of outdoor ALAN exposure, the OR of MetS in Q4 of ALAN exposure was 1.204 (95 %CI: 1.019–1.422). Adverse associations of ALAN with MetS components, including high FG, high TG, and obesity, were also found. Greater associations of ALAN with MetS were found in males, the elderly, urban residents, those with low frequency of physical activity, and those living in areas with low levels of grass cover and tree cover. ConclusionsOutdoor ALAN exposure is associated with an increased MetS risk, especially in males, the elderly, urban residents, those lacking physical activity, and those living in lower levels of grass cover and tree cover.

Multidimensional Internet Use, Social Participation, and Depression Among Middle-Aged and Elderly Chinese Individuals: Nationwide Cross-Sectional Study.

There is growing evidence that the internet has beneficial effects on the mental health of middle-aged and older people (≥45 years), but the evidence is inconclusive, and the underlying mechanisms are less known. This study aims to explore the relationship between multidimensional (devices, frequency, and purpose) internet use and depression in middle-aged and elderly Chinese, as well as the mediating effect of social participation. Moreover, this study will explore the moderating effect of the regional informatization development level (RIDL) on the relationships between individual internet use, social participation, and depression. Data on 17,676 participants aged 45 years or older were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2018 data set. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to identify the presence of depression. Logistic regression was used to explore the relationship between each dimension of internet use and depression. Multiple linear regression was used to explore the mediating effect of social participation and the moderating effect of the RIDL. The results showed that 28.33% (5008/17,676) of the total population had depression. In terms of regional subgroups, respondents living in the western region exhibited the highest proportion of depression (2041/5884, 34.69%). Internet use was negatively associated with depression (odds ratio 0.613, 95% CI 0.542-0.692; P<.001). Various dimensions of internet use positively contributed to individual social participation and reduced individual depression (devices: β=-.170, 95% CI -0.209 to -0.127; frequency: β=-.065, 95% CI -0.081 to -0.047; and purpose: β=-.043, 95% CI -0.053 to -0.031). In addition, the RIDL weakened the relationship between individual-level internet use and social participation (internet use: F74.12,9.82=7.55, P<.001; devices: F51.65/9.88=5.23, P=.005; frequency: F66.74/10.08=6.62, P=.001; and purpose: F66.52/9.78=6.80, P=.001), and negatively moderated the relationship between the frequency of internet use and depression (frequency: F662.67/188.79=3.51, P=.03). This study found that different dimensions of internet use are associated with lower levels of depression. Social participation partially mediates the association between multidimensional internet use and depression in the eastern, central, and western regions, respectively. Additionally, the RIDL helps individuals further their internet use and social participation, reducing the impact of depression. However, this effect weakens sequentially from the western region to the central region and then to the eastern region.

Assessing the Association of Self-Reported Sleep Duration and Metabolic Syndrome Among Middle-Aged and Older Adults in China from the China Health and Retirement Longitudinal Survey.

Objectives: We aim to investigate the correlation between sleep and metabolic syndrome (MS) among a community population 45 years of age and older in China. Methods: A cross-sectional analysis of 9096 participants from China health and longitudinal study was carried out. MS was defined by consensus criteria. Sleep durations were assessed by self-reported questionnaire. Odds ratio (OR) and 95% confidence intervals (CIs) for MS were obtained using multivariable-adjusted regression analysis. Results: Long habitual daytime sleep had a positive influence on MS (OR = 1.50, 95% CI = 1.10-2.06). For elderly, short daytime sleep significantly increased risk of MS (OR = 2.14, 95% CI = 1.25-3.67). Females with long daytime sleep was associated with increased risk of MS (OR = 1.54, 95% CI = 1.04-2.29). Conclusions: Daytime sleep significantly increased risk of MS for middle-aged and elderly Chinese. The hazard role of daytime sleep on MS was various between age and sex groups. Results of this study needed to be verified by future longitudinal studies.

Chinese Visceral Adiposity Index and Depressive Symptoms in Middle-Aged and Elderly Chinese: Dose-Response Correlation and the Effect Mediated by Sleep Time and Life Satisfaction

Depression is a common psychosomatic disorder in clinical practice and may soon become the largest disease burden globally. Studies have focused on the association between obesity and depression but presented controversial results. This study is aimed at exploring the dose-response correlation between Chinese visceral adiposity index (CVAI) and depressive symptoms and the mediating effect of sleep time and life satisfaction in this relationship. We include 4149 individuals aged ≥45 years from wave 2011 and wave 2015 of China Health and Retirement Longitudinal Study (CHARLS), using restricted cubic spline (RCS) to examine possible nonlinear correlation and serial multiple mediation model to examine the mediating effect of sleep time and life satisfaction. Results indicate that there is a significant negative linear correlation between CVAI and depressive symptoms, and each IQR increment in CVAI is associated with 11% lower risk of depressive symptoms. About 50.00% (indirect effect/total effect) of the significant association between CVAI and depressive symptoms is mediated by sleep time and life satisfaction, with life satisfaction playing a relatively major role. Properly visceral adiposity may be protective against depressive symptoms. It could be feasible to alleviate the depressive symptoms in people with too low visceral adiposity by improving their life satisfaction.

Chronic conditions and depressive symptoms in middle-aged and older Chinese adults: Roles of perceived social support and area of residence

BackgroundMany studies have shown that having noncommunicable chronic diseases (NCDs) is strongly associated with depressive symptoms in elderly people; however, the mechanisms of this association are not fully understood. This study aims to investigate whether perceived social support (PSS) mediates the effect of NCDs on depressive symptoms and whether these relationships differ depending on where middle-aged and elderly people live. MethodsThe study population was from the psychology and behavior investigation of Chinese residents (PBICR). A total of 8732 people aged 45 and older were included in the hypothetical modulated model. Perceived Social Support Scale (PSSS) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate PSS and depressive symptoms. ResultsNCDs were positively related to depressive symptoms (β = 0.81, p < 0.01) and indirectly mediated through PSS (β = 0.08). Residency moderated the relationship between NCDs and PSS (β = −0.16, p < 0.01) and between NCDs and depressive symptoms (β = 0.29, p < 0.01). Specifically, the effect of NCDs on PSS and depressive symptoms was greater in rural middle-aged and older adults. ConclusionsNCDs raise the risk of depressive symptoms in middle-aged and older Chinese, with PSS playing a partially protective role. In addition, the area of residence moderated the connection between the number of NCDs and PSS, NCDs, and depressive symptoms in middle-aged and older adults.

Associations between adverse childhood experiences and diabetes among middle-aged and older Chinese: a social-ecological perspective.

This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts. Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9,179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status. Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07 to 1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07 to 1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08 to 1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01 to 1.52), emotional abuse (OR, 1.28; 95% CI, 1.12 to 1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09 to 1.43) were associated with diabetes. ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.

Predicting metabolic syndrome by obesity- and lipid-related indices in mid-aged and elderly Chinese: a population-based cross-sectional study.

To predict the optimal cut-off values for screening and predicting metabolic syndrome(MetS) in a middle-aged and elderly Chinese population using 13 obesity and lipid-related indicators, and to identify the most suitable predictors. The data for this cross-sectional investigation came from the China Health and Retirement Longitudinal Study (CHARLS), including 9457 middle-aged and elderly people aged 45-98 years old. We examined 13 indicators, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). The receiver operating characteristic curve (ROC) was used to determine the usefulness of indicators for screening for MetS in the elderly and to determine their cut-off values, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related indicators with MetS was performed using binary logistic regression analysis. A total of 9457 middle-aged and elderly Chinese were included in this study, and the overall prevalence of the study population was 41.87% according to the diagnostic criteria of NCEP ATP III. According to age and gender, the percentage of males diagnosed with MetS was 30.67% (45-54 years old: 30.95%, 55-64 years old: 41.02%, 65-74 years old: 21.19%, ≥ 75 years old: 6.84%). The percentage of females diagnosed with MetS was 51.38% (45-54 years old: 31.95%, 55-64 years old: 39.52%, 65-74 years old: 20.43%, ≥ 75 years old: 8.10%). The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS. ABSI had a poor prediction ability. Among the middle-aged and elderly population in China, after adjusting for confounding factors, all the indicators except ABSI had good predictive power. The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS.

The relationship between walking ability, self-rated health, and depressive symptoms in middle-aged and elderly people after controlling demographic, health status, and lifestyle variables.

The global aging problem is very serious. With the increase of age, the risk of depression in the elderly is also increasing. It is necessary to find effective strategies to reduce the depressive symptoms of the elderly. This study investigated the relationship between depressive symptoms, walking ability, and self-evaluation health of middle-aged and elderly Chinese after controlling demographic variables, health status, and lifestyle. The data is from the China health and retirement longitudinal study database in 2018. Six thousand eight hundred thirty-five people over the age of 50 have complete information on walking ability, self-assessed health status, and depressive symptoms. SPSS 27.0 software was used to conduct Z-test, logistic regression and linear hierarchical regression analysis on the collected data. The results showed that poor walking ability and poor self-evaluation health status of middle-aged and elderly people were significantly related to depression. The study concluded that middle-aged and elderly people with good walking ability and self-rated health status had a lower risk of depression. This study can provide reference for formulating specific and effective intervention measures for senile depression.

Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS.

With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population. Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models. After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese. The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Longitudinal Association between Uric Acid and Incident Sarcopenia.

Sarcopenia has emerged as a significant public health concern. Uric acid (UA), as a metabolite with excellent antioxidant capacity, has been found to be associated with sarcopenia. However, the casual effects of UA on incident sarcopenia still remain unclear. Our study aimed to explore the longitudinal association between UA and incident sarcopenia among middle-aged and older adults. A total of 5086 participants aged ≥45 years old without sarcopenia at baseline were included from the China Health and Retirement Longitudinal Study (CHARLS). Due to the sex differences, the UA levels were analyzed by categorizing into sex-specific quartiles or by using UA levels as a continuous variable (per 1 mg/dL). The longitudinal association between UA and incident sarcopenia was evaluated using Cox proportional hazards regression models. During the 4-year follow-up period, 552 (10.85%) participants with incident sarcopenia were identified, of which 370 cases were males and 182 cases were females. Compared to the first quartile (Q1) UA levels, the Q3 and Q4 UA levels were significantly associated with lower risk of incident sarcopenia in males (Q3: adjusted hazard ratio (HR), 0.72; 95% CI (confidence interval), 0.54-0.97; Q4: HR, 0.57; 95% CI, 0.41-0.80). When UA was as a continuous variable (per 1 mg/dL), the association in males remained significant (HR: 0.87; 95% CI: 0.79-0.97). No significant association was observed in females. Our findings indicated that UA was negatively associated with incident sarcopenia in males but not in females among middle-aged and older Chinese.

Bidirectional association between depressive symptoms and cardiovascular disease in the middle-aged and elderly Chinese: a 5-year longitudinal study

ObjectiveDepressive symptoms and cardiovascular diseases (CVDs) are important issues affecting the health of the middle-aged and elderly population in China. This study aimed to investigate the bidirectional association between depressive...

The role of cognitive function in the relationship between surrogate markers of visceral fat and depressive symptoms in general middle-aged and elderly population: A nationwide population-based study

BackgroundThe relationship between obesity and depressive symptoms is well documented, but not visceral fat, especially among Chinese adults are scarce. We aimed to investigate the association between visceral fat and depressive symptoms and the mediation of cognitive function. MethodsA total of 19,919 and 5555 participants from the China Health and Retirement Longitudinal Study were enrolled in the cross-sectional and follow-up analyses. Depressive symptoms were measured by the Center of Epidemiological studies depression scale (CES-D). Visceral fat measured by the waist circumference triglyceride (WT) index [calculated as waist circumference (cm)* triglyceride (mmol/L)]. The relationship between the WT index and depressive symptoms was analyzed by binary logistics and Poisson regression. The mediated role of cognitive ability was examined by intermediary analysis. ResultsIn the cross-sectional study, higher visceral fat was associated with a lower risk of depressive symptoms. But in the follow-up study, individuals in quintile 2 to quintile 4 of the WT index have a reduced risk of depressive symptoms after four years. Compared with the lower index, quintile 2 of the WT index protected from difficulty concentrating (RR [95%CI]: 0.90 [0.82,0.98], p = 0.023), feeling scared (RR [95%CI]: 0.86 [0.73,0.98], p = 0.030) and feeling that life could not go on (RR [95%CI]: 0.85 [0.74,0.98], p = 0.023). Moreover, cognitive ability explained 11.52 % of the association between visceral fat and depressive symptoms. ConclusionsOur findings show that moderate visceral fat was associated with a lower risk of depressive symptoms in middle-aged and older Chinese, partly mediated by cognitive function.

Association of nocturnal sleep duration and nocturnal sleep changes with instrumental activities of daily living disability among middle-aged and elderly Chinese

ObjectiveTo investigate the association of baseline nocturnal sleep duration and sleep changes with functional disability in middle-aged and elderly Chinese. MethodsData for this study were collected from the China Health and Retirement Longitudinal Study (CHARLS) from baseline (2011) to the Wave 3 follow-up (2018). 8361 participants free of IADL disability in 2011 and aged ≥ 45 years old were recruited and prospectively followed till 2018 to analyze the association between baseline nocturnal sleep duration and IADL disability. Of these 8361 participants, a total of 6948 participants had no IADL disability at the first three follow-up visits and completed the 2018 follow-up to analyze the association between nocturnal sleep changes and IADL disability.Nocturnal sleep duration (hours) was self-reported at baseline. The coefficient of variation (CV) of nocturnal sleep duration at baseline and three follow-up visits was used to calculate sleep changes and classified into mild, moderate, and severe degrees by the quantiles. Cox proportional hazards regression model was used to analyze the association of baseline nocturnal sleep duration with IADL disability, and the binary logistic regression model was used to analyze the association of nocturnal sleep changes with IADL disability. ResultsAmong the 8361 participants of 50237.5 person-years follow-up with a median follow-up of 7 years, 2158 (25.81%) participants developed IADL disabilities. Higher risks of IADL disability were observed among participants with sleep duration <7 h [HR(95%): 1.23(1.09–1.38)], 8∼<9 h [HR(95%): 1.05(1.00–1.32)] and ≥9 h [HR(95%): 1.21(1.01–1.45)] compared to those with 7∼<8 h. Among the 6948 participants, a total of 745 (10.72%) participants finally developed IADL disabilities. Compared with mild nocturnal sleep changes, moderate [OR(95%): 1.48(1.19–1.84)] and severe [OR(95%): 2.43(1.98–3.00)] sleep changes increased the probability of IADL disability. The restricted cubic spline model showed that a higher degree of nocturnal sleep changes was associated with a greater probability of IADL disability. ConclusionBoth insufficient and excessive nocturnal sleep duration were associated with higher risk of IADL disability in middle-aged and elderly adults, independent of the participants' gender, age, and napping habits. Higher nocturnal sleep changes were associated with a higher probability of disability in IADL. These findings highlight the importance of appropriate and stable nocturnal sleep, and the need to pay attention to population differences in the impact of nocturnal sleep duration on health.

Association between previous cataract surgery and cognition among middle-aged and older Chinese: the China health and retirement longitudinal study (CHARLS)

BackgroundCataract is the primary cause of blindness globally, and surgery offers the only method by which to remove cataracts. We aimed to examine whether previous cataract surgery is associated with cognitive function.MethodsOur study included 13,824 participants. Data from the baseline of the China Health and Retirement Longitudinal Study (CHARLS) were used. The participants were categorized into two groups: with and without previous cataract surgery. Weighted multiple linear regression was used to obtain the β and 95% confidence intervals (CI).ResultsThe participants who had previous cataract surgery (n = 261) scored lower in cognition, including both memory and mental state, than those without previous cataract surgery. After adjusting for socioeconomic factors and metabolic measures, a negative association was evident between previous cataract surgery and cognition (β = −0.647, 95% CI: −1.244, − 0.049). Furthermore, the participants who were older and female demonstrated a decline in cognition, while living in cities and having higher levels education were associated with higher cognition.ConclusionsBetter cognitive function was associated with less previous cataract surgery or cataract occurrence. This suggests that a period of vision loss due to cataract leads to cognitive decline, however further studies are need to dissect the impact of vision loss and cataract surgery on cognitive decline.

The dilution effects of healthy lifestyles on the risk of depressive symptoms attributed to life-course disadvantages among Chinese middle-aged and older adults

BackgroundLife-course disadvantages and unhealthy lifestyles are well-known to independently induce depressive symptoms, but whether adopting healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages remain unknown in China. MethodsThis population-based cross-sectional study included 5724 middle-aged and older people from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms and healthy lifestyles (including regular exercise, reasonable sleep, never smoking, and no heavy alcohol consumption) were collected in 2018 while life-course disadvantages were collected in 2014. ResultsMultiple healthy lifestyles were associated with decreased depressive risks more significantly as the life-course disadvantages increased, with odds ratios (ORs) and 95 % confidence intervals (CIs) of 0.44 (0.25–0.80) and 0.33 (0.21–0.53) for 4 healthy lifestyles in participants with mild and severe life-course disadvantages, respectively. Life-course disadvantages and unhealthy lifestyles had enormous joint effects on depressive symptoms. Finally, adopting multiple healthy lifestyles can dilute the depressive risks attributed to life-course disadvantages and even mask some risks attributed to childhood disadvantages. LimitationsGiven that dietary data were not gathered by the CHARLS, diet was not included in this study. In addition, information on life-course disadvantages was primarily self-reported, which may lead to potential recall bias. Finally, the cross-sectional design of this study cannot capture causal associations well. ConclusionsAdopting multiple healthy lifestyles can well-dilute the depressive risks attributed to life-course disadvantages in middle-aged and older Chinese, which is of great importance for reducing the depressive burden and the construction of healthy aging in China.

The effects of fine particulate matter, solid fuel use and greenness on the risks of diabetes in middle-aged and older Chinese.

Previous studies provided clues that environmental factors were closely related to diabetes incidence. However, the evidence from high-quality and large cohort studies about the effects of PM2.5, solid fuel use and greenness on the development of diabetes among middle-aged and older adults in China was scarce. To separately investigate the independent effects of PM2.5, solid fuel use and greenness on the development of diabetes among middle-aged and older adults. A total of 9242 participants were involved in this study extracted from the China Health and Retirement Longitudinal Study. Time-varying Cox regression was applied to detect the association of diabetes with PM2.5, solid fuel use and greenness, separately. The potential interactive effect of air pollution and greenness were explored using the relative excess risk due to interaction (RERI). Per 10 μg/m3 increases in PM2.5 were associated with 6.0% (95% CI: 1.9, 10.2) increasing risks of diabetes incidence. Females seemed to be more susceptible to PM2.5. However, the effects of solid fuel use only existed in older and lower BMI populations, with hazard ratios (HRs) of 1.404 (1.116, 1.766) and 1.346 (1.057, 1.715), respectively. In addition, exposure to high-level greenness might reduce the risks of developing diabetes [HR = 0.801 (0.687, 0.934)]. Weak evidence of the interaction effect of PM2.5/solid fuel use and greenness on diabetes was found. Both PM2.5 and solid fuel use were associated with the increasing incidence of diabetes. In addition, high-level greenness might be a beneficial environmental factor for reducing the risks of developing diabetes. All in all, our findings might provide valuable references for public health apartments to formulate very fruitful policies to reduce the burden of diabetes. Both PM2.5 and solid fuel use were associated with the increasing incidence of diabetes while high-level greenness was not, which might provide valuable references for public health apartments to make policies.

Glomerular filtration rate estimated by differing measures and risk of all-cause mortality among Chinese individuals without or with diabetes: A nationwide prospective study.

Whether estimated glomerular filtration rates (eGFRs) by differing biomarkers are differentially associated with mortality or whether the associations differ by diabetes status remains unclear, especially in Chinese population. We included 6995 participants without diabetes (mean age: 60.4 years) and 1543 with diabetes (mean age: 61.8 years). Each eGFR measure was divided into normal (≥90 mL/min/1.73 m2 ), modestly declined (60 to <90 mL/min/1.73 m2 ), and chronic kidney disease (CKD) (<60 mL/min/1.73 m2 ) groups. Cox proportional hazards models were used to estimate hazard ratio (HR) of all-cause mortality associated with each eGFR. Over a follow-up of 7 years, 677 and 215 deaths occurred among individuals without or with diabetes, respectively. Among those without diabetes, all measures of modestly declined eGFR were not associated with mortality, whereas CKD defined by eGFR cystatin C (eGFRcys) and eGFR creatinine (eGFRcr)-cys (HRs were 1.71 and 1.55, respectively) but not by eGFRcr were associated with higher risk of mortality. Among diabetes, all measures of modestly declined eGFR (HRs: 1.53, 1.56, and 2.09 for eGFRcr, eGFRcys, and eGFRcr-cys, respectively) and CKD (HRs: 2.57, 2.99, and 3.92 for eGFRcr, eGFRcys, and eGFRcr-cys, respectively) were associated with higher risk of mortality. Regardless of diabetes status, an addition of eGFRcys or eGFRcr-cys to traditional risk factors lead to a larger improvement in the prediction of all-cause mortality risk than adding eGFRcr. The association of eGFR with mortality risk appeared to be varied by its measures and by diabetes status among middle-aged and older Chinese, which needs to be considered in clinical practice.

Association Between Hemoglobin Glycation Index and Metabolic Syndrome in Middle-Aged and Older People.

Hemoglobin glycation index (HGI) is used to describe the difference between estimated and measured glycated hemoglobin A1c (HbA1c). The present study aimed to investigate the association between metabolic syndrome (MetS) and HGI in middle-aged and elderly Chinese. In this cross-sectional study, a multi-stage random sampling method was used to select objects from the permanent residents aged 35 years and above living in Ganzhou, Jiangxi, China. The demographic information, history of illness, physical examination, and blood biochemistry data were obtained. HGI was calculated from fasting plasma glucose (FPG) and HbA1c (HGI = measured HbA1c value - predicted HbA1c value). All participants were divided into low HGI and high HGI groups using the median HGI as a cut-off value. Univariate analysis was used to detect the influencing factors of HGI, and Logistic regression analysis was adopted to analyze the relationship between significant variables found in univariate analysis, MetS, or MetS's components and HGI. A total of 1826 participants were enrolled in the study, and the prevalence of MetS was 27.4%. There were 908 in the low HGI group and 918 in the high HGI group, and the prevalence of MetS was 23.7% and 31.0%, respectively. Logistic regression analysis showed that the prevalence of MetS in the high HGI group was higher than that in the low HGI group (OR=1.384, 95% CI:1.110~1.725), further analysis showed that HGI was related with abdominal obesity (OR=1.287, 95% CI:1.061~1.561), hypertension (OR=1.349, 95% CI:1.115~1.632), and hypercholesterolemia (OR=1.376, 95% CI:1.124~1.684) (all P < 0.05). After adjusting for age, sex, and serum uric acid (UA), the relationship still existed. This study found that HGI is directly associated with MetS.

Grip strength affects the association between platelet count and disability-free survival: Evidence from the China Health and Retirement Longitudinal Study

Background and aimsPrevious studies found elevated platelet count (PLT), especially long-term persist high or increased PLT was associated with less likelihood disability-free survival (DFS). However, whether grip strength affects the relationship between them is still not elucidated. MethodsA total of 6252 participants were recruited in the analysis based on the China Health and Retirement Longitudinal Study. The primary outcome was DFS, evaluated by a composite endpoint based on the first occurrence of either disability (having difficulty in at least one of the 6 activities of daily living: namely, dressing, bathing, continence, eating, getting into or out of bed, and toileting) or all-cause mortality. ResultsThe association of PLT with primary outcome was significantly modified by grip strength (pinteraction = 0.022). The rates of primary outcome were significantly lower among participants with lower baseline PLT in participants with normal grip strength (multivariable odds ratio [OR], 0.67; 95% confidence interval [CI], 0.54–0.84; ptrend < 0.001), but not in those with low grip strength (multivariable OR, 1.70; 95% CI, 0.88–3.15; ptrend = 0.135), for the lowest quartile vs the highest quartile. Adding baseline PLT (quartiles or continuous) to a model containing conventional risk factors significantly improved risk reclassification for primary outcome among those with normal grip strength (most of p < 0.05). ConclusionAn inverse dose-response association of PLT with DFS was found among participants with normal grip strength, but not among those with low grip strength. Low grip strength might weaken the benefit of low PLT on DFS among middle-aged and older Chinese.

The associations of obesity phenotypes with the risk of hypertension and its transitions among middle-aged and older Chinese adults.

This study aimed to investigate the associations of obesity phenotypes with hypertension stages, phenotypes, and transitions among middle-aged and older Chinese. Using the 2011-2015 waves of the China Health and Retirement Longitudinal Study (CHARLS), we conducted a cross-sectional analysis included 9015 subjects and a longitudinal analysis included 4961 subjects, with 4872 having full data on the hypertension stage and 4784 having full data on the hypertension phenotype. Based on body mass index and waist circumstance, subjects were categorized into 4 mutually exclusive obesity phenotypes: normal weight with no central obesity (NWNCO), abnormal weight with no central obesity (AWNCO), normal weight with central obesity (NWCO), and abnormal weight with central obesity (AWCO). Hypertension stages were classified into normotension, pre-hypertension, stage 1 hypertension, and stage 2 hypertension. Hypertension phenotypes were categorized as normotension, pre-hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). The association between obesity phenotypes and hypertension was estimated by logistic regression. A comparison between different sexes was conducted by testing the interaction effect of sex. NWCO was associated with normal → stage 2 (OR: 1.95, 95% CI: 1.11-3.42), maintained stage 1 (OR: 1.62, 95% CI: 1.14-2.29), and normal → ISH (OR: 1.39, 95% CI: 1.05-1.85). AWCO was associated with normal → stage 1 (OR: 1.75, 95% CI: 1.40-2.19), maintained stage 1 (OR: 2.77, 95% CI: 2.06-3.72), maintained stage 2 (OR: 2.80, 95% CI: 1.50-5.25), normal → ISH (OR: 1.56, 95% CI: 1.20-2.02), and normal → SDH (OR: 2.54, 95% CI: 1.72-3.75). An interaction effect of sex existed in the association between obesity phenotypes and hypertension stages. This study highlights the importance of various obesity phenotypes and sex differences in hypertension progression. Tailored interventions for different obesity phenotypes may be warranted in hypertension management, taking into account sex-specific differences to improve outcomes.