Ma Nuo, Alifu Jiasuer, Meng Guilin, Ma Jiangping, Wang Haichao, Meng Xiulin, Liu Xueyuan
Shanghai Tenth Peoplès Hospital, Tongji University School of Medicine, Shanghai, 200092, P. R. China.
Tongren Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092, P. R. China.
Diabetol Metab Syndr. 2025 Aug 6;17(1):317. doi: 10.1186/s13098-025-01881-8.
Studies have shown that individuals with diabetes are more likely to suffer from depression, and metabolic dysregulation may be the pathophysiological mechanism underlying this comorbidity. The Cardiometabolic Index (CMI) is an innovative metric that integrates abdominal obesity and lipid levels, providing a comprehensive assessment of cardiometabolic health. Currently, the relationship between CMI and depression in diabetes has not been clarified. This study aims to explore the association between CMI and depression among American adults with diabetes.
This study enrolled 3,182 patients with diabetes from the National Health and Nutrition Examination Survey (2005-2018). A multivariable logistic regression model, restricted cubic spline (RCS) regression analysis, subgroup analysis, and interaction tests were employed to explore the association between CMI and depression. Mediation analysis was also performed to investigate the role of inflammatory factors-including neutrophils, lymphocytes, White Blood Cells, neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII)-in the association between CMI and depression in patients with diabetes.
We found that CMI is positively associated with depression in diabetes patients, and RCS regression analysis further confirmed a non-linear (L-shaped) relationship between CMI and depression, with an inflection point at CMI = 1.694. Depression risk increased significantly below this threshold but plateaued beyond it, suggesting a threshold effect primarily within the moderate to high CMI range. Subgroup analysis and interaction tests indicated that the association between CMI and depression was consistently present across all subgroups, with no significant differences observed among them (all interaction p-values > 0.05). Female, lower educational, lower household income, unmarried, smokers, and those with hypertension were more likely to develop depression among diabetes patients. Mediation analysis suggested that neutrophils and NLR significantly mediated the CMI-depression relationship, explaining 5.04% and 4.74% of the total effect, respectively.
In patients with diabetes, a non-linear (L-shaped) relationship exists between CMI and depression, and inflammatory factors significantly mediate this relationship.
研究表明，糖尿病患者更容易患抑郁症，代谢失调可能是这种共病的病理生理机制。心脏代谢指数（CMI）是一种创新指标，它整合了腹部肥胖和血脂水平，可全面评估心脏代谢健康状况。目前，糖尿病患者中CMI与抑郁症之间的关系尚未明确。本研究旨在探讨美国成年糖尿病患者中CMI与抑郁症之间的关联。
本研究纳入了来自国家健康与营养检查调查（2005 - 2018年）的3182例糖尿病患者。采用多变量逻辑回归模型、受限立方样条（RCS）回归分析、亚组分析和交互作用检验来探讨CMI与抑郁症之间的关联。还进行了中介分析，以研究炎症因子（包括中性粒细胞、淋巴细胞、白细胞、中性粒细胞与淋巴细胞比值（NLR）和全身免疫炎症指数（SII））在糖尿病患者CMI与抑郁症关联中的作用。
我们发现糖尿病患者中CMI与抑郁症呈正相关，RCS回归分析进一步证实CMI与抑郁症之间存在非线性（L形）关系，拐点为CMI = 1.694。低于此阈值时抑郁症风险显著增加，但超过该阈值后趋于平稳，这表明主要在中高CMI范围内存在阈值效应。亚组分析和交互作用检验表明，CMI与抑郁症之间的关联在所有亚组中均一致存在，各亚组之间未观察到显著差异（所有交互作用p值>0.05）。女性、低学历、低收入家庭、未婚、吸烟者以及患有高血压的糖尿病患者更易患抑郁症。中介分析表明，中性粒细胞和NLR显著介导了CMI与抑郁症的关系，分别解释了总效应的5.04%和4.74%。
在糖尿病患者中，CMI与抑郁症之间存在非线性（L形）关系，炎症因子显著介导了这种关系。
