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Zilin Sun 2 Articles
Metabolic Risk/Epidemiology
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Prediabetes Progression and Regression on Objectively- Measured Physical Function: A Prospective Cohort Study
Shanhu Qiu, Yiming Zhu, Bo Xie, Wenji Chen, Duolao Wang, Xue Cai, Zilin Sun, Tongzhi Wu
Diabetes Metab J. 2023;47(6):859-868.   Published online August 23, 2023
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  • 130 Download
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Prediabetes leads to declines in physical function in older adults, but the impact of prediabetes progression or regression on physical function is unknown. This study assessed this longitudinal association, with physical function objectivelymeasured by grip strength, walking speed, and standing balance, based on the Health and Retirement Study enrolling United States adults aged >50 years.
Participants with prediabetes were followed-up for 4-year to ascertain prediabetes status alteration (maintained, regressed, or progressed), and another 4-year to assess their impacts on physical function. Weak grip strength was defined as <26 kg for men and <16 kg for women, slow walking speed was as <0.8 m/sec, and poor standing balance was as an uncompleted fulltandem standing testing. Logistic and linear regression analyses were performed.
Of the included 1,511 participants with prediabetes, 700 maintained as prediabetes, 306 progressed to diabetes, and 505 regressed to normoglycemia over 4 years. Grip strength and walking speed were declined from baseline during the 4-year followup, regardless of prediabetes status alteration. Compared with prediabetes maintenance, prediabetes progression increased the odds of developing weak grip strength by 89% (95% confidence interval [CI], 0.04 to 2.44) and exhibited larger declines in grip strength by 0.85 kg (95% CI, –1.65 to –0.04). However, prediabetes progression was not related to impairments in walking speed or standing balance. Prediabetes regression also did not affect any measures of physical function.
Prediabetes progression accelerates grip strength decline in aging population, while prediabetes regression may not prevent physical function decline due to aging.
Metabolic Risk/Epidemiology
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Normalized Creatinine-to-Cystatin C Ratio and Risk of Diabetes in Middle-Aged and Older Adults: The China Health and Retirement Longitudinal Study
Shanhu Qiu, Xue Cai, Bo Xie, Yang Yuan, Zilin Sun, Tongzhi Wu
Diabetes Metab J. 2022;46(3):476-485.   Published online March 7, 2022
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  • 212 Download
  • 8 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Creatinine-to-cystatin C ratio is recently suggested to be a surrogate marker for sarcopenia. However, little is known about its association with diabetes. This study aimed to fill in this gap based on a large-scale prospective cohort.
A population-based representative sample of 5,055 participants aged ≥45 years from the China Health and Retirement Longitudinal Study was enrolled between 2011 and 2012 and followed at least once during the subsequent surveys at 2013, 2015, or 2018. Creatinine-to-cystatin C ratio was calculated and normalized by body weight. Incident diabetes was ascertained by plasma glucose, glycosylated hemoglobin, self-reported history, or use of anti-diabetic drugs. Logistic regression analysis and mediation analysis were employed.
During follow-up, 634 participants developed diabetes. The risk of diabetes was gradually and significantly decreased with increased normalized creatinine–cystatin C ratio. The multivariable-adjusted odds ratio for diabetes was 0.91 (95% confidence interval, 0.83 to 0.99) per 1 standard deviation higher of normalized creatinine-to-cystatin C ratio, and this relationship remained significant after controlling for muscle strength. The risk reduction in diabetes was significantly larger in participants with normal-weight and high normalized creatinine-to-cystatin C ratio compared with those with overweight/obesity and high normalized creatinine-to-cystatin C ratio (Pinteraction=0.01). Insulin resistance and inflammation appeared to be key mediators accounting for the observed relationship between normalized creatinine-to-cystatin C ratio and risk of diabetes, with their mediating effect being 93.1% and 22.0%, respectively.
High normalized creatinine-to-cystatin C ratio is associated with reduced risk of diabetes in middle-aged and older adults.


Citations to this article as recorded by  
  • Muscle Quality in Relation to Prediabetes Phenotypes: A Population-Based Study With Mediation Analysis
    Shanhu Qiu, Xue Cai, Xiaoying Zhou, Jinshui Xu, Zilin Sun, Haijian Guo, Tongzhi Wu
    The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): e1151.     CrossRef
  • Sex‐specific associations between skeletal muscle mass and incident diabetes: A population‐based cohort study
    Dan Liu, Nan Li, Yiling Zhou, Miye Wang, Peige Song, Changzheng Yuan, Qingyang Shi, Hui Chen, Kaixin Zhou, Huan Wang, Tao Li, Xiong‐Fei Pan, Haoming Tian, Sheyu Li
    Diabetes, Obesity and Metabolism.2024; 26(3): 820.     CrossRef
  • Diabetes Mellitus Should Be Considered While Analysing Sarcopenia-Related Biomarkers
    Justyna Rentflejsz, Zyta Beata Wojszel
    Journal of Clinical Medicine.2024; 13(4): 1107.     CrossRef
  • Associations of muscle mass and strength with new-onset diabetes among middle-aged and older adults: evidence from the China health and retirement longitudinal study (CHARLS)
    Yun-Yun He, Mei-Ling Jin, Xiang-Yang Fang, Xiao-Juan Wang
    Acta Diabetologica.2024; 61(7): 869.     CrossRef
  • Lower serum creatinine to cystatin C ratio associated with increased incidence of frailty in community-dwelling elderly men but not in elderly women
    Shixian Zhou, Peixia Wang, Linlin Sun, Xinxiu Zhao, Caixia Gong, Yichen Yang, Wen Ren, Yunmei Yang, Qin Zhang, JingJin Jiang
    Aging Clinical and Experimental Research.2024;[Epub]     CrossRef
  • The serum creatinine to cystatin C to waist circumference ratios predicts risk for type 2 diabetes: A Chinese cohort study
    Yinfei Chen, Weiheng Wen, Zhiliang Mai, Ming Wang, Hong Chen, Jia Sun
    Journal of Diabetes.2023; 15(10): 808.     CrossRef
  • Associations of sarcopenia with peak expiratory flow among community-dwelling elderly population: based on the China Health and Retirement Longitudinal Study (CHARLS)
    Yun-Yun He, Mei-Ling Jin, Jing Chang, Xiao-Juan Wang
    European Geriatric Medicine.2023; 15(1): 95.     CrossRef
  • Additive impact of diabetes and sarcopenia on all-cause and cardiovascular mortality: A longitudinal nationwide population-based study
    Eyun Song, Soon Young Hwang, Min Jeong Park, Ahreum Jang, Kyeong Jin Kim, Ji Hee Yu, Nam Hoon Kim, Hye Jin Yoo, Ji A. Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Kyung Mook Choi
    Metabolism.2023; 148: 155678.     CrossRef

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