Associations Between Fasting Plasma Glucose,plasma Albumin And The Risk Of All-cause Mortality In People Aged 65 Years And Over In Longevity Regions Of China

ObjectiveIn recent years,due to the increasing aging of society,the relationship between fasting plasma glucose and all-cause mortality,as well as plasma albumin and all-cause mortality in the older population,has been reported in domestic and international studies.But the association between fasting plasma glucose and all-cause mortality is not completely consistent,and the relationship between plasma albumin and mortality in the elderly is rarely reported.In addition,the associations between fasting plasma glucose combined with plasma albumin and all-cause mortality is unclear.The aim of this study was to investigate the associations between fasting plasma glucose,plasma albumin and the risk of all-cause mortality in the older people aged 65 years and older using the Healthy Aging and Biomarker Cohort Study in China(HABCS),and the effect of fasting plasma glucose combined with plasma albumin on mortality,to provide further evidence for the prevention of premature mortality in the older people.MethodsData from a total of three surveys in HABCS in 2012,2014 and 2017 were used.Fasting venous blood for fasting plasma glucose and plasma albumin testing was collected from the study subjects at the baseline survey and followed up for survival outcomes and time to death.(1)The group was divided into<6.1 mmol/L and≥6.1 mmol/L(elevated glucose)according to fasting plasma glucose concentration,and the dose-response relationship between fasting plasma glucose and all-cause mortality in the elderly was assessed using unrestricted cubic spline,and Cox proportional risk regression model was used to explore the effect of high fasting plasma glucose concentration on the risk of occurrence of all-cause mortality.(2)Based on the plasma albumin level,we divided the group into ≥35g/L(normal)and<35g/L(low plasma albumin).The association between plasma albumin and allcause mortality in the elderly was assessed using unrestricted cubic splines and the dose-response relationship was investigated in different age groups,and the effect of low plasma albumin on the risk of all-cause mortality was investigated using a Cox proportional risk regression model.(3)The association with the risk of all-cause mortality in the elderly was explored based on the presence of diabetes(FPG≥7.0mmol/L or hospital-diagnosed diabetes)and the presence of hypoalbuminemia(ALB<35g/L)as four-level joint variables,and the potential interaction of fasting plasma glucose combined with plasma albumin in affecting mortality was further assessed using an additive interaction model.Results1.In a total of 215 8 subj ects in the study of the association between fasting plasma glucose and risk of all-cause mortality,fasting plasma glucose was positively and nonlinearly associated with the risk of all-cause mortality(non-linear test,P=0.031);the risk of mortality was increased in the ≥6.1 mmol/L group compared with the fasting plasma glucose<6.1mmol/L group[HR(95%CI):1.42(1.21,1.68)].2.In a total of 2204 subjects in the study of the association between plasma albumin and the risk of all-cause mortality,plasma albumin showed a inverse linear association with the risk of all-cause mortality(linear test,P<0.001)and a non-linear association between plasma albumin and death in the>95 years group.The risk of allcause mortality was increased by 41%in the hypoalbuminaemic group compared to the normal plasma albumin group[HR(95%CI):1.41(1.16,1.71)](P<0.001).3.Of a total of 2154 study participants in the study of the association between fasting plasma glucose combined with plasma albumin and the risk of all-cause mortality,the mean age was 87.6 years(SD,11.9 years),330(15.3%)elderly had hypoalbuminemia and 223(10.4%)had diabetes mellitus.After 8241 person-years of follow-up,a total of 1315 older people died.Compared to the non-diabetic&normal plasma albumin group,those with hypoalbuminemia alone,diabetes alone and diabetes combined with hypoalbuminemia had an increased risk of death with HRs(95%CI):1.26(1.07,1.49),1.61(1.34,1.94)and 2.25(1.62,3.13)respectively.In addition,there was no additive interaction between fasting plasma glucose and plasma albumin,[PERI(95%CI):0.15(-0.75,1.42)],[AP(95%CI):0.07(-0.54,0.34)]and[S(95%CI):0.13(0.51,2.53)];nor was a multiplicative interaction observed(P>0.05).ConclusionThere is a non-linear positive association between fasting plasma glucose and death and an inverse linear association between plasma albumin and the risk of allcause mortality,whereas a non-linear inverse association between plasma albumin and death is observed in older people aged≥95 years,with high levels of fasting plasma glucose(FPG≥.1mmol/L)and low levels of plasma albumin(ALB<35g/L)increasing the risk of all-cause mortality in the older people,and diabetes combine with hypoalbuminemia substantially increase.There is no interaction between fasting plasma glucose and plasma albumin,which are independently associated with all-cause mortality outcomes.