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Aging and disease    2019, Vol. 10 Issue (2) : 249-257     DOI: 10.14336/AD.2018.0410
Original Article |
Prospective Study of Glycated Hemoglobin and Trajectories of Depressive Symptoms: The China Health and Retirement Longitudinal Study
Haibin Li1,2, Anxin Wang1,2, Wei Feng1,2, Deqiang Zheng1,2, Qi Gao1,2, Lixin Tao1,2, Jin Guo3, Xiaonan Wang1,2, Xia Li4, Wei Wang5, Xiuhua Guo1,2,*
1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
2Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China.
3Greenwood Medical Company, 300 Highway Burwood, Melbourne, Melbourne, Victoria, Australia.
4Department of Mathematics and Statistics, La Trobe University, Victoria, Australia.
5Global Health and Genomics, School of Medical Sciences and Health, Edith Cowan University, Perth, Western Australia, Australia.
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Abstract  

The longitudinal association between glycated hemoglobin (HbA1c) and different courses of depressive symptoms is understudied. This study aimed to identify different trajectories of depressive symptoms and investigate the relation of HbA1c with the risk of increasing and high-stable depressive symptoms. In the China Health and Retirement Longitudinal Study, depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression scale in three visits (years: 2011, 2013 and 2015) among 9804 participants (mean age 60.0 ± 9.0 years). Group-based trajectory modeling was used to identify trajectories of depressive symptoms. HbA1c was measured at baseline and categorized five groups according to the respective quintile. Multinomial logistic regression was fitted to examine this relationship. Four distinct trajectories of depressive symptoms were identified: low symptoms (n=6401, 65.29%); decreasing symptoms (n=1362, 13.89%); increasing symptoms (n=1452, 14.81%); and high symptoms (n=1452, 14.81%). Adjusting for demographic, health-related, and cognitive factors, the risk ratio (95% confidence interval) pertaining to the highest HbA1c (Quintile 5) for decreasing, increasing, and high symptoms of depression versus low symptoms was 1.01 (0.82-1.25), 1.12 (0.92-1.36), and 1.39 (1.04-1.86) compared with the lowest HbA1c (Quintile 1), respectively. We observed a J-shaped relationship between HbA1c and high depressive symptoms, with the lowest risk at a HbA1c concentration of 5.0%. In summary, in this large population-based cohort, high levels of glycated hemoglobin concentrations were associated with a higher risk of increasing and high-stable symptoms of depression.

Keywords Trajectory      depressive symptoms      glycated hemoglobin     
Corresponding Authors: Guo Xiuhua   
About author:

Currently address: Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China

Issue Date: 14 March 2018
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Haibin Li
Anxin Wang
Wei Feng
Deqiang Zheng
Qi Gao
Lixin Tao
Jin Guo
Xiaonan Wang
Xia Li
Wei Wang
Xiuhua Guo
Cite this article:   
Haibin Li,Anxin Wang,Wei Feng, et al. Prospective Study of Glycated Hemoglobin and Trajectories of Depressive Symptoms: The China Health and Retirement Longitudinal Study[J]. Aging and disease, 2019, 10(2): 249-257.
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http://www.aginganddisease.org/EN/10.14336/AD.2018.0410     OR     http://www.aginganddisease.org/EN/Y2019/V10/I2/249
Characteristic *Quintile 1 (≤4.8 %)Quintile2
(4.9-5.0 %)
Quintile 3
(5.1-5.2 %)
Quintile 4
(5.3-5.5 %)
Quintile 5
(≥5.6 %)
P for Trend
No. of participants22581815190420221805
Glycated hemoglobin, %4.6 ± 0.25.0 ± 0.05.1 ± 0.15.4 ± 0.16.4 ± 1.2<0.001
Age, yr58.2 ± 9.458.4 ± 9.159.0 ± 9.059.4 ± 8.859.8 ± 8.6<0.001
Male gender, no. (%)1088 (48.2)864 (47.6)873 (45.9)925 (45.7)801 (44.4)0.008
Married, no. (%)1997 (88.4)1607 (88.5)1700 (89.3)1787 (88.4)1609 (89.1)0.587
Urban, no. (%)796 (35.3)623 (34.3)664 (34.9)695 (34.4)744 (41.2)<0.001
Educational level, no. (%)<0.001
<Primary school974 (43.1)827 (45.6)895 (47.0)1012 (50.0)839 (46.5)
Primary school542 (24.0)379 (20.9)433 (22.7)455 (22.5)406 (22.5)
Middle school480 (21.3)427 (23.5)391 (20.5)335 (16.6)371 (20.6)
≥High school262 (11.6)182 (10.0)185 (9.7)220 (10.9)189 (10.5)
Smoking status, no. (%)0.069
Never1357 (60.1)1108 (61.0)1165 (61.2)1213 (60.0)1141 (63.2)
Former smoker189 (8.4)157 (8.7)164 (8.6)176 (8.7)171 (9.5)
Current smoker712 (31.5)550 (30.3)575 (30.2)633 (31.3)493 (27.3)
Alcohol frequency, no. (%)<0.001
Never1441 (63.8)1207 (66.5)1277 (67.1)1379 (68.2)1291 (71.5)
<1 time/month199 (8.8)135 (7.4)155 (8.1)151 (7.5)129 (7.1)
≥1 time/month618 (27.4)473 (26.1)472 (24.8)492 (24.3)385 (21.3)
Physician diagnosed diseases, no. (%)
Hypertension487 (21.6)433 (23.9)449 (23.6)528 (26.1)578 (32.0)<0.001
Diabetes mellitus57 (2.5)43 (2.4)43 (2.3)91 (4.5)337 (18.7)<0.001
Cardiac diseases238 (10.5)200 (11.0)241 (12.7)268 (13.3)283 (15.7)<0.001
Stroke46 (2.0)32 (1.8)31 (1.6)41 (2.0)52 (2.9)0.079
Dyslipidemia178 (7.9)143 (7.9)183 (9.6)188 (9.3)253 (14.0)<0.001
Lung diseases227 (10.1)174 (9.6)192 (10.1)224 (11.1)179 (9.9)0.559
BMI, kg/m223.1 ± 3.823.3 ± 3.823.4 ± 3.723.7 ± 4.224.6 ± 4.1<0.001
Obesity, no. (%)463 (20.5)377 (20.8)379 (19.9)421 (20.8)530 (29.4)<0.001
Systolic BP, mm Hg129.9 ± 20.4129.7 ± 20.2129.8 ± 20.0130.5 ± 20.8132.6 ± 19.8<0.001
Diastolic BP, mm Hg75.6 ± 11.775.7 ± 11.875.7 ± 11.575.6 ± 11.776.8 ± 10.80.009
Fasting glucose, mg/dl100.2 ± 19.4101.7 ± 17.0104.3 ± 20.2107.1 ± 20.0140.3 ± 65.3<0.001
LDL Cholesterol, mg/dl109.9 ± 33.2115.6 ± 33.0117.6 ± 35.9118.2 ± 34.8122.2 ± 36.6<0.001
HDL Cholesterol, mg/dl51.6 ± 15.451.9 ± 15.050.9 ± 14.551.9 ± 16.048.5 ± 15.2<0.001
C-reactive protein, log0.0 ± 1.10.1 ± 1.00.1 ± 1.00.2 ± 1.10.4 ± 1.1<0.001
Estimated GFR, ml/min/1.73 m293.5 ± 14.693.1 ± 14.191.8 ± 14.892.2 ± 14.890.9 ± 15.2<0.001
Cognition scores14.9 ± 5.215.0 ± 5.114.6 ± 5.214.4 ± 5.314.4 ± 5.3<0.001
Antidepressant use , no. (%)16 (0.7)8 (0.4)10 (0.5)15 (0.7)14 (0.8)0.508
Table 1  Baseline Characteristics of the Study Participants According to the Quintile of Glycated Hemoglobin (HbA1c).
Figure 1.  Trajectories of Depressive Symptoms from 2011-2015.
Low symptoms (n=6401)Decreasing symptoms (n=1362)Increasing symptoms (n=1452)High symptoms
(n=589)
Model 1: Adjusted for age and gender
Quintile 11.00 (Reference)1.00 (Reference)1.00 (Reference)
Quintile 20.90 (0.75-1.09)1.07 (0.89-1.28)0.85 (0.64-1.13)
Quintile 31.05 (0.88-1.25)1.02 (0.85-1.22)1.08 (0.83-1.41)
Quintile 40.97 (0.81-1.16)1.28 (1.08-1.52)1.00 (0.77-1.30)
Quintile 51.08 (0.90-1.30)1.18 (0.99-1.42)1.29 (1.00-1.67)
Model 2: Adjusted for demographics a and health behaviors b
Quintile 11.00 (Reference)1.00 (Reference)1.00 (Reference)
Quintile 20.89 (0.74-1.07)1.05 (0.88-1.27)0.83 (0.62-1.1)
Quintile 31.04 (0.87-1.25)1.01 (0.84-1.22)1.08 (0.83-1.41)
Quintile 40.94 (0.78-1.13)1.26 (1.06-1.50)0.97 (0.74-1.26)
Quintile 51.12 (0.93-1.35)1.22 (1.02-1.47)1.37 (1.05-1.77)
Model 3: Adjusted for demographics a, health behaviors b and baseline health conditions c
Quintile 11.00 (Reference)1.00 (Reference)1.00 (Reference)
Quintile 20.89 (0.73-1.07)1.05 (0.87-1.26)0.83 (0.62-1.11)
Quintile 31.03 (0.86-1.24)1.00 (0.84-1.21)1.08 (0.82-1.41)
Quintile 40.92 (0.76-1.10)1.24 (1.04-1.47)0.93 (0.71-1.22)
Quintile 51.07 (0.88-1.29)1.18 (0.98-1.42)1.28 (0.97-1.68)
Model 4: Adjusted for demographics a, health behaviors b, baseline health conditions c and cardiac marker d
Quintile 11.00 (Reference)1.00 (Reference)1.00 (Reference)
Quintile 20.88 (0.73-1.06)1.05 (0.87-1.26)0.84 (0.63-1.13)
Quintile 31.03 (0.86-1.24)1.00 (0.83-1.20)1.12 (0.85-1.46)
Quintile 40.90 (0.75-1.08)1.22 (1.02-1.46)0.97 (0.74-1.27)
Quintile 51.05 (0.85-1.28)1.14 (0.94-1.39)1.46 (1.09-1.95)
Model 5: Adjusted for demographics a, health behaviors b, baseline health conditions c, cardiac marker d, antidepressant use and cognition scores
Quintile 11.00 (Reference)1.00 (Reference)1.00 (Reference)
Quintile 20.89 (0.73-1.08)1.05 (0.87-1.27)0.84 (0.63-1.13)
Quintile 31.02 (0.85-1.23)0.99 (0.82-1.20)1.10 (0.84-1.45)
Quintile 40.89 (0.74-1.07)1.21 (1.01-1.44)0.95 (0.72-1.24)
Quintile 51.01 (0.82-1.25)1.12 (0.92-1.36)1.39 (1.04-1.86)
Table 2  Risk Ratios for the Association Between Quintile of Glycated Hemoglobin (HbA1c) and Risk of Trajectories of Depressive Symptoms *
Glycated hemoglobin, %Risk Ratios (95% CI) *
Increasing symptomsHigh symptoms
4.51.01 (0.89-1.14)1.10 (0.91-1.33)
4.80.99 (0.96-1.03)1.00 (0.95-1.06)
5.01.001.00
5.21.04 (0.99-1.08)1.08 (1.01-1.15)
5.51.10 (0.99-1.21)1.22 (1.03-1.43)
5.81.14 (1.00-1.30)1.30 (1.05-1.61)
6.01.16 (1.01-1.33)1.33 (1.05-1.68)
6.21.18 (1.02-1.36)1.35 (1.06-1.72)
6.51.20 (1.04-1.40)1.36 (1.04-1.77)
Table 3  Risk of Incident Increasing and High Depressive Symptoms Associated with Glycated Hemoglobin Level.
Figure 2.  Risk of Incident Increasing and High Depressive Symptoms Associated with Glycated Hemoglobin Level.

Solid curve represents estimates of the risk ratios. The dashed lines represent pointwise 95% confidence intervals. HbA1c of 5% was used as the reference because it approximated the median values. The graphs are truncated at the 5th and 95th percentiles.

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