Association between sarcopenia index based on the serum creatinine to cystatin C ratio and cancer incidence in middle-aged and older adults in China : A nationwide cohort study

Luo, Pincheng and Cai, Shanshan and Zhou, Huanlin and Zhu, Junhui and Yang, Yule and Lian, Yanxue (2026) Association between sarcopenia index based on the serum creatinine to cystatin C ratio and cancer incidence in middle-aged and older adults in China : A nationwide cohort study. Nutrition (Burbank, Los Angeles County, Calif.), 145: 113084. ISSN 1873-1244

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Abstract

OBJECTIVES: To examine the association between a novel sarcopenia index and cancer incidence among Chinese adults aged ≥45 y. METHODS: Data were derived from the China Health and Retirement Longitudinal Study. The sarcopenia index was calculated as the ratio of serum creatinine (mg/L) to serum cystatin C (mg/L), multiplied by 100. Incident cancer was identified through self-reported physician diagnosis. Cox proportional hazards models were used to estimate the association between the sarcopenia index and cancer risk, evaluated both continuously and by tertiles. Dose-response and linearity were assessed using restricted cubic spline regression and likelihood ratio tests, respectively. RESULTS: A total of 10 446 participants (median age, 59 y) were included. During a median follow-up of 8.92 y, 248 participants developed cancer. The sarcopenia index was linearly associated with cancer risk. Each 1.0-SD increase in the index was associated with a 2% reduction in cancer risk. Compared with the lowest tertile (T1), adjusted hazard ratios (HRs) were 0.97 (95% CI, 0.73-1.29; P = 0.83) for T2 and 0.58 (95% CI, 0.41-0.83; P < 0.01) for T3 (P for trend < 0.01). Using T3 as the reference, HRs were 1.67 (95% CI, 1.18-2.36; P < 0.01) for T2 and 1.72 (95% CI, 1.21-2.46; P < 0.01) for T1 (P for trend < 0.01). CONCLUSIONS: A significant inverse association was observed between the sarcopenia index and incident cancer risk in middle-aged and older adults, highlighting the potential role of skeletal muscle health in cancer prevention.