Objective　To investigate the association between triglyceride-glucose-body mass index (TyG-BMI) and depressive symptoms in individuals with cardiovascular-kidney-metabolic (CKM) syndrome, and its heterogeneity across different stages.

Methods This study utilized data from a survey on comorbidities among adults in rural communities in Yichang of Hubei province, conducted in August 2023. Participants diagnosed with CKM sundrome were grouped according to baseline TyG-BMI levels. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression was employed to analyze the association between TyG-BMI and depressive symptoms, followed by stratified analysis by age, sex, education level, smoking/alcohol status, and CKM syndrome stage. Restricted cubic spline (RCS) models were used to assess nonlinear relationships.

Results　A total of 2,089 patients with CKM sundrome stages 0-3 were included. The mean age of participants was (57.0 ± 10.4) years, with 50.8% being female. After full adjustment for confounding factors, each 10-unit increase in TyG-BMI was associated with a 4.9% reduction in depression risk [OR=0.951, 95%CI (0.903, 0.999)]. Subgroup analysis showed that this negative association was more significant in individuals aged ≥ 60 years [OR=0.989, 95%CI (0.980, 0.998)] and those at CKM syndrome stage 0 [OR=0.978, 95%CI (0.961, 0.996)]. RCS model analysis showed a significant nonlinear relationship trend between TyG-BMI and depression symptoms.

Conclusion　The higher TyG-BMI levels were associated with a lower prevalence of depressive symptoms among individuals with CKM syndrome stages 0-3, and this association was more pronounced in metabolically healthy individuals (CKM syndrome stage 0) and individuds aged ≥ 60 years. Nonlinear analysis suggests that moderate levels of TyG-BMI may have neuroprotective effects.

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