# The association between nutritional status, sarcopenia, and depressive symptoms in elderly Chinese patients receiving maintenance hemodialysis: a hospital-based cross-sectional study

## TL;DR

This study finds that poor nutrition and muscle loss are linked to depression in elderly Chinese patients on dialysis.

## Contribution

The study identifies independent associations between nutritional status, sarcopenia, and depressive symptoms in elderly hemodialysis patients.

## Key findings

- Lower nutritional risk index scores are strongly linked to higher odds of depressive symptoms.
- Sarcopenia is significantly associated with increased odds of depression in hemodialysis patients.
- These associations remain significant after adjusting for age, sex, and kidney function.

## Abstract

Depressive symptoms are common among elderly patients undergoing maintenance hemodialysis (MHD), and factors such as nutritional status and sarcopenia may contribute to their mental health deterioration. This study aimed to investigate the relationship between nutritional status, sarcopenia, and depressive symptoms in elderly Chinese MHD patients.

A cross-sectional study was conducted involving 324 elderly Chinese patients undergoing MHD. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), and all patients were categorized into four quartiles Q1-Q4. Sarcopenia was assessed using the SARC-F (Strength, Assistance with Walking, Rising from a Chair, Climbing Stairs, and Falls) scale. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9). Spearman rank correlation analysis and binary logistic regression models were used to examine the association between nutritional status and sarcopenia with depressive symptoms, adjusting for various clinical and biochemical factors.

Among the 324 patients, 17.00% patients (n = 55) had depressive symptoms with 54.00% of males and a median age of 63.24 years, and 21.60% patients (n = 70) had sarcopenia. There was a significant decrease in the prevalence of depressive symptoms in patients with the increasing quartiles of GNRI values. The Spearman correlation and binary logistic regression analyses revealed the potential associations between depression and several factors, such as age, albumin, C-reactive protein, GNRI, and sarcopenia score (p < 0.05). The results suggested that lower GNRI values were significantly associated with increased odds of depressive symptoms, with patients in the lowest quartile (Q1) showing the highest odds (OR: 11.782, p < 0.001). Sarcopenia was also strongly linked to depressive symptoms, with patients with sarcopenia having significantly higher odds of depression (OR: 7.383, p < 0.001). These associations remained significant after adjusting for multiple factors, including age, sex, antecedents, BMI, and kidney function markers.

Poor nutritional status and sarcopenia are independently and significantly associated with depressive symptoms in elderly Chinese MHD patients. Interventions aimed at improving nutritional status and addressing sarcopenia may be beneficial for enhancing mental health and quality of life in this population. Further longitudinal studies are needed to confirm these findings and explore potential therapeutic strategies.