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Background With the population aging, multiple chronic diseases, depressive symptoms, and stroke are increasingly common among middle-aged and elderly adults worldwide. This study aimed to explore the independent associations of multiple chronic diseases and depressive symptoms as well as their combination with incident stroke in a prospective cohort of Chinese middle-aged and elderly adults, and to sensitively estimate the association between each type of chronic disease and incident stroke. Methods This study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8389 participants meeting the inclusion criteria at baseline (between 2011 and 2012) survey were included, and 7108 eligible participants completed the follow-up survey over 8 years (Wave 4, in 2018). Questionnaire information, physical examination, and clinical and biochemical measurements were collected. Results The mean (SD) age at baseline was 58.5 (± 9.1) years. Multiple chronic disease and depressive symptoms were independently associated with incident stroke. After adjusting for control variables, patients having 1 type of chronic disease and depressive symptoms were at 1.943 (95% CI = 1.166–3.238) times higher risk of incident stroke than those without chronic disease and depressive symptoms, and patients having at least 2 types of chronic diseases and depressive symptoms were at 3.000 (95% CI = 1.846–4.877) times higher risk of incident stroke; the magnitudes of the associations increased by the numbers of having chronic diseases and depressive symptoms. Sensitivity analyses incorporating all five types of chronic disease (i.e., hypertension, dyslipidemia, heart disease, diabetes, and chronic kidney disease) showed that the magnitude of the associations between hypertension and incident stroke was most significant. Conclusions We identified significant independent and combined longitudinal associations of multiple chronic diseases and depressive symptoms with incident stroke, and the combined associations reflected a dose–response relationship. The association between hypertension and incident stroke was strongest among the five chronic diseases.

Background Genetic factors may interplay with environmental stressors to contribute to risks of depressive symptoms. This study aimed to investigate the association of FKBP5 polymorphisms and DNA methylation with depressive symptoms among Chinese adolescents, considering the role of parenting style. Methods This study used a nested case-control study design based on a cohort study, and the case (n = 120) and control groups (n = 118) were matched with age. Depressive symptoms, parenting style, and other demographics were measured. Fourteen potential polymorphisms and one promoter region in the FKBP5 gene were selected for genotyping and methylation analysis. Results In the adjusted models, a significant association between FKBP5 rs7757037 and depressive symptoms was found in the codominant model (AG vs. GG; adjusted odds ratio [AOR] = 2.56, 95% CI = 1.13–5.78) and dominant model (AA+AG vs. GG; AOR = 2.38, 95% CI = 1.11–5.120); rs2817032 and rs2817035 polymorphisms were associated with depressive symptoms in the codominant model and dominant model. Significant interactions between rs7757037 and the father’s parenting style were found in the codominant model (P = 0.043) and dominant model (P = 0.043), but the gene-environment interactions were not significant after correcting for multiple testing. Moreover, the significant main effects of FKBP5 methylation status on depressive symptoms were not observed, and there was no significant interaction between FKBP5 methylation status and parenting style on depressive symptoms. Conclusions Further studies are required to confirm the effect of FKBP5 polymorphisms and methylation as well as their interactions with parenting styles in larger samples.

With population aging, diabetes mellitus and cognitive function decline are common health problems among older adults worldwide. This longitudinal study is aimed at estimating the longitudinal associations of newly diagnosed prediabetes and diabetes status with cognitive function among Chinese adults aged 45 years and older and evaluating the clinical risk factors associated with cognitive function. Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8716 participants meeting the inclusion criteria were enrolled between 2011 and 2012 at baseline, and 6125 participants completed the follow-up survey in 2018. Cognitive function, newly diagnosed diabetic status, depression, body mass index, and clinical and biochemical measurements were collected. At baseline, the mean age of the participants was 58.93 (SD: 9.76) years, 3987 (45.7%) were males, 1802 (20.7%) participants were newly diagnosed with prediabetes, and 935 (10.7%) were diabetes patients. After adjusting for control variables, diabetes was a significant risk factor for subsequent cognitive decline (unstandardized β estimate = − 0.50 , 95 % CI = − 0.98 ~ − 0.02 ). Subgroup analyses found that the association of diabetes with cognitive decline was significant in females. Stratification analyses found that among prediabetes patients, triglyceride concentrations were negatively associated with cognitive function; among diabetes patients, high-sensitivity C-reactive protein was significantly associated with cognitive decline. The newly diagnosed diabetes status at baseline was associated with subsequent cognitive decline among middle-aged and elderly Chinese, especially in females. The management of triglycerides through lifestyle modification for prediabetes and specific adjunctive anti-inflammatory therapy for diabetes might benefit cognitive performance.

Background With the population aging, diabetes and cognitive function decline are increasingly common among older adults worldwide. However, the evidence about the effects and mechanism of prediabetes and diabetes on cognitive function is still limited. The purposes of this longitudinal study were to estimate the longitudinal associations of the onset of prediabetes and diabetes status with cognitive function among Chinese adults aged 45 years or older during an 8-year period; to estimate the clinical risk factors associated with cognitive function among patients with prediabetes and diabetes. Methods Participants were enrolled between 2011 and 2012, and followed up between 2018 and 2019 in the China Health and Retirement Longitudinal Study. In this study, we focused on newly diagnosed diabetic status, and those diagnosed with diabetes before or not providing fasting blood samples were excluded. Diabetic status was assessed according to the 2010 American Diabetes Association (ADA) guidelines. The general cognitive function, demographic characteristics, and clinical and biochemical factors were also measured. Results At baseline, 849 (21.3%) participants were first diagnosed with prediabetes, and 444 (11.1%) were diabetes patients. After adjusting for age, gender, marital status, education level, ever smoking, ever drinking, self-comment about health, hypertension, dyslipidemia, depressive symptoms, cognitive function, and clinical and biochemical measurements at baseline, diabetes status was a significant risk factor for subsequent cognitive decline (unstandardized β estimate=-0.47, 95% CI=-0.91~-0.04). Further stratification analyses found that only triglyceride concentrations were negatively associated with cognitive function among prediabetes patients (unstandardized β estimate=-0.004, 95% CI=-0.007~-0.001), and only creatine reactive protein was significantly associated with cognitive decline among diabetes patients (unstandardized β estimate=-0.065, 95% CI=-0.122~-0.009). Conclusions There is a positive longitudinal association between the onset of diabetes and cognitive decline among middle-aged and elderly Chinese. The management of triglycerides through lifestyle modification for prediabetes and specific adjunctive anti-inflammatory therapy for diabetes could benefit cognitive performance.