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Background <p>Depressive symptoms constitute a pressing public-health concern that significantly undermines the mental well-being of older adults. There is a robust association between depression and the progressive loss of muscle mass and strength that characterizes sarcopenia. However, few studies have examined the association between the creatinine-to-cystatin C ratio (CCR), a robust biomarker of sarcopenia, and depression. This study aims to investigate the relationship between CCR and the incidence of depressive symptoms (DS).</p> Methods <p>We conducted a cohort study utilizing data from Wave 1 (2011) and Wave 3 (2013) of the China Health and Retirement Longitudinal Survey (CHARLS). A total of 4,955 individuals aged 45 years and above who were free of DS at baseline were included. The CCR was calculated as serum creatinine divided by cystatin C and categorized into quartiles. The 10-item Center for Epidemiological Studies Depression Scale (CESD-10) was used to assess DS, with a cutoff score of ≥ 12 indicating DS. Multivariate logistic regression models were employed to evaluate the association between the baseline CCR and incident DS over a two-year follow-up period. A restricted cubic splines (RCS) analysis was applied to explore the dose‒response relationship, while sensitivity and subgroup analyses were performed to test the robustness of the findings.</p> Results <p>Compared to participants in the lowest quartile of CCR, those in the third and fourth quartiles had 27.9% (OR = 0.721, 95% CI: 0.570–0.913) and 29.7% (OR = 0.703, 95% CI: 0.548–0.902) lower risks of incident DS, respectively. Each one-unit increase in the CCR was associated with a 5.6% reduction in DS risk (OR = 0.944, 95% CI: 0.901–0.990). RCS analysis revealed a linear relationship between the CCR and DS risk (<i>P</i> for nonlinearity = 0.477). These findings remained consistent in sensitivity and stratified analyses.</p> Conclusion <p>The CCR is inversely associated with the risk of incident DS over 2 years, suggesting that the CCR may serve as a useful biomarker for predicting and managing mental health in middle-aged and older adults.</p>

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Association between creatinine to cystatin C ratio and the incidence of depressive symptoms among middle-aged and older adults: insight from the CHARLS study

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  • 发表日期：

    2025年12月7日

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  • Xiaohui Li,
  • Guirong Song,
  • Jiaqi Ding,
  • Dongmei Hu,
  • Ying Zhang,
  • Guorong Li,
  • Xiao Tang

摘要

Background

Depressive symptoms constitute a pressing public-health concern that significantly undermines the mental well-being of older adults. There is a robust association between depression and the progressive loss of muscle mass and strength that characterizes sarcopenia. However, few studies have examined the association between the creatinine-to-cystatin C ratio (CCR), a robust biomarker of sarcopenia, and depression. This study aims to investigate the relationship between CCR and the incidence of depressive symptoms (DS).

Methods

We conducted a cohort study utilizing data from Wave 1 (2011) and Wave 3 (2013) of the China Health and Retirement Longitudinal Survey (CHARLS). A total of 4,955 individuals aged 45 years and above who were free of DS at baseline were included. The CCR was calculated as serum creatinine divided by cystatin C and categorized into quartiles. The 10-item Center for Epidemiological Studies Depression Scale (CESD-10) was used to assess DS, with a cutoff score of ≥ 12 indicating DS. Multivariate logistic regression models were employed to evaluate the association between the baseline CCR and incident DS over a two-year follow-up period. A restricted cubic splines (RCS) analysis was applied to explore the dose‒response relationship, while sensitivity and subgroup analyses were performed to test the robustness of the findings.

Results

Compared to participants in the lowest quartile of CCR, those in the third and fourth quartiles had 27.9% (OR = 0.721, 95% CI: 0.570–0.913) and 29.7% (OR = 0.703, 95% CI: 0.548–0.902) lower risks of incident DS, respectively. Each one-unit increase in the CCR was associated with a 5.6% reduction in DS risk (OR = 0.944, 95% CI: 0.901–0.990). RCS analysis revealed a linear relationship between the CCR and DS risk (P for nonlinearity = 0.477). These findings remained consistent in sensitivity and stratified analyses.

Conclusion

The CCR is inversely associated with the risk of incident DS over 2 years, suggesting that the CCR may serve as a useful biomarker for predicting and managing mental health in middle-aged and older adults.